HomeMy WebLinkAboutKEITH SCOTT TRUCKING - INSURANCE CERTIFICATE (2)PROGRE./1/E®
MAY 2 6 2004 comet N VFi mIN�ME
ADDITIONAL INSURED
The person or organization named below is a person insured with respect to such liability coverage as is afforded
by the policy but this insurance applies to said insured only as a person liable for the conduct of another insured and
then only to the extent of that liability. We also agree with you that insurance provided by this agreement will be
excess insurance over any other valid and collectible insurance.
NAME OF PERSON OR ORGANIZATION:
CITY OF FORT COLLIN PO BOX 580
LIMIT OF LIABILITY
Bodily Injury
Property Damage
Combined Liability
FORT COLLINS CO 80522
each person/
each accident
each accident
s1.000,000 each accident
All other parts of this policy remain unchanged.
This endorsement changes Policy No.: 04471954-4
Issued to (Name of Insured): KEITH SCOTT
Endorsement Effective: 05/11/04 Expiration: os/11/o5
Form No. 1198 (4-97) ADDITIONAL INTEREST COPY CWT08090016371-129801
PROO/QE.WE®
coum O V ME INEURIINOE
ADDITIONAL INSURED
The person or organization named below is a person insured with respect to such liability coverage as is afforded
by the policy but this insurance applies to said insured only as a person liable for the conduct of another insured and
then only to the extent of that liability. We also agree with you that insurance provided by this agreement will be
excess insurance over any other valid and collectible insurance.
NAME OF PERSON OR ORGANIZATION:
CITY OF FORT COLLIN PO BOX 580
LIMIT OF LIABILITY
Bodily Injury
Property Damage
Combined Liability
FORT COLLINS CO 80522
each person/
each accident
each accident
si,000,000 each accident
All other parts of this policy remain unchanged.
This endorsement changes Policy No.: 04471954-4
Issued to (Name of Insured): KEITH SCOTT
Endorsement Effective: 05/14/04 Expiration: 05/11/05
Form No. 1198 (4-97) ADDITIONAL INTEREST COPY CWT08090016371-729801