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Home My WebLink AboutTWO DOTS - INSURANCE CERTIFICATECLC Policy No. 96-G4-3316-8 EFF DATE MAY 16 2005 1901-F625 FE-6609 A SECTION II ADDITIONAL INSURED ENDORSEMENT Policy No.: 96-G4-3316-8 Named Insured: TWO DOTS INC Additional Insured (include address): CITY OF FORT COLLINS 300 LAPORTE AVE FORT COLLINS CO 80521-2719 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. ❑ Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE-6609 Printed in U.S.A. Policy Number DECLARATIONS PAGE AMENDED MAY 16 2005 9&G4-3316-8 O STATE FARM FIRE AND CASUALTY COMPANY 1555 PROMONTORY CIRCLE, GREELEY CO 80638 0001 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS 20-1901-F625 T 2 Named Insured and Mailing Address TWO DOTS INC 1930 SAUK RD LOVELAND CO 80537-8776 Cov A - Inflation Coverage Index: N/A CONTRACTORS POLICY - SPECIAL FORM 3 Cov B - Consumer Price Index: 189.7 AUTOMATIC RENEWAL - If the POLICY PERIOD is shown as 12 MONTHS, this policy will be renewed automatical subject to the premiums, rules and forms in effect for each succeedin policy period. If this policy is terminated, we wi give you and the Mortgagee/Lienholder written notice in compliance wll h the policy provisions or as required by law. Policy Period: 1 Year The policy period begins and ends at 12:01 am standard time at the Effective Date: DEC 11 2004 premises location. Expiration Date: DEC 11 2005 Location of Covered Premises: 1930 SAUK RD LOVELAND CO 80537-8776 Coverages & Property Section I A Buildings B Business Personal Property Section 11 L Business Liability M Medical Payments Products -Completed Operations (PCO) Aggregate General Aggregate (Other Than PCO) Limits of Insurance $ Excluded 1,000,000 5,000 2,000,000 2,000,000 The Section I deductible will be applied to each occurrence and will be deducted from the amount of loss. Other deductibles may apply - refer to your policy. Forms, Options, and Endorsements Special Form 3 FP-6100 *Section II Additional Insured FE-6609 Amendatory Endorsement FE-6206.1 Tree Debris Removal FE-6451 Contractors Policy Endorsement FE-6467 Theft Deletion Endorsement FE-6308 Glass Deductible Deletion FE-6538.1 * New Form Attached Your policy is amended MAY 16 2005 ADDL INSURED NAME & ADDRESS ADDED ENDORSEMENT FE-6609 ADDED Deductibles - Section I $ 250 Basic Deductible -Section II Property Damage Liab. $ 250 Per Claim Endorsement Premium Increase Audit Period: Annual Discounts Applied: Renewal Year Years in Business Claim Record Continued on Reverse Side of Page Prepared OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY JUN 13 2005 Countersicined FP-8051.1 C H5UO 08/1993 Your policy consists of this page, any endorsements and the policy form. PLEASE KEEP THESE TOGETHER. By DAVID TRUMBO (970) 669-4996 153.56 Agent (o110641a)