HomeMy WebLinkAboutBOULDER DESIGN ALLIANCE ROB DEKIEFFER - INSURANCE CERTIFICATE (3)ACORDTM EVIDENCE OF PROPERTY INSURANCE uozTE
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THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE
RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY.
PRODUCER _-.. _... I. PHO
AIC,NNo, Ertl. (8 6 6) 467 — 8 73 0.... COMPANY _.... __ .... __.. --.
VAN GILDER INSURANCE CORP/PHS Hartford Casualty Ins Co
PO BOX 33015 �
SAN ANTONIO TX 78265
SUB CODE.
INSURED _.... __. _.. _.._ -... _._...
BOULDER DESIGN ALLIANCE ROB
DEKIEFFER
3002 MELISSA LANE
BOULDER CO 80301
LOCATION/DESCRIPTION
Location: 001, Building:
CONSULTANT - NOC
3002 MELISSA LANE
BOULDER CO 80301
001
Policy Coverages:
Special Form Including Theft
Business Income with Extra Expense
Equipment Breakdown Coverage
LOANNUMSER
(POLICY NUMRER
34 SBA LJ6557
EFFECTIVEDATE
EXPIRATION DATE
01J01/2009
01/01/2010
lICONTINUED UNTIL
II I TERMINATED IT CHECKED
THIS REPLACES PRIOR EVIDENCE DATED:
Location Level Coverages:
Business Personal Property - Replacement Cost
OFINSURANCE
$20,300
$500
THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE
POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 30 DAYS
WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT), AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT
ADDITIONAL INTEREST..
NAME AND ADDRESS
City of Fort Collins
Attn: Jan Elliott
256 W. Mountain Avenue
Fort Collins, CO 80521
ACORD 27 (3/93)
- MORTGAGEE ADDITIONAL INSVREO -
X ! LOSS PAYEE
LOAN..
AUTHORIZED REPRESENTATIVE
(J ACORD CORPORATION 1993