HomeMy WebLinkAbout437747 R & D VENDING (ROGER D SORENSEN) - INSURANCE CERTIFICATE (4)CERTIFICATE OF INSURANCE
TY)is ,�t�t ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
-' ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
in ttrrss'flfe'"fdll wing policyholder for the coverages indicated below:
Name of policyholder SORENSEN, ROGER D DBA R&D VENDING
Address of policyholder 2300 SILVER TRAILS COURT
FORT COLLINS, CO 80526-6418
Location of operations COLORADO
Description of operations
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any naid rlaimc
POLICY NUMBER
TYPE OF INSURANCE
POLICY PERIOD
LIMITS OF LIABILITY
Effective Date Expiration Date
(at beginning of policy period
Comprehensive
BODILY INJURY AND
96-E9-9212-2
Business Liz
10/O5/08
10/O5/09
PROPERTY DAMAGE
This insurance includes: N Products - Completed Operations
N Contractual Liability
N Underground Hazard Coverage
Each Occurrence $ 1, 000, 000
N Personal Injury
NAdvertising Injury
General Aggregate $2,000,000
❑ Explosion Hazard Coverage
Products - Completed
❑ Collapse Hazard Coverage
Operations Aggregate $ 2, 000, 000
❑ General Aggregate Limit applies to each project
El
EXCESS LIABILITY
POLICY PERIOD
BODILY INJURY AND PROPERTY DAMAGE
Effective Date Expiration Date
(Combined Single Limit)
❑ Umbrella
Each Occurrence $
❑ Other
Aggregate $
Part 1 STATUTORY
Part 2 BODILY INJURY
Workers' Compensation
and Employers Liability
Each Accident $
Disease Each Employee $ _
Disease - Policy Limit $
POLICY NUMBER
TYPE OF INSURANCE
POLICY PERIOD
LIMITS OF LIABILITY
Effective Date Expiration Date
(at beginning of policy period)
96-GO-0240-5
COMM. UMBRELLA
10/05/08
10/05/09
$1,000,000
661 7044-BO1
AUTOMOBILE INS
O8/01/95
02/01/09
$1,000,000
Name and Address of Certificate Holder
The City of .Fort Collins
Purchasing Division
P.O. Box 580
Fort Collins, CO 80522
Attn: Dave Carey
55&994 a 2-90 Printed in U.S.A.
If any of the described policies are canceled before its
expiration date, State Farm will try to mail a written notice to
the certificate holder 3 0 days before cancellation. If,
however, we fail to mail such notice, no obligation or liability
will be imposed on State Farm or its agents or
representatives.
Additional Insured IIAQ 0 0 1 ) N t
Signature Au horiz d Representative
Bradle D. Bischoff
Agent
Title
December 8, 2008
Date