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Home My WebLink About437747 R & D VENDING (ROGER D SORENSEN) - INSURANCE CERTIFICATE (5)CERTIFICATE OF LIABILITY INSURANCE I DATE05//2010) TM 11 /010 BISCHOFF INSURANCE AGENCY, INC. 1300 Oakridge Dr., #100 Fort Collins, CO 80625 970-223-9400 INSURED Sorensen, Roger D., DBA R&D Vending V 4' 711 2300 Silver Trails Dr. Fort Collins, Colorado 80526-6418 IKOITA:I_7way ONLY AND CONFERS NO RIGHTS UPON THE HOLDER. THIS CERTIFICATE DOES NOT AMEN[ INSURERS AFFORDING COVERAGE INRI IRFR ASMW Fam Fin) antl DaEReNY C.D. INSURER C' INSURER D. NAIC # THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR kDVI POLICY NUMBER POUCYEFFECTIVE POUCYEXPIRATIONSURANCE LIMITS GENERAL LIABILITY 96-E9-9212-2 10/06/2011 10/05/2012 EACHOCCURRENCE $ 100000000 A PREMISES ERtN, D E X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 11 OCCUR MED EXP(" Dire Person) $ PERSONAL &ADV INJURY $ 2,000,000.00 GENERALAGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 2,000,000.00 X POLICY jECTPRO LOD AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000.00 ANY AUTO (Eaawd"t) N) ALL ONMED AUTOS X SCHEDULEDAUTOS 6617044-B01-060 8/01/2011 8/01/2012 (PerpewODILY a 500,000.00 BODILY INJURY HIREDAUTOS NON-O MED AUTOS (Per accident) E PROPERTY DAMAGE $ 100,000.00 (Per awdent) GARAGELIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO - $ AUTO ONLY: ASS X EXCESSIUMBRELLA LIABILITY 96-GO-0240-5 10/05/2011 10/05/2012 EACH OCCURRENCE $ 1,000,000.00 OCCUR CLAIMS MADE AGGREGATE $ 2,000,000.00 $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- LR EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? P E. L. DISEASE -PoLICY LIMIT $ Pes, SECIAL PROVISIONS below OTHER 96-E9-9212-2 Business Property 10/05/2011 10/05/2012 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS I THE CITY OF FORT COLLINS PURCHASING DIVISION C/O DAVE CAREY P.O. BOX 580 FORT COLLINS, CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRnTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER ITS AGENTS OR AUTHORREDREPRESENTAME Wanda L. Johnson, LSA-5 ACORD 25 1988 10/11/2011 15:28 9703955833 FIRE OPERATIONS PAGE 01 96-E9.9212-2 13873 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786 Page 1 of t CMP-4786 ADDITIONAL INSURED —OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 96-E9.9212.2 Named Insured: SORENSEN ROGER D DBA R & D ZENDING 2300 SILVER TRAILS DR FORT COLLINS CO SOS26-6418 Name And Address Of Additional Insured Person Or Organization: THE CITY OF FORT COLLINS 215 N MASON ST FORT COLLINS CO 80524-4402 1. SECTION II — WHO IS AN INSURED of SECTION 11 — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily in- jury", 'property damage", or 'personal and advertising Injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; In the performance of your ongoing opera- tions for that additional insured; or CPAP-47W b. Products -Completed Operations 'Your work" performed for that additional insured and included in the 'products - completed operations hazard". 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a 'suit' brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insur- ance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. O, Copyright State Farm Mutual Automobile Insurance Company. 200E Inchdea copyrlglYac materiel of Insurance Services Cmce, Inc., with its Wm iseion.