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CERTIFICATE OF INSURANCE
Cl CW A02 10 11
This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued
to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided
by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage
is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other
contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at
the policy inception. Subsequent paid claims may reduce these limits.
Certificate Holder.
CITY OF FORT COLLINS
215 N MASON ST
FORT COLLINS, CO USA 805244402
Named Insured:
W WEST EQUIPMENT AND FURNISHINGS CO
LTD A ?7.9
9355 NORTHFIELD BLVD Y6 87 J
DENVER CO 80238
Automobile Liability
Insurer Name: Allstate Insurance Company
Po l' Number. 648637029
X
1 --Any Auto
2 - Owned Autos Only
3 - Owned Priv. Pass. Autos Only
4 -- Owned Autos Other Than Priv.
Pass. Autos Only
5 - Owned Autos Subject to
No Fault
6 - Owned Autos Subject to a Compulsory UM Law
7 -- Specifically Described Autos
8 - Hired Autos Only
9 - Nonowned Autos Only
Policy Effective Date : 0 7 -10 - 2 013
1 Policy Expiration Date: 07 -10 - 2 014
Limits of
$1,000,000
Combined Single Limit (each accident)
Insurance'
BI Per Person
I BI Per Accident
PD Per Accident
Description of 0 rations/Locations/Vehicles/Endorsements/S ' I Provisions
Interested Party Type: Additional Insured - All Other
THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER.
IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(ES) MUST
EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL
INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH
POLICY LANGUAGE OR ENDORSEMENT.
Producer.
LARRY D. MEURISSE
Date:
Authorized Representative:
Includes copyrighted material of Insurance Services Office, Inc., with its permission
BU1148 3 CI CW A02 10 11
Allstate Insurance Company
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Allstate.
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POLICY NUMBER: 648637029
COMMERCIAL AUTO
CA 20 48 02 99
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided under the following.
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERSCOVERAGEFORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by this endorsement.
This endorsement identities person(s) or organization(s) who are "insureds under the Who Is An Insured
Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indi-
cated below.
Endorsement Effective: Countersigned By:
Named Insured:
Authorized Representative)
SCHEDULE
Name of Person(s) or Organization(s):
CITY OF FORT COLLINS
215 N MASON ST
FORT COLLINS, CO USA 805244402
(If no entry appears above, information required to complete this endorsement will be shown in the Declara-
tions as applicable to the endorsement.)
Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the
extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained
in Section 11 of the Coverage Form.
Bu114R 3 CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998
Mdmonal hwmd Copy
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