HomeMy WebLinkAbout493755 KDG ENGINEERING LLC - INSURANCE CERTIFICATE (8)"W
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy Number: 60672-22-32
POLICY CHANGES
Effective Date of Change: 12/15/18
Change Endorsement No.: 003
Named Insured: KDG ENGINEERING LLC
KDG ENGINEERING
7220 W JEFFERSON AVE # 406
LAKEWOOD CO 80235-2031
The following item(s):
Expiration Date: 12/15/19
Agent: 07-17-38G
E4277
1 St Edition
Insured's Name
Insured's Mailing Address
Policy Number
Company
Effective / Expiration Date
Insured's Legal Status / Business of Insured
Payment Plan
Premium Determination
X
Additional Interested Parties
Coverage Forms and Endorsements
Limits / Exposures
Deductibles
Covered Property / Location Description
Classification / Class Codes
Rates
Underlying Insurance
is (are) changed to read (See Additional Page(s)}:
The above amendments result in a change in the premium as follows:
X No Changes To Be Adjusted At Audit Additional Premium Return Premium
$ $
Authorized Representative Signature:
FARM E RS
INSURANCE
914277 1STEOMON 7-02 Indudes (WigMed Material, Insurance Services Office, Inc, with Is Permission. E4277101 PAGE 1 OF 2
E4271-E01
.r-
Policy Changes Endorsement Description
ADD ADDITIONAL INTEREST AND E3306 (WAIVER OF RIGHTS)
ADDITIONAL INSURED-J6840-ED2
SCHEDULED PERSON OR ORGANIZATION PRIMARY AND NON CONTRIBUTORY
CITY OF FORT COLLINS
PURCHASING DEPT
PO BOX 580
FORT COLLINS, CO 80522
LOCATION: 7220 W JEFFERSON AVE # 406
LAKEWOOD, CO 80235
Removal If Covered Property is removed to a new location that is described on this Policy
Permit Change, you may extend this insurance to include that Covered Property at each
location during the removal. Coverage at each location will apply in the proportion
that the value at each location bears to the value of all Covered Property being
removed. This permit applies up to 10 days after the effective date of this Policy
Change: after that, this insurance does not apply at the previous location.
9IA277 1STEOITION 7-02 Includes Copyrighted Material, Insurance Services Office, Inc, with its permission. E4277102 PAGE 2 OF 2
E42771DI