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Cl CW A02 10 11
CERTIFICATE OF INSURANCE
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. Named Insured:
CITY OF FORT COLLINS FUSION FABRICATION INC
PO BOX 580 2508 ZURICH DR UNIT 2
FORT COLLINS, CO USA 805220580 FORT COLLINS CO 80524-1495
Automobile Uability
Insurer Name: Allstate Insurance Company
Pol Number: 648237096
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
X
17 -- Specifically Described Autos
X
8 - Hired Autos Only
X
9 - Nonowned Autos Only
Policy Effective Date : 0 4- 2 8- 2 019
1 Policy Expiration Date: 0 4- 2 8- 2 0 2 0
Limits of
$1, 000, 000
1 Combined Single Limit (each accident)
Insurance:
BI Per Person
I BI Per Accident
PD Per Accident
Description of O rations/Locations/Vehicles/Endorsements/S clal 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(IES) 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.
RICHARD SNYDER INSURANCE AGENCY
Authorized Representative:
Date:03-04-19
CI CW A02 10 11
Includes copyrighted material of Insurance Services Office, Inc., with its permission
Allstate Insurance Company
Page 1 of 1
Additional Insured Copy