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Home My WebLink About462114 ROCKY MOUNTAIN STUDENT MEDIA GROUP - INSURANCE CERTIFICATE (2)THE ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 60327-15-22 POLICY CHANGES Effective Date of Change: 03/04/ 16 Change Endorsement No.: 005 Named Insured: ROCKY MOUNTAIN BATTERY 1475 N COLLEGE AVE FORT COLLINS CO 80524-1215 The following item(s): Expiration Date: 05/09/16 Agent: 07-08-348 E4277 I st Eilitioa 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: No Changes To Be Adjusted At Audit I Additional Premium I Return Premium Authorized Representative Signature: FARMERS INSURANCE 914277 1 ST EDMON 7-02 Indudes Copyrlghied klerfu� Irwrame Services Office, Inc, wish is permission. E4277101 PAGE 1 OF 2 E42WD1 Policy Changes Endorsement Description 1986 FRUEHAUF VIN: 1 H2V04824GE013499 2007 SUPERIOR TRAILER VIN: 159TP 16257C241060 1994 WABASH NATIONAL VIN: 1 JJV532Y8RL209100 1994 WABASH NATIONAL VIN: 1 JJV532Y3RL223566 1997 FORD MEDIUM HEA VIN: 1 FDNF70JXVVA02205 Removal If Covered Property is removed to a new location that is described on this Policy Change, Permit 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. 914217 1ST EDITION 7-02 Includes Copyrighted Material, Insurance Services Office, Inc, with 8s permission. E4277102 PAGE 2 OF 1 142774DI THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 60327-15-22 POLICY CHANGES Effective Date of Change: 03/04/ 16 Change Endorsement No.: 005 Named Insured: ROCKY MOUNTAIN BATTERY 1475 N COLLEGE AVE FORT COLLINS CO 80524-1215 The following item(s): Expiration Date: 05/09/16 Agent: 07-08-348 E4277 I 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: No Changes I I To Be Adjusted At Audit Authorized Representative Signature: Additional Premium I Return Premium FARMERS INSURANCE 9IA277 1ST EDITION 7-02 Includes Copyrighted Maleria4 Irmance Services Office, Inc, with Bs permission. E4277101 PAGE 1 OF 2 E4271-ED1 Policy Changes Endorsement Description 1995 WABASH NATIONAL VIN: 1 JJV532Y8SL224489 1994 WABASH NATIONAL VIN: 1 JJV532Y3RL 197597 1993 WABASH NATIONAL VIN:IJJV532Y9PL196984 1994 WABASH NATIONAL VIN:IJJV532Y7RL222775 1998 FREIGHTLINER CONVENTION VIN: 1 FUY3MDB9WL912770 Removal If Covered Property is removed to a new location that is described on this Policy Change, Permit 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. 914277 1ST EDITION 7-02 Includes Capyri Ned Model, Insurance Services Office, Irv, with is permisien. E4277102 PAGE 2 OF 2 E42771D1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 60327-15-22 POLICY CHANGES Effective Date of Change: 03/04/16 Change Endorsement No.: 005 Named Insured: ROCKY MOUNTAIN BATTERY 1475 N COLLEGE AVE FORT COLLINS CO 80524-1215 The following item(s): Expiration Date: 05/09/16 Agent: 07-08-348 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: No Changes I I To Be Adjusted At Audit I Additional Premium I Return Premium Authorized Representative Signature: Ah FARMERS INSURANCE 914277 1 ST EDMON 7-02 Indudes Copyrighted Material, Insurance Services Office, Inc, wish its permission. 14277101 PAGE 1 OF 2 E4271-EDl Policy Changes Endorsement Description 1992 WABASH NATIONAL VIN: 1JJV532Y4NL170113 2005 FREIGHTLINER M2 106 MED VIN: 1 FVACWDC25HU28426 2000 WABASH NATIONAL VIN: 1 JJV532WXYL681828 2000 WABASH NATIONAL VIN: 1 JJV532W9YF682130 1995 WABASH NATIONAL VIN: 1 JJV532Y9SL224422 Removal If Covered Property is removed to a new location that is described on this Policy Change, Permit 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. 914277 1ST EDITION 7-02 Indudes Copyrighted Material, Insurance Services Office, Inc, with its permission. 14277102 PAGE 2 OF 2 142771D1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 60327-15-22 POLICY CHANGES Effective Date of Change: 03/04/16 Change Endorsement No.: 005 Named Insured: ROCKY MOUNTAIN BATTERY 1475 N COLLEGE AVE FORT COLLINS CO 80524-1215 The following item(s): Expiration Date: 05/09/16 Agent: 07-08-348 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: No Changes I I To Be Adjusted At Audit Authorized Representative Signature: Additional Premium I Return Premium Ah FARMERS INSURANCE 914217 1STEDITION 7-02 Includes Copyrighted Material, Insurance Services Office, Inc, with Is permtsston. E4277101 PAGE 1 OF 2 E4277ID1 Policy Changes Endorsement Description 2003 WABASH NATIONAL VIN: 1 JJV532W13L818812 2003 WABASH NATIONAL VIN: I JJV532W23L818785 Removal If Covered Property is removed to a new location that is described on this Policy Change, Permit 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. 914277 1ST EDITION 7-02 Includes tepyrighled Malerial, Insurance Services Office, Inc, wdh As perrriAim. E4277102 PAGE 2 Of 2 E42T7-EDl FARMERS INSURANCE Common Polity Declarations 1. Named Insured Mailing Address FARMERS INSURANCE EXCHANGE (A RECIPROCAL COMPANY) Members Of The Farmers Insurance Group Of Companies Home Office: 4680 Wilshire Blvd., Los Angeles, CA 90010 COMMERCIAL AUTOMOBILE COVERAGE ROCKY MOUNTAIN BATTERY 1475 N COLLEGE AVE FORT COLLINS CO 80524-1215 F001957189-001-00001 Account Number 07-08-348 Agent No. The named insured is an individual unless otherwise stated: ❑ Partnership 0 Corporation ❑ Joint Venture ❑ Organization (Any other) Type of Business RECYLER Prod. Count F,nI97-1 R-99 Policy Number 2. Policy Period from 0 3 / 0 4 / 16 (not prior to time applied for) to 0 5 / 0 9 / 16 12:01 a.m. Standard Time If this policy replaces other coverage that ends at noon standard time of the same day this policy begins, this policy will not take effect until the other coverage ends. This policy will continue for successive policy periods as follows: If we elect to continue this insurance, we will renew this policy if you pay the required renewal premium for each successive policy period subject to our premiums, rules and forms then in effect. This Policy Consists Of The Following Coverage Parts Listed Below And For Which A Premium Is Indicated. This Premium May Be Subject To Change. Countersigned (Date) Agent: DAVID STANSFIELD Agent Phone: 970-204-0020 RV (Authorized Representative) 56-6169 2ND EDITION 4-14 (6169201 Page 1 of 2 566169-ED2 Forms applicable to all Coverage Parts: Additional Fee Information The following additional fees apply on an account, not a per -policy, basis. * A service fee will be assessed on every installment invoice and will be included in the minimum amount due. However, if you choose to pay the entire account balance in full upon receipt of the first installment, the fee will be waived. In addition, for accounts fully enrolled in online billing and scheduled for recurring Electronic Funds Transfer (EFT) payments the fee will be waived in all states except Connecticut and Georgia. State Installment Fee All states except Alaska, Florida, New Jersey and West Virginia $6.00 Alaska Not applicable Florida $3.00 New Jersey $7.00 West Virginia $5.00 * A returned payment fee applies per check, electronic transaction or other remittance which is not honored by your financial institution for any reason including but not limited to insufficient funds or a closed account. NOTE: If the returned payment is in response to a Notice of Cancellation, coverage still cancels on the cancellation effective date set forth in the notice. State NSF Fee All states except Alaska, Florida, Indiana, Maine, Nebraska, New Jersey, North Dakota, Oklahoma, Virginia and West Virginia $30.00 North Dakota and Oklahoma $25.00 Nebraska and Indiana $20.00 Florida and West Virginia $15.00 Maine $10.00 Alaska, New Jersey and Virginia Not applicable * A late fee will be assessed on each Notice of Cancellation that is issued and will be included in the minimum amount due. State Late Fee All states except Alaska, Florida, Maryland, Missouri, Nebraska, New Jersey, Rhode Island, South Carolina, Virginia, and West Virginia $20.00 Maryland, Nebraska, Rhode Island and South Carolina $10.00 Alaska, Florida, Missouri, New Jersey, Virginia and West Virginia Not applicable The following applies on a per -policy basis. * A reinstatement fee of $25.00 will be assessed if the policy is reinstated over 30 days but under 6 months from the cancellation date. This fee does not apply to Florida, Indiana &Maryland or to Workers' Compensation policies. One or more of the fees or charges described above may be deemed a part of premium under applicable state law. 56-6169 2ND EDITION 4-14 C6169202 Page 2 of 2 56-6169-ED2 BUSINESS AUTO DECLARATIONS FARMERS INSURANCE EXCHANGE X1 POLICY MEMBERS OF FARMERS INSURANCE GROUP OF COMPANIES ❑ COVERAGE PART HOME OFFICE: 4680 WILSHIRE BLVD., LOS ANGELES, CALIFORNIA 90010 ITEM ONE NAMED ROCKY MOUNTAIN BATTERY F001957189-001-00001 INSURED (count Number Pio . Count MAILING 1475 N COLLEGE AVE 07-08-348 60327-15-22 ADDRESS Agent Poky Numbei FORT COLLINS CO 80524-1215 Type of The named insured is an individual ❑ Partnership ❑X Corp. Business RECYLER unless otherwise stated: ❑ Joint Venture ❑ Organization (Other than Partnership or joint venture) Policy Period from 03/04/16 (not prior to time applied for) to 05/09/16 12:01 AM Standard Time If this policy replaces other coverages that end at noon standard time on the same day this policy begins, this policy will not take effect until the other coverage ends. This policy will continue for successive policy periods as follows: If we elect to continue this insurance, we will renew this policy if you pay the required renewal premium for each successive policy period subject to our premiums, rules and forms then in effect. REM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS *This policy provides only those coverages where a char�e is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos'. "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form next to the name of the coverage. *COVERED AUTOS LIMIT THE MOST WE WILL PAY FOR COVERAGES ANY ONE ACCIDENT OR LOSS PREMIUM (LIMITS SHOWN IN THOUSANDS) LIABILITY 7 $ 1000 9,556.00 PERSONAL INJURY PROTECTION valent No -Tau (or equiCoverage) SEPARATELY STATED IN EACH PIP ENDORSEMENT ADDED PERSONAL INJURY PROTECTION SEPARATELY STATED IN EACH ADDED PIP ENDORSEMENT (or equivalent added no-fault cov.) PROPERTY PROTECTION INSURANCE SEPARATELY STATED IN THE P.P.I. ENDORSEMENT MINUS (Michigan only) $ DEDUCTIBLE FOR EACH ACCIDENT AUTO MEDICAL PAYMENTS 7 $ SEE SCHEDULE 160.00 UNINSURED MOTORIST 7 $ SEE SCHEDULE 696.00 UNINSURED MOTORIST $ PROPERTY DAMAGE UNDERINSURED MOTORISTS (When not $ incl. in Uninsured Motorists Coverage) Actual Cas Value or Cost of Repair, whichever is PHYSICAL DAMAGE less minus $ SEE SCHEDULE Ded. for EQch Covered COMPREHENSIVE COVERAGE 7 Auto. But no Deductible to Loss Caused by Fire or 1,836.00 1pts Lightning. See Item Four ffor hhired or borrowed 'autos". PHYSICAL DAMAGE SPECIFIED Actual Cash Value o Cost of a air, w is evQr i Less M' us 25 D a for E c Cpovere Auto tor� ss CAUSES OF LOSS COVERAGE Cass is or Van�a ism. See Item Four for hired or tse rowe *Autos". PHYSICAL DAMAGE Actual Cash Value or Cost of Repair whichever is COLLISION COVERAGE 7 less minus $ SEE SCHEDULE Ded. for Each Covered 3,352.00 Auto. See item four for hired or borrowed "Autos". PHYSICAL DAMAGE $ for each disablement of a covered TOWING AND LABOR "auto. (ACTUAL LIMIT) EMIUM FOR ENDORSEMENTS rTIMATED TOTAL PREMIUM 15 600.00 FARMERS INSURANCE 56-5190 6TH EDMON 3-10 CS190601 PAGE 1 Of 3 S6S190-ED6 Policy Changes Endorsement Description VIN: 1 DTV42X23JW029768 1986 FRUEHAUF VIN: 1 H2V04824GE013499 2007 SUPERIOR TRAILER VIN:159TP16257C241060 1994 WABASH NATIONAL VIN:IJJV532Y8RL209100 1994 WABASH NATIONAL VIN: 1 JJV532Y3RL223566 1995 WABASH NATIONAL Removal If Covered Property is removed to a new location that is described on this Policy Change, Permit 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. 914271 1ST EOITION 1-02 Indudes (opyrighled Nalerial, Imam Services Office, Inc, with Is pernission. E4277102 PAGE 2 OF 2 E4277-E01 BUSINESS AUTO DECLARATIONS (Continued) ITEM THREE SCHEDULE OF COVERED AUTOS YOU OWN 60327-15-22 Policy Number DESCRIPTION TERRITORY PURCHASED Ytar, Mbodel Trade jag, B?dy Type Identi Town & State where Covered Seria Num er (S) Vehiclle ication Number Or i inal Actual Cost & Auto will be principally garaged Covered (VIN) Coil New New (N)) Auto No. USED (t]) 2 02 CHEVROLET G3500 EXPR 17000 FT COLLINS CO 2 1GBJG31R721126954 4 92 FORD CARGO L/T 39854 FT COLLINS CO 2 1FDWH70P7NVA26206 5 88 2500 FT COLLINS CO 2 Z23JW0TRAILERS 6 88 DORSEY TRAILERS 2500 FT COLLINS CO 2 1DTV42X23JW029768 7 86 FRUEHAUF 2500 FT COLLINS CO 2 CLASSIFICATION Except for towing, all physical damage Radius ot Business use Size GVW Age Primary Secondary Code Operation s servi a GCW or Veh. Group Rating Rating loss is payable to you and the loss r retalf Seating Factor Factor payee named below as interests Phy. Covered c - commercial Capacity may appear at the time of the loss. Auto No. Dom. so 29500 0 42 50 6 50 2001 7 50 2001 COVERAGES- PR EMI U MS LIMITS AND DEDUCTIBLE Bence at a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding ITEM TWb column applies instead LIABILITY PERSONAL INJURY PROTECTION ADDED P.I.P. PROP. PROT. I Mi . on Covered *Limit Premium Limit statjed in each P.I.P. EEnd rninu�dp- Premium i tote in e c �c 2 P.I.P. En�. im state ond,min u��egiuctAuto Premium No. ductible shown a ow remium shown w 5 1000 1'165.00 65.00 7 1000 Ota Premium 2,992.00 Bence ot a e( uctible or limit entry in any column below means that the limit or deductible entry in the corresponding ITEM TWO column applies instead) AUTO MED. PAY UNINSURED MOTORISTS UNINSURED UNDERINSURED MOTORISTS Covered PROPERTY DAMAGE Auto No. *Limit Premium * imit Premium * imit remium ' imit Premium 4 5 20.001000 116.0 6 2.00 7 5 2.00 Total Premium 46.00 232.01 Bence of a deductible or limit entry in any column below means t ofe t imit or deductible entry in t e corresponding ITEM TWO column applies instead) COMPREHENSIVE SPECIFIED CAUSES OF LOSS COLLISION TOWING LABOR Covered Limit state �e, TIO r�inus uc Premium imit state in TWO imit state in TWOpinu�d�duct. Premium imit Per Disablement Premium AutoNo. tipple shown ow Premium shown a ow 2 100 89.00 5o0 132.00 4 100 125.00 500 217.00 5 100 9.00 500 16.00 6 100 9.00 500 16.00 7 100 9.00 500 1 16.00 Total Premium 241.00 397.00 *(LIMITS SHOWN IN THOUSANDS) 56-5190 6TH EDITION 3-10 CS190602 PAGE 2 Of 3 S65190-ED6 60327-15-22 BUSINESS AUTO DECLARATIONS (CONTINUED) Policy Nu er REM FOUR SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS LIABILITY COVERAGE RATING BASIS, COST OF HIRE STATE ESTIMATED COST OF HIRE FOR EACH STATE RATE PER EACH $100 COST OF HIRE FACTOR is . (OV. IS RIMARY) PREMIUM PREMIUM Cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your employees or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. PHYSICAL DAMAGE COVERAGE LIMIT OF INSURANCE ESTIMATED RATES PER PREMIUM COVERAGES THE MOST WE WILL PAY ANNUAL EACH $100 DEDUCTIBLE COST OF HIRE COST OF HIRE ACTUAL CASH VALUE COST OF REPAIRS OR $ WHICHEVER IS LESS MINUS COMPREHENSIVE $ DED. FOR EACH COVERED AUTO. BUT NO DEDUCTIBLE APPLIES TO LOSS CAUSED BY FIRE OR LIGHTNING. ACTUAL CASH VALUE,OS I S OR SPECIFIED S WHICHEVER IS LESS MINUS CAUSES OF LOSS $25 DED. FOR EACH COVERED AUTO FOR LOSS CAUSED BY MISCHIEF OR VANDALISM. A CASH VALUE,P R COLLISION $ WHICHEVER IS LESS MINUS $ DED. FOR EACH COVERED AUTO PREMIUM ITEM FIVE SCHEDULE FOR NON -OWNERSHIP LIABILITY NAMED INSUREDS BUSINESS RATING BASIS NUMBER PREMIUM Other than a Social Service Agency Number of Employees Number of Partners Social Service Agency Number of Employees Number of Volunteers IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. Premium shown is payable: $ 15,600.00 at inception. ENDORSEMENTS ATTACHED TO THIS POLICY: IL 00 21-Broad form Nuclear Exclusion (Not applicable in New York) CA00010310 CA00381202 CA01060394 CA01130111 CA20480299 CA21500111 CA23840106 CA239 0306 E02 7-ED1 E2015-ED2 302 - E31 -ED1 E4277-ED1 IL00030498 IL00171198 IL00210498 IL01251113 IL01690498 J6738-ED1 50754-ED2 25-3065 -516 E LOSS PAYEE COUNTERSIGNED BY (Date) Authorized Representative 56-5190 6TH EDITION 3-10 C5190603 PAGE 3 OF 3 56-5190-ED6 POLICY NUMBER: 60327-15-22 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 TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This a ndorsement 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 indicated below. Endorsement Effective: Countersigned By: 03/04/16 Named Insured: ROCKY MOUNTAIN BATTERY Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): NEW BELGIUM BREWING CO C/0 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations 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 II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 POLICY NUMBER: 60327-15-22 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 TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This a ndorsement 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 indicated below. Endorsement Effective: Countersigned By: 03/04/16 Named Insured: ROCKY MOUNTAIN BATTERY Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): CITY OF FORT COLLINS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations 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 II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 60327-15-22 POLICY CHANGES Effective Date of Change: 03/04/ 16 Change Endorsement No.: 005 Named Insured: ROCKY MOUNTAIN BATTERY 1475 N COLLEGE AVE FORT COLLINS CO 80524-1215 The following item(s): Expiration Date: 05/09/16 Agent: 07-08-348 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)1: The above amendments result in a change in the premium as follows: No Changes I I To Be Adjusted At Audit I Additional Premium I Return Premium Authorized Representative Signature: Ah FARMERS INSURANCE 91A277 1ST EDITION 7.02 Includes CepgrigNed Nnleriel, insurome Services Office, Inc, m)h 0s perodssien. E4271101 PAGE 1 OF 2 E4277-E01 Policy Changes Endorsement Description VIN:IJJV532Y8SL224489 1994 WABASH NATIONAL VIN: 1 JJV532Y3RL 197597 1993 WABASH NATIONAL VIN: 1 JJV532Y9PL196984 1994 WABASH NATIONAL VIN: IJJV532Y7RL222775 2003 INTERNATIONAL TRUCK VIN: 3HTMMAAL03N580367 2000 WABASH NATIONAL Removal If Covered Property is removed to a new location that is described on this Policy Change, Permit 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. 914277 1ST EDMON 7-02 Indudes CapyrigMed Material Insurance Services Office, Inc, wilh OS perrriaim. E4277102 PAGE 2 OF 2 E4277-EDl THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 60327-15-22 POLICY CHANGES Effective Date of Change: 03/04/16 Change Endorsement No.: 005 Named Insured: ROCKY MOUNTAIN BATTERY 1475 N COLLEGE AVE FORT COLLINS CO 80524-1215 The following item(s): Expiration Date: 05/09/16 Agent: 07-08-348 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: No Changes To Be Adjusted At Audit Additional Premium Return Premium $ $ Authorized Representative Signature: FARMERS INSURANCE 914277 1ST EDITION 7-02 Includes Copyrighted Malarial, Insurance Services Office, Inc, with Its permission. E4277101 PAGE 1 OF 2 E4277-EOI Policy Changes Endorsement Description VIN: 1 JJV532WXYL681828 2000 WABASH NATIONAL VIN: 1 JJV532W9YF682130 1995 WABASH NATIONAL VIN: 1 JJV532Y9SL224422 1995 WABASH NATIONAL VIN:IJJV572Y6SL288716 1994 WABASH NATIONAL VIN: 1 JJV532Y2RL 197672 2003 WABASH NATIONAL Removal If Covered Property is removed to a new location that is described on this Policy Change, Permit 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. 914277 1ST EDITION 7-02 Includes CoMigMed Malerio4 Insurance Services Office, Inc, with As pernisdan. E4277102 PAGE 2 OF 2 E4277-ED1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 60327-15-22 POLICY CHANGES Effective Date of Change: 03/04/16 Change Endorsement No.: 005 Named Insured: ROCKY MOUNTAIN BATTERY 1475 N COLLEGE AVE FORT COLLINS CO 80524-1215 The following item(s): Expiration Date: 05/09/16 Agent: 07-08-348 E4277 I 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: No Changes To Be Adjusted At Audit Additional Premium Return Premium Authorized Representative Signature: FARMERS INSURANCE 414277 1STEDMON 7-02 Indudes Copyrighled Molerial, Insurance Services Office, Inc., vilh ils pernussion. E4277101 PAGE 1 OF 2 E4277UI Policy Changes Endorsement Description VIN: 1 JJV532W 13L818812 2003 WABASH NATIONAL VIN: 1 JJV532W23L818785 ADD ADDITIONAL INTEREST ADDITIONAL INSURED — CA20480299 ADDITIONAL INSURED -DESIGNATED INSURED CITY OF FORT COLLINS PO BOX FORT COLLINS, CO 80522 Removal If Covered Property is removed to a new location that is described on this Policy Change, Permit 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. 914277 1ST EDMON 7-02 Includes tepyrighled Malarial, Irmarrce Services Office, Inc, wilh is perrrissian. E4277102 PAGE 2 OF 2 E42774DI THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 60327-15-22 POLICY CHANGES Effective Date of Change: 03/04/16 Change Endorsement No.: 005 Named Insured: ROCKY MOUNTAIN BATTERY 1475 N COLLEGE AVE FORT COLLINS CO 80524-1215 The following item(s): Expiration Date: 05/09/16 Agent: 07-08-348 E4277 I 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: No Changes I I To Be Adjusted At Audit Authorized Representative Signature: Additional Premium I Return Premium Ah FARMERS INSURANCE 914277 1STEDMON 7-02 Includes Copyrighled Malerial, Insurance Services Office, Inc, VAh Is permission. [4277101 PAGE 1 OF 2 E4277-ED1