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Home My WebLink AboutWAGNER ELECTRIC - INSURANCE CERTIFICATETHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 60666-62-81 POLICY CHANGES Effective Date of Change: 12/01 / 17 Change Endorsement No.: 007 Named Insured: WAGNER ELECTRIC 7610 HEALY RD CHEYENNE WY 82009-8826 The following item(s): Expiration Date: 05/11/18 Agent: 21-15-3 50 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 I No Changes I I To Be Adjusted At Audit Authorized Representative Signature: Additional Premium I Return Premium Ah FARMERS INSURANCE 914277 1ST EOIMON 7-02 Indudes Copyrighted Material, Insurance Services Office, Inc, whh Is permission. 14277101 PAGE 1 OF 2 E4277-E01 Policy Changes Endorsement Description ADD ADDITIONAL INTEREST AND E3306 (WAIVER OF RIGHTS) ADDITIONAL INSURED-BP04510197 OWNERS, LESSEES, CONTRACTORS W/REQIN CONST CONTRACT CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO 80522 LOCATION: 7610 HEALY RD CHEYENNE, WY 82009 ADD ADDITIONAL INTEREST AND E3306 (WAIVER OF RIGHTS) ADDITIONAL INSURED-BP04510197 OWNERS, LESSEES, CONTRACTORS W/REQ IN CONST CONTRACT BELLISIMO 3702 MANHATTAN AVE STE 201 FORT COLLINS, CO 80526 LOCATION: 7610 HEALY RD CHEYENNE, WY 82009 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 1 GN® �AP]DS DEC 12 Z017 ISSUE 11 914277 1ST EDITION 7-02 Includes Copyrighted Material, Insurance Services Office, Inc., with its permission. 14277102 PAGE 2 OF 2 E4277-EDI