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III IIIIIIIIIIIII III COMMERCIAL CERTIFICATE OF INSURANCE Issue Date (MMIDDIYY) <br />AG 999 <br />Name 'Gary Sorrentino 9 11 95 <br />g 7828 Vance Dr. #201 This certificate is issued as a matter of inlormalion only and confers no rights <br />Address 'Arvada, CO 80003 upon the certificate holder. This certificate does not amend, extend or alter the <br />• coverage afforded by the policies shown below. <br /> COMPANIES PROVIDING COVERAGE: <br />ST. 07 DIST. 24 AGENT 350 M <br />"Y <br /> LEi <br />iER <br />A TRUCK INSURANCE EXCHANGE <br /> RF(;FIVED <br />INSURED LOAIPANY <br /> <br />Name 'William P. Balaz SEP ~ 2 ranee B FARMERS INSURANCE EXCHANGE <br />1995 <br />g ' 203 Sunset Cir, rEnEnNY <br />C MID CENTURY INSURANCE COMPANY <br />Address :Palisade, CO 81526-970~ivision of imneralsSUeologpnEflNY <br /> D <br />COVERAGES <br />THIS IS i0 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEflIOD INDICATED. NOTWITHSTANDING <br />ANY flEOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEflTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE <br />AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED <br />BY PAID CLAIMS. <br />CO. <br />LTR. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE <br />DATE (MM/DDA'Y) POLICY EXPIRATION <br />DATE (MM/DD/YYJ POLICY LIMITS <br /> <br />6EMERIIL l1ABILITT GENERAL <br />AGGREGATE <br />$ <br /> COMMERCIAL GENERAL LIABILITY <br />PAODUCTS~COMPIOPS <br /> - OCCURAENCF VERSION AGGREGATE $ <br /> CONTRACTUAL ~ INCIDENTAL ONLY PERSONAL 8 <br /> OWNERS 8 CON1AACi0AS PAOT. ADVERTISING INJURY $ <br /> EACH OCCURRENCE $ <br /> FIRE DAMAGE (Any one Fne) $ <br /> MEDICAL EXPENSE <br /> (Any one person) $ <br /> <br />B <br />X <br />AUTOMOBRE LIABIIITT <br />0 7 112 9 6 13 2 <br />4/ 2/ 9 5 <br />10 / 2/ 9 5 COMBINED <br />SINGLE LIMIT <br />$ <br /> ALL OWNED COMMERCIAL AUTOS BODILY INJURY <br /> X SCHEDULED AUTOS (PER PERSON) $250,000 <br /> HIRED AUTOS <br />BODILY INJURY <br /> NON~OWNED AUTOS (PEA ACCIDENT) $ 500, 000 <br /> GARAGE LIABILnY PAOPERIY DAMAGE $ 100, OOO <br /> GARAGE AGGREGATE $ <br /> UMBREIIA UABILITT LIMIT $ <br /> WORMERS' COMPENSATION STAMORT <br /> ANO EACH ACCIDENT $ <br /> DISEASE-EACH EMPLOYEE $ <br /> EMPLOTERS' LIABIII7T DISEASE-POLICY LIMIT $ <br />DESCRIPTION OF OPERA710NSRIENICLESIRESTRICTIONSISPECIAL ITEMS: <br />1991 Chev Blazer 1GNDT13Z9M2205844 <br />CERTIFICATE HOLDER CANCELLATION <br />Name The State <br />f C <br />l ~ <br />SH~II <br />A <br />BW <br />D <br />N <br />V <br />~ <br />LI <br />AY <br />I <br />EN N <br />T <br />REA <br />~ <br />F <br />N <br />fl <br />o <br />O <br />OrddO SSUI <br />NG <br />OMP <br />NY <br />ILL <br />E <br />DEA <br />OA <br />O <br />MAIL 30 D <br />WR <br />Ti <br />ICE TO T <br />S <br />O <br />CER <br />I <br />CATE HOLDEP <br />8 'Dept . Of Natural Resources , NAMED i0 THE LEFT, BUi FAILURE 10 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OA LIABILNY OF <br />AddfeSS 'Dl V1SlOn Of Minerals & Ge01 Ogy ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. <br />•Attn: Christine Johnston <br />1313 Sherman Room 215 <br /> <br />Denver, CO 80203 ~~ <br /> AUIHORIZEDREPR A VE <br />56-2CB2 a-BG 1251 Jyq 1]51 <br />