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s _ ~~ <br />y"~ .. <br />~.~ <br />b4~~ <br />COMMERCIAL CERTIFICATE OF INSURANCE Issue Date (MMIODIYYI <br />AGENCY <br />Name 'Gary Sorrentino <br />g 7828 Vance Dr. M201 This cerilicate Is issued as a matter of inlormaGDn.ony and coolers no rights <br />Address 'Arvada , CO 8000 3 upon the certificate hDlder. ihis certificate does not amend, extend or alter the <br /> covera(ae atlorded by the policies shown Delrnv, . <br />r <br /> COMPAMIEIi vROnollla COYERA6E: <br />07 GIST. 24 AGENT 350 <br />Si `a"°O1 <br />. <br />UinlA <br />~ TRUCK INSURANCE EXCHANGE <br />INSURED ~a.ANY <br />~LnLA !FARMERS INSURANCE EXCHANGE <br />Name 'William P. Balaz <br /> <br />g ' 203 Sunset Cir. cnRPµr C MID•CENTURY INSURANCE COMPANY <br />LCT1E~ <br />Address 'Palisade, CO 81526-9706 <br /> CW,urc <br />LFi1FA 0 <br />COYERAOEf <br />THIS ~$ TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSIlEO TO THE INSURED NAMED ABOVE FOA THE POLICY PERIOD NVOfCATED. NO1YVr1H$TANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT Oq OTHER DOC UMENT WITH RESPECt TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE <br />AFFORDED BY THE POLICICS OFSCRIBEO HEREIN t5 SUBJECT i0 ALL THE TERMS, E%LIUSIDN$ AND COND1710NS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED <br />BY PAID CUIMS <br />CO. <br />ITR. TYPE Of INSURANCE POIICV NUMBER POLICY EfFED71VE <br />GATE IMMIDDMl1 POLICY E%PIMTION <br />DATE (MMATOIYY) PDLICY LIMBS <br /> f~L WYIIYT ~~ W~ ( $ <br /> CpMNERLIAL GENfMI LIABILITY <br />TS <br />LOMPAIPS <br /> - OCLURAExtE VERSION ~ T <br />E $ <br /> CONTAALTUAL~INCIpFNTAI ONLY <br />PERSONAL 6 <br /> OWHEAS 8 CDMMCiORS PAOi. ADVEATIyNG INIURY $ <br /> EACH OLCURfIENCE ~ $ <br /> FIAT DAMAGE lMY ane FiA) $ <br /> MEDIUL E%PENSE 'I <br /> (My dle PaloRJ i' $ <br /> <br />Auf0110Wt1YW COMBINED <br />B X fY 07 11296 13 2 4/2/95 10/2/95 SINGLE UMd $ <br /> ALL OWNED COMMERGAL aUTQS ~ <br /> X SCHEOULEDAUTOS 800ttY INJURT' , <br />(PEAPEA$OM $2SO,000 <br /> MREO AUI05 <br /> NON~OVMED AUTOS (PER AL(JDENI) $ <br />500,000 <br /> wRAGEUAeILm <br /> PRDPERTY DAMAGE $ 100, 000 <br /> GARAGE AGGREGATE $ <br /> urMBtt- wwm Liner 8 <br /> ^oNt9u' COV4r1011 tTliftil0l- <br /> AMp EACH ALCIDEM $ <br /> wryp~~ ~Dm DISEASE-EACH FAVLOYFE S <br /> DISEASE-POLICY UMR $ <br />CF7CIIPiIOB a Ot'IMTIOMLrEMItIlLiF27fCr10ta46t'[CYL IiE1R <br />}~ <br />1991 Chev Blazer 1GNDT13Z9M2205844 <br />CERTIFICATE HOLDER <br />CANCELLATIOR <br />Name The State of Colorado sxoufDAN <br />THE ISSUIN( <br />8 -Dept. Of Natural Resources, HAMEOroT <br />Address Division of Minerals a Geology AxrluxDu <br />Attn: Christine Johnston <br />1313 Sherman Room 215 <br />Denver, CO 80203 <br />AUTx01UIE0 <br />6aM2 A~ ~•~1 <br />JHN izss <br />