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Address Info: 1150 O Street, P.O. Box 758, Greeley, CO 80632 | Phone:
(970) 400-4225
| Fax: (970) 336-7233 | Email:
egesick@weld.gov
| Official: Esther Gesick -
Clerk to the Board
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20173591.tiff
.7V-�V-LJ"FV-L VIJI VI THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Page 1 of 1 CMP-4786 ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 96 -B8 -E546-2 Named Insured: MARTINDALE CONSULTANTS INC 4242 N MERIDIAN AVE OKLAHOMA CITY OK 73112-2457 Name And Address Of Additional Insured Person Or Organization: WLED COUNTY ASSESSOR 1400 7TH AVE # NN GREELEY CO 80631-4134 1. SECTION II - WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily inju- ry", "property damage", or "personal and ad- vertising injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or CMP-4786 RECEIVED OCT 162017 WEU) COUNTY COMMISSIONERS b. Products -Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insur- ance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. (*) .)D CY\mon't co.-k'‘ofS to l 2017-3591 6Goo5o RECEIVED OCT 05 2017 WELD COUNTY ASSESSOR GREELEY. COLORADO
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