HomeMy WebLinkAboutLYNNE HULL - INSURANCE CERTIFICATERENEWAL CERTIFICATE
OState Farm Fire and Casualty Company
1555 Promontory Circle
Greeley, CO 80638-0001
W-20-1753-F627 F N 3
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
Insured: HULL, LYNNE
Location: 510 WHEDBEE
FORT COLLINS CO
80524-3132
Add Ins -II: CITY OF FORT COLLINS
Forms, Options, and Endorsements
Special Form 3
FP-6103
Amendatory Endorsement
FE-6206.1
Tree Debris Removal
FE-6451
Business Policy Endorsement
FE-6464
Glass Deductible Deletion
FE-6538.1
Fungus (Including Mold) Excl
FE-6566
Inc Cost and Demolition Cov
FE-6587
Policy Endorsement - Business
FE-6610
Terrorism Insurance Cov Notice
FE-6999
Section II Additional Insured
FE-6609
Dist Mat Violat Statues Excl
FE-6655
Policy Endorsement
FE-6656
9
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N 16109 401 M Agent SID PRIDAY
Telephone (303) 825-7909
POLICY NUMBER 96-EV-31614
Business Policy
FEB 01 2007 to FEB 012008
TO BE PAID BY INSURED
Coverages and Limits
Section I
A Buildings
Excluded
B Business Personal Property
Loss Income
1 900
Actual LOSS
C of
Deductibles - Section I
Basic
500
Other deductibles may
apply - refer to policy
Section II
L Business Liability
$1,000,000
M Medical Payments
5, 000
Gen Aggregate (Other than PCO)
2000, 000
Products -Completed Operations
2:000, 000
(PCO Aggregate)
Annual Premium
$92.00
Forms, Opts, & Endrsmnt
54.00
Bus Liability - Cov L
79.00
Total Amount
$225.00
Premium Reductions
Renewal Year Discount
Yrs in Business Discount
Claim Record Discount
Cov. A - Inflation Index: WA
Cov. B - Consumer Price: 203.9
ff you have moved, please contact your agent.
See reverse side for important information.
REB Prepared DEC 08 2006