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Home My WebLink AboutLYNNE HULL - INSURANCE CERTIFICATE (2)State Farm Fire and Casualty Company O 1555 Promontory Circle Greeley, CO 80638-0001 12 W-20-1753-F627 F N 3 11 10 CITY OF FORT COLLINS 9 PO BOX 580 FORT COLLINS CO 80522-0580 Ilrrl111rrrrlrlrrrlrlrrlrlllrrrrlrlrlrrlrllrrrlrrlrllrrrrrlrll 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 Amendatory Endorsement Tree Debris Removal Business Policy Endorsement Glass Deductible Deletion Fungus (Including Mold) Excl Inc Cost and Demolition Cov Policy Endorsement - Business Terrorism Insurance Cov Notice Section II Additional Insured Dist Mat Violat Statues Excl Policy Endorsement 9 FP-6103 FE-6206.1 FE-6451 FE-6464 FE-6538.1 FE-6566 FE-6587 FE-6610 FE-6999 FE-6609 FE-6655 FE-6656 / 44010-CCLL/ir t4t'S ^*,* i... N 16109 401 M Agent SID PRIDAY Telephone (303) 825-7909 RENEWAL CERTIFICATE FEB 01 2007 to FEB 012008 TO BE PAID BY INSURED Coverages and Limits Section I A Buildings Excluded B Business Personal Property 1 900 C Loss of Income Actual Loss Deductibles - Section 1 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) 2, 000,000 Products -Completed Operations 2, 000, 000 (POO Aggregate) Annual Premium Forms, Opts, & Endrsmnt Bus Liability - Cov L Total Amount Premium Reductions Renewal Year Discount Yrs in Business Discount Claim Record Discount Cov. A - Inflation Index: N/A Cov. B - Consumer Price: 203.9 $92.00 54.00 79.00 $225.00 If you have moved, please contact your agent. See reverse side for important information. REB Prepared DEC 08 2006 CONTINUED FROM FRONT NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy.