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HomeMy WebLinkAbout403996 VAN BREWSTER - INSURANCE CERTIFICATE (6)Evidence of Insurance Additional Interest Interest 90205984 CITY OF FORT COLLINS PO BOX 580 FT COLLINS, CO 80524 Policy Number CS205984-14 Amended Date 05/13/2011 Named Insured VAN O BREWSTER PEGGY L BREWSTER 2132 N CR #25E BELLVUE, CO 80512 Effective Date 05/13/2011 Expiration Date 05/13/2012 This form is not the contract of insurance. It is a memorandum of coverage limited to the interest and applicable to the item below. Liabil w Risk# Coverage Limits of Liability Legal Location Each Person Each Occurrence 2 Combined Single Limit NC' 500,000 680 ACRES AT TWSP 10 RNG 63 ELBERT,CO 2 Medical Payments To Others 5,000 50,000 100 ACRES AT TWSP 6 RNG 81 JACKSON,CO 2 Fire Legal Liability (Farm Structures).. NC' 25,000 80 ACRES AT TWSP 6 RNG 81 JACKSON,CO 160 ACRES AT TWSP 6 RNG 81 JACKSON,CO 80 ACRES AT TWSP 6 RNG 81 JACKSON,CO 80 ACRES AT TWSP 7 RNG 80 JACKSON,CO 400 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 100 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 200 ACRES AT TWSP 008 RNG 070 LARIMER, CO 400 ACRES AT TWSP 007 RNG 070 LARIMER, CO 400 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 100 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 200 ACRES AT TWSP 008 RNG 070 4742053 Colorado Farm Bureau Mutual Insurance Company Pg. 1 9177 E. Mineral Circle, Centennial, CO 80112 Evidence of Insurance Additional Interest Interest 90205984 CITY OF FORT COLLINS PO BOX 580 FT COLLINS, CO 80524 Policy Number CS205984-14 Amended Date 05/13/2011 Named Insured VAN O BREWSTER PEGGY L BREWSTER 2132 N CR #25E BELLVUE, CO 80512 Effective Date 05/13/2011 Expiration Date 05/13/2012 This form is not the contract of insurance. It is a memorandum of coverage limited to the interest and applicable to the item below. Liabil w Risk# Coverage Limits of Liability Legal Location Each Person Each Occurrence 2 Combined Single Limit NC' 500,000 680 ACRES AT TWSP 10 RNG 63 ELBERT,CO 2 Medical Payments To Others 5,000 50,000 100 ACRES AT TWSP 6 RNG 81 JACKSON,CO 2 Fire Legal Liability (Farm Structures).. NC' 25,000 80 ACRES AT TWSP 6 RNG 81 JACKSON,CO 160 ACRES AT TWSP 6 RNG 81 JACKSON,CO 80 ACRES AT TWSP 6 RNG 81 JACKSON,CO 80 ACRES AT TWSP 7 RNG 80 JACKSON,CO 400 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 100 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 200 ACRES AT TWSP 008 RNG 070 LARIMER, CO 400 ACRES AT TWSP 007 RNG 070 LARIMER, CO 400 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 100 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 200 ACRES AT TWSP 008 RNG 070 4742053 Colorado Farm Bureau Mutual Insurance Company Pg. 1 9177 E. Mineral Circle, Centennial, CO 80112 ut FARKA- BUREAU *+ nuuanr4cc. Liabilit Risk# Coverage Limits of Liability Legal Location Each Person Each Occurrence LARIMER, CO 400 ACRES AT TWSP 007 RNG 070 LARIMER, CO 400 ACRES AT TWSP 007 RNG 070 LARIMER, CO 400 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 100 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 200 ACRES AT TWSP 008 RNG 070 LARIMER, CO 100 ACRES AT TWSP 07 RNG 67 WELD, CO 100 ACRES AT TWSP 07 RNG 67 WELD, CO 100 ACRES AT TWSP 07 RNG 67 WELD, CO Your interest in risk(s) 2 is as a Additional Insured. Coverage is restricted to this relationship. Agent's Name JIM MILLER Agent's Address 2231 E. MULBERRYAVE. FT COLLINS, CO 80524 Agent's Phone # (970) 493-0108 Date 03/28/2011 4742053 Colorado Farm Bureau Mutual Insurance Company Pg. 2 9177 E. Mineral Circle, Centennial, CO 80112 ut FARKA- BUREAU *+ nuuanr4cc. Liabilit Risk# Coverage Limits of Liability Legal Location Each Person Each Occurrence LARIMER, CO 400 ACRES AT TWSP 007 RNG 070 LARIMER, CO 400 ACRES AT TWSP 007 RNG 070 LARIMER, CO 400 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 100 ACRES AT TWSP 008 RNG 070 LARIMER, CO 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 200 ACRES AT TWSP 008 RNG 070 LARIMER, CO 100 ACRES AT TWSP 07 RNG 67 WELD, CO 100 ACRES AT TWSP 07 RNG 67 WELD, CO 100 ACRES AT TWSP 07 RNG 67 WELD, CO Your interest in risk(s) 2 is as a Additional Insured. Coverage is restricted to this relationship. Agent's Name JIM MILLER Agent's Address 2231 E. MULBERRYAVE. FT COLLINS, CO 80524 Agent's Phone # (970) 493-0108 Date 03/28/2011 4742053 Colorado Farm Bureau Mutual Insurance Company Pg. 2 9177 E. Mineral Circle, Centennial, CO 80112