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Home My WebLink AboutD O BRIEN BUELL - INSURANCE CERTIFICATEZEARNER$ 11NSBRANEE� A NM E N 6R,03 COMPANY NAME: FARMERS INSURANCE EXCHANGE, LOS ANGELES, CALIFORNIA AN INTER -INSURANCE EXCHANGE, HEREIN CALLED THE COMPANY PART INSURED'S NAME & ADDRESS: D O BRIEN BUELL M LYNN BUELL 1916 PAWNEE DR FT CLLNS CO 80525 ISSUING OFFICE: P. O. BOX 1054 COL SPRINGS,CO 80901 DESCRIPTION OF VEHICLE CERTIFICATE OF INSURANCE POLICY NO: 07 15028 - 56 - 74 POLICY EDITION: 02 EFFECTIVE DATE: 0 4- 2 9- 2 0 0 5 EXPIRATION DATE: CONTINUOUS UNTIL CANCELLED EXPIRATION TIME: 12:00 NOON Standard Time PREMATIC NO A875637 AGENT: Gary W Carnes AGENTNO: 07 08 321 AGENTPHONE: (970) 223-0404 Year Matte Model -. Vehicle Identiffoatbn Number 1998 CHEVROLET SUB V10/K10/V15/K1500 1GNFK16R4WJ301008 COVERAGES * ENTRIES IN THOIISANOS OF MI I ARS ................................... ..... Hodily lrryElry P.D. uninsured Motorist Medicali No Fault Oomprehensiwe: Deda�te Collsion p ]owing Nar Auto H<idA In P.D. 500 j 500 i 100 Each I Each Person 1 Ooourrenoe 500 500 i NC Eaoh i Each Pelson 1 Occurrence XXX 1 XXX XXX ( XXx NC 240 240 t�OC3tl16fOV NCB 1 NC Liab. Medical COV COVERAGE DESIGNATIONS COVERAGES -- Indicated by 'GOV' or the limit of Company's liability against each coverage. 'NC' or 'NOT GOV' means "NOT COVERED.' 'MAX' means 'Maximum Deductible.' BODILY INJURY— Bodily Injury Liability COMPREHENSIVE — Comprehensive Car Damage P.D. — Property Damage Liability COLLISION — Collision - Upset UNINSURED — Benefits for Bodily Injury (including property NON -AUTO — Comprehensive Personal Liability - MOTORIST damage coverage if policy issued in New Each occurrence. Mexico) caused by Uninsured Motorists Medical Payments to Others - MEDICAL — Medical Expense Insurance, Family Medical Each Person. Damage to Property of Others - Expense, and Guest Medical Expense - See Policy for Limits per occurrence. See Policy Provision. If policy contains the E-550 No -Faun TOWING — Towing & Road Service Coverage. Endorsement or No -Fault Coverage D, Auto OTHER — Medical Expense Coverage does not apply. One or more miscellaneous coverages added by endorsement NO-FAULT — See Endorsement E-550 (Illinois E-2250) to the policy. or Coverage D if applicable. This certificate is subject to all of the terms, conditions and limitations set forth in the policy(ies) and endorsements attached to it. "It is furnished as a matter of information only and does not change, modify or extend the policy in any way. It supersedes all previously issued certificates. Upon cancellation or termination of this policy or policies from any cause we will mail 15 days notice in writing to the other Interest shown below. ADDITIONAL INTEREST: CITY OF FT COLLINS PO BOX 580 FT CLLNS CO 80522-0580 25-2866 2-e8 0 5- 0 9- 2 0 0 5 B-02 A2866231