HomeMy WebLinkAboutD O BRIEN BUELL M LYNN BUELL - INSURANCE CERTIFICATEFAPMFRS
,INSURANFF
F A R M E R S a
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: 04 - 29 - 2005
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
Maki
- .Model
Vehicle IdentiFcatkla Number
1998
CHEVROLET
SUB V10/K10/V15/K1500
1GNFK16R4WJ301008
COVERAGES * ENTRIES IN THouseunc nF nn1 I Ass
.......................
Bodily lrFiury R.D.
'
Uninsured MoWrist
Mediow
No Fauk
Camprehansive
Dedu sie -
CoQsian
Oeduatible
.::
Towing
Non-AEft
Bedil In P.D.
500 j 500 ; 100
Each Each
Person I Occurrence
500 1 500 j NC
Each i Each
Person Occurrence
I
XXX i XXX
I
XXX XXX
I
NC
240
240
NOTCOV
NC* NC
Liab. Medical
COV
COVERAGE DESIGNATIONS
COVERAGES -- Indicated by 'COV' 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 Provision.
See Policy for Limits per occurrence.
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
NO-FAULT — See Endorsement E-550 (Illinois E-2250)
coverages added by endorsement
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 2-98 0 5- 0 9- 2 0 0 5 a-02 A2866231