HomeMy WebLinkAbout403996 VAN BREWSTER - INSURANCE CERTIFICATE (3)FC Fafin Exinslau
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AO SOX W47 DENVER COLORADO 60217 MI) 7497600
Evidence of Insurance
Additional Interest
Interest
90205984
CITY OF FORT COLLINS
PO BOX 580
FT COLLINS CO 80524
Policy Number CS205984 11
Amended Date 05/13/2008
Named Insured
VAN 0 BREWSTER
PEGGY L BREWSTER
2132 N CR #25E
BELLVUE CO 80512
Effective Date 05/13/2008
Expiration Date 05/13/2009
This form is not the contract of insurance It is a memorandum of coverage limited to the interest and applicable to the item below
Each Person
Each
Occurrence
Combined Single Limit
NC* 500 000
680 ACRES AT TWSP 10 RNG 63
ELBERT CO
Medical Payments To Others
5 000 50 000
100 ACRES AT TWSP 07 RNG 67
WELD CO
Fire Legal Liability (Farm Structures)
NC* 25 000
100 ACRES AT TWSP 07 RNG 67
100
WELD 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
LARIMER CO
400 ACRES AT TWSP 007 RNG 070
LARIMER CO
400 ACRES AT TWSP 007 RNG 070
LARIMER CO
3843352
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PO BOX bN7 OENVER COGORAOG "2(7 r303) 7<p 7W0
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
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
335 E MOUNTAIN
FT COLLINS CO 80524
Agent's Phone #
(970) 482-3952
Date
05/21 /2008
3843352