HomeMy WebLinkAbout403996 VAN BREWSTER - INSURANCE CERTIFICATE (5)s0
Evidence of Insurance
Additional Interest
Interest
90205984
CITY OF FORT COLLINS
PO BOX 580
FT COLLINS, CO 80524
Policy Number CS205984-12
Amended Date 05/13/2009
Named Insured
VAN O BREWSTER
PEGGY L BREWSTER
2132 N CR #25E
BELLVUE, CO 80512
Effective Date 05/13/2009
Expiration Date 05/13/2010
This form is not the contract of insurance. It is a memorandum of coverage limited to the interest and applicable to the item below.
Risk# I Coverage
2 1 Combined Single Limit
2 1 Medical Payments To Others
2 1 Fire Legal Liability (Farm Structures)
Limits of Liability
Each Person Each
Occurrence
NC* 500,000
5,000
NC*
50,000
25,000
Legal Location
680 ACRES AT TWSP 10 RNG 63
ELBERT, CO
100 ACRES AT TWSP 6 RNG 81
JACKSON,CO
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
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
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
4099458 Colorado Farm Bureau Mutual Insurance Company Pg. 1
9177 E. Mineral Circle, Centennial, CO 80112
Risk# Coverage Limits of Liability Legal Location
Each Person Each
Occurrence
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
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
03/27/2009
4099458 Colorado Farm Bureau Mutual Insurance Company Pg. 2
9177 E. Mineral Circle, Centennial, CO 80112