HomeMy WebLinkAboutVAN O BREWSTER - INSURANCE CERTIFICATE (2)FARKI
BUREAU V
INSURANCE
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 0 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.
Liability
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
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
4109981 Colorndo Farm Bureau Mutual bisurance Company P8. 1
9177 E. Minend Circle, Centennial, CO 80112
FARM
BUREAU'
trrece
Liability
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
04/08/2009
4109981 Colorado Farm Bureau Mutual insurance Company Pg. 2
9177 E. Mineral Circle, Centennial, CO 80112