HomeMy WebLinkAboutBOB & DONNA PRYOR - INSURANCE CERTIFICATEstate Farm Fire and casuaity company
- 1555 Promontory
C'role
Greeley, CO 8069-0001
RENEWAL CERTIFICATE
JUN 252010 to JUN 252011
12 AT 1 - Y-20- 1948-F913 A F
11 006339
10 CITY OF FORT COLLINS
9 215 N MASON ST FL 2
FORT COLLINS CO 80524-4402
Insured: PRYOR, ROBERT B & DONNA
Location
JUN U 3 2010
See schedule page(s) for location of premises
Loss Settlement Provisions (See Policy)
A2 Replacement Cost -Common Construction -Coverage A
B1 Limited Replacement Cost - Coverage B
Forms, Options, and Endorsements
.Farm/Ranch Policy
FP-8105
Ordinance/Law 10%/ $16,750
OPT OL
Special Limits - Money/Jf
FE-8689
Farm/Ranch Policy Endorsement
FE-1302
Fungus (Including Mold) Excl
FE-8728
Terrorism Insurance Cov Notice
FE-6999
Increase Dwlg up to $33,500
OPT ID
Policy Endorsement
FE-8733
Mandatory Reportng Endorsement
FE-5801
Additional Insured Endorsement
FE-8568
TO BE PAID BY INSURED
Coverages and Limits
Section I
A Dwelling $167, 500
B Personal Property 125,625
C Loss of Use Actual Loss
Deductibles - Section I
All Losses 500
Section II
L Farm Liability
(each occurrence) 500, 000
(annual aggregate) 1, 000, 000
M Medical Payments (each person) 1,000
Annual Premium
Previous Balance Due
Premium Reductions
Renewal Discount
Inflation Coverage Index: 229.9
Please help us update the data used to determine your premium. Contact your agent with the year each of
your home's utilities (heating/cooling, plumbing, or electrical) and roof were last updated.
s
0
N
V .
m
Q
n
o
r
0
M
$711.00
6.92
8
7
6
4
3
?7 If you have moved, please contact your agent.
/uLfc4PS�I`vE cc. ?� G �oKyy�y�r �e See reverse side for important Information.
N 21251 soi nn Ag t RAY DEPLE% Prepared
Telephone (970) 226-1200 aes MAY 03 2010
CONTINUED FROM FRONT
Add Ins -II: CITY OF FORT COLLINS
NOTICE TO POLICYHOLDER:
For a comprehensive description of coverages and forms, please refer to your policy.
Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this
policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached
to this notice are also effective on the Renewal Date of this policy.
Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to
your policy. Billing for any additional premium for such changes will be mailed at a later date.
If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any
questions about your insurance coverage, contact your State Farm agent.
Please keep this with your policy.
i_nno__n_.. nc nnnc
State Farm Fire and casualty company
®" 1555 Promontorryy Circle
Greeley, CO 8Q638-0001
12 Y-20- 1948-F913 A
n
006339
70 CITY OF FORT COLLINS
s 215 N MASON ST FL 2
FORT COLLINS CO 80524-4402
F
LOCATION OF COVERED PREMISES
Loc
No of
Portion
No
Acres
of Section
Section Twnshp Range County and State
01
19
Described on
file in the Regional Office.
02
5
Described on
file in the Regional Office.
JUN 0 3 2010
By
Y
C,
O
O
O
C>
O
O
N
OD
O
N
Q
D
C_
O
N
C
a`
m
0
m
0o
m
21252
901
M
Agent RAY
DEPLER
N
Telephone (970) 226-1200 REB Prepared MAY 03 2010