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AMERICAN FAMILY
AMERICAN FAMILY INSURANCE GROUP
6000 AMERICAN PKWY • MADISON WI 53783-0001 • PHONE: (608) 249-2111
January 21, 2011
+0000156 005-316 RAB024 LOAN NUMBER:
THE CITY OF FORT COLLINS -
PO BOX 580
FORT COLLINS CO 80522
POLICY NUMBER: 05XM208101
-RE: __172 N COLLEGE AVE UNIT D FT-COLLINS-CO-80524 - - -
CANCELLATION DATE : 02/03/201 1
INSURED: The Mountain Shop Lle
172 N COLLEGE AVE UNIT D
FT COLLINS CO 80524-4418
This letter into notify you of an important change, indicated by the paragraph checked below, in regard to your
interest in this policy.
X 1. The coverages afforded by the above -numbered policy, issued by the company as identified thereon, will
be canceled on the dates shown above at the time stated in the policy. All liability on the part of the
company, as to your interests, if any, will cease as of that date and time. Any return premium, which
results from cancellation, has been sent to insured directly or through the agent. Please contact same if
questions arise as a result of any premium payment from an escrow account.
2. We have been informed that you no longer have an interest in the above -numbered policy because your
loan has been satisfied. Therefore, as shown above, we have removed all indications of your interest in
the policy.
3. We have been informed that you are no longer a co-insured under the above numbered policy..
Accordingly, we have canceled your interest as co-insured as shown above.
4.. The collision coverage will be removed from this policy on the date shownabove at the time stated in
the policy. Physical damage other than collision coverage will remain in force. The action was taken at.
the request of the insured.
5. The physical damage other than collision coverage will be removed from this vehicle(s) on the date
shown above at the time stated in the policy. Collision coverage will remain in force. This action was
taken at the request of the insured.
6. The physical damage other than collision and collision coverages, provided by this vchicle(s), will be
removed on the date shown above at the time stated in the policy. This action was taken at the request of
the insured.
7. The policy numbered above is canceled and replaced by Policy Number:
Commercial Lines - Farm/RanchDivision
American Family Mutual Insurance Company
AGENT: 005-316 1PHONE: 970-484-2881
DANIEL B RICHMOND AGENCY, INC.
923 E PROSPECT RD
FORT COLLINS CO 80525-1 1 10
UBL-89-4 stock No. 1776,