HomeMy WebLinkAboutLARRY D AND MARY H MAXWELL - INSURANCE CERTIFICATEEvidence of Insurance
Additional interest
Interest Named Insured
90217018
CITY OF FORT COLLINS LARRY D MAXWELL
PO BOX 580 MARY H MAXWELL
FORT COLLINS, CO 80522 5137 NW FRONTAGE RD
FORT COLLINS, CO 80524
Policy Number CS217018-2 Effective Date 02/28/2011
Amended Date 02/28/2011 - Expiration Date 02/28/2012
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# Coverage Limits of Liability Legal Location
Each Person Each
Occurrence
4 Combined Single Limit NC* 1,000,000 72 ACRES AT TWSP 8 RNG 68
LARIMER, CO
4 Medical Payments To Others 1,000 10,000
4 Fire Legal Liability (Farm Structures) NC* 25,000
Your interest in risk(s) 4 is as a Lessor -additional insured.
Coverage is restricted to this relationship.
Agent's Name RICH DAVIS
Agent's Address 335 E. MOUNTAIN AVE.
FORT COLLINS, CO 80524
Agent's Phone # (970) 482-3952
Date 01 /19/2011
4679173 Colorado Farm Bureau Mutual Insurance Company Pg. 1
9177 E. Mineral Circle, Centennial, CO 80112