HomeMy WebLinkAboutLARRY D & MARY H MAXWELL - INSURANCE CERTIFICATEBUR A `
Evidence of Insurance
Additional Interest
Interest
90217018
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS, CO 80522
Policy Number CS217018-3
Amended Date 02/28/2012
Named Insured
LARRY D MAXWELL
MARY H MAXWELL
5137 NW FRONTAGE RD
FORT COLLINS, CO 80524
Effective Date 02/28/2012
Expiration Date 02/28/2013
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
4
Combined Single Limit
NC* 1,000,000
72 ACRES AT TWSP 8 RING 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
506 E. MULBERRY STREET
FORT COLLINS, CO 80524
Agent's Phone #
(970) 493-8080
Date
01 /19/2012
5047125 Colorado Farm Bureau Mutual Insurance Company Pg. 1
9177 E. Mineral Circle, Centennial, CO 80112