HomeMy WebLinkAbout403396 VAN & PEGGY BREWSTER - INSURANCE CERTIFICATEEvidence of Insurance
Additional Interest
Interest
90205984
CITY OF FORT COLLINS
PO BOX 580
FT COLLINS, CO 80524
Policy Number CS205984-16
Amended Date 05/13/2013
Named Insured
VAN O BREWSTER
PEGGY L BREWSTER
2132 N CR #25E
BELLVUE, CO 80512
Effective Date 05/13/2013
Expiration Date 05/13/2014
This form is not the contract of insurance. It is a memorandum of coverage limited to the interest and applicable to the item below.
Liabili
Risk#
Coverage
Limits of Liability
Legal Location
Each Person
Each
Occurrence
2
Combined Single Limit
NC' 500,000
400 ACRES AT TWSP 008 RNG 070
LARIMER, CO
2
Medical Payments To Others
5,000 50,000
150 ACRES AT TWSP 008 RNG 070
LARIMER, CO
2
Fire Legal Liability (Farm Structures)
NC' 25,000
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
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
5480565 Colorado Farm Bureau Mutual Insurance Company Pg. 1
9177 E. Mineral Circle, Centennial, CO 80112
FARM
BUREAU
INSURANCE
Liability"
Risk#
Coverage
Limits of Liabilit
Legal Location
Each Person
Each
Occurrence
LARIMER, CO
200 ACRES AT TWSP 008 RNG 070
LARIMER, 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
640 ACRES AT TWSP 11 RNG 66
ELPASO,CO
640 ACRES AT TWSP 11 RNG 66
ELPASO,CO
640 ACRES AT TWSP 11 RNG 66
ELPASO,CO
640 ACRES AT TWSP 11 RNG 66
ELPASO,CO
680 ACRES AT TWSP 10 RNG 63
ELBERT,CO
Your interest in risk(s) 2 is as a Additional Insured.
Coverage is restricted to this relationship.
'NC = No Coverage
Agent's Name
JIM MILLER
Agent's Address
335 E. MOUNTAIN AVE.
FT COLLINS, CO 80524
Agent's Phone #
(970) 482-3952
Date
04/10/2013
5480565 Colorado Farm Bureau Mutual Insurance Compam Pg. 2
9177 E. Mineral Circle, Centennial, CO 80112
Evidence of Insurance
Additional Interest
Interest
90205984
CITY OF FORT COLLINS
PO BOX 580
FT COLLINS, CO 80524
Policy Number CS205984-16
Amended Date 05/13/2013
Named Insured
VAN 0 BREWSTER
PEGGY L BREWSTER
2132 N CR #25E
BELLVUE, CO 80512
Effective Date 05/13/2013
Expiration Date 05/13/2014
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 Liabili
Legal Location
Each Person
Each
Occurrence
2
Combined Single Limit
NC' 500,000
400 ACRES AT TWSP 008 RNG 070
LARIMER, CO
2
Medical Payments To Others
5,000 50,000
150 ACRES AT TWSP 008 RNG 070
LARIMER, CO
2
Fire Legal Liability (Farm Structures)
NC' 25,000
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
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
5478970 Colorado Farm Bureau Mutual Insurance Company Pg. 1
9177 E. Mineral Circle, Centennial. CO 80112
FARM
BUREAU
WSURAWE
tiabilit . d
Risk#
Coverage
Limits of Liability
Legal Location
Each Person
Each
Occurrence
LARIMER, CO
200 ACRES AT TWSP 008 RNG 070
LARIMER, 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
640 ACRES AT TWSP 11 RNG 66
EL PASO, CO
640 ACRES AT TWSP 11 RNG 66
EL PASO, CO
640 ACRES AT TWSP 11 RNG 66
EL PASO, CO
640 ACRES AT TWSP 11 RNG 66
EL PASO, CO
680 ACRES AT TWSP 10 RNG 63
ELBERT,CO
Your interest in risk(s) 2 is as a Additional Insured.
Coverage is restricted to this relationship.
*NC = No Coverage
Agent's Name
JIM MILLER
Agent's Address
335 E. MOUNTAIN AVE.
FT COLLINS, CO 80524
Agent's Phone #
(970) 482-3952
Date
04/08/2013
5478970 Colorado Farm Bureau Mutual Insurance Company Pg. 2
9177 E. Mineral Circle, Centennial, CO 80112