HomeMy WebLinkAboutVAN O BREWSTER - INSURANCE CERTIFICATE (3)Evidence of Insurance
Additional Interest
Interest Named Insured
90205934
CITY OF FORT COLLINS
VAN O BREWSTER
PO BOX 580
PEGGY L BREWSTER
FT COLLINS, CO 80524
2132 N CR #25E
BELLVUE,CO 80512
Policy Number CS205984-17
Amended Date 05/13/2014
Effective Date 05/13/2014
Expiration Date 05113/2015
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# I Coverage
Each Person Each
Occurrence
ELBERT,CO
Medical Payments To Others 5,000 50,000 640 ACRES AT TWSP 11 RNG 66
ELPASO,CO
Fire Legal Liability (Farm Structures) NC` 25,000 640 ACRES AT TWSP 11 RNG 66
ELPASO,CO
640 ACRES AT TWSP 11 RNG 66
EL PASO, CO
640 ACRES AT TWSP 11 RNG 66
ELPASO,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 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
5830153 Colorado Farm Bureau Mutual Insurance Company Pg. 1
9177 E. Mineral Circle, Centennial, CO 80112
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INSURANCE
Risk#
Coverage
Limits of Liability
Legal Location
Each Person
Each
Occurrence
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
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
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 04/03/2014
5830153 Colorado Farm Bureau Mutual Insurance Company
9177 E. Mineral Circle. Centennial, CO 80112
Pk. 2