HomeMy WebLinkAbout403996 VAN BREWSTER - INSURANCE CERTIFICATE (8)JUL-30-2014 12:30 From: To:2216707 Paae:1�1
ACORo® CERTIFICATE OF LIABILITY INSURANCE
7i3oi2oD1A )
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the Policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certilicate holder in lieu of such enrlarsement(s).
PRODUCER
Farm Bureau Insurance
335 E Mountain Ave
Ft Collins, CO 80524
CONTACT
NAME:
PHONE 970 482-3952 FRo.(970) 4930297
2.
- IL
ADDRESS:
INSURER(S) AFFORDING WVEgAGE
NNCI
INSURER AColorado Farm Bureau Mutual Insurance
INSURED Van Brewster
2132 N. County Road 25E
Bellvue, CO 80512
INSURER B'.
INSURER C:
INSURER D'
INSURER E:
INSURER F'
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NDTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILLm TYPE OF INSURANCE 4aaL rare POLICY E F POLICY EXII
Irrso vry POLICY NUMBER (MMIDDNYYYl IMMIDDNY LIMITS
xEflcuLL oExERu unmLRY
CLAIM&MADE ❑ OCCUR
P7:
EACH OCCURRENCE
$
PREMIS-DAMAGES
$
MED EXP(Any mie Person)
$
PERSONAL&ADV INJURY
$
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PRO-
JECT El LOG
OTHER,
GENERAL AGGREGATE
$
PRODUCTS - COMPIOP AGG
$
a
AUTOMOBILE
LU\BIUTY
ANYAUTO
ALL OWNED SCHEDULED
X AUTOS
O OWNED
HIRED
HIRED AUTOS AUTOS
y
CS205984 ,.
5/13/2014
5/13 /2015
IN L IT
Ea accident
$
BODILY INJURY (Per Person)
$ 100 000
BODILY INJURY (Per aaideno
E 300,000
PROPERTY DAMA E
Per e¢Henl
$ 100OOO
$
-UMBRELLA LIAR
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
S
AGGREGATE
$
DED RETENTION$
WORKERS COMPENSATION
$
AND EMPLOYER$' UABILITY YIN
u PNGPRIET0"ARa1Ct %ECUrWE
OFFICEWMENEER EXCLUPEM ❑NIA
(xv,datory in NN)
STATUTE ER
EL. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEES
li yes, describe under
ESCRIPTION OF OPERATIONS bebw
E,L. DISEASE - POLICY LIMIT
$
1AFarrnowner
Liability
y
CS205984
5/13/2014
S/13/2015
$500,000
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101. Addltiorml Remarks Schedule, may be aeached d more spa. h n"in,ed)
Hay Harvesting at Bobcat Ridge Open Space
CFRTIFICATF Hril ra,a
City of Fort Collins
215 N. Mason St SHOULD ANY F THE OVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPI TION D E THEREOF, NOTICE WILL BE DELIVERED IN
Fort Collins, CO 80524 ACCORDA CE WITH E POLICY PROVISIONS,
Attn: John Stevens AUTHORIZE REPRESE T
1908-2013 ACORD C PORATI N. All rights reserved.
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