HomeMy WebLinkAboutPRYOR, ROBERT & DONNA - INSURANCE CERTIFICATE (2)StateFarm State Farm Fire and Casualty Company
•
• • P.O. Box 82542
Lincoln, NE 68501-2542
RENEWAL CERTIFICATE
JUN 25 2015 to JUN 25 2016
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Y-20- 2544-FAF1
002307 0001
CITY OF FORT COLLINS
215 N MASON ST FL 2
FORT COLLINS CO 80524-4402
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Insured: PRYOR, ROBERT B & DONNA
Location: 6005 S SHIELDS ST
FORT COLLINS CO80526-9631
See schedule page(s) for location of premises
Loss Settlement Provisions (See Policy)
A2 Replacement Cost -Common Construction -Coverage A
B1 Limited Replacement Cost - Coverage B
Forms, Options, and Endorsements
Farm/Ranch Policy
FP-8105
Ordinance/Law 10%/ $18,540
OPT OL
Special Limits - Money/Jf
FE-8689
Farm/Ranch Policy Endorsement
FE-1302.2
Fungus (Including Mold) Excl
FE-8728
Terrorism Insurance Cov Notice
FE-6999
Increase Dwlg up to $37,080
OPT ID
Policy Endorsement
FE-8733
Mandatory Reportng Endorsement
FE-5801
Additional Insured Endorsement
FE-8568
Civil Union Endorsement
FE-8790
Equipment Breakdown Coverage
FE-1320
TO BE PAID BY INSURED
Coverages and Limits
Section I
A Dwelling $185, 400
B Personal Property 139,050
C Loss of Use Actual Loss
Deductibles - Section I
All Losses 500
Section II
L Farm Liability
(each occurrence) 500,000
(annual aggregate) 1,000,000
M Medical Payments (each person) 1,000
Annual Premium
Premium Reductions
Renewal Discount
Inflation Coverage Index
240.5
Please help us update the data used to determine your premium. Contact your agent with the year each of
your home's utilities (heating/cooling, plumbing, or electrical) and roof were last updated.
$834.00
Moving? See your State Farm agent.
See reverse for important information.
6096 301 M Ag6ht NAPOLEON�GIBSON Prepared
Telephone (970) 226-1200 REB MAY 01 2015
Add Ins -II: CITY OF FORT COLLINS
11 316
NOTICE TO POLICYHOLDER:
For a comprehensive description of coverages and forms, please refer to your policy.
Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this
policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached
to this notice are also effective on the Renewal Date of this policy.
Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to
your policy. Billing for any additional premium for such changes will be mailed at a later date.
If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any
questions about your insurance coverage, contact your State Farm agent.
Please keep this with your policy.
folfMah) 10-11-2010
StateFarm State Farm Fire and Casualty Company
•
• • P.O. Sox 82542
Lincoln, NE 68501-2542
Y-20- 2544-FAF1 A F
002307 0001
CITY OF FORT COLLINS
215 N MASON ST FL 2
FORT COLLINS CO 80524-4402
LOCATION OF
COVERED PREMISES
Loc
No of
Portion
No
Acres
of Section
Section
Twnshp Range
01
19
Described on
file in the
Regional Office.
02
5
Described on
file in the
Regional Office.
Y
O
Q1
O
0
O
C.
N
a0
O
d
Cr
Q
N
F
Q-
0
C)
0
M
co
County and State
N 6097 301 M Agent NAPOLEON GIBSON
1 Telephone (970) 226-1200 REs
Prepared MAY 01 2015