HomeMy WebLinkAboutEARL AND KRISTI BERNARD - INSURANCE CERTIFICATETHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY CHANGES
POLICY NUMBER EFFECTIVE DATE ADDL PREMIUM RETURN PREMIUM POLICY CHANGE NO.
05-P87940-01 12/20/2018
ISSUED TO
BERNARD, EARL R III BERNARD, KRISTI J
AGENT CUSTOMER BILLING ACCOUNT 019 - 454 - 815 61
CINDY GERK AGENCY LLC 012 309
PLS
1/7/2019
Page 1
(The above information is needed only when this endorsement is issued after preparation of the policy.)
THIS POLICY IS CHANGED AS FOLLOWS:
OPTION 12 ADDITIONAL NAMED INSURED(S) HAS BEEN ADDED.
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
(ADDL ACRES LARIMER 23 11 69 80
ADDL ACRES LARIMER 23 11 N 69W 240)
All other terms, agreements, conditions, and provisions remain unchanged.
AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S.I.
MADISON, WISCONSIN
AUTHORIZED
REPRESENTATIVE 1, " �C�C COUNTERSIGNED
Pena em,
President Secretary
IL 75 00 Ed. 08/18 Stock No. 02523