HomeMy WebLinkAboutMICHAEL O BLACK AND REINA BACH - INSURANCE CERTIFICATEGEICO GENERAL INSURANCE COMPANY
Certificate of Insurance
P.O. Box 509090
San Diego, CA 92150-9090
Named Insured and Address:
MICHAEL O BLACK AND REINA BACH
14516 W BYERS PL
GOLDEN CO 80401-5169
Name and Address:
CITY OF FORT COLLINS CO rg
PO BOX 580
FORT COLLINS CO 80522
Date of Certificate:01-30-19
Policy Number:4141-61-04-20
Policy Period: 09-18-18 to 03-18-19
(12:01 A.M. Local Time) (12:01 A.M. Local Time)
This Certificate of Insurance does not amend, extend, or alter the coverage afforded by this
policy.
During the term of coverages provided, the Company and the insured shall be bound by the provisions of the policy (or policies) of
insurance in current use by the Company in the state.
This is to certify that the captioned policy includes the limits specified herein for each person and for each occurrence under the
Bodily Injury Liability Coverage; the limits specified herein for each occurrence under the Property Damage Liability Coverage.
Description of Vehicle: 10 TOYOTA 5TDDW5G12AS033673
Description of Vehicle:
COVERAGE LIMITS OF COVERAGE
Bodily Injury Liability $ 300 M and $ 300 M
(Each Person) (Each Occurrence)
Property Damage Liability $ 100M
(Each Occurrence)
INTERESTED PARTY
LIMITS OF COVERAGE
$ M and $ M
(Each Person) (Each Occurrence)
(Each Occurrence)
We agree to provide you with written notice of termination in the event this policy becomes cancelled. Notice provided
may be more than ten (10) days, but not less than ten (10) days.
U99 (09-17)