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Home My WebLink About403996 VAN BREWSTER - INSURANCE CERTIFICATE (11)L9- FARM BUREAU INSUfiANCE Evidence of Insurance Additional Interest Interest 90205984 CITY OF FORT COLLINS PO BOX 580 FT COLLINS, CO 80524 Policy Number CS205984-22 Amended Date 05/13/2019 Named Insured VAN O BREWSTER PEGGY L BREWSTER 2132 N CR #25E BELLVUE, CO 80512 Effective Date 05/13/2019 Expiration Date 05/13/2020 This form is not the contract of insurance. It is a memorandum of coverage limited to the interest and applicable to the item below. Liability Risk# Coverage Limits of Liability Legal Location Each Person Each Occurrence 2 Combined Single Limit NC* 500,000 400 ACRES AT TWSP 008 RNG 070 LARIMER, CO 2 Medical Payments To Others 5,000 50,000 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 2 Fire Legal Liability (Farm Structures) NC* 25,000 100 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 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 7675647 Colorado Farm Bureau Mutual Insurance Company 9177 E. Mineral Circle, Centennial, CO 80112 Pg. 1 Risk# I Coverage Your interest in risk(s) 2 is as a Additional Insured. Coverage is restricted to this relationship. 'NC = No Coverage BU REFARM INSURANCE Liabili Limits of Liability Each Person Each Occurrence Agent's Name MICHAEL LEFFLER Agent's Address 335 E. MOUNTAIN AVE. FORT COLLINS, CO 80524 Agent's Phone # (970) 482-3952 Date 05/06/2019 Legal Location 150 ACRES AT TWSP 008 RNG 070 LARIMER, CO 200 ACRES AT TWSP 008 RNG 070 LARIMER, CO 7675647 Colorado Farm Bureau Mutual Insurance Company 9177 E. Mineral Circle, Centennial, CO 80112 Pg. 2