HomeMy WebLinkAbout403996 VAN BREWSTER - INSURANCE CERTIFICATE (12)9
(FARM
�I BUREAU
INSURANCE
Evidence of Insurance
Additional Interest
Interest
90205984
CITY OF FORT COLLINS
PO BOX 580
FT COLLINS. CO 80524
Policy Number CS205984-19
Amended Date 05/13/2016
Named Insured
VAN O BREWSTER
PEGGY L BREWSTER
2132 N CR #25E
BELLVUE, CO 80512
Effective Date 05/13/2016
Expiration Date 05/13/2017
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
680 ACRES AT TWSP 10 RNG 63
ELBERT, CO
2
Medical Payments To Others
5,000 50,000
640 ACRES AT TWSP 11 RNG 66
EL PASO, CO
2
Fire Legal Liability (Farm Structures)
NCB 25,000
640 ACRES AT TWSP 11 RNG 66
EL PASO, CO
640 ACRES AT TWSP 11 RNG 66
EL PASO, CO
640 ACRES AT TWSP 11 RNG 66
EL PASO, 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 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
6561131
Colorado Farm Bureau Mutual Insurance Company
9177 E. Mineral Circle, Centennial, CO 80112
Pg. 1
FARM
BUREAU
INSURANCE
Liability
Risk#
Coverage
Limits of Liability
Legal Location
Each Person
Each
Occurrence
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
150 ACRES AT TWSP 008 RNG 070
LARIMER, CO
200 ACRES AT TWSP 008 RNG 070
LARIMER, CO
100 ACRES AT TWSP 07 RNG 67
WELD, CO
100 ACRES AT TWSP 07 RNG 67
WELD, CO
100 ACRES AT TWSP 07 RNG 67
WELD, CO
Your interest in risk(s) 2 is as a Additional Insured.
Coverage is restricted to this relationship.
'NC = No Coverage
Agent's Name MICHAEL LEFFLER
Agent's Address 335 E. MOUNTAIN AVE.
FORT COLLINS, CO 80524
Agent's Phone # (970) 482-3952
Date 03/28/2016
6561131 Colorado Farm Bureau Mutual Insurance Company Pg. 2
9177 E. Mineral Circle, Centennial, CO 80112