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HomeMy WebLinkAbout550966 POWERS RESOURCE CENTER LLC - INSURANCE CERTIFICATE (10)StateFarm STATE FARM FIRE AND CASUALTY COMPANY AA STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED MAR 21 2018 3 Ravnta �r3�346 2117 AtlaU M-20-1372-FA65 F N 003330 3123 Addl Insured -Section II Only CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 Office Policy Policy Number 96-CG-G907-9 Policy Period Effective Date EFBI piration Date 12 Months FEB 10 2018 FEB 10 2019 The policy period begins and ends at 12:01 am standard time atthe premises Tocaton. Named Insured POWERS, TARA 1750 30TH ST STE 352 BOULDER CO 80301-1029 Automatic Renewal - If the policy period is shown as 12 months , this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Individual Reason for Declarations: Your policy is amended MAR 21 2018 ADDITIONAL INSURED ADDED FORM CMP-4786 ADDED Endorsement Premium Decrease $ .01 Discounts Applied: Claim Record Prepared APR 12 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 030246 290 Al Continued on Reverse Side of Page N Page 1 of 6