Platte River Implementation Funds Request no. 420

• File Number: 420
• Description: Request for Disbursement of Contribution no. 420 Agreement no. R12AC60020
• State: CO
• Basin: North Platte
• Title: Platte River Implementation Funds
• Water Supply Pro - Doc Type: Correspondence

Wahoo, NE 68066
[phone] Omaha, NE 68154
II INSPRO P.O. Box 6847 [phone]
Lincoln, NE 68506 Fremont, NE 68025
INSURANCE [phone] [phone] West Des Moines, IA
[phone]
West Point, NE 68788
EMPLOYEE OWNED [phone]
copy
INVOICE
Platte River Recovery Implementation Invoice Date 06/25/14
Foundation Invoice No. 604 7 71
P. 0. Box 83107 Bill-To Code PLATT21
Lincoln, NE 68501-3107 Client Code PLATT21
Inv Order No. 1**43 632 0
Named insured: Platte River Recovery Implementation
Amount Remitted: $
Please return this portion with your payment.
Make checks payable to: INSPRO, Inc.
Effective Date Policy Period Coverage Description Transaction Amount
07/28/14 07/28/14 Chubb Group of Insurance Companies
to Policy No. 82104967
07/28/15 *Renewal - Management Liability 1, 729 .00
Invoice Number: 604771 Amount Due: 1, 729 . 00
*Premiums Due and Payable on Effective Date
KLO Page: 1 ORIGINAL INVOICE