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2010-10-27_REVISION - M1977223
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2010-10-27_REVISION - M1977223
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Last modified
6/15/2021 2:22:48 PM
Creation date
11/1/2010 9:38:52 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1977223
IBM Index Class Name
REVISION
Doc Date
10/27/2010
Doc Name
Adequacy Review Response
From
LJ Development, Inc.
To
DRMS
Type & Sequence
AM1
Email Name
MAC
Media Type
D
Archive
No
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Attachment to ACO" CertlIICate for ]BS Five Rivers cattle Feeding, LLC <br />The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage <br />afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy. <br />INSURED <br />]BS Five Rivers Cattle Feeding, LLC <br />1770 Promontory Circle <br />Greeley Co 60634-9039 USA <br />ADDITIONAL POLICIWO If a policy below does <br />INSURER <br />INSURER <br />INSURER <br />INSURER <br />INSURER <br />not include limit information, refer to the corresponding policy on the ACORD <br />certificate form for policy limits. <br />WSR ADWL POLICY NUMBER POLICY POLICY <br />I.TR 049RD TYPE Of UISURANCE POLICY DESCRIMON EFEECrwz RXPIRATTON I DtIfrS <br />DATE. DATE <br />DFSCRIMM OF OPBRATIONS/LOCATIONVVEH)C E&U USIONS ADOW BY 04MORSEMENTISPECIAL PROVISIONS <br />Additional insured Lessor Endorsement on the Automobile Liability policy as interests may apply and <br />where written contractual obligation exists. <br />Certltlcate No : 570040306252
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