HomeMy WebLinkAboutBA-NOM-A-NOM LLC - INSURANCE CERTIFICATEC�.
PO 6ox 2368
BJoomingtOn JL S J 702-2368
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FORT COLLINS
CO 80522-0580
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DATE OF NOTICE: JAN 30 2024
CODE:
NOTE: PLEAS� NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CliANGE OF
ADDRESS IN�ORMATiON.
AD�ITIONAL INSU�tED'S NOiICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2783 FB42-A
NAMED INSURED: PQLICY NO: 436 3874-D04-06N COVERAGE:
BA-NOM-A-NOM LLC YR/MAKE/MODEL: 2017 RAM VAN B! AND P� LIABIIITY
4554 BEACH CT ViN/CAMPER: 3C6TRVDG8HE541203 35oo.oao ���oo,000i$�oo,000
DENVER CO 80211-1453 AGENT NAME: JUNIOR MEDINA 3i000 DED. COMP.
AGENT PHONE: (72D}726-a0ao $1000 DED. COLL.
ENDORSEMENT fVO: 6028BT POLICY EFFECTIVE
JAN 172024 UNTILTERMINATED
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POLlCY MESSAGES: This policy shown above supersedes policy# 4363874-O6M.
The policy includes a loss payabfe clause protecting the add tional insured's interesf ir the described Car to the extent of the insurance
provided and subject to al policy provisions. The add�tional �nsured will be given 10 days notice if the policy is terminated. Until such noi ee
is provided, it shall be presumed that ihe required renewal prem ums have been paid. The addilional insured must not fy us within 10 days of
any change of lnterest or ownersbp coming to their atteniion. Failure to do so w 11 render this po �cy null and void.
FH