HomeMy WebLinkAboutPLANTORIUM - INSURANCE CERTIFICATEt!J\T/e v . • . • •• • • •• .•••
PO Box 2358
8loomington !L 61702-2358
�• ,
a
�
�
�
0
d
AT1 20
FORT COLLINS
PO BOX 580
FORT COLLINS
738
A
oo�ioo ooss
CO 80522-0580
k��'I�lil!"I�I�I�I���I'r'�lil�f�'����"�I"f�"�I'It'I'I�lI����'
DATE OF NOTICE: FEB 01 2024
CODE:
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGAR[31NG ANY CHANGE OF
ADDRESS INFORMATION.
NOTICE OF TERMItVATION OF AN A�f31TIONAL INSURED INTEREST
Siate Farm Mutual Automobile Insurance Company 2310•FAF1-A
NAMED INSURED: PpLICY NO: 063 Doa7-Doi-06M COVERAGE:
ROBERTS, ,lAMES D 8 CYNTHfA L YR/MAKEIMODEL: 2020 CHEVROLET PICKUP
DBA PLANTORIUM VIN/CAMPER: 1GC4YREYOLF160989
PO BOX a85 AGENT NAME: 7ArvrvER BROWN
LAPORTE Cp 80535-0485 AGENT PHQNE: (970)372-4690
3RD PARTY INTEREST 7ERMINATED
EFFECTIVE FEB 14 2024
a
�
�
�
�
�
0
m
8
N
POLICY M�SSAGES:
Protection of the add;tional insured's interest provided by lhi5 policy is terminated as ot the effeclive date above for ihe following reason:
Policy cancelled by insured. This advance notice is solely to protect ihe additional insured's inleresfs as they are aitected by the ownership,
maintenance, or use of the Car described in the poliCy.
fflt
SfateFaR11 STATE FARM�
�.
PO Box 2368
Bloomington !L 6i702-2368
�
�� n
�
�
�
a
s
aTl 20
CITY OF FORT
PO BOX 580
FORT GOLLINS
434
00693A 0655
COLLINS
CO 80522-05B0
I"�!'�I'I���I�'ll'�'I�II���'ll�'ll��ll�l�l�'�II'�I"�I����I�I'i'
DATE OF NOTICE: FE8 01 2024
CODE:
A
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEF7 CORNER
OF THIS PAGE REGAROING ANY CHANGE OF
ADDRESS INFORMATION.
NOTICE OF 7ERMiNATION OF AN ADDtTIONAL INSUFiED INi�REST
State Farm Mutual Automobile fnsurance Company �810-FAF1-A
NAMED INSURED: POLICY NO: 277 2a3fi-a0ti-OSE COVERAGE:
ROBERTS, JAMES D& CYNTHIA L YR/MAKEIMOdEL: 20i3 CHEVROLET VAN
OBA PLANTORlUM VIN/CAMPER: 1GCZGUCG6D1164908
PO BOX 485 AGENT PiAME: TANNEFi BROWN
LAPORTE CO 80535-0485 AGENT PHONE: (970)372-4690
3RD PARTY INTEREST TERMINATED
EFF�CTIVE FEB 14 �Q24
e
R
�
c
�
0
�
�
Y
N
POLICY MESSAGES:
Protection oi the additional insurecf's interest provided by this policy is terminated as oi the effective daie above t4r the tollowing reason:
Policy cancelled by insured. This advance notice is solely to prolect the additional insured'S interesls as they are affected by the ownership,
maintenance, or use ot the car described in the policy.
FqT