HomeMy WebLinkAboutMILLER, THOMAS - INSURANCE CERTIFICATEStateFarm STATE FARM�'
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PO Box 2358
Bloomrngton !L 61702-2358
20A
AT1 20
002077 0093
CITY UF FORT CQLLINS
300 LAPORTE AVE
FORT COLLINS CO 80521-2719
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DATE OF NOTICE: APR 12 2023
COD�:
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISiED AT THE TOP, LEFT CORNEF
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMA710N.
ADDlTIONAL INSURED'S NOTlCE OF COVEAAGE
State Farm Mufuaf Automobile Insurance Company 2838-FA65-A
NAMED INSUREC;: POLICY NO; 227 9997 F2�-06N COVERAGE;
MILLER, THOMAS 1 YRIMAKE/MODEL: 20�5 ACURA SPORT WG BI AND PD LIABILITY
4775 6TH ST VIN/CAMPER: 5J8TB4H37FL009560 $250,O�OI$50o,000/$t0o,0o0
COMPREHENSIVE
BOULDER CO 80304•0863 AGENT NAME: ROBERT ERBEN INS AGCY iNC $100 DED. COLL.
AGENT PHONE: (303i530-0404
ENDORSEMENT NO; sa2aer POLICY EFFECTIVE
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MAF? 21 2023 UNTIL TERMINAT�Q
POLICY MESSAGES: This po icy show� above supersedes po icy# 2279997 06M.
The policy inaudes a loss payab'e clause protect'ng the add�tional insured'S mterest n the described car to the extent ot ihe insurance
provided and subject to all policy provisions. The addltional insured wifl be gwen 10 days notice if the policy is terminated. Until such noiice
is provided, t shal! be presumed Shat the required renewa prem ums have been paid. The addiiional msured must notify us within 10 days of
any change of mterest or ownership commg to their attent on. Fadure to do so w I render this policy nuli and void.
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