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HomeMy WebLinkAbout384033 J J'S TRUCKING - INSURANCE CERTIFICATE03/23/2007 09:54 9704930226 PAGE 01/02 "ATI run A1II��II�NC CERTIFICATE OF INSURANCE SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE CANCELED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. This certifies that: ❑ STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois ® STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois ❑ STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas, Texas ❑ STATE FARM INDEMNITY COMPANY of Bloomington, Illinois, or ❑ STATE FARM GUARANTY INSURANCE COMPANY of Bloomington, Illinois has coverage in force for the following Named Insured as shown below: NAMED INSURED: PFLIPSEN, STAN dba JJ' S TRUCKING ADDRESS OF NAMED INSURED: 221 W DOUGLAS RD., LOT 17, FORT COLLINS CO 90524 POLICY NUMBER 117 3516-DIO-OC-0 EFFECTIVE DATE OF POLICY 10/10/06--04/10/07 DESCRIPTION OF 72 X&CK DUMP TRUCK VEHICLE (including VIN) R5711L512978 LIABILITY COVERAGE 0 YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO LIMITS OF LIA131LITY a. Bodily Injury Each Person 1 MM Each Accident 1 MM b. Property Damage Each Accident 1 MM c. Bodily Injury & Property Damage Single Limit Each Accident 1 HM PHYSICAL DAMAGE COVERAGES ❑ YES M NO ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO a. Com ensive $ Deducbbb $ Deductible $ Deductible $ Deductble ® YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO b. Collision $ 500 Deducible $ Deductible $ Deductible $ Deduclldle LOY LJsy SEE��GO ❑ YES g NO ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO CIRED CAELIABILITY ❑ YES P9 NO ❑ YES ❑ NO [-IYES❑ NO ❑ YES ❑ NO ,OVERAFLEET. COVERAGE FOR MOTOR O VMCLELS E 7 ❑ YES ED NO ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES © NO Licensed 06-1680 03/2 ig tune of A�dh sized R ftsentatim Title Agent's Code Number Date Nelme aril Addressof Certificate Holder Name and Address of Agent ADDITIONAL NAMED INSURED: CITY OF FORT COLLINS CRAMER STATE FARM 215 N MASON ST GARY CRAMER-AGENT FORT COLLINS CO 80521 1275 E MAGNOLIA ST FORT COLLINS CO 80524 INTERNAL STATE FARM USE ONLY: p Request permanent Certifloate of Insurance for liability coverage. 122429.8 Rev. 07-4-2005 o Request Certificate Holder to be added as an Addltional Insured,