HomeMy WebLinkAbout127666 MICHAEL TRUCKING - INSURANCE CERTIFICATE03/23/2007 09:54 9704930226
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"An ARM
A 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 MOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM
THE PATE 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 coveracle in force for the following Named Insured as shown below:
NAMED INSURED: MICHAEL, DNIGHT dba MICHALE TRUCKING
ADDRESSOF NAMED INSURED: 600
ENDICOTT
ST., FORT COLLINS CO 80524-3225
POLICY NUMBER
055 2176-D08-069.-
S55 9543-A26-06L
EFFECTIVE DATE
OF POUCY
10/08/06-04/08/07
01/26/01-07/26/07
DESCRIPTION OF
1997 PETERBUILT
1983 PETERBUILT
VEHICLE (Including VIN)
DUMP
D'374171GL
DUMP
1XP 1XP9D297CDDP161U15
LIABILITY COVERAGE
® YES
❑ NO
® YES ❑ NO
❑ YES
[] NO
❑ YES
❑ NO
LIMITS OF LIABILITY
a. Bodily Injury
Each Person
$500,000
$500,000
$500,000
$500,000
Each Accident
b. Property Damage
Each Accident
$500,000
$500,000
C. Bodily Injury &
Property Damage
Single Limit
Each Accident
$500, 000
$500,000
PHYSICAL DAMAGE
COVERAGES
® YES
❑ NO
0 YES ❑ NO
❑ YES
[]NO
❑ YES
❑ NO
a. Comprehensive.$
2000
Deductible
$ 2000 Deduct"
$
Deductible
$
Deductible
® YES
❑ NO
® YES ❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
b. Collision
$ 2000
Deducible
$ 2000 Deductible
$
Deducible
$
Deductibla
��NON-OWNED
❑ YES
® NO
❑ YES NO
El YES
❑ NO
❑ YES
❑ NO
HIRED CAR COVERAGE
El ❑ YES
® NO
❑ YES ONO
❑ YES
❑ NO
❑ YES
❑ NO
FLEET -COVERAGE FOR
ALLOWDEDANDI ICENSED
MOTOR VEWCL
❑ YES
9 NO
❑ YES ® NO
❑ YES
❑ NO
❑ YES
❑ NO
Licensed Rep. 1680 03/21/2007
Zanature of u ,erect presentative Tile Agent's Code Number Date
me and dress of Certificate Holder Name and Address of Agent
ADDITIONAL NAMED INSURED; CRAMER STATE FARM
%GARY CRAMER
CITY OF FORT COLLINS 1275 E MAGNOLIA. ST #I
215 N MASON ST FORT COLLINS CO 90524
FORT COLLINS CO 80521
IN ILRNAL STATE FARM USE ONLY: LJ Request permanent CertifiCata of Insurance for liability coverage.
122429,3 Rev_ 07-26-2005 0 Request Certificate Holder to be added as an Additional InBured-