HomeMy WebLinkAboutSJW TRUCKING - INSURANCE CERTIFICATEJan 28 2008 11 59RM
BILL COFER STATE FARM 970 223 7919 p 2
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 90 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 Bbomirtgton Illinois
STATE FARM FIRE AND CASUALTY COMPANY of Bloomlttpton,llatois
❑ STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Daily Texas or
❑ STATE FARM INDEMNITY COMPANY of BIoemington Illinois
has coverage m face for the folwmno Named ktsured as shown below
NAMED INSURED Wi=Ck Steven S
ADDRESS OF NAMED INSURr=D, 11083 Higlima3 14 Ault, CO 80610
POLICY NUMBER
1022241D2506C001
1323574DO206AOOI
EFFECTIVE DATE
OF POLICY
10/25/07-04/25/08
10/02/07-04/02/08
DESCRIPTION OF
1978 Petetbuilt
2990 Peterbilt
VEHICLE (IntludiIV VtN}
DuW Truck
VvWpTruckYlu 1XPC
YSN 112296R
D29XOLD293391
LIABILITY COVERAGE
® YES ❑ NO
® YES ❑ NO
❑ YES ❑ NO
❑ YES ❑ NO
LIMITS OF LIABILITY
a Bodily Injury
Each Person
B/A -- see below
N/A -- see below
Each Accident
S/A
M/A
b Property Damage
Each Aaidlent
N/A
x/A
c Bodily Injury &
Property Damage
Single Lang
Each Accident
$1 000 000
$1 000 000
PHYSICAL DAMAGE
COVERAGES
® YES ❑ NO
® YES ❑ NO
❑ YES ❑ NO
❑ YES ❑ NO
a Comprehensive
S 1000 Da&WA99
$ 1000 Deitiadibla
$ DedUctitile
S Deductible
0 YES ❑ NO
® YES ❑ NO
❑ YES ❑ NO
❑ YES ❑ NO
b Collision
$ 1000 Dakwibe
$ 1000 Deducaw
$ DeducBMe
$ Dedudibie
EMPLOYERS NON4NVNED
CAR LIABILFTY COVERAGE
❑YES ®NO
El ®NO
❑YES ❑ NO
❑ YES ❑ NO
HIRED CAR LIABILITY
COVERAGE
❑ YES 0 NO
OYES ® NO
❑ YES ❑ NO
❑ YES ❑ NO
FLEET COVERAGE FOR
ALL OV*ED AND LICENSED
MOTOR VEHICLES 10
YES ® NO
❑ YES ® NO
❑ YES ❑ NO
❑ YES ❑ NO
Fax 221-6707 344 E Foothills Pkwy #7
Port Collins CO 80525
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