HomeMy WebLinkAboutDAVID WEISS - INSURANCE CERTIFICATE486
AMERICAN FAMILY
AMERICAN FAMILY INSURANCE GROUP
6000 AMERICAN PKWY • MADISON WI 53783-0001 • PHONE: (608) 249-2111
May 13, 2005
+0000486
CITY OF FORT
PO BOX 580
FORT COLLINS
125-309
COLLINS
CO 80522
CCCO09
POLICY NUMBER: 05XD4758020005
RE: BUSINESS KEY POLICY
CANCELATION DATE: 05/25/2005
INSURED: WEISS, DAVID
2704 RINGNECK DR
FORT COLLINS CO 80526-2854
LOAN NUMBER:
This letter is to notify you of an important change, indicated by the paragraph checked below, in regard to your
interest in this policy.
X 1. The coverages afforded by the above -numbered policy, issued by the company as identified thereon, will
be canceled on the dates shown above at the time stated in the policy. All liability on the part of the
company, as to your interests, if any, will cease as of that date and time. Any return premium, which
results from cancelation, has been sent to insured directly or through the agent. Please contact same if
questions arise as a result of any premium payment from an escrow account.
2. We have been informed that you no longer have an interest in the above -numbered policy because your
loan has been satisfied. Therefore, as shown above, we have removed all indications of your interest in
the policy.
3. We have been informed that you are no longer a co-insured under the above numbered policy.
Accordingly, we have canceled your interest as co-insured as shown above.
4. The collision coverage will be removed from this policy on the date shown above at the time stated in
the policy. Comprehensive coverage will remain in force. The action was taken at the request of the
insured.
5. The comprehensive coverage will be removed from this policy on the date shown above at the time
stated in the policy. Collision coverage will remain in force. This action was taken at the request of the
insured.
6. The comprehensive and collision coverages, provided by this policy, will be removed on the date shown
above at the time stated in the policy. This action was taken at the request of the insured.
7. The policy numbered above is canceled and replaced by Policy Number:
Commercial Lines - Farm/Ranch Division
American Family Mutual Insurance Company
AGENT: 125-309 PHONE: 970-484-2881
DANIEL RICHMOND
923 E PROSPECT RD
FORT COLLINS CO 80525-1110