HomeMy WebLinkAboutHOFFMAN TRUCKING - INSURANCE CERTIFICATECERTIFICATE OF INSURANCE
SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERWISE
TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, 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: 0 STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois, or
STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois
has coverage in force for the follpwjhg_IUamed Insurl§W ps shown below: ry, I
Named Insured
Address of Named Insured
S'50 <pQSGS-Ca/-
POLICY NUMBER
6&K-
OF PEOOU Y DATE
9 al 3-¢y3ll
DESCRIPTION
/ /d M, C-r
OF
VEHICLE
Du ,K uot
/'
LIABILITY COVERAGE
0 YES 0 NO
0 YES
0 NO
0 YES
0 NO
0 YES
0 NO
LIMITS OF LIABILITY
a. Bodily Irjury
AA �/
Each Person
✓^Y'(/v
Each Accident
b. Property Damage
Each Accident
c. Bodily Irjtry & Properly
Damage Single Unit
Each Accident
PHYSICAL DAMAGE
0 YES 4Z7f NO
0 YES
0 NO
0 YES
0 NO
0 YES
0 NO
COVERAGES
a. Comprehensive
$ Deductible
$
Deductible
$
Deductible
$
Deductible
0 YES >< NO
0 YES
0 NO
0 YES
0 NO
0 YES
0 NO
b. Collision
$ Deductible
$
Deductible
$
Deductible
$
Deductible
EMPLOYER'S
NON -OWNERSHIP
0 YES NO
0 YES
0 NO
0 YES
0 NO
0 YES
0 NO
COVERAGE
HIREP CAR COVERAGE
0 YES 'fi<NO
0 YES
0 NO
0 YES
0 NO
0 YES
0 NO
Cl6 - Apm
IF Signature of uth zed Representa' a if Title Agent's Code Number Dat
Name and Address of Certificate Holder
Holder Name and Address of Agent
CL�i (..��iC.C'�./24J
C215 7"), %lr2tt.,) &. itcytavt
�&tb ad,, C'D 80.5a,4
GARYW. CRAMER, Agent
2038SatMIegeAvpwenue
G
Fort�t1
ins,C mdo
Bus. 9704841374 or970484-7050
CERTIFICATE HOLDER COPY