HomeMy WebLinkAboutROY EDWARDS - INSURANCE CERTIFICATEOSTATE FARM INSURANCE COMPANIES®
1555 Promontorryy Circle
Greeley CO 80638-0001
14A
CITY OF FORT
PURCHASING &
PO BOX 580
FORT COLLINS
COLLINS
RISK MGT
CO 80522-0580
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ADDITIONAL INSUREDS NOTICE OF COVERAGE
State Farm Fire and Casualty Company
DATE OF NOTICE: APR 19 2004
NAMED INSURED:
POLICY NO:
848064-031-06A
COVERAGE:
R EDWARDS, ROY
YR/MAKE/MODEL:
1986 KENWORTH DUMP
el AND PD LIABILITY
N 5809 S COUNTY ROAD 7
VIN/CAMPER:
1XKWD29X865331650
$ t MIL
$500
o FORT COLLINS CO 80528-9414
AGENT NAME:
JOHN K MARTINEZ
DED. COLIL
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AGENT PHONE:
(970)223-7800
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ENDORSEMENT NO: 6028E.5
POLICY EFFECTIVE
APR 05 2004 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 0848064-06.
The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice
is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.