HomeMy WebLinkAbout112307 E & LL TRUCKING - INSURANCE CERTIFICATE (12)CERTIFICATE 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 following Named Insured as shown below:
Named Insured STEFFEN RIC:KY Rr SHIRLEY LEGIC'T dba TRI JCKIN
Address of Named Insured 941 E 4' ST., LOVELAND CO 80537-5735
POLICY NUMBER
S55 8277-E16-06M-00
EFFOF Y DATE
10/20/03-04/20/04
DESCRIPTION OF
VEHICLE
1993 PETERBUILT
LIABILITY COVERAGE
YES 0 NO
Q YES
Q NO
YES
0 NO
Q YES
Q NO
LIMITS OF LIABILITY
a. Bodilylniury
$1,000,000
Each Person
Each Accident
b. Property Damage
$1 000 000
Each Accident
> >
DarrjW Single Unit
Each Accident
PHYSICAL DAMAGE
X:] YES NO
0 YES
Q NO
0 YES
0 NO
0 YES
0 NO
COVERAGES
a. Comprehensive
$ 0� Deductible
$
Deductible
$
Deductible
$
Deductible
YES 0 NO
Q YES
0 NO
0 YES
= NO
= YES
Q NO
b. Collision
$ Deductible
$
Deductible
$
Deductible
$
Deductible
EMPLOYER'S
NON -OWNERSHIP
YES �NO
0 YES
Q NO
0 YES
NO
YES
0 NO
COVERAGE
HIR CAR COVERAGE
n YES ><NO
Q YES
Q NO
0 YES
E=] NO
YES
E::] NO
Signature of ut zed Reloresental0e d Title Agent's Code Number Da e
Name and Address of Certificate Holder Name and Address of Agent
ADDI770NAL NAA&D INSURED:
STATF {ARM Your State Farm Agent
CITY OF FORT COLLINS GARY W. CRAMER
256 W MOUNTAIN ®® 1275 East Magnolia, #1
INSII0.ANCF Fort Collins, CO 80524
FORT COLLINS CO 80521 ° 970-484-1374 or 970484-7050
CERTIFICATE HOLDER COPY
CERTIFICATE OF INSURANCE
SUCIT 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: (] STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois, or
JCJ STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois
has coverage in force for the following Named Insured as shown below:
Named Insured STFFFFN, RICKY & $NTRT RY T.F('G dha+ F & T.T. TRUCKING
Address of Named Insured 941 E 4' ST., LOVELAND CO 80537-5735
POLICY NUMBER
S55 8277-E16-06M-00
EFFECTIVE
OF POLICY DArE
11/16/03-05/16/04
DESCRIPnON OF
VEHICLE
1972 MACK DUMP
LIABILITY COVERAGE
YES Q NO
0 YES
E::] NO
Q YES
0 NO
YES
NO
UMrrS OF LIABILITY
a. Bodily Injury
$11000,000
Each Person
Each Accident
b Pf O way Damage
$1 OLIO OOU
Each Accident
c. Bodily Inlury & Property,
Danege Single Limit
Each Accident
PHYSICAL DAMAGE
YES NO
Q YES
NO
YES
0 NO
YES
[:D NO
COVERAGES
a. Comprehensive
$ Deductible
$
Deductible
$
Deductible
$
Deductible
Q YES NO
Q YES
0 NO
Q YES
0 NO
Q YES
= NO
b. Collision
$ Deductible
$
Deductible
$
Deductible
$
Deductible
EMPLOYER'S
NON -OWNERSHIP
E::] YES >NO
0 YES
E::] NO
= YES
NO
YES
NO
COVERAGE
HIR CAR COV RAGE
Q YES NO
0 YES
0 NO
= YES
0 NO
0 YES
0 NO
c �atQa `� ze min —` `� e N 3 a d
Signatu of uthorized R tatrve� Title Agent's Code Number Date
Name and Address of Certificate Holder Name and Address of Agent
F ADDI77ONAL NAMED INSURED: -I F -1
CITY OF FORT COLLINS STRTF fRRM Your State Farm Agent
"R
256 W MOUNTAIN ®® f 275 East Magnolia, �MER
0524
FORT COLLINS CO 80521 NSU0.RNCp Fort-1374or97s, CO 884-7
970.484-1374 or 970.484-7050
CERTIFICATE HOLDER COPY