HomeMy WebLinkAboutRICKY STEFFEN SHIRLEY LEGG - INSURANCE CERTIFICATER 84559-2-F FIRE OVL
State Farm Fire and Casualty Company
'3001 8th Avenue
Greeley CO 80638
06-1680-22RF
CITY OF FT COLLINS
PURCHASING
FORT COLLINS CO 80521-2711
NAMED INSURED: STEFFEN, RICKY D &
DO NOT PAY PREMIUMS SHOWN ON THIS PAGE.
SEPARATE STATEMENT ENCLOSED IF AMOUNT DUE.
*COPY* DECLARATIONS PAGE *COPY*
PAGE 1 OF 5
POLICY NUMBER 17 6949-D20-06H
POLICY PERIOD FEB 21 20 33 to OCT 20 2003
STATE FARM PAYMENT PLAN NUMBER
0349338220
AGENT
GARY CRAMER
2038 S COLLEGE AVE
FORT COLLINS, CO 80525-1425
PHONE: (970)484-1374
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Your policy consists of this declarations page, the policy booklet - form 9906.5, and any endorsements that apply, including
those issued to you with any subsequent renewal notice.
Replaced policy number 0176949-06G.
* The total premium for the policy period listed above reflects a recent change to your policy plus the 6 month
renewal premium.
Your total current 6 month premium for APR 20 2003 to OCT 20 2003 is $19035.80.
CONTINUED
04395/
155-3866.1 03-2002 (ola025hb)
(01a0251c)
R 84559-2-F FIRE OVL
11
State Farm Fire and Casualty Company
3001 8th Avenue
Greeley CO 80638
06-1680-22RF
CITY OF FT COLLINS
PURCHASING
FORT COLLINS CO 80521-2711
I 'COPY` DECLARATIONS PAGE `COPY'
PAGE 2 OF i
POLICY NUMBER 17 6949-D20-06H
POLICY PERIOD FEB 21 2003 to OCT 20 2003
STATE FARM PAYMENT PLAN NUMBER
0349338220
01 6097AE LEASED MOTOR VEHICLE (ADDITIONAL INSURED) -UNITED CAPITAL LEASING
CORP 995 DALTON AVE CINCINNAT OH 45203-1101.
02 6628E.5 ADDITIONAL INSURED -WESTERN MOBILE/LAFARGE, 1800 N TAFT HILL RD,
FORT COLLINS CO 80521-1344.
03 6028E.5 ADDITIONAL INSURED -CITY OF FT COLLINS PURCHASING DEPARTMENT, 256
W MOUNTAIN FORT COLLINS CO 80521-2711.
01 6037F.11 CERTIFICATE OF INSURANCE-BOONE CONSTRUCTION, PO BOX 270262,
FORT COLLINS CO 80527-0262.
02 6037F.11 CERTIFICATE OF INSURANCE -CORE EXCAVATING, 942 SAND COVEN LANE,
GREELEY CO 80631.
03 6037UUF.11 CERTIFICATE OF INSURANCE-GERRARD EXCAVATING, 1739 S COUNTY RD
04C6037F.11NCCERTTIFFIICATE8OF9INSURANCE-SCHMIDT EARTH BUILDERS, 7250 GREEN
RIDGE RD, WINDSOR CO 80550-8000.
05 6037F.11 CERTIFICATE OF INSURANCE-J B EXCAVATING INC, 1012 NE FRONTAGE
6162GORT COLLINS CO
WORDS, LIABILITY AND PHYSICAL DAMAGE
COVERAGES -EFF JUL 29 2003.
6126FQ AMENDMENT OF DEFINED WORDS AND PHYSICAL DAMAGE COVERAGES
-EXPIRES JUL 29 2003.
6289AH SINGLE LIMIT OF LIABILITY.
6906.2 MOTORMVEHICCLEI&SPHYSSICALUDAMMELCOVERAGB ;NANDACONDITIONS.
USE -COMMERCIAL.
FE-6999 TERRORISM INSURANCE COV NOTICE -EFF APR 20 2003.
Named Insured- STEFFEN RICKY D & LEGG-STEFFEN, SHIRLEY DBA E & LL TRUCKING 941 E 4TH ST
LOVELAND CO 80537-57�5
04396/
155-3866.1 03-2002 (o1a025hbXo1a0254b)
(ola025vc)
Agent: GARY CRAMER
Telephone: (970)484-1374
Prepared JUN 09 2003
1680-625