HomeMy WebLinkAboutWID BOYZ CURT GROEN - INSURANCE CERTIFICATEOSTATE FARM INSURANCE COMPANIES®
1555 Promontory Circle
Greeley CO 80638-0001
41A A
CITY OF FORT COLLINS
DIRECTOR OF PURCHASING AND
RISK MANAGEMENT
PO BOX 580
FORT COLLINS CO 80522-0580
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DATE OF NOTICE: AUG 03 2005
CODE:
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
I ADDITIONAL INSURED'S NOTICE OF COVERAGE I
State Farm Mutual Automobile Insurance Company 2220-F625-I
NAMED INSURED: POLICY NO: 690262.602-061) COVERAGE:
GROEN, CURT YR/MAKE/MODEL: 1986 DODGE PICKUP BI AND PD LIABILITY
N # 109 VIN/CAMPER: 1 B7JW24WOG8066415 $1 MIL
1218 E MAGNOLIA ST UNIT D AGENT NAME: LINDA HORTON
'o FORT COLLINS CO 80524-2754 AGENT PHONE: (970)482-1936
ENDORSEMENT NO: 6028BF POLICY EFFECTIVE
m POLICY MESSAGES: This policy shown above supersedes policyi 0690262-060. AUG 02 2005 UNTIL TERMINATED
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
v, any change of interest or ownership coming to their attention. Failure to do su will render this policy null and void.
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