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HomeMy WebLinkAbout127666 MICHAEL TRUCKING - INSURANCE CERTIFICATE (16)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 MICHAEL, nAanG&U dhah. 41CKAF1 TR-UCKING _ Address of Named Insured 600 ENDICOTT ST., FORT COLLINS CO 80524-3225 POLICY NUMBER 055 2176-D08-06E-00 EFFECTIVEDATE OF POLICY 10/08/03-04/08/04 DESCRIPTION OF VEHICLE 1997 PETER13LUT LIABILITY COVERAGE YES 0 NO 0 YES [] NO 0 YES 0 NO 0 YES 0 NO LIMITS OF LIABILITY a. Bo*" $500,000 Each Person Each Accident $500,000_ b p" Darnage $500,000 Each Accident c. Bo6ty Irjury & Poperty Damage Single Lirtit Each Accident PHYSICAL DAMAGE g] YES 0 NO 0 YES 0 NO 0 YES 0 NO 0 YES _ 0 NO COVERAGES a. Comprehensive t>ZDDQ— Deductible $ Deductible $ Deductible $ Deductible YES 0 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 X NO Q YES Q NO 0 YES 0 NO 0 YES 0 NO COVERAGE HIR D CAR COVERAGE 0 YES NO YES 0 NO 0 YES 0 NO 0 YES _ 0 NO Signature of Kuth&ized Repi&sentpilve Title Agent's Code Number Daj Name and Address of Certificate Holder Name and Address of Agent _ f 1 ADDITIONAL NAMED INSURED: CITY OF FORT COLLINS PURCHASING DEPT 256 W MOUNTAIN AVE FORT COLLINS CO 80521 E14TF i4EM Your State Farm Agent %i GARY W. CRAMER ® !� 1275 Fast Magnolia, #1 INSURANCE Fort Collins, CO 80524 970484-1374 or 970484-7050 CERTIFICATE HOLDER COPY - OSTATE FARM INSURANCE COMPANIES® 1555 Promontory Circle Greeley CO 80638.0001 59 A CITY OF FORT COLLINS DiloruncTNr_ nFPT CERTIFICATE OF INSURANCE DATE OF NOTICE: OCT 15 2003 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 JC] STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois has coverage in force for the following Named Insured as shown below: Named Insured MTC HAVI y DWIGBT dba INIICHAEI . TRUC KING — Address of Named Insured 600 ENDICOTT ST., FORT COLLINS CO 80524-3225 — POLICY NUMBER S55 9543-A26-06G-00 EFFECTIVE DATE OPOLICY 01/26/04-07/26/04 DESCRIPTION OF VEHICLE 1983 PETERBLUT LIABILITY COVERAGE YES 0 NO 0 YES 0 NO 0 YES [D NO 0 YES Q No LIMITS OF LIABILITY a. Bodily Ir4ury $500,000 Each Person Each Accident b Property Damage I $500,000 _ Each Accident c. aodiy Iniury a Property _ Danege Sin* Lail Each Accident PHYSICAL DAMAGE KI YES 0 NO 0 YES 0 NO YES 0 NO 0 YES 0 NO COVERAGES a. Comprehensives2Deductible !1l1I1Q $ Deductible $ Deductible $ Deductible 13 YES 0 NO = YES 0 NO 0 YES 0 NO 0 YES _ 0 NO b. Collision Deductible $ Deductible $ Deductible $ DeductibleEMPLOY NON -OWNERSHIP 0 YES NO 0 YES NO 0 YES NO 0 YES _ 0 NO COVERAGE HIR CAR COVERAGE 0 YES KNO 0 YES 0 NO 0 YES 0 NO 0 YES 0 NO l �Vve� Signature o Aut zed ReMsenn Title Agent's Code Number Plate Name and Address of Certificate Holder Name and Address of Agent ADDIHONAL NAMED INSURED: S TATF FARM Your State Farm Agent CITY OF FORT COLLINS n GARY W. CRAMER PURCHASING DEPT 256 tEm ® 1275 East Magnolia, #1 INSURANCE Fort Collins, CO80524 W MOUNTAIN AVE 970.484.1374 or 970484-7050 FORT COLLINS CO 80521 L J L J CERTIFICATE HOLDER COPY