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Home My WebLink AboutWALDO TRUCKING - INSURANCE CERTIFICATE (9)02/21/2005 09:29 FAX £702280505 GAVE LAWSER 07ATE FARM laoo1/oo1 TEMPORARY AUTO IDENTIFICATION CARDS STATE FARM INSURANCE COMPANIES a GAR INSURANCE CARD POLICY NUMBER 083 4179-B17-06A INSURED WALDO TRUCKING INC EFFECTIVE DATE EEXPIRATION PATS FEB-17-2005 17-2005 CAR•YEARNIAKENEHICLE IDENTIFICATION NUMBER 19�0 KENWORTH DUMP 18 196S CAn NO. 001 COVERAGES (SSE RE VERS3 FOR COVERAGE NAMES) A BODILY INJURY/PROPERTY DAMAGE LIABILITY U ROOT LAWSER, AAVID A 2016 E. HARMONY ROAD FORT COLLINS, CO 80526 CAR INSURANCE CARD POLICY NUMBER 083 4179-B17-06A INSURED WALDO TRUCKING INC EFFECTIVE DATES EYPII�R(A�TIO1N DATE CA73. Rl AKJN000,9 IDEN7IFICA710NaUFAeEp7-Z005 1980 KENWORTH DUMP CAR mCO ERA�GES (SEE REVERSE FOR COVERAGE NAME' 001MkL A BODILY INJURY[PROPERTY DAMAGE LIABILIITY U A°ENT LAWSER DAVID A 2016 E . HA{iHONY ROAD FORT COLLINS, CO 80528 BECAUSE MANY STATES REQUIRE EVIDENCE OF INSURANCE ON DEMAND, ONE COPY OF THIS FORM SHOULD BE CARRIED IN THE VEHICLE AT ALL TIMES. �q 7 qnd !! C7l1 R y f1 130-4180 eS PHONEtjrZQXaA,I1R;" COMPANIES PHONE STX9KWl 8-tQIPG1E COMPANIES Pnnted in U.S.A. 02/21/2005 00:37 FAX 670226050E DAVE LANSER STATE FARM IR001/001 *i0i CERTIFICATE OF INSURANCE 10 STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois ng policyholder for the coverages indicated below: policyholder WalE2 Trucking, LLC Address of policyholder 995 Waldo Lane FORT COLLINS, CO 8052E Location of operations various Descriptionofoperetlons dgUtruck The policies listed below have been issued to .e policyholder for the policy periods shown. The insurance described in these policies Is subiect to all the tamm amLEainne n..A .. Aki.,.,. .i+E,.... nnH,i. T).e Iirn%- nr nahll:+...,E......- — k-..- w--- ...w.._r i.. --.. --'- -'-'-- POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD Effective Qeae Ex iradon Dab LIMITS O U LITY �t innin of ti r eriod Comprehensive BODILY INJURY AND Business Liabil' PROPERTY DAMAGE _ This insurance includes: ❑ products - Completed Operations ® Contractual Liability ® Underground Hazard Coverage Each Occurrence S ® Personal Injury ® Advardsing Injury General Aggregate $ ® Explosion Hazard Coverage Products. Completed Collapse Hazard Coverage Operations Aggregate a Aggregate Limit applies to each project OGeneral POLICY PERIOD ' EXCESS LIABILITY Effective Date Ex 1ratlon Date BODILY INJURY AND PROPERTY DAMAGE (Combined Single Limit) ❑ Umbrella Each Occurrence $ Other Aggregate ; Part t STATUTORY Part 2 BODILY INJURY Workers' Compensation and Employers Liability Each Accident $ Disease Each Employee $ Disease - Poll Limit S POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD Effeetaw Data Ex iradon Date LIMITS OF LIABILITY at beginningof polioy period) 08 Auto 0 17 05 08 17 05 1000000 Name and Address of Certmcate Holder City Of Fort Collins IT any or Lne oesonoe0 policies are canceled before its expiration date, State Farm will try to mail a written notice to the caMeate holder 45 days before oanceileltion. If, however, We fail to mail such notice, no obligation or liability will be Imposed on State Fans or its agents or representatives. Signature of AuaEo hM Repreearrtobve ildi'I'l 4- Date VA-04 a 2-90 PriiaW in U,5 A.