HomeMy WebLinkAboutSTEVEN WINICK - INSURANCE CERTIFICATESTATE FARM INSURANCE COMPANIES®
Ns
1555 Promontorryy Cirofe
Greeley CO 1 38 0001
17A
AT1 20 A
00W8
CITY OF FT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
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DATE OF NOTICE FEB 14 2008
CODE
NOTE PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Fire and Casualty Company 1623 F913 I
NAMED INSURED POLICY NO 102 2241 D25 06D COVERAGE '
g WINICK STEVEN J YR/MAKE/MODEL 1978 PETERBILT DUMP BI AND PD LIABILITY
11083 HIGHWAY 14 VIN/CAMPER 112296N $1 MIL
AULT CO 80610 9717 AGENT NAME BILL GOFER $1000 DED COMP
$1000 DED COLL
> AGENT PHONE (970)223 7900
Q ENDORSEMENT NO 6028BF POLICY EFFECTIVE
'o JAN 28 2008 UNTIL TERMINATED
cy POLICY MESSAGES This policy shown above supersedes policy# 1022241 060
q The policy includes a loss payable clause protecting the additional insured a 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
any change of interest or ownership coming to their attention Failure to do to will render this policy null and void
0
w
FEB Z ty 2006
RECEIVED
FRT