HomeMy WebLinkAboutWINICK STEVEN J - INSURANCE CERTIFICATESTATE FARM INSURANCE COMPANIES®
1555 Promonbryry Cede
Greeley CO 80538 0001
DATE OF NOTICE FEB 20 2008
CODE
22A
AT1 20
000400
CITY OF FT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
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NOTE PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION
ADDITIONAL INSUREDS NOTICE OF COVERAGE ---�I
State Farm Fare and Casualty Company 1623 F913 l
NAMED INSURED POLICY NO 1022241 D2506E COVERAGE
WINICK STEVEN J YR/MAKE/MODEL 1978 PETERBILT DUMP BI AND PD LIABILITY
gi 11083 HIGHWAY 14 VIN/CAMPER 112296N $1 MIL
AULT CO 80610 9717 AGENT NAME BILL GOFER $10000 DDEDD COLMLP
AGENT PHONE (970)223 7900
_ ENDORSEMENT NO 6028BF POLICY EFFECTIVE
POLICY MESSAGES This policy shown above supersedes policy# 1022241 06D FEB 14 2008 UNTIL TERMINATED
The policy moludes 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 Unlit 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 that attention Failure to do to will render this policy null and void
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FRT