HomeMy WebLinkAboutWINICK STEVEN J - INSURANCE CERTIFICATE (2)II OSTATE FARM INSURANCE COMPANIES®
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1555 Promontorryy Cede
Greeley CO 80636 0001
16A
ATt 20 A
000415
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
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ADDITIONAL INSURED'S NOTICE OF COVERAGE
DATE OF NOTICE FEB 25 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
State Farm Fire and Casually Company 1623 F913 I
NAMED INSURED POLICY NO 1323874 D02 06B COVERAGE
WINICK STEVEN J YR/MAKE/MODEL 1990 PETERBILT DUMP BI AND PD LIABILITY
11083 HIGHWAY 14 VIN/CAMPER 1XPOD29XOLD293391 $1 MIL
AULT CO 80610 9717 AGENT NAME BILL GOFER $1000 DED COMP
$1000 DED COLL
ENDORSEME T NO 6028BF3 7900 POLICY EFFECTIVE
° n POLICY MESSAGES This policy shown above supersedes policy! 1323874 06A JAN 28 2008 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
v� is provided It shall be presumed that the required renewal premiums have been paid The additional insured must notify us within 10 days of
n any change of interest or owneiship coming to their attention Failure to do so will render this policy null and void
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