HomeMy WebLinkAboutWINICK STEVEN J - INSURANCE CERTIFICATE (3)i � STATE FARM INSURANCE COMPANIES®
1555 Promontorryy Circle
Greeley CO 80636 0001
22A
AT1 20 A
000505
CITY OF FT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
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ADDITIONAL INSURED'S NOTICE OF COVERAGE
DATE OF NOTICE FEB 29 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 Casualty Company 1623 F913 1
NAMED INSURED POLICY NO 102 2241 D25 06F COVERAGE
WINICK STEVENJ YR/MAKE/MODEL 1978 PETERBILT DUMP BI AND PC LIABILITY
11083 HIGHWAY 14 VIN/CAMPER 112296N $1 MIL
AULT CO 806109717 AGENTNAME SILLCOFER $100 DED DED COMP
AGENT PHONE (970)223 7900
LL
ENDORSEMENT NO 60288F POLICY EFFECTIVE
• POLICY MESSAGES This policy shown above supersedes polloyf 7022241 06E FEB 21 2008 UNTIL TERMINATED
A The policy Includes a loss payable clause protecting the additional insured s interest in the described car to the extent of the insurance
r provided and subject to all policy provisions The additional Insured will be given 10 days notice if the policy is terminated Until such notice
u� 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 so will render this policy null and void
2
FRT