HomeMy WebLinkAbout127666 MICHAEL TRUCKING - INSURANCE CERTIFICATE (3)CERTIFICATE OF INSURANCE
SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE
CANCELED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE
CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM
THE DATE WRITTEN THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY
ANY POLICY DESCRIBED BELOW
This certifies that ❑ STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington Illinois
® STATE FARM FIRE AND CASUALTY COMPANY of Bloomington Illinois
❑ STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas Texas
❑ STATE FARM INDEMNITY COMPANY of Bloomington Illinois or
❑ STATE FARM GUARANTY INSURANCE COMPANY of Bloomington Illinois
has coverage in force for the following Named Insured as shown below
NAMED INSURED MICHAEL DWIGHT dba MICHAEL TRUCKING
ADDRESS OF NAMED INSURED 600
ENDICOTT
ST FORT
COLLINS CO 80524
POLICY NUMBER
055 2176-DOB-06J-
S55 9543-A26-06Q
EFFECTIVE DATE
OF POLICY
10/8/07-04/08/08
01/26/07-07/08/08
DESCRIPTION OF
1997 PETERBUILT
1983 PETERBUILT
VEHICLE (Including VIN)
DUMP
D379171GL
359 DUMP
1XP9D29XODP161015
LIABILITY COVERAGE
® YES
❑ NO
❑ YES
® NO
❑ YES
❑ NO
❑ YES
❑ NO
LIMITS OF LIABILITY
a Bodily Injury
Each Person
$500 000
Each Accident
$500 000
b Property Damage
Each Accident
$500 000
c Bodily Injury &
Property Damage
Single Limit
Each Accident
$500 000
PHYSICAL DAMAGE
COVERAGES
® YES
❑ NO
® YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
a Comprehensive
$ 2000
Deductible
$ 2000
Deductible
$
Deductible
$
Deductible
® YES
❑ NO
® YES
❑ NO
❑ YES
[]NO
❑ YES
❑ NO
b Collision
$ 2000
Deductible
$ 2000
Deductible
$
Deductible
$
Deductible
�we�E cLiCOVERAGE
❑ YES
® NO
❑ YES
® NO
[]YES
[]NO
❑ YES
[]NO
COVERAGE CAR LIABILITY
❑ YES
® NO
❑ YES
® NO
❑ YES
❑ NO
❑ YES
❑ NO
FLEET COVERAGE FOR
ALL GWNLICENSED
MOTOR VVEEH AND
❑ YES
® NO
❑ YES
® NO
❑ YES
❑ NO
❑ YES
❑ NO
Licensed
Rep
1680 01/30/08
r
Title
Agent's Code Number Date
ame and rasa of C rtificate Holder
Name and Address of Agent
CRAMER STATE FARM
CITY OF FORT
COLLINS
GARY CRAMER
215 N Mason
ST
1275 E MAGNOLIA ST
kI
Fort Collins
CO 80521
FORT COLLINS CO
80524
INTERNAL STATE FARM USE ONLY ❑ Request permanent Certificate of Insurance for liability coverage
122420 3 Rev 07 26 2005 ❑ Request Certificate Holder to be added as an Additional Insured