HomeMy WebLinkAbout384033 J J'S TRUCKING - INSURANCE CERTIFICATE (3)ACERTIFICATE 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 PFLIPSEN STAN dba JJ S
TRUCKING
ADDRESS OF NAMED INSURED 221
W DOUGLAS
RD LOT
17 FORT COLLINS CO
80524
POLICY NUMBER
117 3516-D10-06-0
EFFECTIVE DATE
OF POLICY
10/10/07-04/10/08
DESCRIPTION OF
72 MAcx DUMP
TRUCK
VEHICLE (Indudrg VIN)
RS711LS12978
LIABILITY COVERAGE
® YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
LIMITS OF LIABILITY
a Bodily Injury
Each Person
1 MM
Each Accident
1 MM
b Property Damage
Each Accident
1 MM
c Bodily Injury &
Property Damage
Single Limit
Each Accident
250/500
PHYSICAL DAMAGE
COVERAGES
❑ YES
® NO
[]YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
a Comprehensive
$
Deductible
$
Deducbble
$
Deductible
$
Deductible
® YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
b Collision
$ 500
Deductible
$
Deductible
$
Deductible
$
Deductible
EMPLOYERS NON -OWNED
CAR LIABILITY COVERAGE
❑ YES
ONO
❑ YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
HDr ED � LIABILITY
El YES
® NO
❑ YES
[_1 NO
El YES
[:1 NO
❑ YES
[_1 NO
FLEET COVERAGE FOR
ALLCA
MOTOR VIE IC
❑ YES
® NO
❑ YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
Licensed
06-1680 01/29/2008
re A Tale Agent's Code Number Date
me armAliddress of Certificate Holder Name and Address of Agent
DDITIONAL NAMED INSURED
CITY OF FORT COLLINS CRAMER STATE FARM
215 N Mason ST GARY CRAMER-AGENT
Fort Collins CO 80521 1275 E MAGNOLIA ST
FORT COLLINS CO 80524
INTERNAL STATE FARM USE ONLY N Request permanent Certificate of insurance for liability coverage
122429 3 Rev 07 28 2005 0 Request Certificate Holder to be added as an Additional Insured