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Home My WebLink AboutSMITH CHARLES PATRIOT TRUCKING - INSURANCE CERTIFICATE05/01/2008 12: 53 0704930226 PAGE ee2/02 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 80 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 0 STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois Q 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 followinci Named Incurar9 a!z shm.h hol..,..• NAMED INSURED: SMSTH, CHARLES dbL PATRIOT TRUCKING ADDRESS Of= NAMED IN RED-, 8590 MA14 0 WAR DR., WELLINGTON CO $0549 POLICY NUMBER 030 6873-E09-068- EFFECTIVEDATE OF POLICY 11/09/07-05/09/08 DESCRIPTION OF 1994. R8NWORTH T600 VEHICLE_ (Including VIN) iXKAUU9k51t,1619314 LIAEILITY COVERAGE ® YES Q NO _ NO (,� YES Q NO Q YES Q NO LIMITS OF LIABILITY - a. Bodily Injury Each Person I M7 Each Accident tMM —.....___...---- b. Property Damage Each Accident 1 MIA �• c. Bodily Injury & •• Property Damage Single Limit Each Accident 1 MM PHYSICAL DAMAGE COVERAGES ® YES EINO Q YES ❑ NO ` Q YES Q NO Q YES ONO a. Com rehen$IVe $ 1000 Deductible _$ Deductible $ Deductible $ Deductible ® YES Q NO Q YES Q NO ❑ YES LINO Q YES ©NO b, Collision — $ 1000, Deductible $ _ Deductible $ Deductible $ Deductible EMPLOYERS NON -OWNED CAR UAM1 rrYCOVEiRAGE Q YES ® NO Q YFS ❑ NO Q YES Q NO -- © YES ❑ NO HIREDCAR LIABILITY MveRAG6 ❑ YES ® NO AY ES ❑N(i Q YES ❑ NO Q YES [J NO FLEET-OOVERAGEFOR -� ALL OWNED AND UCENSFD MOTOR VEHICLES Q YES N NO Q YES ❑ NO []YES ❑ NO ©YES Q NO f` LiCGrided nn ure o ulhoriz R9pro$ tagve Title All, Me a and Addr A Certificate Holder y_ Name and Addres$ of Aslent CITY OF FORT COLLINS C.RAME:R STATE FARM A:L7 N t9A;ON AGENT GARY CRAMLIt FORT COLLINS CO 80524 1275 .8 MAGNOLIA ST 41 FORE COLLINS CO 80524 ._.___..__...._.. _.... �,..ay„o,,,N,,,,,a„�„k�Ul uocdie unnaurance, ror uaDguy coverage. 122429.5 Rev. 07.282006 Cj Request Canifioto Holder to be added as an Additional Insured.