HomeMy WebLinkAboutAMERICAN PALLET AND TRUCK WASH - INSURANCE CERTIFICATE8
STATE FARM INSURANCE COMPANIE5—
b
1555 Promontorryy Circle
Greeley CO 80638-0001
7A
All 1 20 A
000626
CITY'S DIRECTION OF
PURCHASINGAND RISK MANAGEMENT
PO BOX 580
FORT COLLINS CO 80522-0580
ADDITIONAL INSURED'S NOTICE OF COVERAGE
DATE OF NOTICE: MAY 14 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 Mutual Automobile Insurance Company 1933-F911-V
NAMED INSURED: POLICY NO: 671264-F23-06F COVERAGE:
AMERICAN PALLET & TRUCK WASH YR/MAKE/MODEL: 1994 MITSUBISHI FLAT BED BI AND PD LIABILITY
LLC VIN/CAMPER: JW60EGIGXRL003468 60D
3700 CANAL DR AGENT NAME: VOYVODIC INS AGENCY INC $250 ED. COMP.
$250 DED. COLL.
FORT COLLINS CO 80524-8535 AGENT PHONE: (303)693-1600
ENDORSEMENT NO: 6028BF POLICY EFFECTIVE
POLICY MESSAGES: This policy shown above supersedes policylt 0671264-06E. MAY 08 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
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.
FRY