HomeMy WebLinkAbout384033 J J'S TRUCKING - INSURANCE CERTIFICATE (5)STATE FARM INSURANCE COMPANIESO
O 1555 Promontoryy Circle
Greeley CO 80638-0001
11A
AT1 20 A
000469
CITY OF FORT COLLINS
215 N MASON ST
FORT COLLINS CO 80524-4402
IIrJdlrrrrlrindrLlr,LL+LIrrIILrr,JdrrrII,LLJJri
DATE OF NOTICE: OCT 10 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.
I ADDITIONAL INSURED'S NOTICE OF COVERAGE J
State Farm Fire and Casualty Company 1680-F913-1
NAMED INSURED: POLICY NO: It 7 3516-D10-06H COVERAGE:
9 PFL IPSEN, STAN YR/MAKE/MODEL: 1972 MAGIC DUMP SI AND PD LIA1111.ITY
$ i 00
DBA JJ'S TRUCKING VIN/CAMPER: RS711 LS12978 MP eu $1 MI DED. CO.
221 W DOUGLAS RD LOT 17 AGENT NAME: GARY CRAMER $1000 DED. COLL
> FORT COLLINS 00 80524-1392 AGENT PHONE: (970)484-1374
ENDORSEMENT NO: 60288E POLICY EFFEOTWE
00"1703 2008 UNTIL TERMINATED
iv POLICY MESSAGES: This policy shown above supersedes policyii 1173576-066.
The policy includes a loss payable clause protecting the additional h18Uied'b 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 it the policy is terminated. lhniil rur.h nelice
u; is provided, it shall be presumed that the required renewal premiums have been paid. The additional incur ed must notiiy ue within r, Jaye of
any change of interest or ownership coming to their attention. Failure to do so vvill render this policy null and veil.
d
C)
FRl'
STATE FARM INSURANCE COMPANIESO
O 1555 Promontoryy Circle
Greeley CO 80638-0001
11A
AT1 20 A
000469
CITY OF FORT COLLINS
215 N MASON ST
FORT COLLINS CO 80524-4402
IIrJdlrrrrlrindrLlr,LL+LIrrIILrr,JdrrrII,LLJJri
DATE OF NOTICE: OCT 10 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.
I ADDITIONAL INSURED'S NOTICE OF COVERAGE J
State Farm Fire and Casualty Company 1680-F913-1
NAMED INSURED: POLICY NO: It 7 3516-D10-06H COVERAGE:
9 PFL IPSEN, STAN YR/MAKE/MODEL: 1972 MAGIC DUMP SI AND PD LIA1111.ITY
$ i 00
DBA JJ'S TRUCKING VIN/CAMPER: RS711 LS12978 MP eu $1 MI DED. CO.
221 W DOUGLAS RD LOT 17 AGENT NAME: GARY CRAMER $1000 DED. COLL
> FORT COLLINS 00 80524-1392 AGENT PHONE: (970)484-1374
ENDORSEMENT NO: 60288E POLICY EFFEOTWE
00"1703 2008 UNTIL TERMINATED
iv POLICY MESSAGES: This policy shown above supersedes policyii 1173576-066.
The policy includes a loss payable clause protecting the additional h18Uied'b 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 it the policy is terminated. lhniil rur.h nelice
u; is provided, it shall be presumed that the required renewal premiums have been paid. The additional incur ed must notiiy ue within r, Jaye of
any change of interest or ownership coming to their attention. Failure to do so vvill render this policy null and veil.
d
C)
FRl'