HomeMy WebLinkAbout384033 J J'S TRUCKING - INSURANCE CERTIFICATE (6)STATE FARM INSURANCE COMPANIESO'
O 1555 Promontoryy Circle
Greeley CO 80838-0001
13A
AT 20 A
000355
CITY OF FORT COLLINS
215 N MASON ST
FORTCOLLINS CO 80524-4402
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DATE OF NOTICE: OCT 14 2008
CODE:
NOTE: PLEASE NOTIFY STATE FARAN AT THE
ADDRESS LISTED AT THE TOP, LEFT- CORNE4
OF TEAS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Fire and Casualty Company 1680-F9?3-I
NAMED INSURED: POLICY NO: 117 3516-D10-061 COVERAGE-
PFLIPSEN, SI"AN
DBA JJ'S TRUCKING
221 W DOUGLAS RD LOT 17
FOR COLLINS CO 80624-1392
BI AND PD LIABILITY k' '
$ 1 MII.
$1000 BED. COMP.
$1000 DED. COL.L.
POLICY EFFECTIVE
OCT 03 2008 UN RL'1-I:'-RMINA FED
POLICY MESSAGES:
The policy includes a loss payable: olause protecting the additional insured% interest in the described ear to the extent at the insurance
provided and subject to al! policy provisions. The additional insured will be given 10 days notice itthe policy is terminated. Until such notice
is provided, it shall be presumed that the required renewal premiums have I:een paid. The addltiomii insured must rolity us within 10 days of
any change of interest of ownenlhip coming to their attention. failure to do so will gander this policy mill rand void.
YR/MAKE/MODEL•
1972 MACK DUMP
VIN/CAMPER:
R8711LS12978
AGENT NAME:
GARY CRAMER
AGENT PHONE:
(970)484-1374
ENDORSEMENT NO:
6028BF
FRT