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Home My WebLink AboutDAN ADAMS TERRY JACCAUD AD JAC CONSTRUCTION - INSURANCE CERTIFICATESTl1T[ fRM M CERTIFICATE 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: Dan Adams & Terry Jaccaud DBA AD-JAC Construction CO. LLC ADDRESS OF NAMED INSURED: 6342 w loth St Greeley, CO 80634 POLICY NUMBER 161 5299-F18-06 161 5300-F18-06 161 5301-F18-06 EFFECTIVE DATE OF POLICY 12/18/08-06/18/09 12/18/08-06/18/09 12/18/08-06/18/09 DESCRIPTION OF 1977 Ford 2000 GMC K2500 1994 Toyota Xtra VEHICLE (including VIN) E38HHY62814 1GTGK29U8YE429007 JT4VN13D1R5131496 LIABILITY COVERAGE ® YES ❑ NO ® YES ❑ NO ® YES ❑ NO ❑ YES ❑ NO LIMITS OF LIABILITY a. Bodily Injury Each Person 1,000,000 1,000,000 250,000 Each Accident 1,000,000 1,000,000 500,000 b. Property Damage Each Accident 1,000;000 1,000,000 250,000 c. Bodily Injury & Property Damage Single Limit Each Accident PHYSICAL DAMAGE COVERAGES ® YES ❑ NO ® YES ❑ NO ❑ YES ® NO ❑ YES ❑ NO a. Comprehensive $ 250 Deductible $ 250 Deductible $ Deductible $ Deductible ® YES ❑ NO ® YES ❑ NO ❑ YES ®NO ❑ YES ❑ NO b. Collision $ 500 Deductible $ 500 Deductible $ Deductible $ Deductible EMPLOYERS NON -OWNED CAR LIABILITY COVERAGE ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO ❑ YES NO ❑ HIRED CAR LIABILITY COVERAGE ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO ❑ YES ❑ NO FLEET - COVERAGE FOR ALL OWNED AND LICENSED MOTOR VEHICLES ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO ❑ YES ❑ NO Name ana Aaa City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 NTERNAL STATE FARM USE ONLY: ent 06-2258 01/16/09 Title Name ana Aaaress of Agent's Code Number Date Best Insurance Agency 1990 59th Ave Ste D Greeley, CO 80634 Reauest permanent Certificate of Insurance for liabilitv coverage 122429.3 Rev. 07-26-2005 ® Request Certificate Holder to be added as an Additional Insured.