HomeMy WebLinkAboutJW TRUCKING - INSURANCE CERTIFICATE (5)Feb 20 2009 2:44PM
BILL COFER STATE FARM 970 223 7919 P.1
CERTIFICATE OF INSURANCE
SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE
CANCELED OR OTHERWISE TERAMNATED 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 GOES 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, Timms, or
❑ STATE FARM INDEMNITY COMPANY of BloomlrWon, Illinois
has OOVerane in ferry fnr fho, fn11nu8nre Rravneii t..-..—A ......k_... -___-
NAMED INSURED: JW Trucking Inc
ADDRESS OF NAMED INSURED:
600 Louise Ln, Fort Collins, CO 80521-3037
POLICY NUMBER
055-7203-D08 06I
EFFECTIVE DATE
OF POLICY
10/08/08-10/08/09
DESCRIPTION OF
1990 Kenworth
VEHICLE (Including VIN)
T600 Dump Truck
1XKAD09X5I.S551242
LIABILITY COVERAGE
® YES ❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
LIMITS OF LIABILITY
a. Bodily Injury
Each Person
N/A -- see below
Each Accident
N/A
b. Pro perty Damage
Each Accident
N/A
c. Bodily Injury &
Property Damage
Single Limit
Each Accident
$11000, 000
PHYSICAL DAMAGE
COVERAGES
® YES ❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
a. Comprehensive
$ 1000 D
$
Deductitle
$
Dedueme
$
DeductibleYES]
b. Collision
NO
0 YES
Q NO
11 YES
p NO
p YES
❑ NO
EMPLOYERS NON�YtiVNED
$ 1000 Deductible
$
Deductible
$
Deductible
$
Deductible
❑ YES
❑ NO
CAR LIABILITY COVERAGE
❑YES ® NO
❑ YES Q NO
❑ YES ❑ NO
HIRED CAR LIABILITY
COVERAGE
❑ YES NO
❑ YES
❑ NO
❑ YES
❑ NO
YES
❑ NO
FLEET - COVERAGE FOR
❑ YES
❑ NO
ALL OWNED AND LICENSED
MOTOR VEHICLES
❑YES NO
0 YES ❑ NO
❑ YES ❑ NO
LSA4 1623 02/20/2009
Signature orArtfltorapatNe Authorized RepreserTNte Agerd's Code Number Date
Name and Address of Certificate Holdler {Name and Address of Agent
�City of Fort Collins Bill Cofer
ATTN: Michelle Reynolds 344 73 Foothills Pkwy #7
1?0 BOX 580 Fcrt Collins, CO 80525
Fort Collins, CO 80522
Fax 221-6707 W. C"
FIRE 86 I
Ro* Mountain AFO FM
INTERNAL STATE FARM USE ONLY: ❑ Request PenrmneM Ce tiliogte of hnsurarnce for liability coverage.
122429.2 Rev. M10-� M Request Certificate Holder to be added as am Additional insured.