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1555 Promontorryy Circle
Greeley CO 80638-0001
DATE OF NOTICE: MAR 02 2009
CODE:
180
AT1 20 A
002918
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
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NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
>NOTICE OF TERMINATION'OF AN<ADDITIONAL INSUREDINTEREST
State Farm Fire and Casualty Company 1623-F913-1
NAMED INSURED: POLICY NO: 132 3874-DO2-06F COVERAGE:
go WINICK, STEVEN J YR/MAKE/MODEL: 1990 PETERBILT DUMP
N 11083 HIGHWAY 14 VIN/CAMPER: 1XPOD29XOLD293391
AULTCO 80610-9573 AGENT NAME: BILL COFER
> AGENT PHONE: (970)223-7900
3RD PARTY INTEREST TERMINATED
m EFFECTIVE MAR 15 2009
N POLICY MESSAGES:
9 Protection of the additional insured's interest provided by this policy is terminated as of the effective date above for the following reason:
Policy cancelled for nonpayment of $1281.95. This advance notice is solely to protect the additional insured's interests as they are affected
by the ownership, maintenance, or use of the car described in the policy.
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FRT