HomeMy WebLinkAboutSTEVEN J WINICK - INSURANCE CERTIFICATE (5)a
STATE FARM INSURANCE COMPANIESO
O 1555 Promontorryy Circle
Greeley CO 80638-0001
181
AT1 20 A
002919
CITY OF FT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
DATE OF NOTICE: MAR 02 2009
CODE:
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 INSURED INTEREST
State Farm Fire and Casualty Company
1623-F913-1
NAMED INSURED:
POLICY NO:
102 2241-D25.06J COVERAGE:
WINICK, STEVEN J
YR/MAKE/MODEL:
1978 PETERBILT DUMP
11083 HIGHWAY 14
VIN/CAMPER:
112296N
AULT CO 80610.9573
AGENT NAME:
BILLOOFER
AGENT PHONE: (970)223-7900
3RD PARTY INTEREST TERMINATED
EFFECTIVE MAR 15 2009
POLICY MESSAGES:
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 $1051.23. 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.
FRT