HomeMy WebLinkAbout127666 MICHAEL TRUCKING - INSURANCE CERTIFICATE (10)STATE FARM INSURANCE COMPANIESO
s DATE OF NOTICE: APR 08 2009
i555 Promontorryy Circle CODE:
Greeley CO 80838-000>
21A
AT1 20 A
000504 NOTE: PLEASE NOTIFY STATE FARM AT THE I
CITY OF FORT COLLINS ADDRESS LISTED AT THE TOP, LEFT CORNER c
A7TN: PURCHASING X 580 OF THIS PAGE REGARDING ANY CHANGE OF
FORT PO OCOLLINS CO 80522-0580 ADDRESS INFORMATION.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Fire and Casualty Company 1680-F913-1
NAMED INSURED: POLICY NO: 552176-D08-06L COVERAGE: '�ix'-`
MICHAEL, DWIGHT YR/MAKE/MODEL' 1997 PETERBILT DUMP 61 AND PD LIABILITY
DBA MICHAEL TRUCKING VIN/CAMPER: D374171GL $500,0001$.500,000/$500,000
$2000 DED. COMP.
2450 W ELIZABETH ST AGENT NAME: GARY CRAMER $2000 DED. COLL.
FORT COLLINS CO 80521-4120 AGENT PHONE: (970)484-1374
ENDORSEMENT NO: 6028BF POLICY EFFECTIVE
APR 08 2009 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 055217E-06K.
The policy includes a lose payable clause protecting the additional insured's interest in the described carto the extent of the insurance
provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice
is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
FRT