HomeMy WebLinkAboutJW TRUCKING INC - INSURANCE CERTIFICATEFeb 20 2009 2:44PM HILL COFER STATE FARM 970 223 7919 P.1
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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 SO 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, or
❑ STATE FARM INDEMNITY COMPANY of Bloomington, Illinois
has coverage in force for the fonomino Namara inairn-d a¢ ahnurn hot^ --
NAMED INSURED: ,TW Trucking Fnc
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 Kenvrorth
VEHICLE (Including VIN)
T600 Dump Truck
1XXADB9X5LJ551242
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. Property Damage
Each Accident
N/A
c. Bodily Injury &
Properly Damage
Single Limit
Each Accident
$1, 000, 000
PHYSICAL DAMAGE
COVERAGES
® YES ❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
a. Comprehensive
$ 1000 Deductive _
$
Deductible
$
Deductible
$
Deductible
YES ❑ NO
❑ YES
❑ NO
❑ YES
[]NO
❑ YES
[]NO
b. Collision
$ 1000 Deductible
$
Deductive
$
Deductible
$
Deductible
EMPLOYERS NON -OWNED
CAR LIABILITY COVERAGE
❑ YES N 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 UCENSED
MOTOR VEHICLES
❑ YES JZ NO
❑ YES
❑ NO
❑ YES
❑ NO
❑ YES
❑ NO
LSA4 1623 02/20/2009
Signature ofAuthoraed Representative T-re umber rbre
name ana Aut Tess oT Leniticate Holder Name and Address of ent
City o£ Fort Collins Bill Cofer
ATTN: Michelle Reynolds 344 E Foothills Pkwy #7
PO Box 580 Fart Collins, CO 80525
Fort Collins, CO 80522
Fax 221-6707 W. COFER 06-ims
FIRE 86
Rocky Mountain AFO 1`90
INTERNAL STATE FARM USE ONLY: ❑ Request pemlanant Certirirate of Insurance for liability coverage.
122429.2 Rev. 06-10-2004 l5d Rmik-s& t:�