HomeMy WebLinkAboutJW TRUCKING - INSURANCE CERTIFICATE (3)STATE FARM INSURANCE COMPANIES®
1555 Prornontoryry G)rcle
Greeley GO 80638-0001
179 A
AT 1 20
002618
CITY OF FORT COLLINS
PO BOX 580 80522-0580
FORT COLLINS CO
NOTICE OF TERMINATION OF AN ADDITIONAL INSURED INTEREST
DATE OF NOTICE: APR 14 2009
CODE:
6
NOTE- PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS AGE REGARDING ANY CHANGE OF
ADDRESS
1
1623-F913-1
COVERAGE:
Comany
State Farm Fire and Casualty P POLICY NO: 55 0 KEN
ORT
MP
NAMED INSURED: YR/MAKEIMODEL: JXKADg9X5W5512g2
$ jW TRUCKING INC VIN/CAMPER: BILL COFER
Cry 600 LOUISE LN AGENT NAME: 97p 223.7900 3RD PARTY INTEREST TERMINATED
FORT COLLINS CO 80521-3037 AGENT PHONE: i EFFECTIVE APR 27 2009
'm
a
on
� the ownership,
& POLICY MESSAGES: this olicy is terminated as of the etlective date above for the following yeas
Protection of the additional insured's interest provided by P
policy cancelled A insured. This advance notice is solely to Protect the additional insured's Interests as they are affected y
maintenance, or use of the car described in the policy.
0
FPT