HomeMy WebLinkAbout127666 MICHAEL TRUCKING - INSURANCE CERTIFICATE (5)aSTATE FARM INSURANCE COMPANIES®
1555 Promontory Circle
Greeley CO 80636-0001
DATE OF NOTICE: MAY 29 2009
CODE:
29A
AT 1 20
000397
CITY OF FORT COLLINS
ATTN: PURCHASING
PO BOX 580
FORT COLLINS CO 80522-0580
A
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
State Farm Fire and Casualty Company 1680-17913-1
NAMED INSURED: POLICY NO: 552176-D08-06L COVERAGE:
MICHAEL, DWIGHT YR/MAKE/MODEL: 1997 PETERBILT DUMP el AND PD LIABILITY
DBA MICHAEL TRUCKING VIN/CAMPER: D374171GL $500,000/$500,000/$500,000
2460 W ELIZABETH ST AGENT NAME: GARY CRAMER $2000 DED. COMP.
$2000 DED. COLL.
FORT COLLINS CO 80521-4120 AGENT PHONE: (970)484-1374
ENDORSEMENT NO: 6028BF POLICY EFFECTIVE
POLICY MESSAGES: This policy shown above supersedes policy$ 0552176-06K. APR 08 2009 UNTIL TERMINATED
The policy includes a loss payable clause protecting the additional insured's interest in the described car to 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.
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FRT II