HomeMy WebLinkAbout384033 J J'S TRUCKING - INSURANCE CERTIFICATE (7)OSTATE
FARM INSURANCE COMPANIES®
1555 Promontory Circle
Greeley CO 80638-0001
17A
AT 1 20 A
000386
CITY OF FORT COLLINS
215 N MASON ST
FORT COLLINS CO 80524-4402
DATE OF NOTICE: JUN 11 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.
ADDITLONAL INSUR.ED'S NOTICE OF COVERAGE"
..
State Farm Fire and Casualty Company
1680-F913-1
NAMED INSURED:
POLICY NO:
117 3516-D10-06K
COVERAGE: '
g PFLIPSEN, STAN
YR/MAKE/MODEL:
1972 MACK DUMP
BI AND PD LIABILITY
N DBA JJ'S TRUCKING
VIN/CAMPER:
RS711 LS12978
$ 1 MIL
$1000 DED. COMP.
221 W DOUGLAS RD LOT 17
AGENT NAME:
GARY CRAMER
$1000 DED. COLL.
> FORT COLLINS CO 80524-1392
AGENT PHONE'
1970)484-1374
ENDORSEMENT NO: 60286E POLICY EFFECTIVE
m JUN 01 2009 UNTIL TERMINATED
N POLICY MESSAGES: This policy shown above supersedes policy# 1173516-06J.
co
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.
0
FRT