HomeMy WebLinkAbout384033 J J'S TRUCKING - INSURANCE CERTIFICATE (8)RSTATE FARM INSURANCE COMPANIES
1555 Promontory Circle
Greeley CO 80638-0001
15A
AT 20 A
Il Vlljl 1
CITY OF FORT COLLINS
215 N MASON ST
FORT COLLINS CO 80524-4402
ADDITIONAL INSURED'S NOTICE OF COVERAGE
DATE OF NOTICE: JUL 15 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.
State Farm Fire and Casualty Company
1680-F913-1
NAMED INSURED:
POLICY NO:
1173516-D10-06L
COVERAGE:
S
PFLIPSEN, STAN
YR/MAKE/MODEL:
1972 MACK DUMP
BI AND PD LIABILITY
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
AGENTPHONE:
1970N484-1374
ENDORSEMENT NO: 6028BF POLICY EFFECTIVE
JUL 02 2009 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy* 11 73516-06K.
The policy includes a loss payable clause protecting the additional insured's interest in the described car tc 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 teiminated. Until such notice
is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured most 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.
FRi