HomeMy WebLinkAbout127666 MICHAEL TRUCKING - INSURANCE CERTIFICATE (8)STATE FARM INSURANCE COMPANIES®
1555 Promontory Circle
Greeley CO 80636-0001
DATE OF NOTICE: OCT 22 2009
CODE:
126
AT 1 20 A
002466
CITY OF FORT COLLINS
ATTN: PURCHASING
PO BOX 580
FORT COLLINS CO 80522-0580
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NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
NOTICE OF TERMINATION : OF A:THIRID PARTY INTEREST
State Farm Fire and Casualty Company 1680-F913-1
NAMED INSURED: POLICY NO: 55 2176-DO8-06L COVERAGE:
CS MICHAEL, DWIGHT YR/MAKE/MODEL: 1997 PETERBILT DUMP BI AND PD LIABILITY
N DBA MICHAEL TRUCKING VIN/CAMPER: D374171 GL
2450 W ELIZABETH ST AGENT NAME: GARY CRAMER
m FORT COLLINS CO 80521-4120 AGENT PHONE: (970)484-1374
3RD PARTY INTEREST TERMINATED
o EFFECTIVE NOV 04 2009
N POLICY MESSAGES:
Protection of the third party's interest provided by this policy is terminated as of the effective date above for the following reason:
Cancellation of Liability Coverage. This advance notice is solely to protect the third party's interests as they are affected by the ownership,
maintenance, or use of the car described in the policy.
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FRT