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Home My WebLink About384033 J J'S TRUCKING - INSURANCE CERTIFICATE (10)sr�ss r IN®M®E CERTIFICATE OF INSURANCE QI SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE CANCELED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. This certifies that: ® STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois ® STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois ❑ STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas, Texas ❑ STATE FARM INDEMNITY COMPANY of Bloomington, Illinois, or ❑ STATE FARM GUARANTY INSURANCE COMPANY of Bloomington, Illinois has coverage in force for the following Named Insured as shown below: NAMED INSURED: PFLIPSEN, STAN ADDRESS OF NAMED INSURED: 221 W DOUGLAS RD LOT 17FORT COLLINS CO 80524-1392 POLICY NUMBER 117 3516-D10-06N 150 7989-BO4-061 161 1662-FOl-06E EFFECTIVE DATE OF POLICY 12-01-2009 10-16-2009 10-06-2009 DESCRIPTION OF 72 MACK RS711LS12978 76 MAC 88 KENWORTH T800 VEHICLE (Including VIN) R686ST8447 1XKDD29X5JS512834 LIABILITY COVERAGE ® YES ❑ NO ® YES ❑ NO ® YES ❑ NO ❑ YES ❑ NO LIMITS OF LIABILITY a. Bodily Injury Each Person Each Accident b. Property Damage Each Accident c. Bodily Injury & Property Damage Single Limit Each Accident 1 Million 1 Million 1 Million PHYSICAL DAMAGE COVERAGES ® YES ❑ NO ❑ YES ® NO ® YES ❑ NO ❑ YES ❑ NO a. Comprehensive $ 2000 Deductible $ Deductible $ 2000 Deductible $ Deductible ❑ YES ® NO ❑ YES ® NO ® YES ❑ NO ❑ YES ❑ NO b. Collision $ Deductible $ Deductible $ 2000 Deductible $ Deductible EMPLOYERS NON -OWNED CAR LIABILITY COVERAGE ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO ❑ YES ❑ NO HIRED CAR LIABILITY ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO ❑ YES ❑ NO COVERAGE FLEET - COVERAG OR ALL OWNED AND NSED YES ® NO [:1YES ® NO [:1 YES ® NO [:1 YES [:1 NO MOTOR VEHI S ,/ 1680-06 03-10-2010 Signatur of Aut rizeo�Repf"esentative Title Agent's Code Number Date Name nd dress of Certificate Holder Name and Address of Agent City of ort Collins Gary Cramer 215 N. Madison St 1275 E Magnolia unit I Fort Collins, CO 80522 Fort Collins, CO 80524 INTERNAL STATE FARM USE ONLY: ❑ Request permanent Certificate of Insurance for liability coverage. 122429.3 Rev. 07-26-2005 ® Request Certificate Holder to be added as an Additional Insured.