HomeMy WebLinkAbout384033 J J'S TRUCKING - INSURANCE CERTIFICATE (14)OSTATE FARM INSURANCE COMPANIES®
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1555 Promontorryy Circle
Greeley CO 80636-0001
DATE OF NOTICE: DEC 17 2010
CODE:
14A
AT1 20 A
000275
CITY OF FORT COLLINS
215 N MASON ST
FORT COLLINS CO 80524-4402
ADDITI:ONALINSURED'S NOTICE OF COVERAGE
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: 117 3516-D10-06P COVERAGE:
PFLIPSEN, STAN :� YR/MAKE/MODEL: 1972 MACK DUMP BI AND PD LIABILITY
ccv DBA JJ'S TRUCKING V "l o VIN/CAMPER: RS711 LS12978 $1 MIL
221 W DOUGLAS RD LOT 17 AGENT NAME: GARY CRAMER
> FORT COLLINS CO 80524-1392 AGENT PHONE: (970)484-1374
ENDORSEMENT NO: 6028BF POLICY EFFECTIVE
E DEC 07 2010 UNTIL TERMINATED
N POLICY MESSAGES: This policy shown above supersedes policy# 1173516-060.
The policy includes a lose 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
N 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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