HomeMy WebLinkAbout480487 RISING SUN FENCE & CONSTRUCTION LLC - INSURANCE CERTIFICATE (6)a
STATE FARM INSURANCE COMPANIES®
2700 South Sunland Drive
Tempe AZ 85282-3387
DATE OF NOTICE: OCT 18 2013
CODE:
71A
AT1 20
OD0605 0093
CITY OF FORT COLLINS
ATTN: PURCHASING
PO BOX 580
FORT COLLINS CO 80522-0580
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 1069-FC15Z
NAMED INSURED: POLICY NO: 017 0829-806-50F COVERAGE:
e BIRKEMEYER,CHARLES D&DAVID YR/MAKEIMODEL: 2007 DODGE PICKUP BI AND PD LIABILITY
ry & BETHANY DBA RISING uN VIN/CAMPER: 1 D7KS28C37J509443 $1 0 D l$ . MILT$ t MIL
NO' N I I /III p-,� (j,fr� $500 DED. COMP.
FENCE & CONSTRUCTION l I r `1� 0 " AGENT NAME: ALAN OSE $500 DED. COLL.
i 121 US HIGHWAY 85 AGENT PHONE: (307)778-7770
a° CHEYENNE WY 82007-9646 ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
'o OCT 11 2013 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy* 0170829-50E.
The policy includes a lose payable clause protecting the additional insured's Interest In the described car to the erdent of the insurance
n provided and subject to all policy provisions. The additional insured will be given 10 days notice If the policy is terminated. Until such notice
v� 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 Poficy null and void.
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