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HomeMy WebLinkAbout127666 MICHAEL TRUCKING - INSURANCE CERTIFICATE (20)STATE FARM INSURANCE COMPAI �• 1555 Promonfo Circle Greeley CO 8 38-0001 15A AT1 20 000622 0093 CITY OF FORT COLLINS 215 N MASON ST wrirl FORT COLLINS CO 80524-4402 �Il�rrll�llllllrlrllillirlr�'I�I�Illlrrlrlr�lr�rrlllll�l���l���'I DATE OF NOTICE: DEC 10 2013 CODE: NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. AOMONA(INSUREO'S NOTICE OF COVERAGE State Farm Fire and Casualty Company 1680-FAFi-I NAMED INSURED: POLICY NO: 279 3128-Cl B-06B COVERAGE: j-3MICHAEL, DWIGHT YR/MAKE/MODEL: 1997 INTERNATIO DUMP BI AND PD LIABILITY N 2450 W ELIZABETH ST VIN/CAMPER: 1 HTSHADRSVH473601 $50010001$50010001$500,000 FORT COLLINS CO 80521-4120 AGENT NAME: GARY CRAMER $2000 DED. COMP. $2000 DED. COLL. > AGENT PHONE: (970)484-1374 ENDORSEMENT NO: 6028BT POLICY EFFECTIVE m DEC 03 2013 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policys 2793128-06A. $ The policy includes a loss payable clause protecting the additional insured's Interest in the described oar to the eldent 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 is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must nofify us within 10 days of any change o1 interest or ownership coming to their attention. Failure to do so will render this policy null and void. 0 FRT