HomeMy WebLinkAbout541246 FRENCH CONCRETE INC - INSURANCE CERTIFICATE (2)STATE FARM INSURANCE COMPANIES®
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1655 Promontorryy Clrole
Greeley CO 80638-0001
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000595 0093 .
CITY OF FORT COLLINS
DIRECTOR PURCHASING/RISK MGT
PO BOX
580
FORT COLLINSLI
CO 80522-0580
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DATE OF NOTICE: SEP 19 2014
CODE:
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 Mutual Automobile Insurance Company 1506-FA65-K
NAMED INSURED: POLICY NO: 172 8428-E07-06G COVERAGE:
FRENCH,JOSHUA YR/MAKE/MODEL: 1999 FORD FLATBED 61 AND PC LIABILITY
q+ PO BOX 193 VINIXAMPER: 1 FDXW46FOXE091947 $ 1 MIL
MABONVILLE CO 80541-0193 AGENT NAME: JIM CAUFIELD $1000 DED. COMP.
$1000 DED. COLL.
AGENT PHONE: (970)669-4121
ENDORSEMENT NO: 6028ST POLICY EFFECTIVE
0
SEP 03 2014 UNTIL TERMINATED
� POLICY MESSAGES: This policy shown above supersedes polioyi 1728428-06F.
R The policy includes a loss payable clause protecting the additional insured's interest in the described oar to the 9)denl 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 wlthln 10 days of
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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