HomeMy WebLinkAbout541246 FRENCH CONCRETE INC - INSURANCE CERTIFICATE (3)StateFafm STATE FARM®
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1555 Promontory Circle
Greeley CO 80638-0001
21A
AT1 20
000743 0090
CITY OF FORT COLLINS
DIRECTOR PURCHASING/RISK MGT
PO BOX 580
FORT COLLINS CO 80522-0580
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DATE OF NOTICE: MAR 10 2015
CODE:
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
ADDITIONAL INSURER'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
1506-FA65-K
NAMED INSURED: POLICY NO:
172 8428-E07-06H
COVERAGE:
FRENCH CONCRETE INC YR/MAKE/MODEL:
1999 FORD FLATBED
BI AND PD LIABILITY
PO BOX 193 VIN/CAMPER:
1 FDXW46FOXEC91947
$ 1 MIL
$1000 DED COMP.
MASONVILLE CO 80541.0193 AGENT NAME:
JIM CAUFIELD
$1000 DED. COLL.
AGENT PHONE:
(970)669-4121
ENDORSEMENT NO:
6028BT
POLICY EFFECTIVE
FEB 13 2015 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy* 1728428.06G.
The policy includes a lose payable clause protecting the additional insured's interest in the described car to the e)dent 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 notity us within 10 days of
any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.