HomeMy WebLinkAbout112297 VINEY TRUCKING INC - INSURANCE CERTIFICATE (19)State Farm STATE FARM®
1555 Promontory Circle
Greeley CO 80638-0001
11A
AT1 20
000872 0093
CITY OF FORT COLLINS FINANCIAL
SERVICES PURCHASING DIVISION
PO BOX
FORT COLLINSLI
CO 80522-0580
I' I I I' I I I I I' I II I I I I I I' I I I I I I III I I I I I I I I I' I I I' 11' I I I I I I I I' I' 111111
DATE OF NOTICE. MAR 16 2015
CODE: 33380
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 2157-FAFl-A
NAMED INSURED: 1 1 n �n POLICY NO: 057 1122-E17-060 CAR 097 COVERAGE:
VINEY TRUCKING INC 1 \ j� `-, YR/MAKE/MODEL: 2005 PETERBILT SEMI TRK BI AND PD LIABILITY
p'o PO BOX 1446 VIN/CAMPER: 1XP5OB9X55D856513 $ 2 MIL
LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COMP.
N
$1000 DED. COLL.
AGENT PHONE: (970)493-2196
o ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
c JAN 12 2015 UNTIL TERMINATED
ev POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060071.
The policy includes a loss payable clause protecting the additional insured's interest in the described oar to the extent of the insurance
S provided and subject to all policy provisions. The additional insured will be given 10 days notice it 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
o any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
0
N
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2157-FAFl-A
NAMED INSURED: POLICY NO: 0571122-El7-060 CAR 098 COVERAGE:
VINEY TRUCKING INC YR/MAKE/MODEL: 2004 PETERBILT SEMI TRK BI AND PD LIABILITY
PO BOX 1446 VIN/CAMPER: 1 XP5DB9X94D818538 $ 2 MIL
LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COMP.
AGENT PHONE: (970)493-2196 $1000 DED COLL
ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
JAN 12 2015 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060073.
The policy includes a lose payable clause protecting the additional insured's interest in the described oar 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
any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2157-FAFl-A
NAMED INSURED: POLICY NO: 0571122-El7-060 CAR 099 COVERAGE:
VINEY TRUCKING INC YR/MAKE/MODEL: 2014 SIDUMP R TRL DMP $1000 DED COMP
PO BOX 1446 VIN/CAMPER: 1 D9FS4026EC688179 $1000 DED COLL
LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC
AGENT PHONE: (970)493-2196
ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
POLICY MESSAGES: JAN 12 2015 UNTIL TERMINATED
The policy includes a loss payable clause protecting the additional insured's interest in the described oar 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
any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
FRT