HomeMy WebLinkAbout112297 VINEY TRUCKING INC - INSURANCE CERTIFICATE (17)StateeFarm STATE FARM®
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1555 Promontory Circle
Greeley CO 80638-0001
24A
AT1 20
000635 0093
CITY OF FORT COLLINS FINANCIAL
SERVICES PURCHASING DIVISION
_ PO BOX 580
FORT COLLINS CO 80522-0580
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DATE OF NOTICE: APR 09 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: POLICY NO: 0571122-El7-060 CAR 104 COVERAGE:
VINEY TRUCKING INC YR/MAKE/MODEL: 2004 KENWORTH SEMI TRK BI AND PD LIABILITY
o PO BOX 1446 VIN/CAMPER: 1 XKWDB9X04RO65303 $ 2 MIL
N LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED COMP.
� $1000 DED. COLL.
AGENT PHONE: (970)493-2196
o ENDORSEMENT NO: 60286T POLICY EFFECTIVE
c FEB 18 2015 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 0571122.060080.
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The policy includes a loss payable clause protecting the additional insured's interest in the described oar to the extent of the insurance
o 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
o any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
FRT