HomeMy WebLinkAbout128365 NATIONAL RESEARCH CENTER (THOMAS MILLER) - INSURANCE CERTIFICATESTATE FAR
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PO Box 853922
Richardson, TX 75085-3922
28A
AT1 20
000952 0093
CITY OF FT COLLINS, ITS
OFFICIERS, AGENTS AND
FOR LAPORTECOLLIN AVE
FORT COLLINS CO 80521-2719
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DATE OF NOTICE: MAY 14 2019
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 INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2388-FA65-A
NAMED INSURED: POLICY NO: 227 9997-F21-06L COVERAGE:
MILLER, THOMAS I YR/MAKE/MODEL: 2015 ACURA SPORT WG BI AND PD LIABILITY
4775 6TH ST VIN/CAMPER: 5J8T84H37FL009560 $250,0003500,0003100,000
BOULDER CO 80304-0863 AGENT NAME: JEFF OGBURN COMPREHENSIVE
AGENT PHONE: $10o DED. COLL.
(303)530-0404
ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
APR 12 2019 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 2279997-06K.
The policy includes a loss payable clause protecting the additional insured's interest in the described car 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