HomeMy WebLinkAbout128365 NATIONAL RESEARCH CENTER (THOMAS MILLER) - INSURANCE CERTIFICATE (2)StateFaM STATE FARM®
PO Box 853922
Richardson, TX 75085-3922
25A
AT1 20
000933 0093
CITY OF FORT COLLINS
300 LAPORTE AVE
1 FORT COLLINS CO 80521-2719
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DATE OF NOTICE: MAY 02 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-F21-06K COVERAGE:
MILLER, THOMAS I YR/MAKE/MODEL: 2015 ACURA SPORT WG BI AND PD LIABILITY
It4775 6TH ST VIN/CAMPER: 5J8TB4H37FL009560 COMPREHENSIVE
1oo.000
c COMPREHENSIVE
N BOULDER CO 80304-0863 AGENT NAME: JEFF OGBURN $100 DED. COLL.
AGENT PHONE: (303)530-0404
ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
APR 09 2019 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 2279997-06J.
0M The policy includes a loss payable clause protecting the additional insured's interest in the described car 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
co is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
g 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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