HomeMy WebLinkAbout399025 CLEAN AIR LAWN CARE INC - INSURANCE CERTIFICATE (4)StateFarm STATE FARM®
AW
PO Box 9009
Tempe, AZ85281-9709
DATE OF NOTICE: MAR 06 2019
CODE:
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N
AT1 20
INTEREST -CITY
PO BOX 580
FORT COLLINS
287
A
003472 0055
OF FORT COLLINS
CO 80522-0580
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NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
NOTICE OF TERMINATION OF AN ADDITIONAL INSURED INTEREST
State Farm Mutual Automobile Insurance Company 2644-FAF1-A
NAMED INSURED: POLICY NO: 366 8766-D17-06C COVERAGE:
REYNIER, JUSTIN YR/MAKE/MODEL: 2008 CHEVROLET PICKUP
321 DEL CLAIRRD VIN/CAMPER: 1GCEC14088Z199223
FORT COLLINS CO 80525-2512 AGENT NAME: CHIP BEAKE INSURANCE AGCY INC
AGENT PHONE: (970)482-1936
3RD PARTY INTEREST TERMINATED
EFFECTIVE MAR 19 2019
POLICY MESSAGES:
Protection of the additional insured's interest provided by this policy is terminated as of the effective date above for the following reason:
Policy cancelled by insured. This advance notice is solely to protect the additional insured's interests as they are affected by the ownership,
maintenance, or use of the car described in the policy.