HomeMy WebLinkAbout551529 SUPERTREES INC - INSURANCE CERTIFICATEState&rm STATE FARM®
PO Box 853922
Richardson, TX 75085-3922
DATE OF NOTICE: JUN 19 2019
CODE:
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AT1 15
CITY OF FORT
PO BOX 580
FORT COLLINS
54A
000631 0093
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.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
2185-FA70-A
NAMED INSURED: POLICY NO:
381 7241-F28-37A
COVERAGE:
SUPERTREES INCORPORATED YR/MAKE/MODEL:
2016 TOYOTA PICKUP
BI AND PD LIABILITY
30519 S MERIDIAN RD VIN/CAMPER:
5TFUY5F12GX502825
$ 1 MIL/$ 1 MIL 1 MIL
$100 DED. COMPP..
HUBBARD OR 97032-9437 AGENT NAME:
JUSTIN STEARNS
$soo DED. COLL.
AGENT PHONE:
6028BJ1 7378
ENDORSEMENT NO:
POLICY EFFECTIVE
MAY 16 2019 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 3817241-37.
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