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HomeMy WebLinkAbout112297 VINEY TRUCKING INC - INSURANCE CERTIFICATE (21)StafeFWM STATE FARM® ARL 1555 Promontory Circle Greeley CO 80638-0001 13A AT1 20 000577 0093 CITY OF FORT COLLINS FINANCIAL SERVICES PURCHASING DIVISION r PO BOX 580 FORT COLLINS CO 80522-0580 IIIIIIItIiI'IIIIIIIII�II'11I11111�II�ILIII�I���II�IIL��II��il11 0 0 0 0 0 0 A DATE OF NOTICE: MAY 18 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 COVEMOE State Farm Mutual Automobile Insurance Company 2157-FAF1-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 013 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 1997 PETERBILT TRACTOR BI AND PD LIABILITY 2 MIL PO BOX 1446 VIN/CAMPER: 1 XP5DB8X2VD433065 $ 000 DED. COMP. LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COLL. AGENT PHONE: (970)493-2196 o ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED N POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. 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 cc 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. 0 N ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAFl-A NAMED INSURED: POLICY NO: 0571122-E17-06P CAR 023 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 1994 PETERBILT TRACTOR BI AND PD LIABILITY PO BOX 1446 VIN/CAMPER: 1 XP5DR9X7RD347733 $ 2 MIL $1000 DED. COMP. LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COLL. AGENT PHONE: (970)493-2196 ENDORSEMENT NO: 6028ST POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. The policy includes a loss payable clause protecting the additional insured's interest in the described oar 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. m LADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAF1-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 033 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 1996 PETERBILT TRACTOR BI AND PD LIABILITY PO BOX 1446 VIN/CAMPER: 1 XPFDB9X4TD398321 $ 2 MIL LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DEC. COMP. $1000 DED. COLL. AGENT PHONE: (970)493-2196 ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. The policy includes a loss payable clause protecting the additional insured's interest in the described oar 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. w FRT ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAFl-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 045 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2001 PETERBILT TRACTOR BI AND PD LIABILITY PO BOX 1446 VIN/CAMPER: 1 XPFDB9X61 D563718 $ 2 MIL LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COMP. AGENT PHONE: (970)493-2196 $1000 DED COLL. ENDORSEMENT NO: 6028BT POLICY EFFECTIVE POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. MAY 17 2015 UNTIL TERMINATED 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. 0 m ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAF1-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 054 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2001 PETERBILT TRACTOR BI AND PD LIABILITY PO BOX 1446 VIN/CAMPER: 1 XP5DB9X41 D541292 $ 2 MIL LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COMP. AGENT PHONE: (970)493-2196 $1000 DED LOLL. ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 172015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. 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 9 any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. m ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAF1-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 059 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2006 TRAVIS TRL DUMP $1000 DED COMP. PO BOX 1446 VIN/CAMPER: 48X1 F392861004289 $1000 DED. COLL. LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC AGENT PHONE: (970)493-2196 ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. 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. N A ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAF1-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 063 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2003 KENWORTH TRACTOR BI AND PD LIABILITY PO BOX 1446 VIN/CAMPER: 1 XKWD89X13J705001 $ 2 MIL LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COMP. AGENT PHONE: (970)493-2196 $1000 DED. LOLL. ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. 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. BCK1 State&rm STATE FARM® 1555 Promontory Circle Greeley CO 80638-0001 13A 20 000577 0093 CITY OF FORT COLLINS FINANCIAL SERVICES PURCHASING DIVISION r PO BOX 580 FORT COLLINS CO 80522-0580 DATE OF NOTICE: MAY 18 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 COVERAGE771 State Farm Mutual Automobile Insurance Company 2157-FAFl-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 065 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2003 TRAVIS TRL $1000 DED. COMP. v PO BOX 1446 VIN/CAMPER: 48X1 F382431002603 $1000 DED. COLL. LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC o AGENT PHONE: (970)493-2196 cm ENDORSEMENT NO: 60286T POLICY EFFECTIVE c MAY 17 2015 UNTIL TERMINATED ro POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. 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 o 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. ADDITIONAL INSURED'S NOTICE 4F GO3VERAGE State Farm Mutual Automobile Insurance Company 2157-FAF1-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 070 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2005 PETERBILT TRACTOR el AND PD LIABILITY PO BOX 1446 VIN/CAMPER: 1 XP5DB9X15D846500 $ 2 MIL $1000 DED. COMP. LAPORTE 00 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COLL. AGENT PHONE: (970)493-2196 ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. The policy includes a loss payable clause protecting the additional insured's interest in the described oar 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 D any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. �i 0 0 m ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAF1-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 072 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2008 TRAIL KING TRAILER $1000 DED. COMP. PO BOX 1446 VIN/CAMPER: 1 TKLC41258WO38627 $1000 DED. COLL. LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC AGENT PHONE: (970)493-2196 ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. The policy includes a loss payable clause protecting the additional insured's interest in the described oar 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. co 0 CD FRT ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAFl-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 074 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2008 TRAIL KING TRL DUMP $1000 DED. COMP. PO BOX 1446 VIN/CAMPER: ITKSC40228WO54961 $1000 DED. COLL. LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC AGENT PHONE: (970)493-2196 ENDORSEMENT NO: 6028ST POLICY EFFECTIVE POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. MAY 17 2015 UNTIL TERMINATED The policy includes a loss payable clause protecting the additional insured's interest in the described oar 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. 0 ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAFt-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 075 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2005 KENWORTH TRACTOR BI AND PC LIABILITY PO BOX 1446 VIN/CAMPER: 1 XKWD89X95R096258 $ 2 MIL LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COMP. AGENT PHONE: (970)493-2196 $1000 DED. COLL. ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. 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 Ig cc any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. 0 0 m ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAFl-A NAMED INSURED: POLICY NO: 0571122-E17.06P CAR 076 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2008 TRAIL KING TRAILER $1000 DEC. COMP. PO BOX 1446 VIN/CAMPER: 1 TK8040268WO54963 $1000 DED. COLL. LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC AGENT PHONE: (970)493-2196 ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. 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. co 0 w >ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAFl-A NAMED INSURED: POLICY NO: 0571122-E17-06P CAR 079 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2001 PETERBILT TRACTOR BI AND PD LIABILITY PO BOX 1446 VIN/CAMPER: 1 XPFDB9X41 N541260 $ 2 MIL LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COMP. AGENT PHONE: (970)493-2196 $1000 DED. LOLL. ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. The policy includes a loss payable clause protecting the additional insured's interest in the described oar 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. BCK1 StatefaIM STATE FARM® AIL 1555 Promontory Circle Greeley CO 80638-0001 13A 20 000577 0093 CITY OF FORT COLLINS FINANCIAL SERVICES PURCHASING DIVISION 1i• PO BOX 580 FORT COLLINS CO 80522-0580 A DATE OF NOTICE: MAY 18 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-FAF1-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 081 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: NONOWNED AUTO BI AND PD LIABILITY PO BOX 1446 VIN/CAMPER: $ 2 MIL R' LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC AGENT PHONE: (970)493-2196 o ENDORSEMENT NO: 60286T POLICY EFFECTIVE 6164CR 6165BT MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy,# 0571122-060. CD 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 o any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. 0 N ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAF1-A NAMED INSURED: POLICY NO: 0571122-E17-06P CAR 097 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2005 PETERBILT SEMI TRK BI AND PD LIABILITY PO BOX 1446 VIN/CAMPER: 1 XP5DB9X55D856513 $ 2 MIL $1000 DED. COMP. LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. LOLL. AGENT PHONE: (970)493-2196 ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. The policy includes a loss payable clause protecting the additional insured's interest in the described oar 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. ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAFl-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 098 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2004 PETERBILT SEMI TRK BI AND PD LIABILITY PO BOX 1446 VIN/CAMPER: 1 XP5DB9X94D818538 $ 2 MIL LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COMP. $1000 DED. COLL. AGENT PHONE: (970)493-2196 ENDORSEMENT NO: 6028ST POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. The policy includes a loss payable clause protecting the additional insured's interest in the described oar 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 Iv any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. co FRT ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAFl-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 099 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2014 SIDUMP R TRL DMP $1000 DED. COMP. PO BOX 1446 VIN/CAMPER: 1 D9FS4026EC688179 $1000 DED. COLL. LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC AGENT PHONE: (970)493-2196 ENDORSEMENT NO: 6028BT POLICY EFFECTIVE POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. MAY 17 2015 UNTIL TERMINATED The policy includes a loss payable clause protecting the additional insured's interest in the described oar to the e)dent 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. ge ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAF1-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 100 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2014 SIDUMP R TRL DMP $1000 DED. COMP. PO BOX 1446 VIN/CAMPER: 1 D9FS4026EC688117 $1000 DED. COLL. LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC AGENT PHONE: (970)493-2196 ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. The policy includes a loss payable clause protecting the additional insured's interest in the described oar to the e)dent 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 co any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. co a9 ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAF1-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 103 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2001 PETERBILT SEMI TRK BI AND PD LIABILITY PO BOX 1446 VIN/CAMPER: 1 XP5D49X11 D550799 $ 2 MIL LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COMP. AGENT PHONE: (970)493-2196 $1000 DED. COLL. ENDORSEMENT NO: 6028BT POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the e)dent 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 9 any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. ro 0 m ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 2157-FAF1-A NAMED INSURED: POLICY NO: 057 1122-E17-06P CAR 104 COVERAGE: VINEY TRUCKING INC YR/MAKE/MODEL: 2004 KENWORTH SEMI TRK BI AND PD LIABILITY PO BOX 1446 VIN/CAMPER: 1 XKWDB9X04R065303 $ 2 MIL LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DED. COMP. AGENT PHONE: (970)493-2196 $1000 DED. LOLL. ENDORSEMENT NO: 6028ST POLICY EFFECTIVE MAY 17 2015 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the e)dent 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. BCK1