HomeMy WebLinkAbout129614 PROFESSIONAL DOCUMENT SOLUTIONS INC - INSURANCE CERTIFICATE (2)StateFarm STATE FARM®
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2700 South Sunland Drive
Tempe AZ 85282-3387
DATE OF NOTICE: JUN 17 2015
CODE:
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CITY OF FORT
PO BOX 580
FORT COLLINS
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000586 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
1478-FAF1-A
NAMED INSURED: POLICY NO;
213 9004-F22-06C
COVERAGE:
PROFESSIONAL DOCUMENT YR/MAKE/MODEL:
2012 MAZDA STA WAG
BI AND PD LIABILITY
SOLUTIONS INC VIN/CAMPER:
JMICW2BL400119009
00,
$100,0001$3$100,000
DED. COOMP.MP.
$1000 ED.
4114 S TIMBERLINE RD UNIT 100 AGENT NAME:
DAVE LAWSER
$1000 DED. COLL.
FORT COLLINS CO 80525-6026 AGENT PHONE:
(970)226-1306
ENDORSEMENT NO: 6028BT
POLICY EFFECTIVE
JUN 04 2015 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 2139004-0613.
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.
FRT