HomeMy WebLinkAbout555745 AISLING INC - INSURANCE CERTIFICATE (3)Statefarm STATE FARM®
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1555 Promontory Circle
Greeley CO 50638-0001
DATE OF NOTICE: AUG 24 2015
CODE:
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AT1 20
000606 0093
THE CITY OF FORT COLLINS
PO BOX 580
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.
ADDITIONAL INSVO D`S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
2339-FA65-A
NAMED INSURED: POLICY NO:
272 8907-F10-06B
COVERAGE:
AISLING INC YR/MAKE/MODEL:
1998 GMC VAN
BI AND PD LIABILITY
1827 E MULBERRY ST VIN/CAMPER:
1 GTDM19WOWB540920
$ 1 MIL
$100 DED. COMP,
FORT COLLINS CO 80524-3525 AGENT NAME:
TRUMBO INSURANCE AGENCY INC $500 DIED COLL.
AGENT PHONE:
(970)669-4996
ENDORSEMENT NO:
6028BT
POLICY EFFECTIVE
AUG 12 2015 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 2728907-06A.
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.
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