HomeMy WebLinkAbout541246 FRENCH CONCRETE INC - INSURANCE CERTIFICATE (4)SfafeFarm STATE FARM'
ADL
3 Ravinia Dnve
Atlanta GA 30346-2117
18A
AT1 20
000643 0093
CITY OF FORT COLLINS
DIRECTOR PURCHASING/RISK MGT
,_. PO BOX 580
;_; FORT COLLINS CO 80522-0580
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DATE OF NOTICE: JAN 212016
CODE:
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 71
State Farm Mutual Automobile Insurance Company 1506-FA65-A
NAMED INSURED: POLICY NO: 172 8428-E07-06J COVERAGE:
FRENCH CONCRETE INC YR/MAKE/MODEL: 1999 FORD FLATBED BI AND PD LIABILITY
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PO BOX 193 VIN/CAMPER: 1 FDXW46FOXEC91947 $11000 DED. COMP.
MASONVILLE CO 80541-0193 AGENT NAME: JIM CAUFIELD $1000 DED. COLL.
AGENT PHONE: (970)669-4121
CD
ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
JAN 01 2016 UNTIL TERMINATED
N POLICY MESSAGES: This policy shown above supersedes policy# 1728428-061.
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
g 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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