HomeMy WebLinkAbout129614 PROFESSIONAL DOCUMENT SOLUTIONS INC - INSURANCE CERTIFICATE (3)StateFarm STATE FARM®
WW.
3 Ravinia Drive
Atlanta GA 30346-2117
DATE OF NOTICE: JAN 08 2016
CODE:
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AT1 20
CITY OF FORT
PO BOX 580
FORT COLLINS
14A
A
000580 0093
COLLINS
CO 80522-0580
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-FAFl-A
NAMED INSURED: POLICY NO:
012 8787-A17-061
COVERAGE:
PROFESSIONAL DOCUMENT YR/MAKE/MODEL:
2006 FORD VAN
BI AND PD LIABILITY
$100,0,0001$100,000
0
SOLUTIONS INC VIN/CAMPER:
1 FTNS241_06DA62967
DED.
$1000 ED. COMP.
4114 S TIMBERLINE RD AGENT NAME:
DAVE LAWSER
$1000 DED. COLL.
FORT COLLINS CO 80525-6026 AGENT PHONE:
(970)226-1306
ENDORSEMENT NO:
6028BT
POLICY EFFECTIVE
DEC 04 2015 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 0128787-06H.
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.