HomeMy WebLinkAbout112297 VINEY TRUCKING INC - INSURANCE CERTIFICATE (22)W
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StateFarm STATE FARM
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PO Box 799100
Dallas TX 75379
127
AT1 20
003566 0055
CITY OF FORT COLLINS FINANCIAL
SERVICES PURCHASING DIVISION
PO BOX
580
FORT COLLINSLI
CO 80522-0580
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DATE OF NOTICE: DEC 03 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.
NOTICE OF TERMINATION OF AN ADDITIONAL INSURED INTEREST
State Farm Mutual Automobile Insurance Company
2157-FAFl-A
NAMED INSURED: POLICY NO:
057 1122-E17-06P CAR 013 COVERAGE:
VINEY TRUCKING INC YR/MAKE/MODEL:
1997 PETERBILT TRACTOR
PO BOX 1446 VIN/CAMPER:
1XP5DB8X2VD433065
LAPORTE CO 80535-1446 AGENT NAME:
DARYL ALEXANDER INS AGCY INC
AGENT PHONE:
(970)493-2196
3RD PARTY INTEREST TERMINATED
EFFECTIVE DEC 16 2015
POLICY MESSAGES:
Protection of the additional insured's interest provided by this policy is terminated as of the effective date above for the following reason:
Policy cancelled by insured. This advance notice is solely to protect the additional insured's interests as they are affected by the ownership,
maintenance, or use of the car described in the policy.