HomeMy WebLinkAbout399025 CLEAN AIR LAWN CARE INC - INSURANCE CERTIFICATE (5)StateF&M STATE FARM®
AW
PO Box 853922
Richardson, TX 75085-3922
DATE OF NOTICE: APR 24 2018
CODE:
a
R
W
0
0
N
K
A
0
i
,0 4
AT1 20
INTEREST -CITY
PO BOX 580
FORT COLLINS
50A
000957 0093
OF FORT COLLINS
CO 80522-0580
I��IIII��I�I�����'�IIIII�IIII��ILI��II��I����IIII�III��I��II�I�I
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
ADDITIONAL INSUIRED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
2644-FAF1-A
NAMED INSURED: POLICY NO:
366 8766-D17-06C
COVERAGE:
REYNIER, JUSTIN YR/MAKE/MODEL:
2008 CHEVROLET PICKUP
BI AND PD LIABILITY
321 DEL CLAIR RD VIN/CAMPER:
1GCEC14088Z199223
$ 1 MIL 1 MIL /$ 1 MIL
$1000 DE D. COMP.
FORT COLLINS CO 80525-2512 AGENT NAME:
CHIP BEAKE INSURANCE AGCY INC $1000 DED. LOLL.
AGENT PHONE:
(970)482-1936
ENDORSEMENT NO: 6028BT
POLICY EFFECTIVE
APR 13 2018 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 3668766-06B.
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.