HomeMy WebLinkAbout583340 BROCC FRAMING INC - INSURANCE CERTIFICATE (4)StateFarm STATE FARM®
PO Box 853922
Richardson, TX 75085-3922
20A
AT1 20
001032 0093
CITY OF FORT COLLINS
PURCHASING DEPARTMENT
PO BOX 580
FORT COLLINS CO 80522-0580
A
DATE OF NOTICE: APR 05 2018
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
State Farm Mutual Automobile Insurance Company 2392-FAF1-A
NAMED INSURED: POLICY NO: 277 2986-C14-06A COVERAGE:
BROCCOLI, BEN DBA BROCC YR/MAKE/MODEL: 2001 GMC BOX BI AND PD LIABILITY
a FRAMING VIN/CAMPER: 1GDJG31R711173125 $ 1 MIL
o $1000 DIED. COMP.
N 7668 BIG VALLEY DR AGENT NAME: MOSKALSKI INS AND FIN SVCS INC $1000 DED. COLL.
4 LOVELAND CO 80537-9702 AGENT PHONE: (970)493-1888
ENDORSEMENT NO: 60288T POLICY EFFECTIVE
MAR 26 2018 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 2772986-06.
0M The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
o 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
c 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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