HomeMy WebLinkAbout127666 MICHAEL TRUCKING - INSURANCE CERTIFICATE (22)0
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Sfa%Farm STATE FARM®
PO Box 853922
Richardson, TX 75085-3922
15A
AT1 20
000874 0093
CITY OF FORT COLLINS
215 N MASON ST
FORT COLLINS CO 80524-4402
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DATE OF NOTICE: JUN 19 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 INSUIRED'S NOTI € Ft.0VERAGE
State Farm Fire and Casualty Company
1680-FAF1-A
NAMED INSURED:
POLICY NO:
279 3128-C18-06D
COVERAGE:
MICHAEL, DWIGHT
YR/MAKE/MODEL:
2012 FREIGHTLIN 106
BI AND PD LIABILITY
2450 W ELIZABETH ST
VIN/CAMPER:
1 FVHC3BS2CDBD4454
$ 1 MIL
$1000 DED. COMP.
FORT COLLINS CO 80521-4120
AGENT NAME:
GARY CAMMER
$1000 DED. COLL.
AGENT PHONE:
(970)484-1374
ENDORSEMENT NO:
6028BT
POLICY EFFECTIVE
MAY 01 2018 UNTIL TERMINATED
POLICY MESSAGES:
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.
FRT
