HomeMy WebLinkAbout102204 RAM GLASS SERVICE - INSURANCE CERTIFICATEStateFarm STATE FARM®
A.
PO Box 853922
Richardson, TX 75085-3922
DATE OF NOTICE: JUN 19 2018
CODE:
AT1 20
CITY OF FORT
PO BOX 580
FORT COLLINS
144
003401 0055
COLLINS
CO 80522-0580
A
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 ADDM-.QNAL INSURED INTEREST
State Farm Mutual Automobile Insurance Company 2545-FA65-A
NAMED INSURED: POLICY NO: 437 1823-D01-06 CAR 001 COVERAGE:
KATAM INC DBA RAM GLASS YR/MAKE/MODEL: 2006 FORD PICKUP
SERVICE VIN/CAMPER: 1 FTWW31 P36ED38591
PO BOX 273003 AGENT NAME: DOUG RAJOTTE
FORT COLLINS CO 80527-3003 AGENT PHONE: (970)667-9220
3RD PARTY INTEREST TERMINATED
EFFECTIVE JUL 02 2018
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.
FRT