HomeMy WebLinkAbout128365 NATIONAL RESEARCH CENTER INC - INSURANCE CERTIFICATE (30)c
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SfateFaM STATE FARM®
PO Box 853922
Richardson, TX 75085-3922
14A
AT1 20
001078 0093
CITY OF FT COLLINS, ITS
OFFICIERS, AGENTS AND
300 LAPORTE AVE
FORT COLLINS CO 80521-2719
DATE OF NOTICE: MAY 02 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.
RECEIVE®
MAY 0 9 2018
City Manager's Office
AAiFTI0NAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2388-FA65-A
NAMED INSURED: POLICY NO: 227 9997-F21-06J COVERAGE:
MILLER, THOMAS I YR/MAKE/MODEL: 2015 ACURA SPORT WG BI AND PD LIABILITY
C/O NATIONAL RESEARCH CENTER VIN/CAMPER: 5J8TB4H37FL009560 $ 2 MIL
COMPREHENSIVE
2955 VALMONT RD STE 300 AGENT NAME: JEFF OGBURN $100 DED. COLL.
BOULDER CO 80301-1360 AGENT PHONE: (303)530-0404
ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
APR 19 2018 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 2279997-061.
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.