HomeMy WebLinkAbout129614 PROFESSIONAL DOCUMENT SOLUTIONS INC - INSURANCE CERTIFICATE (4)StateFarm STATE FARM®
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PO Box 853922
Richardson, TX 75085-3922
DATE OF NOTICE: MAY 03 2018
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CITY OF FORT
PO BOX 580
FORT COLLINS
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003595 0055
COLLINS
CO 80522-0580
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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 ADDITIONAL INSURED INTEREST
State Farm Mutual Automobile Insurance Company
1478-FAF1-A
NAMED INSURED: POLICY NO:
012 8787-A17-061
COVERAGE:
PROFESSIONAL DOCUMENT YR/MAKE/MODEL:
2006 FORD VAN
SOLUTIONS INC VIN/CAMPER:
1FTNS24LO6DA62967
4114 S TIMBERLINE RD AGENT NAME:
DAVE LAWSER
FORT COLLINS CO 80525-6026 AGENT PHONE:
(970)226-1306
3RD PARTY INTEREST TERMINATED
EFFECTIVE MAY 16 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.