HomeMy WebLinkAbout399025 CLEAN AIR LAWN CARE INC - INSURANCE CERTIFICATE (6)RateftM STATE FARM@
PO Box 9009
Tempe, AZ85281-9709
19A
AT1 20
000727 0093
CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
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DATE OF NOTICE: FEB 20 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>NOTIC'E OF COVERAGE
State Farm Mutual Automobile Insurance Company 2644-FAF1-A
NAMED INSURED:
REYNIER, JUSTIN
321 DEL CLAIR RD
R FORT COLLINS CO 80525-2512
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POLICY NO:
363 8801-005-06A
COVERAGE:
YR/MAKE/MODEL:
2007 TOYOTA PICKUP
BI AND PD LIABILITY
VIN/CAMPER:
5TENX22N87Z404700
$ 1 MIL /$ 1 MIL /$ 1 MIL
$1000 DED. COMP.
AGENT NAME:
CHIP BEAKE INSURANCE AGCY INC $1000 DED. LOLL.
AGENT PHONE:
(970)482-1936
ENDORSEMENT NO:
6028BT
POLICY EFFECTIVE
FEB 07 2018 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 3638801-06.
The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice
is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days
any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
ADDITIONAL IN$IJAED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2644-FAF1-A
NAMED INSURED:
POLICY NO:
425 0861-C10-06A
COVERAGE:
REYNIER, JUSTIN
YR/MAKE/MODEL:
2017 HONDA PICKUP
BI AND PD LIABILITY
321 DEL CLAIR RD
VIN/CAMPER:
5FPYK3F58HB029719
$ 1 MIL /$ 1 MIL /$ 1 MIL
FORT COLLINS CO 80525-2512
AGENT NAME:
CHIP BEAKE INSURANCE AGCY INC $500 DED. COMP.
$500 DED. COLL.
AGENT PHONE:
(970)482-1936
ENDORSEMENT NO:
6028BT
POLICY EFFECTIVE
FEB 07 2018 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy#4250861-06.
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
v any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
FRT