HomeMy WebLinkAbout505935 TRANSITION LEADERSHIP INC - INSURANCE CERTIFICATE (2)State&rm STATE FARM®
A.
PO Box 853922
Richardson, TX 75085-3922
DATE OF NOTICE: JAN 18 2017
CODE:
r
v
AT1 20
CITY OF FORT
PO BOX 582
FORT COLLINS
36A
A
000897 0093
COLLINS
CO 80522-0582
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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.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
1478-FAF1-A
NAMED INSURED: POLICY NO:
209 4441-D03-06C
COVERAGE:
ATHEY, PATRICIA & TIMOTHY YR/MAKE/MODEL:
2012 TOYOTA SPORT WG
BI AND PD LIABILITY
3301 SAGEWATER CT VIN/CAMPER:
JTEDC3EH1C2004166
$ t MIL/$ 1 MILT$ 1 MIL
$250 DED. COMP.
FORT COLLINS CO 80528-9471 AGENT NAME:
DAVE LAWSER
$250 DED. COLL.
AGENT PHONE:
(970)226-1306
ENDORSEMENT NO:
6028BT
POLICY EFFECTIVE
DEC 06 2016 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 2094441-06B.
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