HomeMy WebLinkAboutNAVO, KIRK & LINDA - INSURANCE CERTIFICATE (2)StateeFaIM STATE FARM®
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PO Box 9009
Tempe, AZ 85281-9709
DATE OF NOTICE: APR 28 2017
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AT1 20
FORT COLLINS
PO BOX 580
FORT COLLINS
35A
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000712 0093
PURCHASING DEPT
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.
ADDITIONAL INSUIRED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
2455-FA65-A
NAMED INSURED: POLICY NO:
198 7914-C28-06D
COVERAGE:
NAVO, KIRK & LINDA YR/MAKE/MODEL:
2011 SUBARU STA WAG
BI AND PD LIABILITY
$100,
4690 WISCONSIN AVE VIN/CAMPER:
4S4BRBAC1B3404246
$500 ED. DED. COOMP.MP./$100,000
LOVELAND CO 80538-6833 AGENT NAME:
SHARON E YOUNIE INS AGENCY INC $500 DED. COLL.
AGENT PHONE:
(970)663-7880
ENDORSEMENT NO:
6028BT
POLICY EFFECTIVE
APR 20 2017 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 1987914-06C.
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.