HomeMy WebLinkAbout129614 PROFESSIONAL DOCUMENT SOLUTIONS INC - INSURANCE CERTIFICATE (6)StateFarm STATE FARM®
PO Box 9009
Tempe, AZ85281-9709
DATE OF NOTICE: FEB 06 2017
CODE:
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N
ATE 20
CITY OF FORT
PO BOX 580
FORT COLLINS
22A
000775 0093
COLLINS
CO 80522-0580
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
—771
State Farm Mutual Automobile Insurance Company
1478-FAF1-A
NAMED INSURED: POLICY NO:
213 9004-F22-06D
COVERAGE:
PROFESSIONAL DOCUMENT YR/MAKE/MODEL:
2014 FORD SPORT WG
BI AND PD LIABILITY
SOLUTIONS INC VIN/CAMPER:
1FMCU9J98EUB30526
$100,0$1000 ED. DED.00/$3COOMP.MP.$100,000
4114 S TIMBERLINE RD UNIT 100 AGENT NAME:
DAVE LAWSER
$1000 DED. COLL.
FORT COLLINS CO 80525-6026 AGENT PHONE:
(970)226-1306
ENDORSEMENT NO: 6028BT
POLICY EFFECTIVE
JAN 27 2017 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 2139004-06C.
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.
FRT