HomeMy WebLinkAbout495782 ABOVE ALL WINDOW CLEANING - INSURANCE CERTIFICATEI
CE
9
0
N
t0
ca
6
co
d
8
N
StateFarm STATE FARM®
Cab
3 Ravinia Drive
Atlanta GA 30346-2117
138
AT1 20
003959 0055
CITY OF FORT COLLINS FINANCIAL
SERVICES PURCHASING DIVISION
PO BOX 580
FORT COLLINS CO 80522-0580
I"I'll"IIIII"'I"I11111111111111111'll'lll'llllllllllllll'1'I�I
A
DATE OF NOTICE: NOV 16 2016
CODE: 33380
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 THIRD PARTY'S COVME
State Farm Mutual Automobile Insurance Company
2465-FB05-A
NAMED INSURED: POLICY NO:
213 1039-A27-06C
COVERAGE:
QUINTANA, TIMOTHY YR/MAKE/MODEL:
2005 CHEVROLET VAN
$250 DED. COMP.
4457 CLAY ST VIN/CAMPER:
1GCFG15X351246611
$250 DED. COLL.
DENVER CO 80211-1432 AGENT NAME:
ANGELO CHAVEZ
AGENT PHONE:
(303)954-0509
POLICY EFFECTIVE
NOV 02 2016 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 2131039-06B.
The policy includes a loss payable clause protecting the third party's interest in the described car to the extent of the insurance provided and
subject to all policy provisions. The third party 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 third party 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