HomeMy WebLinkAbout112297 VINEY TRUCKING INC - INSURANCE CERTIFICATE (28)Statee&rm STATE FARM®
OW.
PO Box 853922
Richardson, TX 75085-3922
14A
20
000828 0093
CITY OF FORT COLLINS FINANCIAL
SERVICES PURCHASING DIVISION
PO BOX
580
FORT COLLINSLI
CO 80522-0580
DATE OF NOTICE: JUN 07 2017
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.
/'' . IONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2157-FAFi-A
NAMED INSURED: POLICY NO: 057 1122-E17-06R CAR 081 COVERAGE:
VINEY TRUCKING INC YR/MAKE/MODEL: NONOWNED AUTO BI AND PD LIABILITY
PO BOX 1446 VIN/CAMPER: $ 2 MIL
R LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC
q AGENT PHONE: (970)493-2196
o ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
6164CR 6165BT MAY 17 2017 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 0571122-06Q.
00
c The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
o 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
o any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
ADDITIONAL INSUREDSNOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2157-FAFi-A
NAMED INSURED: POLICY NO: 057 1122-E17-06R CAR 100 COVERAGE:
VINEY TRUCKING INC YR/MAKE/MODEL: 2014 SIDUMP R TRL DMP $1000 DED. COMP.
PO BOX 1446 VIN/CAMPER: 1 D9FS4026EC688117 $1000 DED. COLL.
LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC
AGENT PHONE: (970)493-2196
ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
MAY 17 2017 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 0571122-06Q.
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.
A
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2157-FAF1-A
NAMED INSURED: POLICY NO: 057 1122-E17-06R CAR 103 COVERAGE:
VINEY TRUCKING INC YR/MAKE/MODEL: 2001 PETERBILT SEMI TRK BI AND PD LIABILITY
PO BOX 1446 VIN/CAMPER: 1XP5D49X11D550799 $ 2 MIL
LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DIED. COMP.
$1000 DED. COLL.
AGENT PHONE: (970)493-2196
ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
MAY 17 2017 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060.
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.
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ADDITIONAL INSUREDS NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2157-FAF1-A
NAMED INSURED: POLICY NO: 057 1122-E17-06R CAR 108 COVERAGE:
VINEY TRUCKING INC YR/MAKE/MODEL: 2008 TRAIL KING BTM TRLR $1000 DED. COMP.
PO BOX 1446 VIN/CAMPER: iT8LC412X8W071896 $1000 DED. COLL.
LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC
AGENT PHONE: (970)493-2196
ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
POLICY MESSAGES: This policy shown above supersedes policy# 0571122-06Q. MAY 17 2017 UNTIL TERMINATED
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.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2157-FAF1-A
NAMED INSURED: POLICY NO: 057 1122-E17-06R CAR 112 COVERAGE:
VINEY TRUCKING INC YR/MAKE/MODEL: 2016 TRAIL KING BTM TRLR $1000 DED. COMP.
PO BOX 1446 VIN/CAMPER: 1TKL04124GWO31546 $1000 DED. COLL.
LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC
AGENT PHONE: (970)493-2196
ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
POLICY MESSAGES: This policy shown above supersedes policy# 0571122-060. MAY 17 2017 UNTIL TERMINATED
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.
ADDITIONAL INSUREDS NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2157-FAF1-A
NAMED INSURED: POLICY NO: 057 1122-E17-06R CAR 117 COVERAGE:
VINEY TRUCKING INC YR/MAKE/MODEL: 1994 PETERBILT TRACTOR BI AND PD LIABILITY
PO BOX 1446 VIN/CAMPER: 1XP5DR9X7RD347733 $ 2 MIL
LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC $1000 DIED. COMP.
$1000 DED. COLL.
AGENT PHONE: (970)493-2196
ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
POLICY MESSAGES: This policy shown above supersedes policy# 0571122-06Q. MAY 17 2017 UNTIL TERMINATED
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.
BCKI