HomeMy WebLinkAbout112297 VINEY TRUCKING INC - INSURANCE CERTIFICATE (29)a
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StateFarm STATE FARM®
QW®
PO Box 853922
Richardson, TX 75085-3922
21A
AT1 20
000774 0093
CITY OF FORT COLLINS FINANCIAL
SERVICES PURCHASING DIVISION
PO BOX 580
FORT COLLINS CO 80522-0580
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DATE OF NOTICE: FEB 06 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.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
2157-FAF1-A
NAMED INSURED: POLICY NO:
057 1122-E17-060
CAR 116 COVERAGE:
VINEY TRUCKING INC YR/MAKE/MODEL:
2004 KENWORTH SEMI TRK
BI AND PD LIABILITY
PO BOX 1446 VIN/CAMPER:
iXKWDB9X04R065303
$ 2 MIL
$1000 DED. COMP.
LAPORTE CO 80535-1446 AGENT NAME:
DARYL ALEXANDER INS AGCY
INC $1000 DED. LOLL.
AGENT PHONE:
(970)493-2196
ENDORSEMENT NO:
6028BT
POLICY EFFECTIVE
JAN 26 2017 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 0571122-06Q104.
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