HomeMy WebLinkAbout112297 VINEY TRUCKING INC - INSURANCE CERTIFICATE (30)StateiFarm STATE FARM®
PO Box 853922
Richardson, TX 75085-3922
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CITY OF FORT COLLINS FINANCIAL
SERVICES PURCHASING DIVISION
PO BOX 580
FORT COLLINS CO 80522-0580
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DATE OF NOTICE: FEB 02 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.
NOTICE OF TERMINATION OF AN ADDITIONAL INSURED INTEREST
State Farm Mutual Automobile Insurance Company 2157-FAF1-A
NAMED INSURED: POLICY NO: 057 1122-E17-06Q CAR 115 COVERAGE:
VINEY TRUCKING INC YR/MAKE/MODEL: 2001 PETERBILT TRACTOR
PO BOX 1446 VIN/CAMPER: iXPFDB9X61D563718
LAPORTE CO 80535-1446 AGENT NAME: DARYL ALEXANDER INS AGCY INC
q AGENT PHONE: (970)493-2196
0 3RD PARTY INTEREST TERMINATED
EFFECTIVE FEB 15 2017
POLICY MESSAGES:
Protection of the additional insured's interest provided by this policy is terminated as of the effective date above for the following reason:
o Policy cancelled by insured. This advance notice is solely to protect the additional insured's interests as they are affected by the ownership,
00 maintenance, or use of the car described in the policy.
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