HomeMy WebLinkAbout555745 AISLING INC - INSURANCE CERTIFICATE (7)StateFarm STATE FARM®
PO Box 853922
Richardson, TX 75085-3922
DATE OF NOTICE: JAN 02 2018
CODE:
iCPA
AT1 20
003226 0055
THE CITY OF FORT COLLINS
PURCHASING
FINANCIAL SERVICES/PURCHASING
M-A DIVISION
PO BOX 580
FORT COLLINS CO 80522-0580
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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 1648-FAF1-A
NAMED INSURED: POLICY NO: 272 8907-F10-06C COVERAGE:
AISLING INC YR/MAKE/MODEL: 1998 Gfv1C VAN
1827 E MULBERRY ST VIN/CAMPER: 1GTDM19WOWB540920
FORT COLLINS CO 80524-3525 AGENT NAME: RONNY BUSH
AGENT PHONE: (970)484-3993
3RD PARTY INTEREST TERMINATED
EFFECTIVE JAN 15 2018
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:
Policy cancelled for nonpayment of $528.26. This advance notice is solely to protect the additional insured's interests as they are affected
by the ownership, maintenance, or use of the car described in the policy.
FRT