HomeMy WebLinkAbout541246 FRENCH CONCRETE INC - INSURANCE CERTIFICATE (8)u
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State&rm STATE FARM®
PO Box 853922
Richardson, TX 75085-3922
21A
AT1 20
000887 0093
CITY OF FORT COLLINS
DIRECTOR PURCHASING/RISK MGT
PO BOX 580
FORT COLLINS CO 80522-0580
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DATE OF NOTICE: JAN 17 2017
CODE:
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
1506-FA65-A
NAMED INSURED: POLICY NO:
172 8428-AO9-06L
COVERAGE:
FRENCH CONCRETE INC YR/MAKE/MODEL:
1999 FORD FLATBED
BI AND PD LIABILITY
PO BOX 193 VIN/CAMPER:
1FDXW46FOXEC91947
$ t MIL
$1000 DED. COMP,
MASONVILLE CO 80541-0193 AGENT NAME:
JIM CAUFIELD
$1000 DED. COLL.
AGENT PHONE:
(970)669-4121
ENDORSEMENT NO:
6028BT
POLICY EFFECTIVE
JAN 09 2017 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 1728428-06K.
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.