HomeMy WebLinkAbout125758 FULLER LANDSCAPING - INSURANCE CERTIFICATE (12)StateeFFarm STATE FARM®
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PO Box 853922
Richardson, TX 75085-3922
28A
AT1 20
000606 0093
CITY OF FT COLLINS PURCHASING
PO BOX 580
FORT COLLINS CO 80522-0580
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DATE OF NOTICE: MAY 26 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
2157-FAF1-A
NAMED INSURED: POLICY NO:
018 1361-D19-06L
COVERAGE:
FULLER, BRIAN K YR/MAKE/MODEL:
1999 GMC STAKE
BI AND PD LIABILITY
4836 KIVA DR VIN/CAMPER:
4KDB4B1 R9XJ005865
$ 1 MIL
LAPORTE CO 80535-9507 AGENT NAME:
DARYL ALEXANDER INS AGCY INC
AGENT PHONE:
(970)493-2196
ENDORSEMENT NO:
6028BT
POLICY EFFECTIVE
APR 25 2017 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 0181361-06K.
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.
FRT