HomeMy WebLinkAboutWINTER, NORE V & MARY CRAIG - INSURANCE CERTIFICATE (3)Statefarm STATE FARM®
PO Box 853922
Richardson, TX 75085-3922
DATE OF NOTICE: SEP 22 2017
CODE:
27A
AT1 20
000719 0093
CITY OF FORT COLLINS
ITS OFFICERS AGENTS AND
EMPLOYEES
281 N COLLEGE AVE
FORT COLLINS CO 80524-2404
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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.
ADDITIONAL INSUREWS NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2097-FA65-A
NAMED INSURED: POLICY NO: 361 8395-D23-061 COVERAGE:
WINTER, NORE V & MARY CRAIG YR/MAKE/MODEL: 2009 FORD SPORT WG BI AND PD LIABILITY
1265 YELLOW PINE AVE VIN/CAMPER: IFMCU59339KB47342 $ 1 MIL
c $500 DED. COMP.
N BOULDER CO 80304-2264 AGENT NAME: KELLY EYEN INSUR AGENCY INC $500 DED. COLL.
c AGENT PHONE: (303)444-5646
ENDORSEMENT NO: 6028BT POLICY EFFECTIVE
SEP 18 2017 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 3618395-06H.
c The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
o provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice
co is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
c any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
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