HomeMy WebLinkAboutBA-NOM-A-NOM LLC - INSURANCE CERTIFICATEStateFd/m STATE FARM�'
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PO Box 2368
Bloomrngtor� IL 61702-2368
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AUTO CITY OF
PO BOX 580
FORT COLLINS
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002015 0093
FORT COLLINS
CO 80522-0580
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DATE (�F NOTICE: MAR 31 2Q23
CODE:
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT GORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
ADDITlONAL INSURED'S NUTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 27as-FBa2-A
NAMED INSURED: POI.ICY NO: 436 3874-Do4-o6M COVERAGE:
BA-NOM-A-NOM LLC YR/MAKE/MODEL: 20» RAM VAN BI AND PD LIABILITY
d554 BEACH CT VIN/CAMPER: 3C6TRVpG8HE541203 $500,000/$500,000/$100.000
$,00 oe�. coMP.
DENVER CO 80211-1453 AGENT NAME: JUNIOR MEDINA $54o DED. COLL.
AGENT PHONE: (720)726-aoa0
ENQORSEMENT NO: 602887 POLlCY EFFECTIVE
MAR 30 2623 UNTIL TERMINATED
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POI�ICY ME$SAG�S: This policy shown above supersedes policy# 4363874-06L.
7he policy includes a loss payable clause protecSing ihe additional insured's interes� in the described car to the extent of the insurance
provided and subject to all policy provisions. 7ha additional insured will be given 10 days notice if the po �cy is terminated. Until such notice
is provided, it shall be presumed thaf the required renewal premiums have been paid. The additiona! insured musl notify us within 16 days oi
any �hange o( interest or ownership coming to their attention. Failure to do so will render this policy nul and void.
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