HomeMy WebLinkAboutInsurance Certificate: Patton Kent & Amy
I I DATE OF NOTICE: SEP 25 2013
l'"_"`>J PO Box 5000 CODE:
Dupont WA 98327-5000
35A
AT1 15 A
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NOTE: PLEASE NOTIFY STATE FARM AT THE
CITY OF ASHLAND ADDRESS LISTED AT THE TOP, LEFT CORNER
51 WINBURN WAY OF THIS PAGE REGARDING ANY CHANGE OF
--it ASHLAND OR 97520-2735 ADDRESS INFORMATION.
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ADDITIONAL'INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2155-FAE6H
NAMED INSURED: POLICY NO: 280 2324-A27.37J COVERAGE:
S PATTON, KENT & AMY YR/MAKE/MODEL: 2013 SUBARU STA WAG 61 AND PO LIABILITY
a $100,0001$300,000/$25,000
9 HILLCREST 6T VIN/CAMPER: JF1 GPAR6XD2897397 $100 DED. COMP.
ASHLAND OR 97520-2811 - AGENT NAME: BRIAN CONRAD $250 DED. COLL.
AGENTPHONE: (541)482-8470
r ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
m SEP 21 2013 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 2802324-371.
m The policy includes a loss payable clause protecting the additional insured's interest in the described car to the edent of the insurance
provided and subject to all policy provisions. The additional insured will be given 10 days notice it 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 notilty-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.
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Sharlene Stephens
From: Pieter Smeenk [smeenkp@ashland.or.us]
Sent: Tuesday, October 01, 2013 357 PM
To: 'Sharlene Stephens'
Cc: 'Engineering-Staff 'Community Development'
Subject: RE: Kent & Amy Patton
This is probably for Public Works project #2012-16: "High Capacity Well Testing". Rob Morris and I are working with
Amy on it.
From: Sharlene Stephens [mailto:stephens@ashland.or.us]
Sent: Tuesday, October 01, 2013 3:54 PM
To: Community Development; Engineering-Staff
Subject: Kent & Amy Patton
Who in your building over there does business with Kent & Amy Patton? Their automobile insurance company
sent us an additional insured's notice of coverage. I just need to know who to sent this to. Thanks, Sharlene
Sharlene P. Stephens
Risk Management Specialist
Administrative Services
City of Ashland, 20 East Main St., Ashland, OR 97520
(541) 552-2090 - PHONE
TTY 1 (800) 735-2900
(541) 552-2017 - FAX
steohens(a.ashland. or. us
This email transmission is official business of the City of Ashland, and it is subject to Oregon Public Records Law for
disclosure and retention. If you have received this message in error, please contact me at (541) 552-2090. Thank
you.
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