HomeMy WebLinkAboutInsurance Certificate: Slate James & Lori
l'•°•••21 PO Box 5000 DATE OF NOTICE: OCT 02 2013
Dupont WA 98327-5000 CODE:
120A
AT1 15 A
0601 0093
NOTE: PLEASE NOTIFY STATE FARM AT THE
THE CITY OF ASHLAND, , OREGON,
AND IT'S ELECTED OFFICIALS, ADDRESS LISTED AT THE TOP, LEFT CORNER
OFFICERS AND EMPLOYEES OF THIS PAGE REGARDING ANY CHANGE OF
51 WINBURN WAY ADDRESS INFORMATION.
ASHLAND OR 97520-2735
s
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ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2145-FAESH
NAMED INSURED: POLICY NO: 000 7963-E18-37G COVERAGE:
SLATE, JAMES L & LORI L YR/MAKE/MODEL: 2006 CHEVROLET PICKUP BI AND PO LIABILITY
PO BOX 569 VIN/CAMPER: 1 GCHK23U46F182721 $1001000/$30010001$50,000
TALENT OR 97540-0569 AGENT NAME: LARRY NICHOLSON $250 DED. COMP
AGENT PHONE; NDORSEMENT NO: 6028BJ2 3233
E
POLICY EFFECTIVE
SEP 05 2013 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy/ 0007963-37F.
a The policy includes a lose payable clause protecting the additional insured's interest in the described car to the e#ent 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
n 'IB provided, it shall be-pres[aned-that the required renewalpremiums-have been paid. The additional insured must notify us-withiml0-daye-of
q 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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