HomeMy WebLinkAboutInsurance Certificate: Martin Main
States m. STATE FARMO
DATE OF NOTICE: SEP 22 2014
APO Box sow CODE:
Dupont WA 98327-6000
27A
AT1 16 A n
000545 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE 7
CITY OF ASHLAND ADDRESS LISTED AT THE TOP LEFT CORNER n
SISK 455 OU BLVD OF THIS PAGE REGARDING AkY CHANGE OF 5
ASHLAND ND OR OR 97520-2135 ADDRESS INFORMATION. 4
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ADDITIQNAL:IN;iURED S NIOTICE OF t'VRAICE
State Farm Mutual Automobile Insurance Company 2134-FAESA
NAMED INSURED: POLICY NO: 213 7117-F08-37U COVERAGE:
MAIN, MARTIN L YR/MAKE/MODEL: 1996 NISSAN PICKUP BI AND PD LIABILITY
y $100,000/$300,0050,000
c 2779 CAMP BAKER RD VIN/CAMPER: 1 N6HD16Y5SG354928 COMPREHENSIVE
N MEDFORD OR 97501-9608 AGENT NAME: RORY WOLD INSURANCE AGENCY INC $250 DED. COLL.
AGENT PHONE: (541)773-1404
0
o ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
SEP 18 2014 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 2137117-37T.
$ The policy Includes a lose payable clause protecting the additional Insured's Interest in the described oar to the e)dent of the Insurance
provided and subject to all policy provisions. The additional Insured will be given 10 days notioe 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.
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Sharlene Stephens
From: Sharlene Stephens [stephens@ashland.or.us]
Sent: Monday, September 29, 2014 1:40 PM
To: 'Chris Chambers'
Subject: RE: Small Woodlands Services car ins
Thank you!!
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
stephens(7aashland.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.
-----Original Message----
From: Chris Chambers [mailto:chamberc(@ashland.or.us)
Sent: Monday, September 29, 2014 11:10 AM
To: Sharlene Stephens
Subject: Small Woodlands Services car ins
This came to me so I'm sending you a copy as well.
Chris
-----Original Message-----
From: FireHousel(@ashland.or.us [mailto:FireHousel(@ashland.or.us]
Sent: Monday, September 29, 2014 8:06 AM
To: Chris Chambers
Subject: Message from "Fire1-Ricoh-4501A"
This E-mail was sent from "Fire1-Ricoh-4501A" (Aficio MP C4501A).
Scan Date: 09.29.2014 11:05:44 (-0400)
Queries to: FireHousel(@ashland.or.us
1