HomeMy WebLinkAboutInsurance Certificate: Kerry Kencairn
b StateFarm STATE FARM®
DATE OF NOTICE: FEB 09 2015
PO Box 5000 CODE:
Dupont WA 98827-5000
54A
AT1 15 A
ooossa 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE
CITY OF ASHLAND AND THEIR ADDRESS LISTED AT THE TOP, LEFT CORNER
ELECTED OFFICIALS OFFICERS & OF THIS PAGE REGARDING ANY CHANGE OF
• EMPLOYEE'S
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20 E MAIN ST ADDRESS INFORMATION.
ASHLAND OR 97520-1850
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ADDITIONAL INSURED'S NOTICE OF COVERAGE;
State Farm Mutual Automobile Insurance Company 2155-FAE&A
NAMED INSURED: POLICY NO: 171 6843-A14.37B COVERAGE:
KENCAIRN, KERRY YR/MAKE/MODEL: 2010 MINI 2DR BI AND PD LIABILITY
$100,000/$300,000/$100,000
147 CENTRAL AVE VIN/CAMPER: WMWMF7058ATX42126 $100 DED. COMP.
ASHLAND OR 97520-1714 AGENT NAME: BRIAN CONRAD $500 DED. COLL.
AGENT PHONE: (541)482-8470
`o ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
JAN 16 2015 UNTIL TERMINATED
N POLICY MESSAGES: This policy shown above supersedes policy#t 1716843-37A.
8 The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
provided and subject to all policy provisions. The additional insured will be given 10 days notice 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
o 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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