HomeMy WebLinkAboutInsurance Certificate: Baldwin, Randy & Michelle
5tat8FatM STATE FARM`F'
-AIL
WW. PO Box 5000 DATE OF NOTICE: APR 07 2015
Dupont WA 98 32 7-5 0 00 CODE:
134
AT1 15 A
002908 0055
CITY OF ASHLAND NOTE: PLEASE NOTIFY STATE FARM AT THE
20 E MAIN ST ADDRESS LISTED AT THE TOP, LEFT CORNER
zm ASHLAND OR 97520-1850 OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
~IIIIIIIIIIIIIIjIjj~Iilllll~lll~IlIII~II~II~"~I~~III~IlIi"~IIII
n
NOTICE OF THIRD PARTY'S COVERAGE
State Farm Mutual Automobile Insurance Company 2339-FAE6A
NAMED INSURED: POLICY NO: 263 7835-A16-37B COVERAGE:
BALDWIN, RANDY & MICHELLE YR/MAKE/MODEL: 2012 CHEVROLET PICKUP $100 DED. COMP.
548 HOGAN AVE VIN/CAMPER: 1 GCNCPEX4CZ127877 $500 DED. COLL.
MEDFORD OR 97504-4303 AGENT NAME: RUSS WIMMER INS AGENCY INC
AGENT PHONE: (541)776-7877
POLICY EFFECTIVE
APR 01 2015 UNTIL TERMINATED
POLICY MESSAGES:
The policy includes a loss payable clause protecting the third party's interest in the described car to the extent of the insurance provided and
subject to all policy provisions. The third party 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 third party 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,
3
NOTICE OF THIRD PARTY'S COVERAGE
State Farm Mutual Automobile Insurance Company 2339-FAESA
NAMED INSURED: POLICY NO: 145 5228-A13-37C COVERAGE:
BALDWIN, RANDY & MICHELLE YR/MAKE/MODEL: 2003 CHEVROLET PICKUP $100 DED. COMP.
548 HOGAN AVE VIN/CAMPER: 1 GCEC14X03Z286376 $500 DED. COLL.
MEDFORD OR 97504-4303 AGENT NAME: RUSS WIMMER INS AGENCY INC
AGENT PHONE: (541)776-7877
POLICY EFFECTIVE
APR 01 2015 UNTIL TERMINATED
POLICY MESSAGES:
The policy includes a loss payable clause protecting the third party's interest in the described car to the extent of the insurance provided and
subject to all policy provisions. The third party will be given 10 days notice if the policy is terminated. Until such notioe is provided, it shall be
presumed that the required renewal premiums have been paid. The third party 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.
FRT