HomeMy WebLinkAboutInsurance Certificate: Kerry Kencairn (2)
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DATE OF NOTICE: JUN 01 2015
PO Box 5000 CODE:
Dupont WA 98327-5000
43A
AT1 15 A
000342 0093
CITY OF ASHLAND AND THEIR NOTE: PLEASE NOTIFY STATE FARM AT THE
ELECTED OFFICIALS OFFICERS & ADDRESS LISTED AT THE TOP, LEFT CORNER
EMPLOYEE'S OF THIS PAGE REGARDING ANY CHANGE OF
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: 330 3415-A14-37 COVERAGE:
KENCAIRN, KERRY YR/MAKE/MODEL: 2003 SUBARU STA WAG BI AND PD LIABILITY
c 147 CENTRAL AVE VIN/CAMPER: 4S3BH686237654751 $100,000!$300,000!$100,000
N ASHLAND OR 97520-1714 AGENT NAME: BRIAN CONRAD
AGENT PHONE: (541)482-8470
ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
C, MAY 05 2015 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 1716843-37B.
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The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
o provided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Until such notice
00 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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