HomeMy WebLinkAboutInsurance Certificate: Kerry Kencairn ,Stageir rm STATE FARM"
Cv DATE OF NOTICE: SEP 09 2016
PO 13ox 5.000
CODE:
DuPont UL/A 9 332? .5:,Cq
59A
AT1 A
000922 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
U-42 EMPLOYEE S ADDRESS INFORMATION.
20 E MAIN ST
ASHLAND OR 97520-1850
ADDITIONAL INSUREDS NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2155-FAE6-A
NAMED INSURED: POLICY NO: 330 3415-A14-37A COVERAGE:
KENCAIRN, KERRY YR/MAKE/MODEL: 2014 SUBARU SPORT WO BI AND PD LIABILITY
147 CENTRAL AVE VIN/CAMPER: JF2SJAHCOEH433306 $100,0001300,0001100,000
o $250 DED. COMP.
C ASHLAND OR 97520-1714 AGENT NAME: BRIAN CONRAD $250 DED. COLL.
9 AGENT PHONE: (541)482-8470
o ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
SEP 07 2016 UNTIL TERMINATED
POLICY MESSAGES:
0 64 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
is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
g 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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