HomeMy WebLinkAboutInsurance Certificate: Jeremy Holmes
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DATE OF NOTICE: NOV 22 2016
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"10913 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE
CITY OF ASHLAND ADDRESS LISTED AT THE TOP, LEFT CORNER
20 E MAIN ST OF THIS PAGE REGARDING ANY CHANGE OF
T ASHLAND OR 97520-1850 ADDRESS INFORMATION.
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ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2245-FAE6-A
NAMED INSURED: POLICY NO: 152 8700-F29-37G COVERAGE:
HOLMES, JEREMY YR/MAKE/MODEL: 2005 VOLVO STA WAG BI AND PD LIABILITY
$100,0004300,000$100,000
0 25 SUMMIT AVE VIN/CAMPER: YV1 SZ592351 177735 COMPREHENSIVE'
N MEDFORD OR 97501-2547 AGENT NAME: MANNY SAENZ $500 DED. COLL.
AGENT PHONE: (541)770-2878
o ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
NOV 18 2016 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 1528700-37F.
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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