HomeMy WebLinkAboutInsurance Certificate: Alan Contreras
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
E4277
Policy Number: 60506-82-10 1st Edition
POLICY CHANGES
Effective Date of Change: 03/01/17 Expiration Date: 01 / 10/ 18
Change Endorsement No.: 004 Agent: 73-01-363
Named Insured: CONTRERAS, ALAN
725 BEACH ST
ASHLAND OR 97520
The following item(s):
Insured's Name Insured's Mailing Address
Policy Number Company
Effective / Expiration Date Insured's Legal Status / Business of Insured
Payment Plan Premium Determination
X Additional Interested Parties Coverage Forms and Endorsements
Limits / Exposures Deductibles
Covered Property / Location Description Classification / Class Codes
Rates Underlying Insurance
is (are) changed to read {See Additional Page(s)}:
The above amendments result in a change in the premium as follows:
X No Changes To Be Adjusted At Audit Additional Premium Return Premium
Authorized Representative Signature:
FARMERS
INSURANCE
914277 1ST EDITION 7-02 Includes Copyrighted Material, Insurance Services Office, Inc., with its permission. E4277101 PAGE 1 OF 2
E4277-ED1
Policy Changes Endorsement Description
CHANGE ADDITIONAL INTEREST
ADDL INSURED - DESIGNATED PERSON OR ORGANIZATION - BP04480197
CITY OF ASHLAND
20 E. MAIN ST.
ASHLAND, OR 97520
LOCATION : 725 BEACH ST
ASHLAND, OR 97520
Removal If Covered Property is removed to a new location that is described on this Policy
Permit Change, you may extend this insurance to include that Covered Property at each
location during the removal. Coverage at each location will apply in the proportion
that the value at each location bears to the value of all Covered Property being
removed. This permit applies up to 10 days after the effective date of this Policy
Change: after that, this insurance does not apply at the previous location.
914277 1ST EDITION 7-02 Includes Copyrighted Material, Insurance Services Office, Inc., with its permission, E4277102 PAGE 2 Of 2
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I
POLICY NUMBER: 60506-82-10 BUSINESSOWNERS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON
OR ORGANIZATION
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS POLICY
SCHEDULE*
Name Of Person Or Organization:
CITY OF ASHLAND
* Information required to complete this Schedule, if not shown on this endorsement, will be shown in the
Declarations.
The following is added to Paragraph C. Who Is An
Insured in the Businessowners Liability Coverage
Form:
4. Any person or organization shown in the Sched-
ule is also an insured, but only with respect to
liability arising out of your ongoing operations
or premises owned by or rented to you.
BP 04 48 01 97 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 ❑