HomeMy WebLinkAboutInsurance Certificate: Randy & Michelle Baldwin
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CITY QF ASHLAND NOTE: PLEASE NOTIFY STATE FARM AT THE
20 E MAIN ST ADDRESS LISTED AT THE TOP, LEFT CORNER
ASHLAND OR 97520-I~50 OF THIS PAGE REGARDING ANY CHANGE OF
~ ADDRESS INFORMATION.
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N~TIGE OF THIRD PARTY'S ~(7VERAGE
State Farm Mutual Autamabile Insurance Gampany 2333-FAE6A
NAMED INSURED: POLICY NO: i45 5228-A13-37D COVERAGE:
BALDWIN RANDY & MlGHELLE YRIMAKEIMODEL: 2003 CHEVROLET PICKUP $100 DED. GDMP.
3746 DEVILS GARDEN RD VINICAMPER: 1GCEG14X03Z286376 $500 DED, COLL.
" MEDFQRD OR 975049714 AGENT NAME: ROSS WIMMER INS AGENCY INC
o AGENT PHONE: (541)77G-7877
o PQLIGY EFFECTIVE
w MAY 01 2017 UNTIL. TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 1455228-37C.
~ 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
o subject to al! policy provisions. The third party will be giver? 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 ofi any change of interest or
g ownership coming to their attention. Failure to do so will render this policy null and void.
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