HomeMy WebLinkAboutInsurance Certificate: Randy Baldwin StateftM STATE FARM@
m DATE OF NOTICE: MAY 09 2018
PO Box 853922
Richardson, TX 75085-3922 CODE:
it 165
AT1 15 A
003037 0055
CITY OF ASHLAND NOTE: PLEASE NOTIFY STATE FARM AT THE
20 E MAIN ST ADDRESS LISTED AT THE TOP, LEFT CORNER
ASHLAND OR 97520-1850 OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
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NOTICE OF THIRD PARTY'S COVERAGE
State Farm Mutual Automobile Insurance Company 2339-FAE6-A
NAMED INSURED: POLICY NO: 145 5228-A13-37F COVERAGE:
a BALDWIN, RANDY YR/MAKE/MODEL: 2015 GMC PICKUP $100 DED. COMP.
1950 MARSH LN VIN/CAMPER: 1GTR1TEC9FZ298030 $500 DED. COLL.
R MEDFORD OR 97501-4548 AGENT NAME: RUSS WIMMER INS AGENCY INC
AGENT PHONE: (541)776-7877
POLICY EFFECTIVE
MAY 07 2018 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 1455228-37E.
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
6 subject to all policy provisions. The third party will be given 10 days notice if the policy is terminated. Until such notice is provided, it shall be
'0 presumed that the required renewal premiums have been paid. The third party must notify us within 10 days of any change of interest or
8 ownership coming to their attention. Failure to do so will render this policy null and void.
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