HomeMy WebLinkAboutInsurance Certificate: Richard Callagan StaterNM STATE FARMO
A. DATE OF NOTICE: MAY 11 2018
PO Box 853922 CODE:
Richardson, TX 75085-3922
46A
AT1 15 A
CITY OF ASHLA 000677 NO 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE
20 E MAIN ST ADDRESS LISTED AT THE TOP, LEFT CORNER
r ASHLAND OR 97520-1850 OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
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ADDITIONAL INSUIRED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2134-FAE&A
NAMED INSURED: POLICY NO: 089 7708-A18-37E COVERAGE:
CALLAGAN, RICHARD YR/MAKE/MODEL: 2004 TOYOTA PICKUP BI AND PD LIABILITY
$1 MIL
° 265 BALL RD VIN/CAMPER: 5TEWN72N44Z441651 C
OMPREHENSIVE
EAGLE POINT OR 97524-8543 AGENT NAME: RORY WOLD INSURANCE AGENCY INC $1000 DE D. COLL.
9 AGENT PHONE: (541)773-1404
is ENDORSEMENT NO: 60286J POLICY EFFECTIVE
APR 272018 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# 0897708-37D.
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
co 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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FRT