HomeMy WebLinkAboutInsurance Certificate: Jeremy Holmes StateF&M STATE FARMO
® DATE OF NOTICE: APR 25 2018
PO Box 5000 CODE:
DuPont, WA 98327-5000
63A
AT1 15 A
000792 0093
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
7 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-F29-37H COVERAGE:
HOLMES, JEREMY YR/MAKE/MODEL: 2015 SUBARU STA WAG BI AND PD LIABILITY
v $100,000/$300,000/$100,000
25 SUMMIT AVE VIN/CAMPER: 4S413SACC8173334813 COMPREHENSIVE
MEDFORD OR 97501-2647 AGENT NAME: MANNY SAENZ $500 DED. COLL.
AGENT PHONE: (541)770-2878
ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
APR 23 2018 UNTIL TERMINATED
POLICY MESSAGES:
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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