HomeMy WebLinkAboutInsurance Certificate: Kerry Kencairn StateFarm STATE FARM®
00® DATE OF NOTICE: JUN 14 2019
PO Box 5000 CODE:
DuPont, WA 98327-5000
424
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AND OF OFFICID ND FICIR NOTE: PLEASE NOTIFY STATE FARM AT THE ELECTED OFFICIALS OFFICERS & ADDRESS LISTED AT THE TOP, LEFT CORNER
r•• EMPLOYEE'S OF THIS PAGE REGARDING ANY CHANGE OF
pC 20 E MAIN ST ADDRESS INFORMATION.
F*+ < ASHLAND OR 97520-1850 •
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ADDITIONAL INSURER'S NOTICE OF COVERAGE ` ' -
State Farm Mutual Automobile Insurance Company 1281-FAE6A
NAMED INSURED: POLICY NO: 330 3415-A14-37C COVERAGE:
KENCAIRN,KERRY YR/MAKE/MODEL: 2014 SUBARU SPORT WG BI AND PD LIABILITY
a $100,000/$300,000/$100,000
S 147 CENTRAL AVE VIN/CAMPER: JF2SJAHCOEH433306 $250 RED.COMP.
" ASHLAND OR 97520-1714 AGENT NAME: ZEPH ROBERTSON $1000 DER.COLL.
q AGENT PHONE: (541)488-2134
0 ENDORSEMENT NO: 5028BJ POLICY EFFECTIVE
c JUN 05 2019 UNTIL TERMINATED
m POLICY MESSAGES: This policy shown above supersedes policy#3303415-37B.
,, The policy includes a lass 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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