HomeMy WebLinkAboutInsurance Certificate: Mark & Christine Waalter StateFann STATE FARM°
DATE OF NOTICE: APR 22 2019
PO Box 853922
Richardson, TX 75085-3922 CODE:
44A
AT1 15 A
000sss 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE
CITY OF ASHLAND O R 97520-1850 ADDRESS LISTED AT THE TOP, LEFT CORNER
ASHLAND O
20 E MAIN ST OF THIS PAGE REGARDING ANY CHANGE OF
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ADDRESS INFORMATION.
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ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 95FA-FB622A
NAMED INSURED: POLICY NO: 254 2884-D03-37X COVERAGE:
WALTER,MARK D&CHRISTINE L YR/MAKE/MODEL: 2013 VOLVO 4DR BI AND PD LIABILITY
`r 13290 S SQUIRE DR VIN/CAMPER: YV1612FS1 D1218342 $1 MIL/$1 MIL 1 MIL
67 OREGON CITY OR 97045-5911 AGENT NAME: JEFF LANDSTROM $250 DED.COMP.
$500 DED.COLL.
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AGENT PHONE: (503)518-7100
ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
APR 09 2019 UNTIL TERMINATED
• POLICY MESSAGES: This policy shown above supersedes policy#2542884-37W.
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The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
• 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
8 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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ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 95FA-FB62A
NAMED INSURED: POLICY NO: 254 2884-D03-37X COVERAGE:
WALTER,MARK D&CHRISTINE L YR/MAKE/MODEL: 2013 VOLVO 4DR BI AND PD LIABILITY
13290 S SQUIRE DR VIN/CAMPER: YV1612FS1D1218342 $1 MIL/$1 MIL/$1 MIL
OREGON CITY OR 97045-5911 AGENT NAME: JEFF LANDSTROM $250 DED.COMP.
AGENT PHONE: (503)518-7100 $500 DED.LOLL.
ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
APR 09 2019 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy#2542884-37W.
The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
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
Fi 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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