HomeMy WebLinkAboutInsurance Certificate: Walter,Mark D. & Christine L .aavaawin" .71/41C.
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CD-U® DATE OF NOTICE: FEB 09 2022
PO Box 2368
Bloomington IL 61702-2368 CODE:
42A
AT1 15 A
000sas 0093
CITY OF ASHLAND NOTE: PLEASE NOTIFY STATE FARM AT THE
20 E MAIN ST ADDRESS LISTED AT THE TOP, LEFT CORNER
ASHLAND OR 97520-1849 OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
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State Farm Mutual Automobile Insurance Company 95FA-FB62-A
NAMED INSURED: POLICY NO: 410 4205-D03-37 COVERAGE:
WALTER,MARK D&CHRISTINE L YR/MAKE/MODEL: 2013 VOLVO 4DR BI AND PD LIABILITY
r 13290 SQUIRE DR VIN/CAMPER: YV1612FS1D1218342 $2 MIL
g OREGON CITY OR 97045-5911 AGENT NAME: JEFF LANDSTROM $500 DED.COMP.
$500 DED.COLL.
AGENT PHONE: (503)518-7100
ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
DEC 20 2021 UNTIL TERMINATED
11 POLICY MESSAGES: This policy shown above supersedes policy#2542884-37Z.
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
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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State Farm Mutual Automobile Insurance Company 95FA-FB62A
NAMED INSURED: POLICY NO: 410 4205-D03-37 COVERAGE:
WALTER,MARK D&CHRISTINE L YR/MAKE/MODEL: 2013 VOLVO 4DR . BI AND PD LIABILITY
13290 SQUIRE DR VIN/CAMPER: YV1612FS1D1218342 $2 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
DEC 20 2021 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy#2542884-37Z.
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
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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