HomeMy WebLinkAboutInsurance Certificate: Polaris Land Surveying LLC a46av"4"Die a 1 a 1 G raruV1-
O�-( „ • DATE OF NOTICE: JUN 09 2022
PO Box 2368
Bloomington IL 61702-2368 - CODE:
113A
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000798 oosa NOTE: PLEASE NOTIFY STATE FARM AT THE
THE CITY OF ASHLAND, ITS ADDRESS LISTED AT THE TOP, LEFT CORNER
EMPLOYEES
ELECTED OFFICIALS, OFFICERS & OF THIS PAGE REGARDING ANY CHANGE OF
20EMAINST ADDRESS INFORMATION.
+- ASHLAND OR 97520-1849
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<��?4�'�QIdAL INSUREE3.S. .O. .Ct:.OF.f✓��IERAG ...
State Farm Mutual Automobile Insurance Company 0908-FAE6A
•
NAMED INSURED: POLICY NO: L23 4521-D30-37J • COVERAGE:
POLARIS LAND SURVEYING LLC YR/MAKE/MODEL: 2001 TOYOTA PICKUP BI AND PD'LIABILITY
Z: PO BOX 459 VIN/CAMPER: 5TEWN72N21Z728384 $1 MIL/$1 MIL/$1 MIL
ASHLAND OR 97520-0016 AGENT NAME: JON SNOWDEN INSURANCE AGCY INC $20 DDD.COMP.
AGENT PHONE: (541)482-2461 $200 DED.COLL.
ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
JUN 19 2022 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy#L234521-371.
The policy includes a loss payable clause protecting the additional insureds 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
g any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
FRT