HomeMy WebLinkAboutInsurance Certificate: Polaris Land Surveying LLC (3) O 0 DATE OF NOTICE: JUN 10 2022
PO Box 2358 CODE:
Bloomington IL 61702-2358
73A
AT1 15 A
000549 ooss NOTE: PLEASE NOTIFY STATE FARM AT THE
THE CITY OF ASHLAND, ITS ADDRESS LISTED AT THE TOP, LEFT CORNER
ELECTED OFFICIALS, OFFICERS OF THIS PAGE REGARDING ANY CHANGE OF
l z & EMPLOYEES
� 20 E MAIN ST ADDRESS INFORMATION.
ASHLAND OR 97520-1849
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State Farm Mutual Automobile Insurance Company 090B-FAE&A
NAMED INSURED: ' POLICY NO: 090 4953-B09-37G COVERAGE:
POLARIS LAND SURVEYING LLC YR/MAKE/MODEL: 1999 TOYOTA PICKUP BI AND PD LIABILITY
g PO BOX 459 VIN/CAMPER: 4TAWN72NXXZ489828 $1 MIL/St MIL/$1 MIL
R ASHLAND OR 97520-0016 AGENT NAME: JON SNOWDEN INSURANCE AGCY INC $50 DED.COMP.
AGENT PHONE: (541)482 2461 $250 DED.LOLL.
ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
F MAY 19 2022 UNTIL TERMINATED
CM POLICY MESSAGES: This policy shown above supersedes policy#0904953-37F.
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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
al 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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