HomeMy WebLinkAboutInsurance Certificate: Walter, Mark & Christine Jwcvraruv 5 I A I t I-AKIVI'
O G® DATE OF NOTICE: FEB 03 2021
PO Box 853922
Richardson, TX 75085-3922 CODE:
58A .
ATI 15 A
000807 0093 OFNOTE: PLEASE NOTIFY STATE FARM AT THE
20 E
CITY MAIN ASHLANDADDRESS LISTED AT THE TOP, LEFT CORNER
g..4 STTOF THIS PAGE REGARDING ANY CHANCE OF
ASHLAND OR 97520-1849 ADDRESS INFORMATION.
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ADD 1.9NAL INSURED'S NOTICE F COVERAGE
<State Farm Mutual Automobile Insurance Company, ,` , :: • - ' . 95FA-FB62A.` - •
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NAMED INSURED: - POLICY NO: 254 2884-D03-37Y - COVERAGE: .
WALTER,MARK D&CHRISTINE L YR/MAKE/MODEL: 2013 VOLVO 4DR BI AND PD LIABILITY
v 13290 S SQUIRE DR VIN/CAMPER: YV1612FS1D1218342 $2 MIL
N OREGON CITY OR 97045-5911 AGENT NAME: JEFF,LANDSTROM $500 DED.COMP.
c $500 DED.COLL.
o AGENT PHONE: (503)518-7100
ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
JAN 13 2021 UNTIL TERMINATED
ii POLICY MESSAGES: This policy shown above supersedes policy#2542884-37X.
, The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
_.5_.provided and subject to all_,policy„prov_isions.The additionalinsured: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 premiumsHave been'paid."-The additional'insured must notify us within i0-days of ` = "'- -
g any change of interest or ownership corning to their attention. Failure to do so will render this policy null and void.
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ADDITCOL I
NANSURED:S:NOTICE:QF:COVERAG:.: :
State Farm Mutual Automobile Insurance Company 95FA-FB6aA •
NAMED INSURED: . POLICY NO: 254 2884-D03-37Y COVERAGE: '
WALTER,MARK D&:CHRISTINEL . • •YR/MAKE/MODEL: 2013 VOLVO ,4DR • . , - • BI AND PD LIABILITY .
13290 S SQUIRE DR.' ..VIN/CAMPER:
.VIN/CAMPER:. • ,YV1612FS1D121.8342 $2'MIL '
• '
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$250DED COMP '
,
OREGONCITY:OR970.45 591-0 "' '' ._AGENT•NAME:. '.•,JEFF LANDSTROM , ,- $500 DED COLL.,
: . AGENT.PHONE, (503)518-7100 ;. _ .
s
ENDORSEMENT NO :6028BJ POLICY EFFECTIVE^
•' t. • • • JAN 13 2021:UNTIL TERMINATED ,
POLICY�MESSAGES 'This policy shown,above supersedes policy#2542884 37X.;
The policy includes aloss payad
able clause protecting the ditional insureds.interest in the described carto the extent of the insurance =.
provided.and subject to all policy provisions.The.additional insured,Will be,given 10.0a0-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 .
hi 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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