HomeMy WebLinkAboutInsurance Certificate: Williams, Molly awwrarne ,I H I C r'HI'1IVI"
�® DATE OF NOTICE: SEP 21 2023
PO Box 2358 CODE:
Bloomington IL 61702-2358
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ooisso 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE
51 LINBUOR
CITY RNWAY ASHLAND ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
• � ASHLAND OR 97520-1849 ADDRESS INFORMATION.
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. State Farm Mutual Automobile Insurance Company 2275-FAE6-A
NAMED INSURED: POLICY NO: 155 6519-C22-37H COVERAGE:
WILLIAMS,MOLLY J- YR/MAKE/MODEL: 2012 FORD SPORT WG BI/PD LIABILITY
0 1319 HARRISBURG DR VIN/CAMPER: 1FMCUOE72CKC19053 $100,000/$300,000/$100,000
MEDFORD OR 97501-8113 AGENT NAME: RUSSELL P BROWN INS AGENCY INC $100 DED.COMP.
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$500 DED.LOLL.
AGENT PHONE: (541)776-8466
o ENDORSEMENT NO: 6097BC POLICY EFFECTIVE
SEP 22 2023 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy#1556519-37G.
The policy includes a loss payable clause protecting the additional insureds interest in the described car to the extent of the insurance
II" provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice
m is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
6 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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