HomeMy WebLinkAboutInsurance Certificate: Walter, Mark D.& Christine L .�.. .!. V I f\I L. 11 1 IIYI ..
DATE OF NOTICE: OCT 04 2023
AoPO Box 2368 CODE:
Bloomington IL 61702-2368
105A
AT1 15 A
001784 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE
51 WINBUOR
CITY RNWAY ASHLAND ADDRESS LISTED AT THE TOP, LEFT CORNER
� ASHLAND OR 97520-1849 OF THIS PAGE REGARDING ANY CHANGE OF
- ADDRESS INFORMATION.
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Qly0m0INIAL::INSURED:Sticy icell :C VERACE:<: = : ::<:::::::::*i>:
• State Farm Mutual Automobile Insurance Company • ' •. . , . : • ' '95FA-FB62•A ' ' ";
NAMED INSURED: POLICY NO: 410 4205-D03 37A . COVERAGE:'
WALTER,MARK D&CHRISTINE L ' YR/MAKE/MODEL: 2013 VOLVO 4DR BI AND PD LIABILITY'
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13290 SQUIRE DR VIN/CAMPER: YV1612FS1D1218342 $2
$ OREGON CITY OR 97045-5911 AGENT NAME: JEFF LANDSTROM $5000 D DED.COMP.
qi AGENT PHONE: (503)518-7100 $500 DED.LOLL.
`3o ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
OCT 03 2023 UNTIL TERMINATED
m POLICY MESSAGES: This policy shown above supersedes policy#4104205-37.
The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
S 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.
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State Farm Mutual Automobile Insurance Company 95FA-FB62A
NAMED INSURED: POLICY NO: 410 4205-D03-37A 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
' OCT 03 2023 UNTIL TERMINATED '. ..
POLICY MESSAGES: This policy shown above supersedes.policy#4104205-37. ' . '• ,' .
The'policy includes a loss payable clause protecting the additional insured's'interest in the described canto 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
iiany change of interest or ownership coming to their attention. Failure to'do so will render this policy null and void. ' . .
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