HomeMy WebLinkAboutInsurance Certificate: Williwams, Molly Jga*Fx m STATE FARM`
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PO Box 2368
Bloomington IL 61702-2368
42A
AT1 15
001109 0093
CITY OF ASHLAND
20 E MAIN ST
r ASHLAND OR 97520-1814
DATE OF NOTICE: APR 04 2025
CODE:
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
ADDITIONAL INSUIRED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
2275-FAE6-A
NAMED INSURED: POLICY NO:
$500 DED. COLL.
AGENT PHONE:
(541)776-8466
ENDORSEMENT NO:
6028BJ
POLICY EFFECTIVE
MAR 19 2025 UNTIL TERMINATFn
POLICY MESSAGES: This policy shown above supersedes policy# 1556519-37J.
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
is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
any change of interest or ownership coming to their attention, Failure to do so will render this policy null and void.
FRT
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