HomeMy WebLinkAboutInsurance Certificate: Williams, Molly StatdfXM STATE FARM®
® DATE OF NOTICE: AUG 25 2025
PO Box 2368
Bloomington IL 61702-2368 CODE::
62A
AT1 15 A
000839 0093
CITY OF ASHLAND NOTE: PLEASE NOTIFY STATE FARM AT THE
20 E MAIN ST ADDRESS LISTED AT THE TOP, LEFT CORNER
ASHLAND OR 97520-1814 OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
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ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 2275-FAE6-A
NAMED INSURED: POLICY NO: 155 6519-C22-37L COVERAGE:
WILLIAMS,MOLLY J YR/MAKE/MODEL:
AGENT NAME: RUSSELL P BROWN INS AGENCY INC $600 DED.COLL.
AGENT PHONE: (541)776-8466
ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
� POLICY MESSAGES: This policy shown above supersedes policy#1556519-37K. AUG 18 2025 UNTIL TERMINATED
$ The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
b 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 wiiMin 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