HomeMy WebLinkAboutInsurance Certificate: Walter, Mark D & Christine L StateFarm STATE FARM@
DATE OF NOTICE: JUL 13 2026
PO Box 2368 CODE:
Bloomington IL 61702-2368
16A
AT1 15 A
000620 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE
CITY OF ASHLAND ADDRESS LISTED AT THE TOP, LEFT CORNER
51 WINBURN WAY OF THIS PAGE REGARDING ANY CHANGE OF
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ASHLAND OR 97520-1849 ADDRESS INFORMATION.
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ADDITIONAL INSURED'S.NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 95FA-FB62-A
NAMED INSURED: POLICY NO:
AGENT NAME: JEFF LANDSTROM $500 DED.COLL.
4 AGENT PHONE: (503)518-71,0,0
o ENDORSEMENT NO: 602813J POLICY EFFECTIVE
w JUN 30 2026 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy#4104205-37D.
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The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
o provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice
is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
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any change of interest or ownership coming to their attention. Failure to do so will render this poi
licy null and void.
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ADDITIONALINSOREWS>NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 95FA-FB62-A
NAMED INSURED: POLICY NO:
AGENT NAME: JEFF LAND$tROM $ DED'COMP.
AGENT PHONE: (503)518-710d} $50 0 o DED.COLL.
ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
JUN 30 2026 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy#4104205-37D.
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.
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