HomeMy WebLinkAboutInsurance Certificate: Walter, Mark D & Christine L (2) StatehrM STATE FARM®
DATE OF NOTICE: JUL 22 2026
PO Box 2368 CODF:
Bloomington IL 61702-2368
12A
AT1 15 A
000559 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE
CITY OF ASHLANO ADDRESS LISTED AT THE TOP, LEFT CORNER
51 WINBURN WAY
ASHLAND OR 9752®-I49 OF THIS PAGE REGARDING ANY CHANGE OF
AS
ADDRESS INFORMATION.
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F�DITI4NAL INSURED'.S NOTICE OF COVERACE
State Farm Mutual Automobile Insurance Company 95FA-FB62-A
NAMED INSURED: POLICY NO:
AGENT NAME: JEFF LANDSTROM $500 DED.COLL.
AGENT PHONE: (503)518-7100
o ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
JUL 20 2026 UNTIL TERMINATED
POLICY MESSAGES:
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
cois 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 policy null and void.
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ADDITIONAL INSUREDS NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company 9517A-FB62A
NAMED INSURED: POLICY NO:
AGENT NAME: JEFF LANDSTROM $250 DED.COMP.
AGENT PHONE: (503)518-7100 $500 DED.COLL.
ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
JUL 20 2026 UNTIL TERMINATED
POLICY MESSAGES:
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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