HomeMy WebLinkAboutInsurance Certificate: Bertocchi Builders
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PO Box 5000
Dupont WA 98327.5000
DATE OF NOTICE: MAR 142011
CODE:
30A
ATl
15
A
000134
CITY OF ASHLAND
20 E MAIN ST
ASHLAND OR 97520-1850
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
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-IA-D~1TI0NALlNSURED'S NOTICE OF COVERAGE
Slate Farm Mutual Automobile Insurance Company
NAMED INSURED: POLICY NO: 0026612.F22.37M
~ BERTOOOHI, MARK YR/MAKE/MODEL: 20050HEVROLET PIOKUP
'1' OBA BERTOOOHI BUILDER6 VIN/CAMPER: 1 GCHK23235F847Q07
:: 1860 GABRIEL WAY AGENT NAME: JON SNOWDEN
,; MEDFORD OR 97501.4154 AGENT PHONE: (541)482.2461
I! ENDORSEMENT NO: 6028BJ
9A13.F473-H
COVERAGE:
Bl AND PO LIABiLITY
$1 00,0001$300,0001$50,000
$250 DED. COMP
$1000 DED. COLL
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N POLICY MESSAGES: This policy shown above supersedes policyl 0026612.37L.
~ The polioy includes a IOS8 payable c1allse protecting the additional insured's interest in the de8cribed 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 ia terminated. Until 8uch notice
~ is provided, it shall be presumed that the required renewal premiums have been paid. The additional inaured must notify U8 within 10 days of
~ any change of inter8&t or ownership coming to their attention. Failure to do 80 will render this policy null and void.
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POLlOY EFFEOTIVE
FEB 22 2011 UNTIL TERMINATED
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PO Box 5000
Dupont WA 98327-5000
DATE OF NOTICE: MAR 08 2011
CODE:
4tA
An
15
A
000291
CITY OF ASHLAND
20 E MAIN ST
ASHLAND OR 97520-1850
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY,CHANGE OF
ADDRESS INFORMATION.
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APOITIONl4l.lNSl.IREO'S NOTICE OF COVERAGE
3late Farm Mutual Automobile Insurance Company
,~AMED INSURED: POLICY NO: 0026612.F22.37M
3ERTOCCHI, MARK YR/MAKE/MODEL: 2005 CHEVROLET PICKUP
JBA BERTOCCHI BUILDERS VIN/CAMPER: 1 GCHK23235F847007
1860 GABRIEL WAY AGENT NAME: JON SNOWDEN
~EDFORD OR 97501-4184 AGENT PHONE: (541)482.2461
ENDORSEMENT NO: 6028BJ
9A13.F473-H
COVERAGE:
81 AND PD LIABILITY
$1 00,OOOI$300,DOOI$50.ooo
$250 OED, COMP,
$1000 OED, COLL
POLICY EFFECTIVE
FEB 22 2011 UNTIL TERMINATED
[II
'OLICY MESSAGES: Thia polley ahown above aupersedea policY' 0026612-37L.
rhe policy includes a 1088 payable clause protecting the additional insured's interest in the described car to the extent of the insurance
)rovided and subject to all policy provisions. The additional insured will be given 10 days notice if the policy is terminated. Untilauch notice
8 provided, it shall be presumed that the required renewal premiums have been paid. The additional insured muat notify us within to days of
my change of interest or ownership coming to their attention. Failure to do ao will render this policy null and void.
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