HomeMy WebLinkAboutSKMBT_C35113042510230STATE FARM INSURANCE COMPANIES@
900 Old River Road
Bakersfield CA 93311-9501
286A
AT1 02 A
000309 0093
TOWN OF TIBURON
1505 TIBURON BLVD
TIBURON CA 94920-2530
DATE OF NOTICE: MAR 18 2013
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 INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
2515-Fl 50-J
NAMED INSURED: POLICY NO:
182 7401-DO9-05F
COVERAGE:
HARRISON, ROBERT YR/MAKE/MODEL:
2013 CHEVROLET 4DR
BI AND PD LIABILITY
26 NEDS WAY VIN/CAMPER:
131 RE6E48DU100586
$ 1 MIL/$ 1 MIL,$ 1 MIL
$100 DED
COMP
TIBURON CA 94920-1580 AGENT NAME:
SHEILA MAGHADO
.
.
$250 DED. COLL.
AG ENT PHONE:
(415)440-9984
ENDORSEMENT NO: 6028BU POLICY EFFECTIVE
APR 09 2013 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policyt 1827401-05E.
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 20 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