Laserfiche WebLink
State&M STATE FARM <br />in. <br />PO box 653922 <br />Richardson, 7X 75005-3922 <br />66A <br />AT1 23 <br />on0939 0093 <br />CITY OF SANTA ANA, ISAOA <br />20 CIVIC CENTER PLZ FL 4TH <br />SANTA ANA CA 92701-405B <br />I'll 111111111111111'Il11111 �1ui�'loll. 11111 <br />DATE OF NOTICE: DEC 04 2019 <br />CODE: <br />NOTE: PLEASE NOTIFY STATE FARM AT THE <br />ADDRESS LISTED AT THE TOP, LEFT CORNER <br />OF THIS PAGE REGARDING ANY CHANGE OF <br />ADDRESS INFORMATION. <br />rADDITIONAL INSURED'S NOTICE OF COVERAGE - - - -- j <br />State Farm Mutual Automobile Insurance Company 7501-FA48-A <br />NAMED INSURED: POLICY NO: 4414187-F24-75W COVERAGE: <br />NANCY K BOHL INC YR/MAKE/MODEL: 201713MW SPORT:WG ON AND Ph LIABILITY <br />N DBA THE COUNSELING TEAM VIN/CAMPER: 5UXKR6C36N0U13705 $ i MIL IS 1 MIL 41 MIL <br />INTERNATIONAL AGENT NAME: SKALA INSURANCE AGENCY INC %10e10DEO.CDMP <br />4 PO BOX 10427 AGENT PHONE: (909)883-8861 $100 DEO. Mt, <br />9 SN BERNRDNO CA 92423-0427 ENDORSEMENT NO:-:60266U POLICY EFFECTIVE <br />OCT 31 2019 UNTIL TERMINATED <br />POLICY MESSAGES: This policy $flown Above supersedes policy# 4414187.75V. <br />The policy includes a lass payable clause protecting the additional insured's interest in the described car to the extent of the insurance <br />o provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is ternimatedUnul such notice <br />m is provided. It shag be presumed that the required renewal premiums have been pald.The additional insured must notify us within 10 days of <br />S any change of interest or ownership coming to their attentien.Failure to do so will render this policy null and void. <br />MT <br />