COI - Applied Survey Research, Inc. - Expires 2023-05-11II
StateFarm STATE FARM®
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POBox2368
Bloomington IL 61702-2368
16A
AT1 02
000111 0093
CITY OF GILROY ISAOA
7351 ROSANNA ST
GILROY CA 95020-6196
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DATE OF NOTICE: JUN 08 2022
CODE:
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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State Farm Mutual Automobile Insurance Company
NAMED INSURED: POLICY NO: 335 2611-B06-05Y
'<I' CONNERY, SUSAN B & PETER & YR/MAKE/MODEL: NONOWNED AUTO
0 APPLIED SURVEY RESEARCH IN VIN/CAMPER:
i ~~~r6N1S1tIE CA 95077-1927 :g~~i ~~~~~= t~~\)~~~-~666
:,g ENDORSEMENT NO: 6028BU
c-6164DP 6165CS
f,ii POLICY MESSAGES: This policy shown above supersedes policy# 3352611-05X.
2551-FC05-A
COVERAGE:
Bl AND PD LIABILITY
$1 MIL
POLICY EFFECTIVE
MAY 11 2022 UNTIL TERMINATED
'i 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 1erminated. Until such notice
co is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of g 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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