COI - Brian Porenval - Expires 2022-10-02DIVIDE INSURANCE AGY
102-,5 FAIR OAKS #202
FAIR OAKS, CA 95628
PR99RE111YE'
C0MMERC/AL
BRIAN PROVENCAL
TURLEY & ASSOCIATES
2431 CAPITOL AVE
SACRAMENTO, CA 95816
Final Bill
BRIAN PROVENCAL
Policy Number: 04377418-6
Underwritten by:
United Financial Cas Co
Date of Mailing: October 4, 2021
Policy Period: Oct 2, 2021 - Oct 2, 2022
Page 1 of 1
DIVIDE INSURANCE AGY
1-916-961-0553
Online Service
progressiveagent.com
Customer Service
1-800-444-4487
Please note that you no longer have insurance with us, effective October 2, 2021.
Your policy was canceled at your request. Please see your payment summary below for more information.
If you've scheduled a payment, we've canceled it; please pay the amount due (if any).
If you have questions about your cancellation, or would like to learn how to keep this policy or purchase a new one,
please call your Agent.
..................................................................................................................
Policy premium for coverage until October 2, 2021 $0.00
Total
Total amount paid
...............................................
Total refund amount
Fonn 6269 (10r 10)
DIVIVE INSURANCE AGY
10235 FAIR OAKS #202
FAIR OAKS, CA 95628
THE CITY GILROY
7351 ROSANNA ST
GILROY, CA 95020
Additional insured endorsement
Name of Person or Organization
THE CITY GILROY
7351 ROSANNA ST
GILROY, CA 95020
RR94GRE11/11F
COMMERCIAL
Policy number: 04377418-6
Underwritten by:
United Financial Cas Co
Insured:
BRIAN PROVENCAL
October 4, 2021
Policy Period: Oct 2, 2021 - Oct 2, 2022
Mailing Address
United Financial Cas Co
PO Box 94739
Cleveland, OH 44101
1-800-444-4487
For customer service, 24 hours a day,
7 days a week
The person or organization named above is an insured with respect to such liability coverage as is
afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of
another insured and then only to the extent of that liability. We also agree with you that insurance
provided by this endorsement will be primary for any power unit specifically described on the
Declarations Page.
Limit of Liability
Bodily Injury Not applicable
Property Damage Not applicable
Combined Liability $1,000,000 each accident
All other terms, limits and provisions of this policy remain unchanged.
This endorsement applies to Policy Number: 04377418-6
Issued to (Name of Insured): BRIAN PROVENCAL
TURLEY & ASSOCIATES
Effective date of endorsement:10/02/2021
Form I i98 (0 i,04)
Policy expiration date: 1010212022