COI - Alvin J Elliott Sr - Expires 2022-08-23StateFarm STATE FARM®
0
PO Box 2368
Bloomington IL 61702-2368
DATE OF NOTICE: AUG 03 2022
CODE:
0101-ST -0000
121000.8 (o108210 06-06-2014
90
AT1 02
000950 0055
CITY OF GILROY ITS OFFICERS
OFFICIALS AND EMPLOYEES
PUBLIC WORKS DEPT
7351 ROSANNA ST
GILROY CA 95020-6196
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NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
CROWDED
AUG 0 9 2022
GILROY CITY CLERK'S OFFICE
RE
NOTICE OF TERMINATION OF A THIRD PARTY INTEREST
State Farm Mutual Automobile Insurance Company
NAMED INSURED:
ELLIOTT SR, ALVIN J
DBA ALS SEPTIC TANK SERVICE
PO BOX 2225
MORGAN HILL CA 95038-2225
POLICY NO: 052 8917-B22-050
YR/MAKE/MODEL: 1995 INTERNATNL TRUCK
VIN/CAMPER: 1 HTGLADTOSH676617
AGENT NAME: ANDREW EDWARDS
AGENT PHONE: (408)782-3000
3737-FBFFA
COVERAGE:
BI AND PD LIABILITY
3RD PARTY INTEREST TERMINATED
EFFECTIVE AUG 23 2022
POLICY MESSAGES:
Protection of the third party's interest provided by this policy is terminated as of the effective date above for the following reason:
Cancellation of Liability Coverage. This advance notice is solely to protect the third party's interests as they are affected by the ownership,
maintenance, or use of the car described in the policy.
FRT