HomeMy WebLinkAboutCOI - Kostielney, Kevin & Elizabeth A - Expires 2021-04-21State Farm
Stale Farm General Insurance Company
PO Box 853907
Richardson, TX 75085-3907
NOTICE OF CANCELLATION
POLICY NUMBER
Homeowners Policy
DATE CANCELED
05-BW-W 147-2
APR 21 2021
8
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0
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AT1 H-02- 2846-FBFF H F DATE DUE PLEASE PAY THIS AMOUNT
CITY OF GIOLO33 ROY HCDO3 Al MAR 252021 $290 Q2
7351 ROSANNA ST Payer - Insured
RA
GILROY CA 95020-6141
Insured:
KOSTIELNEY, KEVIN &
ELIZABETH A
1IhI'I1"111111111111111IIIhhhhhlIIIIIhIIIIIihl111111fll1I1I"II 1514 ROSETTE WAY
GILROY CA 95020-2619
Payer - Insured
SFPP No:
Important Message(s)
1116314102
Location: 1514 ROSETTE WAY
GILROY CA 95020-2619
As of the "Date Prepared" shown below, we have not received the premium required to keep this policy in force. Therefore, this
policy is canceled effective 12:01 a.m. (or NOON if required by state law) on the "Date Canceled" shown hereon. Upon your
written request, we shall then furnish the facts on which this cancellation is based. If full premium payment has been made and/or
is received and accepted prior to or on the date of cancellation, you will receive a Notice of Reinstatement, verifying continuous and
uninterrupted coverage under this policy.
Agent JIM FOSDICK
Telephone (831) 637-4442
State Farm
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Please fold and tear here
MOVING'/ PLEASE.SEE_YOUR STATE FARM AGENT N�RdR=FRFg
INSURED
KOSTIELNEY, KEVIN & ELIZABETH A
POLICY NUMBER
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05-BW-W147-2 HO - HOMEOWNERS
0209104211
."= 17 4303 7919
See reverse for important information.
Please keep this part for your record.
Prepared: MAR 30 2021_
PLEASE RETURN THIS PART WITH YOUR
CHECK MADE PAYABLE TO STATE FARM.
DATE DUE
MAR 25 2021
PLEASE PAY THIS AMOUNT
$290.02
For office use only
0323
Prepared: MAR 30 2021
N 04 Al
Please contact your State Farm Agent if you
have any questions about your policy.
FIRE CANCEL
$290.02
0421
500111100029002 805155440147212502>
When you provide a check as payment, you authorize us either to use information from your check to make a one-time
electronic fund transfer from your account or to process the payment as a check transaction. When we use information
from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same
day we receive your payment, and you will not receive your check back from your financial institution.
(01 f301 rc)
For your protection, you are urged to secure other insurance to prevent any lapse in coverage.
For a list of insurers, please see the "Home Insurance Finder" provided on the California Department of Insurance
website, homeinsurancefinder.insurance.ca.gov. If insurance cannot be obtained through another insurance company,
you may be eligible for fire coverage through the California FAIR Plan. Details may be obtained from this association at:
PO BOX 76924
Los Angeles CA 90076-0924
(800) 339-4099 or (213) 487-0111
www.cfpnet.com
If you believe your policy has been wrongfully canceled, you may have the matter reviewed by the California
Department of Insurance. The Department can be contacted at www.insurance.ca.gov, 1-800-927-HELP (4357) or
Consumer Services Division, 300 South Spring Street, Los Angeles, CA 90013.
(01 f312aa)