HomeMy WebLinkAboutCOI - Applied Survey Research, Inc. - Expires 2022-04-06StateFarm STATE FARM®
PO Box 853922
Richardson, TX 75085-3922
DATE OF NOTICE: APR 23 2021
CODE:
0101-ST -0000
121000.8 (c1 a0821f) 06-06-2014
36A
AT1 02
000132 0093
CITY OF GILROY ISAOA
7351 ROSANNA ST
GILROY CA 95020-6196
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A
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
NAMED INSURED:
CONNERY, SUSAN B & PETER &
APPLIED SURVEY RESEARCH IN
PO BOX 1927
WATSONVILLE CA 95077-1927
335 2611-B06-05R
NONOWNED AUTO
JILL JUDD
ENDORSEMENT NO: 6028BU -1666 POLICY EFFECTIVE
6164DP 6165CS
POLICY MESSAGES: This policy shown above supersedes policy# 3352611-05Q.
The policy includes a loss payable clause protecting the additional insureds 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 terminated. Until such notice
is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
2551-FC05-A
COVERAGE:
BI AND PD LIABILITY
$ 1 MIL
POLICY NO:
YR/MAKE/MODEL:
VIN/CAMPER:
AGENT NAME:
AGENT PHONE:
APR 06 2021 UNTIL TERMINATED
FRT
DATE OF NOTICE: APR 21 2021
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