HomeMy WebLinkAboutCOI - Applied Survey Research, Inc. - Expires 2022-05-2530115etarm STATE FARM`''
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PO Box 853922
Richardson, TX 75085-3922
25A
AT 1 02
000120 0093
CITY OF GILROY ISAOA
7351 ROSANNA ST
r•• GILROY CA 95020-6196
�Illll�lllllllll��l�ll�lllll���lllllllllll��ll��lillllllll�ill��l
DATE OF NOTICE: JUN 17 2021
CODE:
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 2551-FC05-A
NAMED INSURED: POLICY NO: 335 2611-806-05U COVERAGE:
CONNERY, SUSAN B & PETER & YR/MAKE/MODEL: NONOWNED AUTO BI AND PD LIABILITY
c APPLIED SURVEY RESEARCH IN VIN/CAMPER: $ t MIL
oN PO BOX 1927 AGENT NAME: JILL JUDD
WATSONVILLE CA 95077-1927 AGENT PHONE: (831)462-1666
o ENDORSEMENT NO: 6028BU POLICY EFFECTIVE
w 6164DP 6165CS MAY 25 2021 UNTIL TERMINATED
CY POLICY MESSAGES: This policy shown above supersedes policy# 3352611-05T.
The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
o provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminated. 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
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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StateFang STATE FARM®
m
PO Box 853922
Richardson, TX 75085-3922
21A
AT1 02
000133 0093
CITY OF GILROY ISAOA
7351 ROSANNA ST
•• GILROY CA 95020-6196
KMAe
'll'lll�lll'lllllll"I'llll'III'11'llllll'llllll'llllllllllllllll
DATE OF NOTICE: JUN 16 2021
CODE:
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
ADDITIONAL INSUREDS NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
2551-FC05•A
NAMED INSURED: POLICY NO:
335 2611-806-05U
COVERAGE:
CONNERY, SUSAN B & PETER & YR/MAKE/MODEL:
NONOWNED AUTO
BI AND PD LIABILITY
APPLIED SURVEY RESEARCH IN VIN/CAMPER:
$ 1 MIL
PO BOX 1927 AGENT NAME:
JILL JUDD
WATSONVILLE CA 95077-1927 AGENT PHONE:
(831)462-1666
ENDORSEMENT NO: 6028BU
POLICY EFFECTIVE
6164DP 6165CS MAY 25 2021 UNTIL TERMINATED
N POLICY MESSAGES: This policy shown above supersedes policy# 3352611-05T.
The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
o 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
cs 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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