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StateFarm STATE FARM® <br /> c <br /> c�C:® DATE OF NOTICE: SEP 25 2025 <br /> PO Box 2368 CODE: <br /> Bloomington IL 61702-2368 <br /> 48A <br /> AT1 02 A <br /> 000045 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE <br /> CITY OF PLEASANTON ADDRESS LISTED AT THE TOP, LEFT CORNER <br /> piPO BOX 520OF THIS PAGE REGARDING ANY CHANGE OF <br /> PLEASANTON CA 94566-0802 ADDRESS INFORMATION. <br /> IIII111111IIIIn0lnIIIIIIIhIIIIIIIIIIIII11IIII11IIPIIIIIIIII <br /> 8 <br /> 0 <br /> E, <br /> s <br /> ADDITIONAL INSURED'S NOTICE OF COVERAGE <br /> State Farm Mutual Automobile Insurance Company 378F-FA57-A <br /> NAMED INSURED: POLICY NO: 331 8286-A01-05K COVERAGE: <br /> D&D COMMERCIAL& YR/MAKE/MODEL: 2021 FORD PICKUP 81 AND PD LIABILITY <br /> v• RESIDENTIAL PAINTING INC VIN/CAMPER: 1 FTFW1 RGOMFC64059 $t 0 D <br /> $250 DED.COMP. <br /> IL <br /> R AND RICE,DAVID AGENT NAME: JILL CASH Moo DED.COLL. <br /> PO BOX 518 AGENT PHONE: (925)892-8000 <br /> EAGLE ID 83616-0461 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE <br /> SEP 15 2025 UNTIL TERMINATED <br /> F. POLICY MESSAGES: This policy shown above supersedes policy#3318286-05W <br /> co <br /> $ The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance <br /> 13 provided and subject to all policy provisions.The additional insured will be given 20 days notice if the policy is terminated. Until such notice <br /> ,, is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of <br /> cs• any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. <br /> N <br /> FRT <br />