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StateFarnm STATE FARM® <br /> C> <br /> O'( DATE OF NOTICE: DEC 23 2025 <br /> PO Box 2368 CODE: <br /> Bloomington IL 61702-2368 <br /> 41A <br /> AT1 02 A <br /> 000039 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE <br /> CITY OF PLEASANTON ADDRESS LISTED AT THE TOP, LEFT CORNER <br /> ;1PO BOX TON20 CA 94566-0802 OF THIS PAGE REGARDING ANY CHANGE OF <br /> 1• PLEASANTADDRESS INFORMATION. <br /> 1440lollophimlllllllllllllllluIlllhllllilu <br /> O <br /> a <br /> 0 <br /> s <br /> ADDITIONAL INSURED'S NOTICE OF COVERAGE <br /> State Farm Mutual Automobile Insurance Company 378P-FA57-A <br /> NAMED INSURED: POLICY NO: 331 8286-A01-05L COVERAGE: <br /> D&D COMMERCIAL& YR/MAKE/MODEL: 2021 FORD PICKUP BI AND PD LIABILITY <br /> RESIDENTIAL PAINTING INC VIN/CAMPER: 1 FTFW1 RGOMFC64059 $t MIL <br /> $250 DED.COMP. <br /> AND RICE, DAVID AGENT NAME: JILL CASH $1000 DED.COLL. <br /> PO BOX 518 AGENT PHONE: (925)892-8000 <br /> EAGLE ID 83616-0461 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE <br /> NOV 18 2025 UNTIL TERMINATED <br /> POLICY MESSAGES: This policy shown above supersedes policy#3318286-05K. <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 /> 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 /> 8 any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. - --- <br /> FRT <br />