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ateFarm STATE FARM' <br /> ` ' DATE OF NOTICE: JAN 27 2026 <br /> PO Box 2368 CODE: <br /> Bloomington IL 61702-2368 <br /> 53A <br /> AT1 02 A <br /> 000054 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE <br /> CITY OF PLEASANTON ADDRESS LISTED AT THE TOP, LEFT CORNER <br /> PO BOX 520OF THIS PAGE REGARDING ANY CHANGE OF <br /> PLEASANTON CA 94566-0802 ADDRESS INFORMATION. <br /> iIi1, 'uiuIlllill1IuiuldIIllhilIiIII'IIilliilIIIIIIIIII1109II <br /> ADDITIONAL INSURED'S NOTICE OF COVERAGE <br /> State Farm Mutual Automobile Insurance Company 378F-FA57-A <br /> NAMED INSURED: POLICY NO: 331 8286-A01-05N COVERAGE: <br /> 0&D COMMERCIAL& YR/MAKE/MODEL: 2021 FORD PICKUP BI AND PD LIABILITY <br /> RESIDENTIAL PAINTING INC VIN/CAMPER: 1FTFW1RGOMFC64059 $t MIL <br /> $250 DED.COMP. <br /> AND RICE,DAVID AGENT NAME: JILL CASH $1000 DED.LOLL. <br /> PO BOX 518 AGENT PHONE: (925)892-8000 <br /> EAGLE ID 83616-0461 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE <br /> JAN 01 2026 UNTIL TERMINATED <br /> POLICY MESSAGES: This policy shown above supersedes policy#3318286-05M. <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 /> any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. <br /> FRT <br />