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Stafthfl!m STATE FARM® <br />® PO Box 2358 <br />Bloomington IL 61702-2358 <br />165A <br />AT1 19 <br />001671 0093 <br />CITY OF PLEASANTON <br />IT'S OFFICERS, EMPLOYEES <br />AND AGENTS <br />PO BOX 520 <br />PLEASANTON CA 94566-0802 <br />lll1lll1llll'llJill "1'Il'Illlill'Illll'Ii1'Illlllllllll'Illllll <br />DATE OF NOTICE: AUG 19 2025 <br />CODE: <br />NOTE: PLEASE NOTIFY STATE FARM AT THE <br />ADDRESS LISTED AT THE TOP, LEFT CORNER <br />OF THIS PAGE REGARDING ANY CHANGE OF <br />ADDRESS INFORMATION. <br />State Farm Mutual Automobile Insurance Company <br />6BBC-FB04A <br />NAMED INSURED: <br />POLICY NO: <br />G55 6793 -B19 -59D <br />COVERAGE: <br />BI AND PD LIABILITY <br />SLOANE, LAWRENCE & SANDRA <br />YR/MAKE/MODEL: <br />2019 FORD SPORT WG <br />$1 MIL/$1 MIL1 MIL <br />$ <br />9830 GIAVENO CIR UNIT 1633 <br />VIN/CAMPER: <br />1FMCUGHDOKUA30261 <br />COMPREHENSIVV E <br />NAPLES FL 34113-8374 <br />AGENT NAME: <br />TIM COLLIER INS AGCY INC <br />$250 DED. COLL. <br />AGENT PHONE: (239)541-4444 <br />ENDORSEMENT NO. 6028BV <br />POLICY EFFECTIVE <br />JUL 30 2025 UNTIL TERMINATED <br />POLICY MESSAGES: This policy shown above supersedes policy# G556793 -59C. <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 10 days notice if the policy is terminated. Until such notice <br />cc 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 sa-v+ft render this policy null and void. - - <br />N <br />r <br />FRT <br />