Laserfiche WebLink
DATE OF NOTICE: <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 />NAMED INSURED: <br />STATE FARM <br />POLICY NO: <br />YR/MAKE/MODEL: <br />VIN/CAMPER: <br />COVERAGE: <br />POLICY MESSAGES: <br />12 <br />1 <br />0 <br />0 <br />0 <br />. <br />8 <br />(o <br />1 <br />a <br />0 <br />8 <br />2 <br />1 <br />f <br />) <br />06 <br />- <br />0 <br />6 <br />- <br />2 <br />0 <br />1 <br />4 <br />® <br />FRT <br />CITY OF PLEASANTON <br />200 OLD BERNAL AVE <br />PLEASANTON CA 94566-7016 <br />MAY 13 2022 <br />PO Box 2368 <br />Bloomington IL 61702-2368 <br />IP <br />P <br />D <br />46 <br />9 <br /> <br />0 <br />2 <br />4 <br />9 <br />05 <br />00 <br />0 <br />1 <br />1 <br />5 <br />MA <br />Y <br /> <br />1 <br />2 <br /> <br />2 <br />0 <br />2 <br />2 <br />00 <br />9 <br />3 <br />02 <br />23 <br />A <br />AAT1 <br />000115 0093 <br />23A <br />02 <br />____ <br />____ <br />____ <br />____ <br />ADDITIONAL INSURED'S NOTICE OF COVERAGE <br />State Farm Mutual Automobile Insurance Company <br />469 0249-F28-05E <br />PRADO, LESLI & PRADO, <br />ERNESTO M <br />508 FALCON WAY <br />LIVERMORE CA 94551-2681 <br />KATIE BRAZIL INSURANCE AGY INC <br />(925)344-4696 <br />242B-FA57 <br />2020 LINCOLN SPORT WG <br />2LMPJ8KP9LBL06881 <br />BI AND PD LIABILITY <br />$ 1 MIL <br />COMPREHENSIVE <br />$1000 DED. COLL. <br />POLICY EFFECTIVE <br />MAY 11 2022 UNTIL TERMINATED <br />This policy shown above supersedes policy# 4690249-05D. <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 />AGENT NAME: <br />AGENT PHONE: <br />ENDORSEMENT NO:6028BU <br />-A <br />000115 <br />01 <br />0 <br />1 <br />- <br />S <br />T <br />- <br />- <br />0 <br />0 <br />0 <br />0 <br />Docusign Envelope ID: CF0C4BE7-53EE-4E99-B83C-59AA654D5090