HomeMy WebLinkAboutCertificate of Insurance*
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State&rM STATEFARM#
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PO Box 2358
Bloomington u0/702a358
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THE TOWN OF LOS ALTOS HILLS,
ITS ELECTIVE AND APPOINTED
OFFICERS EMPLOYEES" AND
VOLUNT
EERS 26379 FREMONT RD
LDS ALTOS HLS CA 94022
111111-11111-11- HII- 11-111. 1111111111111 1111111111111
A
DATE 0FNOTICE: JUN 3U2082
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
State Farm Mutual Automobile Insurance Company �---
NAMED INSURED: POLICY NO: V27 4276 -A21 -05U
ATK|NG.ALEXANDER YR/MAKE/MODEL: 2022 HONDA SPORT WG BI AND PD LIABILITY
26S9OORCHARD HILL LN VIN/CAMPER: 5J8RW1H84NAU11938 |L
LOS ALTOS HLGCA 84022�416 JAMES mu»»oeo�oo�p�
AGENT '~~~'^' mnnoDED. COLL.
AwEN(650)941-5000
ENDORSEMENT NO: 8O288U POLICY EFFECTIVE
POLICY MESSAGES: This policy shown aboved|| y#V27427OO5T JUN 152O22UNTIL TERMINATED
The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance
provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminated. Until such notice
mprovided, Ushall Uopresumed that the required renewal premiums have been paid. The additional insured must notify uowithin 10days of
any change nfinterest orownership coming totheir attention. Failure todoouwill render this policy null and void.
FRT