Laserfiche WebLink
<br />FEB 24,2006 12:06 <br /> <br />~..., I~f" <br />.. <br /> <br />000-000-00000 <br /> <br />CERTIFICATE OF INSURANCE <br /> <br />11I""UIICt <br /> <br />Page 2 <br /> <br />SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE <br />CANCELED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE <br />CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM <br />THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY <br />ANY POLICY DESCRIBED BELOW. <br />This certifies that: ~ STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, IllinoIs <br />o STATE FARM FIRE AND CASUAL TV COMPANY of Bloomington, illinois <br />o STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas, Texas <br />o STATE FARM INDEMNITY COMPANY of Bloomington, IIlino;s, or <br />o STATE FARM GUARANTY INSURANCE COMPANY of Bloomington, Illinois <br />has coverage .n force for the followi"-g._~.,,,.rned Insured as shown belo~:.. . .. _____ _____n__._ <br /> <br />NAMED INSURED: ^LL' iTY '1l\NAC~MENT <br /> <br />ADDRESS OF NAMED INSURFD: <br /> <br />~'/"'lj .s I,A Cjf.:Nf\(~^ ftl.VI). l,()~; ANCjl';[,I',:, C^ 9n(J,3,rl~46()[ <br /> <br />POLICY NUMBER i)6:1-.(16:~3-A16-7~ <br />_.___...".__.._ _~__'_n'.___.. <br />EFFECTIVE DATE <br />OF POLICY en:!"/o" <br />_n__._.....__ <br /> <br />DESCRIPTION OF <br />VEHICU, (InC>ud,ng VIN) <br /> <br />t':NOL <br /> <br />LIABILITY COVERAGE [8] YES <br />. . ..----..,,- <br />LIMITS OF LIABILITY <br />a. Bodily Inlury <br />Each Person <br /> <br />!::.ach Accident <br /> <br />b. Property D.m.ge <br />L___n__ Each Accident <br />I c. Bodily Injury & <br />I Property Damage <br />Single Limit <br />Each Accident <br />PHYSICAL DAMAGE <br />COVCRAGeS <br />. ~..(;~~~~en~iv.... <br /> <br />1 Ml':"'L':GN <br /> <br />DYES <br />$ <br />DYES <br />$ <br />t8l YES <br /> <br />L;t~_ <br /> <br />b. Collision <br /> <br /> <br />II\': lR) <br /> <br />DNO <br /> <br />t8l NO <br /> <br />DOOuctibkl <br />t8l NO <br />Deductible <br /> <br />DNO <br /> <br />~NO <br /> <br />~NO <br /> <br />DYES <br /> <br />DNO <br /> <br />DNO <br /> <br />DyE'S <br /> <br />DYES <br />$ <br />DVES <br />$ <br />DVES <br /> <br />DVES <br /> <br />DNO <br />Deductible <br /> <br />[J YES lJ NO <br />L__...___ Oe<!~otible <br />DYES 0 NO <br />$ Deductible <br />DYES 0 NO <br />.------. <br />DYES 0 NO <br /> <br />DNO <br />Oadudibla <br /> <br />DNO <br />.-..--,,---."'..- <br />DNO <br /> <br />DYES <br /> <br />DNO <br /> <br />DYES <br /> <br />DNO <br /> <br />DYES <br /> <br />DVES <br />$ <br />DYES <br />$ <br />DYES <br />DYES <br /> <br />[lYES <br /> <br />DNO <br /> <br />, <br />i <br />.J <br /> <br />DNO I <br />Deduclible , <br />DNOI <br />Deductible ' <br /> <br />DNO <br />[]NO <br /> <br />DNO <br /> <br />:~T^~'r' A(3FNT /frlJ.8~t O~.I/;>J1!Ofi <br />TiUo Agent's Code Number- Date <br />l'J~me and Address 0' Agent.........______.... . __ <br />WII.I,:^f" II^MMON[)~;. ACENT <br />~TAT~: f"Al{M ':N[iURANCE C()Mr'AN.TF',~; <br />IlHY"l W_OI,Y'MJ'IC ~'\I,VlJ :-;'1'1-: H:W <br />l/.l:3 ANCI::Ll:.::.;, CA 900tjlj <br /> <br />INTERNAL STATE ~AHM USE ONL.V <br />ln42(l:, He.... 07-26-2005 <br /> <br />U ReQ'~e-;t- pennanent C8rtificate of Inl>utance fOr liabIlity f;(;~~~.;9a <br />o Reque~1 Certificate Hol~( 10 be ndded .'$ ~"l Addition..' Insurod <br />