State Farm - 190 Walnut AvePO Box 2358
Bloomington IL 61702-2358
DATE OF NOTICE: MAR 01 2023
CODE:
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000086 0093
CITY OF CAMPBELL REDEVELOPMENT
AGENCY, ITS OFFICERS, EMP &
VOLUNTEERS, ATTN:BOB KASS
70 N FIRST ST
CAMPBELL CA 95008-1459
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NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
3348-FC05-A
NAMED INSURED: POLICY NO:
V22 9669-005-05S
COVERAGE:
OBERDORFER, JEFF J YR/MAKE/MODEL:
2021 VOLKSWAGEN 4DR
BI AND PD LIABILITY
190 WALNUT AVE APT 207 VIN/CAMPER:
3VWC57BU3MM003529
$ 1 MIL
$1000 DED. COMP.
SANTA CRUZ CA 95060-3970 AGENT NAME:
LAUREEN YUNGMEYER
$1000 DED. LOLL.
AGENT PHONE:
(831)423-4700
ENDORSEMENT NO:
6028BU
POLICY EFFECTIVE
FEB 27 2023 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# V229669-05R.
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
is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
FRT
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PO Box 2358
Bloomington 1L 61702-2358
35A
AT1 02
000085 0093
CITY OF CAMPBELL AND CITY OF
CAMPBELL DEVELOPMENT AGENCY
ATTENTION BOB KASS
70 NORTH 1ST ST
CAMPBELL CA 95008-1459
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DATE OF NOTICE: MAR 01 2023
CODE:
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
ADDITIONAL INSUREVS NOTICE OF COVERAGE ::1
State Farm Mutual Automobile Insurance Company 3348-FC05-A
NAMED INSURED: POLICY NO: V22 9669-005-05S COVERAGE:
OBERDORFER, JEFF J YR/MAKE/MODEL: 2021 VOLKSWAGEN 4DR BI AND PD LIABILITY
190 WALNUT AVE APT 207 VIN/CAMPER: 3VWC57BU3MM003529 $ 1 MIL
SANTA CRUZ CA 95060-3970 AGENT NAME: LAUREEN YUNGMEYER $1000 DED. COMP.
$1000 DED. LOLL.
AGENT PHONE: (831)423-4700
ENDORSEMENT NO: 6028BU POLICY EFFECTIVE
FEB 27 2023 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy# V229669-05R.
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
is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of
any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
FRT