Insurance Certificate STATE FARM INSURANCE COMPANIES®
IMSURAM% DATE OF NOTICE: MAR 24 2014
Tulsa State 74146 Boulevard '� �11j /]
Tulsa OK 74146 v � CODE:
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SALINA KS. 67402-0736 OF THIS PAGE REGARDING ANY CHANGE OF 5
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.ADDITIONAL:INSURED::S;:NOTICE>.OF>O.:O.VERAGE>:>: 3>s< :»::<::> > > : ><z < > :>:»> >>>» << <: >:<:'>:<:< >>:::: :?>': s>? » :» >>
State Farm Mutual Automobile Insurance Company 9408-FAA9Z
NAMED INSURED: POLICY NO: 078 0344-C13-16H COVERAGE:
e RE PEDROTTI INC YR/MAKE/MODEL: 2012 CHEVROLET PICKUP BI AND PD LIABILITY
N 5855 BEVERLY AVE STE A VIN/CAMPER: 1 GCRKSE7XCZ226341 $500,000
MISSION KS 66202-2609 AGENT NAME: JOHN BURNS $1000 DED.COMP.
$1000 DED.COLL.
> AGENT PHONE: (913)469-9010
& ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
IT; MAR 20 2014 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy#0780344-16G.
7, 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 10 days notice if the policy is terminated. Until such notice .
ui is provided,it shall be presumed that the required renewal prerrmihms have been paid:-The additional insured must notify us-withiml0 days of >--- -- --
9, any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
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` STATE FARM INSURANCE COMPANIES®
DATE OF NOTICE: JUL 29 2013
- 12222 State Farm Boulevard CODE:
Tulsa OK 74146
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PO BOX CITY OF SALINA UTILITIES DEPT ADDRESS LISTED AT THE TOP, LEFT CORNER
SALINA KS 67402-0736 OF THIS PAGE REGARDING ANY CHANGE OF 5
ADDRESS INFORMATION. 4
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State Farm Mutual Automobile Insurance Company 9408-FAASZ
NAMED INSURED: POLICY NO: 063 3743-A22-161 COVERAGE:
o RE PEDROTTI INC YR/MAKE/MODEL: 2012 FORD SPORT WG BI AND PD LIABILITY
N 5855 BEVERLY AVE STE A VIN/CAMPER: 1 FMHK8D89CGA56280 $500,000
MISSION KS 66202-2609 AGENT NAME: JOHN BURNS $1000 DED.COMP.
$1000 DED.COLL.
AGENT PHONE: (913)469-9010
cc ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE
JUL 25 2013 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersedes policy#0633743-16H.
oThe 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 10 days notice if the policy is terminated. Until such notice
• ui--is'provided,it shall be presumed-that the•required-renewal-premiums-have been-paid:-The-additional insured-must notify-us within-10-days-of.-- -- — --
p, any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void.
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