ACCEPTED ANY_ALL AL 08.15.24-10.30.24.pdf
PDF 6 MB Posted
- Attached to
- Master Agreement AZ|CTR069161
- Contract number
- CTR069161
- Issued by
- Arizona
About this file
This document is an automobile insurance policy declarations page and additional insured's notice of coverage from State Farm Mutual Automobile Insurance Company. The policy is issued for K & K Systems, located in Tupelo, MS, with Summers Ins and Fin Svcs Inc as the agent. The policy is associated with AZDOT (Arizona Department of Transportation) Risk Management and covers a 2018 Dodge commercial vehicle.
The policy provides comprehensive coverage for a commercial vehicle with various liability protections, including bodily injury and property damage liability. The policy number is 290 1853-D30-24B, effective from August 15, 2024 to October 30, 2024, with a total premium of $308.74. Coverage includes $1,000,000 limit for each accident, $2,000 deductible for comprehensive and collision coverage, and uninsured motor vehicle coverage. The policy includes a loss payable clause protecting the additional insured's interest in the described vehicle, with provisions for 10-day notice of termination and requirements for notifying the insurer of any changes in ownership or interest.
View the file
Other files
Show all 11
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
G0171 Highlight
G0171 Highlight
G0171 Accepted
DATE OF NOTICE:
CODE:
NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDRESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGARDING ANY CHANGE OF
ADDRESS INFORMATION.
NAMED INSURED:
STATE FARM
POLICY NO:
YR/MAKE/MODEL:
VIN/CAMPER:
COVERAGE:
POLICY MESSAGES:
.8
(o 1a f)
-0 6-
FRT
AZDOT
1324 N 22ND AVE
PHOENIX AZ 85009-3715
JUN 21 2021
PO Box 888818 Dunwoody, GA 30356-9814
IP
PD
JU
N
A
AAT1
000241 0093
25A
ADDITIONAL INSURED'S NOTICE OF COVERAGE
State Farm Mutual Automobile Insurance Company
290 1853-D30-24B
K & K SYSTEMS
687 PALMETTO RD
TUPELO MS 38801-7662 SUMMERS INS AND FIN SVCS INC
(662)369-0337
3262-FBD4
2018 DODGE FLTBDTRK
3C7WRSCL3JG325145
BI AND PD LIABILITY
$ 1 MIL
$2000 DED. COMP.
$2000 DED. COLL.
POLICY EFFECTIVE
JUN 14 2021 UNTIL TERMINATED
This policy shown above supersedes policy# 2901853-24A.
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 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.
AGENT NAME:
AGENT PHONE:
ENDORSEMENT NO: 6028BJ
-A
000241
-S T-
-0
File details come from the government source that posted it. Updated .