ACCEPTED ANY_ALL AL 08.15.24-10.30.24.pdf
PDF 6 MB Posted
- Attached to
- Master Agreement AZ|CTR071340
- Contract number
- CTR071340
- Issued by
- Arizona
About this file
This document is an automobile insurance policy declaration page and additional insured notice from State Farm Mutual Automobile Insurance Company for K & K Systems, located in Tupelo, MS. The policy is managed through Summers Insurance and Financial Services, Inc. in Aberdeen, MS, and is associated with AZDOT (Arizona Department of Transportation) Risk Management. The policy covers a 2018 Dodge commercial vehicle with the VIN 3C7WRSCL3JG325145, effective from August 15, 2024 to October 30, 2024.
The insurance policy provides comprehensive coverage including liability, medical payments, comprehensive and collision coverage, and uninsured motor vehicle protection. The total premium for the policy period is $308.74, with specific coverage limits such as $1,000,000 for liability and $2,000 deductibles for comprehensive and collision coverage. The policy appears to be a renewal, replacing a previous policy number, and includes a waiver of subrogation in favor of AZDOT. The additional insured notice highlights a loss payable clause protecting the additional insured's interest in the described vehicle, subject to all policy provisions.
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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 .