2022/12/13 Act 1 Construction, Inc. (9)StatoErm STATE FARMoT&.PO Box 2368Blooni ng ton I L 6 1 7 02- 2368
DATE OF NOTICE: JAN 05 2023
CODE:
1014ATI 23
001051 0093CITY OF l.IEI'I I FEE29844 HAUN RD
r.tEN I FEE CA 92546-6539Frr.i$
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NOTE: PLEASE NOTIFY STATE FARM AT THE
ADDBESS LISTED AT THE TOP, LEFT CORNER
OF THIS PAGE REGAROING ANY CHANGE OF
ADDBESS INFORMATION.
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ADDITIONAL INSUBED'S NOTICE OF COVERAGE
Stals Farm Mulual Aulomobils lnsurance Company 1045-FACEA
NAMED INSURED: PoLIcY No: 711 4075-A23.75D CoVERAGE:
ACT 1 CONSTRUCTION INC YR/MAKE/MODEL: 2015 INTL TANK TRK Br
^ND
PD LIABILITY
444 6rH Sr VIN/CAMPER: iim,rr,rrvurvrorrooos3l $r'ollto.r. "orr.NORCO CA 92860-1758 AGENT NAME: TONY FREEMAN $2ooo DED. coLt.AGENTPHONE: (sos)s42-6464
ENDORSEMENT NO: 6O28BU POLICY EFFECTIVE
DEC 13 2022 UNTIL TERt\,4iNATED
POLICY MESSAGES: This policy shown above supersedes policy# 7114075-75C.
The policy includes a loss payable clause prolecting the addilional insured's interesi in ihe described car io the exlent o, lhe Lnsurance
provided and subj€ct lo all policy provisions. The addilional insured will be given 30 days noiice ii lhe policy is terminaled. Until such nolice
is provided, it shall be presumed that the required renewal pr€miums have been paid. The addilional insured musl nolily us within 10 days ol
any change ol inlerest or ownership coming lo lheir atlention. Failure to do so will render lhis po icy null and void
ADDITIONAL INSUBED'S NOTICE OF COVERAGE
Stale Farm Mutual Aulomobile lnsurance Company 1045-FACEA
NAMED INSURED: POLICY NO: 636 1132.A02.75H COVERAGE:
ACT 1 CONSTRUCTION INC YR/MAKE/MODEL: 2019 FOBD U.T]L TRK BIAND PD LIABIL]TY
444 6TH ST VIN/CAMPER: 1 F D8W3ET 1 K8C52394 $ 1 MIL
NORCO CA 92860.1758 AGENTNAME: TONY FREEI'AN I3T99 RER 99I4PAGENTPHONE: (9os)e42-6464
ENOORSEMENT NO: 602{iBU PoLIcY EFFECTIVE
DEC 13 2022 UNTIL TERMINATED
POLICY MESSAGES: This policy shown above supersades policy# 6361132-75G.
The policy includes a loss payable clause protecting the addilional insured's interest in the described car lo the extenl of the insurance
provided and subjecl lo all policy provisions. The additional insured will b€ given 30 days notice it the policy is l6rminaled. Until such notice
=. is provided, rl shall be presumed lhal th€ required renewal premiums have b€en paid. The addilional insured musl noliiy us within 10 days ol
N any change ol rnleresl or ownership coming to their atlenlion. Failure lo do so will render lhis F,olicy null and void.
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ADDITIONAL INSURED'S NOTICE OF COVEHAGE
Stale Farm Mulual Aulomobile lnsurance Company 1045-FACEA
NAUED INSURED: PoLIcY No: 7114074-A29.75D covEBAGE:
ACT 1 CONSTBUCTION tNC YR/MAKE/MODEL: 20j3 |NTL TANK TRK Bt AND pD LlABtLtTy
444 6TH ST VIN/CAMPER: r HTMMAAL9DJ254o37 s 1 MIL
NoRCocA s2860-r758 aGENi r.rar',re: roNy FREEMAN 33333BE8.33[AGENTPHONE: (909)942-6464
ENDORSEMENT NO: 60288U POLICY EFFECTIVE
DEC 13 2022 UNTIL TERIVINATED
POLICY MESSAGES: This policy shown above supersedes policy#7114074-75C.
The policy includes a loss payable clause prolecting the additional insured s inle.esl in the described car lo lhe exlenl o, lhe insurance
provided and subjecl to all policy provisions. The additional insured will b€ given 30 days noiice il the policy is terminated. Unlil such notice
^ is provided, il shall be pr8sumed lhal the required renewal premiums havebe€npaid. The addilional insured musl nolify us wilhin l0daysol
fi any change ol rnleresl or ownership coming 10 their atlenlion. Fallure to do so will render this policy null andvoid.
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