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12/23 '98 13 23 ID :STATE FARM — LAWTON INS . FAX :541- 485 -4326 PAGE 2 <br /> CERTIFICATE OF INSURANCE <br /> SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERWISE <br /> TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT IN NO <br /> EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE <br /> DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. <br /> This cenifies that: >4 STATE FARM MUTUAL AU I OMOBILE INSI IRANCF COMPANY n1 Bloomington, Illinois. or <br /> I 1 SIATE FARM FIRP AND CASUALTY COMPANY 01 I3lrxnnirkjlcxl, Illinois <br /> has coverage in force for the tollowino Namlnsured as shown bel w: ,, - n f� �s. <br /> Named Insured kee L. I .( .Ji `'"`�f� Ie " 4 • . <br /> Address of Named Insured ... ..65(7 . N 7 1 vf c''S <br /> h e ,3.0_.c -._0 . .. . ` 7 7 4 ? Z ? -•e_... ..- _.... <br /> POI ICY NUMBER 0 ( 15 - t D 9oX A3 ? <br /> Of POi ICY EFFECTIVE DATE -_ (, I ' . 7 ( c 1( <br /> POl • �( L <br /> DESCRIPTION OF 1 -( io e <br /> VI Hici f ` 4 4 C [I) SYCGLII (o oao 72, <br /> I 1/0411 11Y COVI HAGI 4. YU'S r. NO r 1 YES I I NO 1 1 YES 1 . 1 NO r 1 YES FT NO <br /> LIMIIR 01 LIABIIJIY ^� <br /> a. Bn Ny Injury <br /> Each Person /e) D (DO <br /> no, A illunl... • 3 00 ( DO a . -_.... — <br /> b. Property unnwge . , 00 O <br /> poi Aw nl idu . . <br /> c Kw Ii' ry a Aupi'ty <br /> Dane Swop txrA <br /> Lads AU:itfont <br /> PIIYSICAI. DAMAGE I,KYLS I.. I NO I 1 YI s r I NO I l YI S r No I .•] Y1•$ I._ 1 NO <br /> COVERAGES <br /> 1 o E:a)qplelwnsivr)_ _ $ ,1b0 Oxkwtiblu $_ •.. , • Deductible $ __._._ Loehr lible $ ....... _.... DeducliWu_ <br /> I4 YES I. 1 NO I 1 YES 1 1 NO I. I YES 1. •.I NO 1 1 YES 1 1 NO <br /> b. Collarnn $.2 Onodut:liblu $ Duducliblu _.._.$ ._.._.... Deduclutblu - $ Dudutit4t <br /> Nc)N owNrest I 1.1 YES I5(NO 1 1 YES I 1 NO I ..I YLh 1 No f 1 YES [ 1 NO <br /> COVERAGE — <br /> HIRE C VEIIAOL 1 1 YLR ( N O L....I YFG ( .1 N() ( I Yrs 1 I No I vrs [,] No <br /> Sig uro of Authorized Roprot:nntativo W1ille Agertl's Coda NI ml'xar Dato <br /> Name and Address of Certificate H Name and Address of Agent <br /> 1 . . I . <br /> C,4 f '.hM ,.. I'AIIAWTON <br /> 1 •FnRM INSURANCi• <br /> ,(� 1 ' Coburg ROad <br /> .�� ( �". Lk ir.bb4RNC� I.ugene, OR97401 <br /> / D td 1.'4 1 ) 48.) - 62011 <br /> `6 <br /> L /''f%wl , d 1 7 /o- I 1 <br />