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FARMERS INSURANCE Fax:541-345-9698. Jun 16 2009 11:10am P002/002 <br /> GO~fIP~NY ~$~E: I;'ARMERS YNSUR.ANCE CO~I~',~N'`! OF GR~GtJ~T, i~1Y I;SI3flRC3, O~2 <br /> F~d~DE~C~ ®F l9~~U~~~ F®~ ~~~~4H~~~3~~2 i~T~~~~FS <br /> ZNSURED'S ~I~,`v!E & ADDRESS: t <br /> <br /> . OK-HLi'I $ROVJ1~ PQi'C:'N0: 73.17$3-7.-~~ i <br /> PG;_,_CX F.7TT':Cti: 2ND i <br /> SCOTT C Y3ROWN <br /> SSG S 6'7'T~ S^^ ~.~FNCTit <br /> r, t~,4; 06126: <br /> 2E',(3f~ <br /> r <br /> EXPIR~T':ON ;7.a'='T:: Cf?~i"!N(1©LS :1N' x'.~. CA':tiCEI..~~'~a <br /> SPFLB OR 9'7478 <br /> JSStihG OFFFCr~: I <br /> ' NORTI-YWEST Sx.?ie~ICEgOI~?' 4Gt'\T: 1~iicl-,a.z;i i-$ Gzshca <br /> 23175 ~~V ~e~nzti Street; H?llsbc~=o, OR 97Y.24 <br /> i ACS?vT tiC: 73 1.5 35R ~ ; _ ~ , <br /> AG:;V ~ , _ ,ON-: (~4 _,334 (.4tJG ~ . <br /> year 7 4nak. . <br /> j F~pdef t ~2hiefef~wi9ficatiGr!?'fu;Z~z: <br /> .20()6 DOZ3GE I RANI PU 350(3 R~:G C!-~Y3 2iFJ) ~~3)6lh/L4FC26G:Z6967 <br /> CO{iERAGES m. cNT'RTFS il~ a <br /> HCUSai~DS OF i~OLi,IaRS. <br /> J3G5iI Jn,~ury ! Yla~hn~~:edAJlOxpn~t. ~ tvAed!ca;/ t Corn ~ ~ ! <br /> Y Y'.~. v of igipr. i T <br /> oc,'n~ I Non-~.so # <br /> o i "emu. _ No.C~~~lc Dec+L=ti;;1: Dt~cl~ccible ~ --'--_1--..._.._ i <br /> ,.GO 3G0 5~ ~ ! 1G0 ~ ~ 300 ~ ~ J ~ ~ ~ <br /> ` ! '0 S~Cp7r0 ~CiG ! 7G \C , ti` ~;C ~ <br /> . t:ach E2ih ! Eacn iad: ~ ~ i ~ 's <br /> ~61SOp ~VCiICfE!:C2 J ~4ISOfl eECUFi4rCE ~ ' I :.i{ti7. i°~1C~c:~cs:l <br /> "~'k?is ev:cienc~ ;s sub,~ccr t~ al! o>c tk~e t:errns, ccnd•,rio~s a:~d t_mications set fart:: in :3ae ~o(?cv'3cs a,d ei?dc:rsem.enis <br /> ati:aeh~d tc i4- I; As f~_rr~?shed as a zx~a:t'ar o~ iliigr;raTio~? o~:y a d ~iocs rot c?~ar_~e, mcGJxy exr.^r~d lYle pol~cv n ary <br /> ~vay. ~t s~;~ersec~es aYa.rJreviossly is~ue~ certificar.:r. <br /> CSC 1.?@J^!'1.Gt~C.: ~.C~CltlOna -iI?1.2SEiSt: <br /> S~;a.CO CQlVi~U~YT'x'' CI;EDIT UNYON <br /> 1'O EOX 58025 <br /> ~'T_JI~~J?Lr~ W,~, 9813H-I.G25 <br /> l • <br /> 06/7.5; <br /> 2C)G> <br /> ' ~'.ayh:)f~X,t`:J ~PJ:YL`SQr1;.. LivC Dc;f~ <br /> iviici~ae~ H ~isYaer aC;;ati'-NO: 73 T__5 3,50 <br /> 377 ~bu_ Rd ~ r <br /> "g ;AGE\1"?i-iU\I~`: (~4,,?334-OGly <br /> Eugene OR 97413:-511G <br /> ' 25-6234 5-04 <br /> ~;&234? 0? <br /> -06,1612009 TUE 11.:09 [T~/RY, FIO .5490] QJ002 <br /> <br />