TEMPORARY AUTO
IDENTIFICATION CARD
STATE FARM®
This card is invalid if the policy for which it was issued lapses or is terminated.
CAR INSURANCE CARD IF YOU HAVE AN ACCIDENT-
NOTIFY POLICE IMMEDIATELY
POLICY NUMBER 276 4521-C30-42A 001
1. Get names, addresses, and phone numbers of persons involved and
INSURED DAWSON,JORDAN D witnesses. Also get driver license numbers of persons involved and license
plate numbers/states of vehicles.
2. Don't admit fault or discuss the accident with anyone but State Farm or
police.
EFFECTIVE DATE FEB-23-2016 EXPIRATION DATE SEP-30-2016
3. Promptly notify your agent, log on to statefarm.com®, or visit State Farm
CAR-YEAR/MAKE/VEHICLE IDENTIFICATION NUMBER Pocket Agent® to file a claim.
2014 TOYOTA YARIS 4D HB 4CYL GA
VNKKTUD37EA008472 For Emergency Road Service call 1-877-627-5757
If coverage A is indicated on the left side of this card, then the
COVERAGES
A BODILY INJURY/PROPERTY coverage provided by the policy meets the requirements of the
DAMAGE LIABILITY Tennessee Financial Responsibility Law of 1977.
D COMPREHENSIVE $500
G COLLISION $500 HOW TO IDENTIFY YOUR COVERAGES
U1
AGENT
TEMPORARY
NICHOLS, DOUG
NAIC # 25143
A
C
SEE POLICY FOR FULL NAME AND DEFINITION
Liability
Medical Payments
S Death, Dismemberment
and Loss of Sight
5724 WESTERN AVE D Comprehensive U Uninsured Motor Vehicle - BI
KNOXVILLE, TN 37921
G Collision U1 Uninsured Motor Vehicle - BI/PD
H Emergency Road Service UNOC Use of Nonowned Cars
PHONE# 865-588-0106 L Physical Damage Z Loss of Earnings
R1,R2 Car Rental and Travel
STATE FARM® Expense
Because many states require evidence of insurance on demand, one copy of this form
should be carried in the vehicle at all times.
A toll free number is available for Emergency Road Service and is located on your
insurance card.
1001607 2002 137877 201 05-17-2012
