CERTIFICATE OF INSURANCE CARDS

STATE FARM®

STATE OF MICHIGAN - CERTIFICATE OF NO FAULT INSURANCE

SECRETARY OF STATE'S COPY
SECRETARY OF STATE'S COPY
This certificate shall be filed with your applications for vehicle registration. An PENALTY FOR OPERATION WITHOUT INSURANCE
authorized Michigan insurer, certifies that it has issued a policy complying with
Act 294, P.A. 1972. as amended for the described motor vehicle.
INSURED POLICY NUMBER 725 6846-F14-22C Michigan Law requires that the owner or registrant of a motor vehicle
SOMERVILLE,LYNN M registered in this state must have insurance or other approved security for the
3416 HALEH CIR SE APT H payment of no-fault benefits on the vehicle at all times. An owner or registrant
GRAND RAPIDS, MI 49546-5957
who drives or permits a vehicle to be driven upon a public highway without
the proper insurance or other security is guilty of a misdemeanor.
A person convicted of such a misdemeanor shall be fined not less than
$200.00 nor more than $500.00, imprisoned for not more than 1 year, or both.
EFFECTIVE DATE EXPIRATION DATE
OCT-18-2023 DEC-14-2023
CAR-YEAR/MAKE/VEHICLE IDENTIFICATION NUMBER
2010 JEEP GR CHEROKEE LAREDO 4W A person who supplies false information to the secretary of state under this
1J4PR4GK4AC103239

TEMPORARY
section or who issues or uses an invalid certificate of insurance is guilty of a
State Farm Mutual Automobile Insurance Company misdemeanor punishable by imprisonment for not more than 1 year, or a fine
of not more than $1,000.00, or both.
AGENT LUKE BAGNALL INS AGENCY
1277 36TH ST SW
WYOMING, MI 49509-3469
PHONE# 616-534-8608 WARNING - When a named excluded person operates a vehicle, all
liability coverage is void - no one is insured. Owners of the vehicle and
others legally responsible for the acts of the named excluded person
*EXPIRATION DATE APPLIES ONLY IF PREMIUM HAS BEEN PAID. remain fully personally liable.
STATE FARM®

STATE OF MICHIGAN - CERTIFICATE OF NO FAULT INSURANCE KEEP THIS CERTIFICATE IN YOUR VEHICLE AT ALL TIMES, If you fail to
produce it upon a police officers's request, you will be responsible for a
KEEP THIS CERTIFICATE IN YOUR VEHICLE civil infraction.

An authorized Michigan insurer, certifies that it has issued a policy complying

with Act 294, P.A. 1972. as amended for the described motor vehicle. PENALTY FOR OPERATION WITHOUT INSURANCE
INSURED POLICY NUMBER 725 6846-F14-22C Michigan Law requires that the owner or registrant of a motor vehicle
SOMERVILLE,LYNN M registered in this state must have insurance or other approved security for the
3416 HALEH CIR SE APT H payment of no-fault benefits on the vehicle at all times. An owner or registrant
GRAND RAPIDS, MI 49546-5957 who drives or permits a vehicle to be driven upon a public highway without
the proper insurance or other security is guilty of a misdemeanor.
A person convicted of such a misdemeanor shall be fined not less than
$200.00 nor more than $500.00, imprisoned for not more than 1 year, or both.
EFFECTIVE DATE EXPIRATION DATE
OCT-18-2023 DEC-14-2023
CAR-YEAR/MAKE/VEHICLE IDENTIFICATION NUMBER A person who supplies false information to the secretary of state under this
2010 JEEP GR CHEROKEE LAREDO 4W section or who issues or uses an invalid certificate of insurance is guilty of a
1J4PR4GK4AC103239 misdemeanor punishable by imprisonment for not more than 1 year, or a fine

AGENT
TEMPORARY
State Farm Mutual Automobile Insurance Company
LUKE BAGNALL INS AGENCY
of not more than $1,000.00, or both.

WARNING - When a named excluded person operates a vehicle, all

1277 36TH ST SW liability coverage is void - no one is insured. Owners of the vehicle and
WYOMING, MI 49509-3469 others legally responsible for the acts of the named excluded person
PHONE# 616-534-8608
remain fully personally liable.

*EXPIRATION DATE APPLIES ONLY IF PREMIUM HAS BEEN PAID. For EMERGENCY ROAD SERVICE use the State Farm mobile app,
log on to statefarm.com, or call 877-627-5757.
STATE FARM®

Emergency Road Service information is located on your insurance card.

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