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RatOMM STATE FARM® <br />PO Box 853922 <br />Richardson, TX 75085-3922 <br />82A <br />AT 1 23 <br />001177 0093 <br />CITY OF SANTA ANA PUBLIC <br />WORKS <br />20 CIVIC CENTER PLZ * M-36 <br />SANTA ANA CA 92701-4058 <br />DATE OF NOTICE: MAY 29 2019 <br />CODE: <br />NOTE: PLEASE NOTIFY STATE FARM AT THE <br />ADDRESS LISTED AT THE TOP, LEFT CORNER <br />OF THIS PAGE REGARDING ANY CHANGE OF <br />ADDRESS INFORMATION. <br />ADDITIONAL INSURED'S NOTICE OF COVERAGE <br />State Farm Mutual Automobile Insurance Company 1 167-FB8A-A <br />NAMED INSURED: POLICY NO: 471 7092-E19-75E COVERAGE: <br />HENNESSEY & HENNESSEY, LLC YR/MAKE/MODEL: NONOWNED AUTO BI AND PD LIABILITY <br />17602 17TH ST STE 102 # 246 VIN/CAMPER: $1 MIL <br />TUSTIN CA 92780-7915 AGENT NAME: TERRY BRADSHAW <br />AGENT PHONE: (714)637-4120 <br />ENDORSEMENT 140: 6028BU POLICY EFFECTIVE <br />6164DP 6165CS MAY 14 2019 UNTIL TERMINATED <br />POLICY MESSAGES: This policy shown above supersedes policy# 4717092-75D. <br />The policy includes a loss payable clause protecting the additional insured's interest In the described car to the extent of the insurance <br />provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminated. Until such notice <br />is provided, it shall be presumed that the required renewal premiums have been paid. The additional Insured must notify us within 10 days of <br />any change of Interest or ownership coming to their attention. Failure to do so will render this policy null and void. <br />rHt <br />