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M 19279 <br />RENEWAL DECLARATIONS (CONTINUED) <br />Office Policy for MENTE INC <br />Polity Number 92-EK-V825-4 <br />IMPORTANT NOTICE: <br />Potri: California law requires us to provide you with Informal for filing complaints with the state Insurance Depanment regarding the <br />coverage and service provided under this policy. <br />Your agent's name and contact information are provided on the front of this document. Another option is to reach am by <br />mail or phone directly to: <br />Slate Farime Executive Customer service <br />PO Box 2320 <br />Bloomington IL 61702 <br />' Phone C1800-STATEFARId(1800-7828332) <br />Department of Insurance complaints should he filed only after you and Slow Farm or your agent or other company <br />representative have failed to reach a satisfanow agreement on a problem. <br />California Department of Insurance <br />Consumer Services Division <br />300 Saint Spring Street <br />Los Angeles, CA 90013 <br />Phone A 1-800 927-HELP (4354 or visit wow insmance ca rrov/01-conaune a <br />NOTICE TO POLICYHOLDER: <br />For a comprehensive description of coverages and forms, please refer to your policy. <br />Policy changes requested before the 'Date Prepared', which appear on this notice, are effective on the Renewal Date of this <br />policy unless otherwise indicated by a separate endorsementbinder, or amended declarations. Any coverage forms attached <br />to this notice are also effective on the Renewal Date of this policy - <br />Policy changes requested after the "Date Prepared' will be sent to your as an amended declarations or as an endorsement to <br />your policy. Billing for any additional premium for such changes will be mailed at a later date. <br />If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any <br />questions about your insurance coverage, contact your State Farm agent. <br />Please keep this with your policy. <br />Prepared <br />MAR 032020 VCopynght State FarmMuaal Pulomobile Insurance Coiryany.2088 <br />CMP-4000 Includes copynglned marmot N lnwrance Services Office, Inc., with Hs prmiszon. <br />019282294 Continued on Reverse Side of Page Page 7 of 8 <br />N <br />Risk M91agYnlehf Dia(aio8 <br />al.`j"ort•ocfr'A REVIEWED S APPROVM BY: <br />®' Risk Management Analyst <br />