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1 <br /> 15DW1 05-11-1999 DECLARATIONS PAGE — 1 OF 3 MATCH 00111 <br /> STATE <br /> ® M <br /> ' STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY <br /> INSURANCE 31303 AGOURA ROAD WESTLAKE VILLAGE CA 91363 <br /> 12 <br /> 11 nY.XI A/y,9 <br /> 70 ��Y-llY�iOLWIA�y0 04 <br /> POLICY NUMBER W27 8388—A24-75L e <br /> 9 00111 <br /> *** THE CITY OSANTA7ANA5&3THE6E <br /> *C* SANTA ANA FINANCING AUTHORITY POLICY PERIO[MAY 03 1949TOJUL 24 1999 6 <br /> *0* THEIR OFFICERS , AGENTS & 3 <br /> *P* EMPLOYEES ATTN JEFF STEVENS 3 <br /> *Y* 20 CIVIC CENTER PLAZA STE M28 <br /> *** SANTA ANA CA 92701-4010 __ <br /> ._ DO NOT PAY PREMIUMS SHOWN ON THIS PAGE, <br /> N A M E D INSURED : ACTIVE PARTITIONS SEPARATE STATEMENT ENCLOSED IF AMOUNT DUE.—— <br /> DESCRIBED YEAR MAKE MODEL BODY STYLE VEHICLE IDENTIFICATION NUMBER CLASS <br /> VEHICLE 1997 FORD F350 <br /> PICKUP 1FTJW36G3VEA67677 1HOHO210 <br /> COVERAGES(AS DEFINED IN POLICY) <br /> SYMBOL-PREMIUM-COVERAGE NAME LIMITS OF LIABILITY SEE REVERSE SIDE FOR IMPORTANT MESSAGE <br /> A $209. 94 BODILY INJURY /PROPERTY DAMAGE LIABILITY <br /> C LIMIT OF LIABILITY—COVERAGE A 1 ,000,000 EACH ACCIDENT <br /> $21 . 32 MEDICAL PAYMENTS <br /> LIMIT OF LIABILITY—COVERAGE C <br /> EACH PERSON <br /> D250 $67. 20 $250 DEDUCTIBLE COMPREHENSIVE <br /> VE <br /> G250 $127. 04 $250 DEDUCTIBLE COLLISION <br /> H $1 . 73 EMERGENCY ROAD SERVICE <br /> R1 $4. 82 CAR RENTAL AND TRAVEL EXPENSES <br /> U $17. 11 UNINSURED MOTOR VEHICLE <br /> LIMITS OF LIABILITY—U <br /> EACH PERSON , EACH ACCIDENT <br /> 30 ,000 <br /> U1 $1 . 65 UNINSURED MOTOR VEHICLE PROPERTY DAMAGE0 ,000 <br /> ADDITIONAL USE OF NON—OWNED CAR COVERAGE <br /> $2. 23 BIPD LIABILITY <br /> $. 43 MEDICAL <br /> $7. 20 PHYSICALPAYMENT DAMAGE <br /> $460. 67 TOTAL PREMIUM FOR POLICY PERIOD MAY 03 1999 TO JUL 24 1999 <br /> $1023. 72 CURRENT 6 MONTH PREMIUM FOR JAN 24 1999 TO JUL 24 1999 <br /> THIS IS YOUR DECLARATIONS PAGE. CONTINUED <br /> PLEASE ATTACH IT TO YOUR AUTO POLICY BOOKLET, <br /> YOUR POLICY CONSISTS OF THIS PAGE,ANY ENDORSEMENTS,AND THE POLICY BOOKLET, FORM 9805. 5 PLEASE KEEP TOGETHER <br /> REPLACED POLICY W278388-75K <br /> M U T L V O L. 155-4976 CA.3 <br /> I <br />