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15DW1 05-11- 1999 DECLARATIONS PAGE <br /> 2 OF 3 MATCH 00110 <br /> STATE FARM <br /> o STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY <br /> ®'O <br /> INSURANCE 31303 AGOURA ROAD WESTLAKE VILLAGE CA 91363 <br /> 12 <br /> 11 IXaX oXr)aftX, POLICY NUMBER W27 8388-A24-75L 8 <br /> 10 <br /> 7 <br /> 9 00110 75-8533-116E 6 <br /> *** THE CITY OF SANTA ANA & THE POLICY PERIOIIMAY 03 1999 TO JUL 24 1999 5 <br /> *C* SANTA ANA FINANCING AUTHORITY <br /> *0* THEIR OFFICERS , AGENTS & 3 <br /> *P* EMPLOYEES ATTN JEFF STEVENS 2 <br /> *Y* 20 CIVIC CENTER PLAZA STE M28 , <br /> *** SANTA A N A CA 9 2 7 01-4 010 DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. -- <br /> NAMED 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 PICKUP 1FTJW36G3VEA67677 1HOH0210 <br /> COVERAGES(AS DEFINED IN POLICY) SEE REVERSE SIDE FOR 1NF'ORTANT MESSAGr <br /> SYMBOL-PREMIUM-COVERAGE NAME LIMITS OF LIABILITY <br /> FXCEPTTONS A!UD FNDORSEMENTS <br /> FINANCED- LASALLE NORTHWEST NATIONAL BANK , 4747 W IRVING PARK ROAD , CHICAGO <br /> IL 60641-2764. <br /> 01 6028E . 5 <br /> NTA <br /> ANA POLICE ADMIN IHOLDING SFACILITY IPROJECT , 1043OWP CIVIC ANY TCENTER DRTN BOB U STE S A201 , <br /> SANTA ANA CA 92703-2348 . <br /> 02 6028E . 5 ADDITIONAL INSURED-CRSS CONSTRUCTORS INC ATTN ROB THOMPSON SANTA <br /> ANA POLICE ADMIN HOLDING FACILITY PROJECT , 1043 W CIVIC CENTER DR STE 200 , <br /> SANTA ANA CA 92703-2348. <br /> 03 6028E . 5 ADDITIONAL INSURED-THE CITY OF SANTA ANA & THE SANTA ANA <br /> FINANCING AUTHORITY THEIR OFFICERS , AGENTS & EMPLOYEES ATTN JEFF STEVENS , <br /> 20 CIVIC CENTER PLAZA STE M28 , SANTA ANA CA 92701-4010. <br /> 01 6037F . 11 CERTIFICATE OF INSURANCE-BECKMAN INSTRUMENTS ATTN : MIKE JARVIS , <br /> PO BOX 3100 , FULLERTON CA 92834-3100. <br /> 02 6037E . 12 CERTIFICATE OF INSURANCE-BECKMAN INSTRUMENTS , ATTN VIVIAN 2500 <br /> HARBOR BLVD , FULLERTON CA 92835-2600. <br /> 03 6037E . 12 CERTIFICATE OF INSURANCE-BUILDERS GUILD INC , ATTN : MINDY J <br /> DUFFEL 4950 E INGRAM , MESA AZ 85205-3315 . <br /> 04 6037F . 11 CERTIFICATE OF INSURANCE-HUGHES RESEARCH LABORATORIES , ATTN : <br /> LYNN JONES 3011 MALIBU CANYON RD , MALIBU CA 90265-4737. <br /> 05 6037F . 11 CERTIFICATE OF INSURANCE-TURELK , INC , FO BOX 93101 , LONG BEACH <br /> CA 90809-3101 . <br /> 06 6037F . 11 CERTIFICATE OF INSURANCE-ENTERPRISE RENT-A-CAR ATTN : LEAH <br /> GANDINGCO , 820 MALCOLM RD , BURLINGAME CA 94010- 1407. <br /> 6082AG . 1 AMENDATORY ENDORSEMENT : CHANGES-DEFINED WORDS ; FINANCED <br /> VEHICLES ; INSURED ' S DUTIES ; COVERAGES AND CONDITIONS . <br /> 6289MM SINGLE LIMIT OF LIABILITY . <br /> RESIDENCE-882 QUEENSDALE CIR , CORONA CA 91720 . <br /> 6049NN USE OF NONOWNED CARS - LIABILITY COVERAGES PHIL SUTHERLAND EFFECTIVE <br /> 9-7-95 . <br /> 6033C USE OF NONOWNED CARS - PHYSICAL DAMAGE COVERAGE , $25 ,000 LIMIT <br /> APPLIES TO ITEM 3B , PHIL SUTHERLAND . <br /> CONTINUED <br /> THIS IS YOUR DECLARATIONS PAGE. <br /> PLEASE ATTACH IT TO YOUR AUTO POLICY BOOKLET. 4 <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 I <br />