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StateFarm <br />State Farm General Insurance Company <br />6028AU ADDITIONAL INSURED <br />(Prior Notice of Termination) <br />This endorsement is a part of your policy. Except for the changes it makes, all other terms of the <br />policy remain the same and apply to this endorsement. It is effective at the same time as your policy <br />unless a different effective date is specified by us in writing. <br />It is agreed that LIABILITY COVERAGE A of your policy is extended to the party named <br />on the declarations page as an Additional Insured. The Additional Insured is subject to the <br />provisions of the policy granting coverage to an insured other than you. The Additional Insured: <br />1. has the same right of recovery under this policy as before: <br />2. is not liable for any premium or other expense under this policy: <br />3. is not a member of the State Farm Mutual Automobile Insurance Company of Bloomington, Illinois. <br />This policy will not be changed or terminated as to the interest of the Additional Insured unless we <br />give such insured notice. The number of days' notice we will give is ten unless another number is <br />shown on the declarations page. <br />POLICYHOLDER: GUS MARQUEZ DBA GREENTECH LANDSCAPE INC <br />POLICY NUMBER: 654 4003-B19-75 2013 FORD TRUCK F150 <br />COVERAGE: BI AND PD LIABILITY $1 MIL <br />EFF DATE: August 19, 2021 UNTIL TERMINATED <br />NAME OF PERSON(S) OR ORGANIZATION(S): <br />'The City of Santa Ana, its officers, employees, agents, and representatives are named as additional <br />insured" <br />Agreement Number N-2020-097 <br />Additional Insured: <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />6028AU <br />©, Copyright, State Farm Mutual Automobile Insurance Company, 2011 <br />�. Rik MuagnnmfBivisa- <br />- 4 REVIEWED & APPROVED 8,: <br />�A 4 %azi {�centarx <br />s-MRislcMAnaJenlilYCie ralAde <br />