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State Farm Mutual Automobile Insurance Company <br />PO Box 2368 <br />3loomington IL 61702-2368 <br />NAMED INSURED 00803 <br />75-6AEB-1 A F <br />ODOM 0058 <br />ALL CITY MANAGEMENT SERVICES, <br />INC <br />10440 PIONEER BLVD STE 5 <br />SANTA FE SPGS CA 90670-8238 <br />DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. <br />IF AN AMOUNT IS DUE, THEN A SEPARATE STATEMENT IS ENCLOSED. <br />YOUR CAR <br />20623-1-A MATCH 00803 MUTL VOL <br />DECLARATIONS PAGE <br />PAGE I OF 2 <br />POLICY NUMBER 711 6928-B01-75D <br />POLICY PERIOD AUG 13 2025 to FEB 01 2026 <br />12:01 A.M. Standard Time <br />STATE FARM PAYMENT PLAN NUMBER <br />1348377123 <br />AGENT <br />FLORENCE HARRISON <br />227 S LA BREA AVE <br />INGLEWOOD, CA90301-2317 <br />PHONE: (310)330-8220 <br />2017 HYUNDAI SANTA FE SPORT WG 5XYZU3LB5HG487101 100HCV10 <br />Bodily Injury Limits _r__---- .W,r--- __--- _ --- __---- — ______—_______ <br />��-- <br />- _ <br />$1,000,000 $1,000,000 <br />__ __ _ <br />_- <br />Each Accident <br />-- - - --- <br />C <br />--- - — ---- - W-- ----- _ ------ <br />Medical Payments Coverage <br />---- - �- _ <br />$40 28 <br />_ <br />-- — <br />— — <br />$10,000 <br />_ <br />G <br />Collision Coverage - $1,000 Deductible <br />$297.24 <br />I <br />EmergencyR erice overag .' <br />. <br />R1 <br />Car Rental and Travel Expenses Coverage <br />$46. 04 <br />Each Day, Each Loss <br />U <br />_ _ __ _ _ �__� <br />Uninsured Motor Vehicle Coverage <br />—_� ----- �- __- <br />$109 55 <br />--- __--- __--- __---- <br />____--- __---- __________--- __---- _________ <br />_ E�ac�h__�P��e�rson, Each �Accident <br />--- __---- __---- ______--- __---- _________--- _ _ <br />U1 <br />Uninsured Motor Vehicle Property Damage Coverage <br />$12.82 <br />IMPORTANT NOTICE <br />For your protection California law requires the following to appear with this policy: Any person who knowingly presents <br />false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is <br />guilty of a crime and may be subject to fines and confinement in state prison. <br />Replaced policy number 7116928-750. <br />Notice of insurance information collection practices - personal, family, or household insurance transactions: <br />We may collect customer information from persons other than the Individual or individuals applying for coverage. Such customer <br />information as well as other personal or privilegedinformation subsequently collected may, In certain circumstances, be disclosed <br />to third parties without your authorization as perrnitted by law. <br />You have the right to submit a written request to access, correct, amend, or delete your personal information and the right to <br />receive a response within 30 days of submitting your request. If we deny your request, you have the right to file a statement <br />with us containing the information you feel is accurate and fair along with the reasons you disagree with our denial. Instructions <br />on how to file such request and our full privacy notice can be found www.statefarm.com/customer-oare/privacy-security/privacy <br />or contact your State Farm Agent. <br />Your total renewal premium for AUG 012025 to FEB 012026 is $1,885.96. <br />Location used to determine rate charged-10440 PIONEER BLVD STE 5, SANTA FE SPGS CA 90670. <br />CONTINUED <br />11049/08636 See Reverse Side <br />155-3866 CA.2 052002 (ola025fo) <br />11SXON (ola025te) <br />