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· Jul 5G2-BS1 - iOBB p. 4 <br />·COPY* DI~CLARATIONS AGE '0o~¥ <br /> <br />OB I}3 12:59p Geo,-ge Bullock <br /> Fam~ Mutual Autol~obile Insurance l~ompany <br />3130,~ .Agobra Road <br />Wes~ke Village CA 913~3 <br /> <br /> 75-863~,1 U <br /> <br />REBECCA ~AUCEDA <br />157 T.E}'LEY ST AP ¢ <br />HAC~NDAiHGTS CA t~)45-4574 <br /> <br />POLICY NUI~BER 81 2431-F_~8-75 - <br /> <br />POLICY PERIOD MAY 28 2003 fo NOV 28 200 <br /> <br />NAMEP INSURED: <br /> <br />COAST APPRAISALS INC <br /> <br />AGENT <br />DREW M/~ITIN <br />11119 SAI~]TA GERTRUDES AVENUE <br />WHITTIER; CA 90604-3350 '- <br /> <br /> DO liOT PAY PREMIUI~ SHOWN ON THI~ PAGF- PHONE: (~2)943-4343 or (,~62)943-932~1 <br /> .~EPAI~ATE ~TATEMENT ~NCLOSED IF AMOUNT DUE. <br /> <br />1997 TOYOTA CAMRY 4DR JT2BG22K4V0088050 ' 6H00A110 <br /> <br /> 1997 <br /> :~ See p~licy for co_¥~ra~le details. TOYOTA <br /> <br /> Limits of Liability-Coverage A-Bodily Iniury <br /> <br /> Each A~ident <br /> DS00 ~ $500 Deductible ~m~rehensive $49.95 <br /> H ~ Emergency ~ad ~w~e $Z.88 <br /> ~ Lim~ of Liabili~ - Car Renta E~n~ <br /> ~ $50 ~ $~,200 <br /> ~. Um~s of Uabili~-U <br /> <br />~.~:~'~:~ ~' "~ ~:~ ~ ~: $100~000 $300,000 <br /> <br />~our ~licy ~nsis~s of ~is de~l~mflons page, th~ ~licy ~oklet - fo~ 9805A, and ~y endomements that app,, including <br />tno~ msue~ to you wire any su~equem ~newm notice. <br /> <br /> ", ' '' ....... ., ~ ....... ~ .......... ,~ ~',-.,.,~:;~,,~,~ ~, ~-,~;~q,,7, , , .......... ~ · , ..... ~ ..... <br />--~--' .......... --, ' ....... ')' '~ ................. -. C.':~"' . <br /> 602~U ADDITIONAL INSURED-REBECCA SAUCEDA, 15746 TETLEY ST APT~14, HACIENDA <br /> HGTS ~ 91745+4574 <br /> 6030S BUSINES~ NAMED INSUREO ENDORS~ENT <br /> 6893PP AMENDMENT OF CAR RENTAL AND TRAVEL'EXPENSES COVERAGES <br /> 6905A AMEN~ENT OF DEFINED WORDS. LIABILITY. MEDICAL PAYMENTS, <br /> UNINSURED MOTOR VEHICLE AND PHYSICAL DA~GE COVERAGES. <br /> N~ed Insured- GOLD ~AST APPRAISALS INC 115~ TELEG~PH RO STE 214 SA~A FE SPGS CA <br />9067~31 O0 <br /> <br />PRO\' El-) AS <br /> <br />FORM <br /> <br />Agent: !~REW MARTIN <br /> <br /> <br />