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<br />
<br />OB 133 12:59p Geor-ce Bullock
<br />State Fan~ Mutual Autoll~obile Insurance (~ompa!w
<br />3,,~ $O.~ ,Ago. bra Road
<br />west~Ke VJ#age CA 9~.3~3
<br />
<br /> 75-8637-1 U
<br />
<br />REBECCA SAUCEDA
<br />157 T.E)'LEY ST AP 4
<br />HAC~NDAiHGTS CA ~45-4574
<br />
<br />NAM~I) IN,~URED: ~OL~) COAST APPRAIS~.LS INC
<br />
<br />5B2-651 -IOBB p. 4
<br />
<br /> *COPY* DI~CLARATIONS ~AGE 'cosy
<br />
<br />POLICY NUI~IBER 81 2431-E~8-75
<br />
<br />POLICY PERIOD MAY 28 2003 to NOV 28 200
<br />
<br /> AGENT
<br /> DREW M)~:ITIN
<br /> 11119 SAI~TA GERTRUDES AVENUE
<br /> WHll-BER, CA 90604-3350
<br />
<br /> DO ~IOT PAY PREMIUIIIS SHOWN ON THI~ PAGE. PHONE: (~2)943-4343 or (,~62)943-9323
<br /> SEPARATE STATEMENT ENCLOSED IF AMOUNT DUE.
<br />
<br />!..~:'..YEA. lA ',J.~,.~;:... MAKE- ~' .*~'; '.-."~ .,,'MODEL. z'~.;.;e:.~:'I~ODY'-~'rYLE~i~'.... 'VEHICLE.ID~IUM~BER ~'.,~ ~"r~" ',~, CLASS: :'"r"'
<br /> 1997 TOYOTA CAMRY 4DR JT2BG22K4V0088050 ' 6H00A110
<br />
<br />1 IF../'. '~2~um'L~ ~ 1':.~ ~,~cDJ(nete~ ".. ~'"~'~.. ~'":.~ ~ ..~.,~"r,i ~,~.',,~'.~'.;~*e'~-~.'%~.~a-.~.q.~..,',::..',,~ ~,D[3e~mml~miee ' ,,~".. '~ '/,' '
<br />I 3 ." ..... '"'" '"." .V ........... ., '".".".'W": .; ' ??-.' "'.:"'".".'~>. '"'. , '~ '":' ' · .' ,,;,..... ,..."...:.' . ..:,..,.,,,~ar~:';',',: ..........
<br /> i 1997
<br /> ~ See policy for coverage details. TOYOTA
<br />
<br /> Limits of Liability-Coverage ~-Bodily 19~ury
<br />
<br /> ,~ Each Accident
<br /> DS00 i $500 Deductible Comprehensive $49.95
<br />
<br /> H ~ Emergency Road Son/ice $2.88
<br />· ~ ., " ........ ' '. ..... ' ''~' ;'~'"'~.'" ''~""~,' e,~/~e,'~.,;;,[',?
<br /> ,Al ,',,".', ..... ,~.,~,.., Car RentaFTmve Expenses ,: ,. -.., , .,..,~ .... ,~'.'?';:'P'?; ::,.'~?=;'?' ,~.,!'.,,'.*.'$~"60,"'~,~. r~; D,,', ,'
<br /> ! Limits of Liabil,',,~, - Car Rental E~nse
<br /> i $50 ~ $~ ~o0 .......
<br />
<br /> [ Umits of Liability-U
<br />~!~:L~;~~'.~'~~~}~':~ .~;?~,~..,~¢~i ~ ~,~'~: . ~ ~A'~-~,~'~ "..." "~ ";~ ~ '~.' ~ ' ' ~ , ~ ~ ~.'.:""""! ...... ~" "~':~ '~ ~"~":~'~Z;,~;~.~,j;,~:,~i.~g
<br />.... i $~ o9~ooo $300,000
<br />
<br />Your policy ccnsis~s of this declarations page, the policy booklet - form 9805A, and any endorsements that apply, including
<br />those issued to yo~u with any subeequent renewal notice.
<br />
<br />6028AU ADDITIONAL INSURED-REBECCA SAUCEDA, 15746 TETLEY ST APT#14, HACIENDA
<br />HGTS CA 91745+4574.
<br />6030S BUSINESS NAMED INSURED ENDORSEMENT
<br />6893PP AMENDMENT OF CAR RENTAL AND TRAVEL'EXPENSES COVERAGES.
<br />6gOSA AMENDMENT OF DEFINED WORDS. LIABILITY. MEDICAL PAYMENTS,
<br /> UN,INSURED MOTOR VEHICLE AND PHYSICAL DAMAGE COVERAGES.
<br />Nmed Insured- GOLD COAST APPRAISALS lNG 11506 TELEGRAPH RD STE 21 ¢ SANTA FE SPGS CA
<br />90670-3100
<br />
<br />l)oi~u V t'itv /\tic,ney
<br />
<br />FORM
<br />
<br />Agent: ~REW MARTIN , ,, .....,
<br />
<br />
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