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<br />--- <br />. r~J STATE FARM INSURANCE COMPANIES@ <br /> <br />900 Old River Road <br />Bakersfield CA 93311 <br /> <br />DATE OF NOTICE: APR 08 2004 <br /> <br />39A <br /> <br />A <br /> <br />A - ,;>,þO 3 - ,;)J-I3 <br /> <br />CITY OF SANTA ANA CT <br />ATTN; CITY CLERK <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701-4058 <br /> <br />11,1,",1,11,"111'111"11,1"111111,1,1,1"1",1,111111"1,11 <br /> <br />¡ADDITIONAL INSURED'S NOTICE OF COVERAGE <br /> <br />State Farm Mutual Automobile Insurance Company <br />NAMED INSURED: POLICY NO: V541083.A15-75M <br />S HARTL, DAVID E YR/MAKE/MODEL: 1993 LEXUS 4DR <br />::: 3808 E LARKSTONE DR VIN/CAMPER: JT8UF11 E7P0151 684 <br />:!: ORANGE CA 92869-5355 AGENT NAME: TANYA PEARSON <br />~ AGENT PHONE: (714)289-1226 <br />a: ENDORSEMENT NO: 6028AU <br /> <br />0- <br />N POLICY MESSAGES: This policy shown above supersedes policyl V541 083-75L. <br />i The policy includes a los8 payable clause protecting the additional insured's interest in the de~oríbed car to the extent of the insurance <br />-- provided and $ubject to all policy provisions. The additional ¡n,urad will be given 20 days notice if the policy is terminated, Until 8u~h notice <br />; is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 daya of <br />('II any change of interest or ownerahip coming to their attention. Failure to do so will render this policy nul! and void. <br />"I <br />0 <br />~ <br /> <br />COVERAGE: <br />Bl AND PD LIABILITY <br />$1 MILI$1 M\L/$1 MIL <br />$100 OED. COMPo <br />$250 DED COLL, <br />POLICY EFFECTIVE <br />MAR 23 2004 UNTIL TERMINATED <br /> <br />~//L <br /> <br /> <br />{1Æß~ <br />