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<br />6037F.11 CERTIFICATE OF INSURANCE <br /> <br />35996-4-2 ~ <br />Agent 8549 <br />AFO 418 <br /> <br />This is to certify that: <br />State Fann Mutual Automobile Insurance Companv , of Bloomington, <br />Illinois has coverage in force as shown below for the named insured. If the coverage is changed or tenninated we will give 10 <br />days written notice to: <br /> <br />CITY OF SANTA ANA CT <br />ATTN: CITY CLERK <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701-4058 <br /> <br />Description ofVehic1e: <br /> <br />1993 <br /> <br />LEXUS <br /> <br />JT8UFl1E7POl51684 <br /> <br />LIABILITY - COVERAGE A <br />Limits of Liability <br /> <br />Bodily Injury <br />each person I each accident <br /> <br />1000000 $ 1000000 <br /> <br />Property Damage <br />each accident <br /> <br />Bodily Injury and Property Damage <br />Single Limit <br /> <br />$ <br /> <br />$ <br /> <br />1000000 <br /> <br />$ <br /> <br />each accident <br /> <br />" <br />~ <br />~ <br />m <br />0 <br />rn <br /> <br />This Certificate ofInsurance does not change the coverage provided by the described policy. <br /> <br />s <br /> <br />Named Insured <br /> <br />HARTL, DAVID E <br /> <br />M <br />0 <br />0 <br />N <br />N <br />0 <br />~ <br /> <br />Policy Number <br /> <br />V541083.Al5-75M <br /> <br />~~~~-\Ç>/. <br /> <br />Chief Executive Officer <br /> <br />Effective Date <br /> <br />MAR 23 2004 <br />12:01 A.M, Standard Time <br /> <br />Countersigned <br /> <br />(Year) <br /> <br />¡;; <br />0 <br />~ <br />0- <br />M <br /> <br />6037F.ll <br /> <br />By <br /> <br />Authorized Representative <br /> <br />~¿/~ <br /> <br />