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Policy Number DECLARATIONS PAGE COVERAGE SUMMARY <br />92-92-2579-2 AUG 13 2004 <br />STATE FARM GENERAL INSURANCE COMPANY ~••••••~ <br />31303 AGOURA RD, WESTLAKE VILLAGE,CA 91363-0001 <br />A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS <br />Agent Copy <br />Named Insured antl Mailing Adtlress <br />1308-F412 S <br />CLIFFORD, SUSAN SAXE DR <br />A PROFESSIONAL CORPORATION <br />16530 VENTURA BLVD STE 203 <br />ENCINO CA 91436-4535 <br />Cov A -Inflation Coveragge Index: N/A <br />BUSINESS POLICY -SPECIAL FORM 3 Cov B -Consumer Pricelndex: 185.2 <br />AUTOMATIC RENEwaL - If the POLICY PERIOD is shown as 12 MONTHS, this policy will be renewed, automatically <br />subject to the remiums, rules and forms in effect for each succeedin policy period. If this policy is terminated, we will <br />give you and tie Mortgagee/Lienholder written notice in compliance wi~h the policy provisions or as required by law. <br />Policy Period: 12 Months The policy period begins and ends at 12:01 am standard time at the <br />Effective Date: APR 18 2004 premises location. <br />Expiration Date: APR 18 2005 <br />Requested By: Additional Insuretl <br />Location of Covered Premises: <br />16530 VENTURA BLVD STE 203 <br />ENCINO CA 91436-4535 <br />Coverages & Property <br />Section I <br />A Buildings <br />B Business Personal Property <br />C Loss of Income - 12 Months <br />Section II <br />L Business Liability <br />M Medical Payments <br />Protlucts-Completed Operations <br />(PCO) Aggregate <br />General Aggregate (Other <br />Than PC ) <br />Limits <br />Excluded <br />5 119,700 <br />S Actual Loss <br />4 1,000,000 <br />3 5,000 <br />5 2,000,000 <br />2,000,000 <br />ce <br />Deductibles -Section I <br />500 Basic <br />In case of loss under this policy, the deductible will be <br />applied to each occurrence and will be deducted from the <br />amount of the loss. Other deductibles may apply -refer to <br />Forms, Options, and Endors <br />Special Form 3 <br />Policy Endorsement <br />Terrorism Insurance Cov Notice <br />Amendatory Endorsement <br />Debris Removal Endorsement <br />Business Policy Endorsement <br />Amendatory Collapse <br />ents <br />FP-6143 <br />FE-6506.2 <br />FE-6999 <br />FE-6205 <br />FE-6451 <br />FE-6464 <br />FE-6551 <br />Policy Premium <br />Discounts Applietl: <br />Renewal Year <br />Years in Business <br />Enclosed Building <br />Protective Devices <br />Sprinkler <br />Claim Record <br />.'PRO(~V~EllASJ'TO r vita. <br />~_.tur;; :;tit[ Sheedy <br />Continued on Reverse Side of Page I Asois[an~ ~,ty Attorney <br />OTHER LIMITS AND EXCLUSIONS MAV APPLY • REFER TO YOUR POLICY <br />Prepared <br />AUG 13'2004 Countersigned <br />FP-8030.2C BOL3 By <br />06/1993 EROL HASSAN <br />Your policy consists of this page, any endorsements t3to) sas-657s <br />and the policyform. PLEASE KEEP THESE TOGETHER. <br />Agent <br />(ott217ffi) <br />