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,,Jun-17 03 10:26a <br /> <br />STRTE FRRM IMS <br /> <br />31037~2436 <br /> <br />T~at <br /> <br /> CERTIFICATE OF INSURANCE <br />[] STATE FARM FiRE AND CASUALTY COMPANY, Bloomington, Illinois <br />[] STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois <br />[] STATE FARM FiRE AND CASUALTY COMPANY, Scarborough, Ontario <br />I-I STATE FARM FLOEIbA iNSURANCE COMPANY, Winter Haven, Florida <br />~] STATE FARM LLOYD$, Dallas, Texas <br /> <br />insures the following policyholder for the coverages indicated below <br /> <br /> Pollcyhoider TELFORD$ <br /> Address of policyholder C/O nINDA K. LARSON, 1255 19t~' ST.,HEgMOSA SgACH,Ck. 902~4-3309 <br /> Location of operations <br /> Description of operations <br />The policJes listed below have been issued to tho policyholder for tl~'e policy Deriods shown. The insurance described in these policies is <br />subject to all the terms exclusions, and conditions of those policies. The limits of liabilib, shown may have been reduced by any paid <br />claims. <br /> POUCY?ERIOD ' LIMITS oF LIABILITY <br /> POLICY NUMBER TYPE OF INSURANCE I Effective Date: F-~q3im§~ IDa*e {at beginning of policy period) <br /> " ' I Comprehensive "' i BODILY INJURY AND <br /> J Business Liability J i PROPERTY DAMAGE <br /> <br /> r"l Contractual Liability <br /> [] Underground Hazard Coverage <br /> <br />Personal Injury <br />Advertising injury <br />Explosion Hazard Coverage <br />Collapse Hazard Coverage <br /> <br /> EXCESS LIABILITY <br />[] Umbrell~ <br />[] Other <br /> <br />Workers' Compensation <br />and Empioyers Liability <br /> <br /> POLICY PERIOD <br />Effective Date <br /> <br />POUCY NUMBER <br /> <br />92-Q8-0204-7 <br /> <br />TYPE OF INSURANCE <br />BUSINESS <br /> <br /> POLICY PERIOD <br />Effective Date: Expirali~ Data <br /> <br />Each Occurreece <br /> <br />General Aggregate <br /> <br />Products - Corn plated <br />Operations Aggregate <br /> <br /> [ 04/25/04 <br />04/25/03 : <br /> <br />BODILY INJURY AND PROPERTY DAMAGE <br />(Combined Single Limit) <br />Each Occurrence $ <br />Aggregate $ <br /> <br />Part 1 STATUTORY <br />Part 2 BODILY INJURY <br /> <br />Each Accident $ <br />Disease - Each Employees <br />Disease - Policy Limit $ <br /> <br />UMITS OF UABILITY <br /> <br /> (at beginning of policy period) <br />$1,000,000//G~,N AGG-$2.000,000 <br /> <br />1'HE CERTIFICATE OF INSURANCE IS Not A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY <br />AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. <br /> <br />Name and Address of Certificate Holder <br /> <br />THE CITY OF SANTA ANA <br />20 CIVIC CENTER PLARA <br />SANTA ANA, CA. 92701- 4010 <br /> <br />If any of the described policies are canceled before <br />its expiration date, State Farm ,:hall mail a <br />written notice to the certificate holder 30 days before <br />cancellation. If however, we fail to mail such notice, <br />no obligation or liability will be imposed on State <br />Farm or its. agents or repreaentative~. <br /> <br />Title Date <br /> <br />A§enfs Cede Stamp <br /> <br />AFO Code F'7 7 6 <br /> <br /> <br />