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· ~Jun 47 02 10:268 <br /> <br />STRTE FRRM I~S <br /> <br />3103792436 <br /> <br />at <br /> <br />CERTIFICATE OF INSURANCE <br /> <br />[] STATE FARM FIRE AND CASUALTY COMPANY, Bloorninglon, Illinois <br />[] STATE FARM GENERAL iNSURANCE COMPANY, Bloomington, Illinois <br />[] STATE FARM FiRE AND CASUALTY COMPANY, $carborough, Ontario <br />[] STATE FARM FLORIDA iNSURANCE COMPANY, Wintar Haven, Florida <br />[] STATE FARM LLOYDS, Dallas, Texas <br /> <br />insures the following policyholder for the coverages indicated below:. <br /> <br /> Policyholder TELFORDS <br /> Address of policyholder C/O LINDA K. LARSON, 1255 19:h ST., HERMOSA B£ACH, CA. 90254-3309 <br /> Location of operations <br /> Description of operations <br />The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is <br />subject to ail the terms exclusions, and condltlons of those policies. The limits of liability shown may have been reduced by any paid <br /> <br />claims. <br /> <br /> POLICY NUMBER TYPE OF INSURANCE <br /> Comprehensive <br /> <br />............................... ~ .u .s! .n.e.s.s..L.i.a.b.i.~[t.y. ......... <br /> This Insurance includes: [] ProduCtS - Completed Operations <br /> [] Contractual Liability <br /> [] Undergrou~ld Hazard Cove~age <br /> [] Personal injury <br /> / [] Advertising thiury <br /> n Explosion Hazard Coverage <br /> [] Collapse Hazard Cove'age <br /> <br /> EXCESS LIABILITY <br /> <br /> [] Umbrella <br /> [] Other <br /> <br /> Workers' Compensation <br /> and Ernpioyers Liability <br /> <br /> POLICY PERIOD <br />Effective Date; F.x~lio~ <br /> <br />POLICY PERIOD <br /> Expiratio~ Dar, <br /> <br />Effective Date <br /> <br />POLICY NUMBER <br /> <br />TYPE OF INSURANCE <br /> <br /> POLICY PERIOD <br />Effective Date i Expiration Date <br /> <br />92-Q8-0204-7 G BUSINESS <br /> <br />04/25/03 I 04/25/04 <br /> <br /> UMITS OF UABIUTY <br />(at beginning of policy period) <br /> <br />BODILY INJURY AND <br />PROPERTY DAMAGE <br /> <br />Each Occurrence $ <br />General Aggregate $ <br /> <br />Products - Completed $ <br />Operations Aggregate <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 /> LIMITS OF LIABIMTY <br /> (at beginning of policy period) <br />Si, 000,000//G~N AGG-$2,000, <br /> <br />THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMAI'IVELY NOR NEGATIVELY <br />AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN· <br /> If any of the described policies are canceled before <br /> <br />Name and Address of Certificate Holder <br /> <br />THE CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANA,CA.92701-4010 <br /> ;,,F~X£),~,I~ .,:\S lO FORM <br /> <br />its expiration date, State Farm =hall mail a <br />written notJoe to the certificate holder 30 days before <br />cancellation. If however, we fail to mail such notice, <br />no obligation er liability will be imposed on State <br />Farm or its.agents or representatives. <br /> <br />Title Date <br /> <br />Agent's Code Stamp <br />AFO Code F? 7 6 <br /> <br /> <br />