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.~un ~17 O~ 10:26~ <br /> <br />STATE FARM IMS <br /> <br />3103792436 <br /> <br />at <br /> <br /> CERTIFICATE OF INSURANCE <br /> <br />[] STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois <br />[] STATE FARM GENERAL iNSURANCE COMPANY, Bloomington, Itlinois <br />[] STATE FARM FiRE AND CASUALTY COMPANY, Scarborough, Ontario <br />[] STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida <br />[] STATE FARM LLOYDS, DAUBS, Texas <br /> <br /> POLICY NUMBER <br /> <br />This insurance inc{udes: <br /> <br />insures the following policyholder for the coverages indicated below: <br /> <br /> Poficyholder TELFO&D$ <br /> Address of policyholder C/O LINDA K. LARSON, 3.255 19t)' ST., NgKMOSA BEACH, CA. 90254-3309 <br /> LocaUon of operations <br /> Description of operations <br />The policies listed below have bee~ issued to the policyholder for the policy periods shown. The insurance described in these policies is <br />subject to all the terms exclusions, and conditions of those policies, The limits of liability shown may have been reduced by any paid <br />claims, <br /> I ........POLICY PERIOD LIMITS OF MABIMTY <br /> TYPE OF INSURANCE I Effective Da~, F.~ralion Date {at beginning of policy period) <br /> Comprehensive BODILY INJURY AND <br /> Business Liability . J .................................... PROPERTY DAMAGE <br /> <br />0 Contractual Liabilib/ <br />[] Underground HaZard Coverage <br />[] Personal Injury <br />[] Advertising Injury <br />[] Explosion Hazard Coverage <br />[] Collapse Hazard Coverage <br /> <br /> EXCESS L~ABt LITY <br />[] Umbrella <br />[] O. thor <br /> <br />Workers' Compensation <br />and Employers Liability <br /> <br /> POLICY PERIOD <br />Effective Date I~m'don Date <br /> <br />Each Occurrence $ <br /> <br />General Aggregate <br /> <br />Products - Completed <br />Operations Aggregate <br /> <br />BODILY INJURY AND PROPERTY DAMAGE <br />(Combined Single Umit) <br />Each Occurrence $ <br />Aggregate $ <br />Part 1 STATUTORY <br />Part 2 8DOILY INJURY <br /> <br />Each Accident $ <br />Disease - Each Employees <br />Disease - Policy Limit $ <br /> <br />POUCY NUMBER <br /> <br />92-Q8-0204-7 G <br /> <br />TYPE OF INSURANCE <br /> <br />BUSINESS <br /> <br /> 1~3LICY PERIOD <br />Effective Date i Emplrali~.~ Data <br /> <br /> [ 04/25/04 <br />04/25/03 : <br /> <br /> UMITS OF UABIUTY <br />(at beginning of policy periOd) <br /> <br />$1,000,000//GBN AGG-$2,000,000 <br /> <br />THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NErrHEE AFFIRItIATIVELY 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 />TH~ CITY O~' SANTA ANA <br />20 CIVIC CENTER <br />SANTA .~.NA, CA. 927 O 1- 40 <br /> <br /> / <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 ~lays before <br />cenceltatioo, if however, we fail to mail such notice, <br />no obligation Or liability will be imposed on State <br />Farm or it~.agents or representatives. <br /> <br />AGSNT 06/17/03 <br /> <br />Title Date <br /> <br />Agenfs Cede Stamp <br /> <br />AFO Code F776 <br /> <br /> <br />