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State Farm Mutual Automobile Insurance Company <br />PO Box 2368 <br />Bloomington IL 61702-2368 <br />AT2 A-2CC1 A <br />MELGOZA, JORGE B & MELGOZA, <br />ANNA <br />6867 GOLFCREST DR APT 51 <br />SAN DIEGO CA 92119-2444 <br />APPROVED <br />By Tu Tran Nguyen at 4:46 pm, Apr 14, 2026 <br />Policy Number: 583 7885-D15-55C <br />Policy Period: April 15, 2026 to October 15, 2026 <br />Vehicle: <br />2012 HONDA ACCORD <br />Principal Driver: <br />JORGE B MELGOZA <br />Notice of insurance information collection practices - <br />personal, family, or household insurance transactions: <br />We may collect customer information from persons other <br />than the individual or individuals applying for coverage. <br />Such customer information as well as other personal or <br />privileged information subsequently collected may, in certain <br />circumstances, be disclosed to third parties without your <br />authorization as permitted by law. <br />Policy Number: 583 7885-D15-55C <br />Prepared February 20, 2026 <br />1004583 <br />AUTO RENEWAL <br />PREMIUM PAID: $800.61 <br />DO NOT PAY. <br />Your premium is billed through the State Farm Payment Plan <br />State Farm Payment Plan Number: 1235506212 <br />Your State Farm Agent <br />LAZARO INSURANCE AGENCY INC <br />Office: 619-229-6799 <br />Address: 3924 EL CAJON BLVD <br />SAN DIEGO, CA 92105-1023 <br />If you have a new ordierent car, have added any ddvers orhave moved, <br />please contact your agent. <br />Thank you for choosing State Farm. <br />You have the right to submit a written request to access, <br />correct, amend, or delete your personal information and the <br />right to receive a response within 30 days of submitting your <br />request. If we deny your request, you have the right to file a <br />statement with us containing the information you feel is <br />accurate and fair along with the reasons you disagree with <br />our denial. Instructions on how to file such request and our <br />full privacy notice can be found <br />(continued on next page) <br />Page number 1 of 5 <br />143562 202 01-15-2018 <br />ONVENIENE SAVES <br />TIME, MONEY <br />... AND TREES. <br />You have the option to pay your bills online by opting <br />for ePayment on statefarm.corff. <br />Get to a better State`. <br />r <br />