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<br />-fA1 <br />~ <br /> <br />STATE FARM INSURANCE COMPANIES~ <br /> <br />DATE OF NOTICE: APR 08 200 <br /> <br />900 Old Ri.e, Rood <br />Bal<erofield OA 93311 <br /> <br />39A <br /> <br />A <br /> <br />A -';>"003- .;t13 <br /> <br />CITY OF SANTA ANA CT <br />ATTN; CITY CLERK <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701-4058 <br /> <br />1I.11'111.1I",1II""..II.l..III....I.I.I..I...I.IIIII,,.1.I1 <br /> <br />!AODlTlONAi..lt.lSURED'S NOllCE OF COVER.AGE <br /> <br />Slal. Farm Mutual Automobile Insur'lnce Company <br />NAMED INSURED: POLICY NO: V541083.A15.75M <br />~ HARTL,DAVIOE YRIMAKElMODEL: 1993LEXIJS 4DR <br />:;: 3808 E LARKBTONE DR VINICAMPER: JT6UF11E7POI51684 <br />.. ORANGE CA 92669.6355 AGENT NAME: TANYA PEARSON <br />AGENT PHONE: ('14)259-1226 <br />ENDORSEMENT NO: 6028AU <br /> <br />COVERAGE: <br />81 AND PO LIABILITY <br />$1 MILl$1 MllI$1 MIL <br />$100 OED. COMPo <br />$250 OED. COll <br /> <br />1i <br />11: <br /> <br />POUOY EFFEOTlVE <br />MAR 23 2004 UNTIL TERMINATED <br /> <br />" <br />;;; POLICY MESSAGES: Thi. poIloy .hown obove .uperoecle. polio~ V541083.75L. <br />I The poUay inDludn alas. payable clause proteoting the additional il\&.ured', Interest in the deaOflbed car to the extent of the il'llumnee <br />....... provided and "ubi_otto aU policy provi.&onl. The additional inaured will be gi'ven 20 claY' notice If the policy Is terminaled. Until &U"I\ notice <br />; ia prollidecl, it ahall be presumed that the required renewal premlullCI have been paid. The additional insu.red mua.t notify u8within 10 daye of <br />g Any oe-l1ange CJI in1erelt or owneranip corrina to their ILtlention. Failure to do 10 will rend.r thll policy null and void. <br />~ <br />~ <br /> <br />~//~ <br /> <br />IV' <br /> <br />