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<br />6037F.11 CERTlFlCA TE OF INSURANCE <br /> <br />35996-4-2 - 4 <br />Agent 8549 <br />AFO 418 <br /> <br />~ <br /> <br />This is to certilY that: <br />Stale Fann Mutual Automobile Insurance Company . of Bloomington, <br />Illinois has coverage in force as shown below for the named insured. If the coverage is changed or terminated we will give 10 <br />days wrinen notice to: <br /> <br />CITY OF SANTA ANA CT <br />ATTN: CITY CLERK <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701-4058 <br /> <br />Description ofVemcle: 1993 <br /> <br />LEXUS <br /> <br />IT8UFllE7POl51684 <br /> <br />UABILITY -COVERAGE A <br />Limits of Liability <br /> <br />Bodily Injury <br />each person I $ca(;h accident <br /> <br />$ 100()000 1000000 <br /> <br />Property Damage <br />each accident <br /> <br />Bodily Injury and Property Damage <br />Single Limit <br /> <br />$ 1000000 <br /> <br />$ <br /> <br />each accident <br /> <br />This Certificate of Insurance does not change the coverage provided by the described policy. <br /> <br />r <br />, <br />; <br />, <br />, <br />, <br /> <br />Named Insured HARTL, DAVID E <br /> <br />Policy Nwnber V54 I083.AI5-7SM <br /> <br />&~~~~-\~/. <br /> <br />Chief Executive Officer <br /> <br />Effuctive Date <br /> <br />MAR 23 2004 <br />12:01 A.M. Standard Time <br /> <br />Countersigned <br /> <br />(Yeor} <br /> <br />By <br /> <br />Au1horized RepresenlBJive <br /> <br />6037F.1l <br /> <br />~b/~ <br /> <br />