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<br />'fAi <br />~ <br /> <br />STATE FARM INSURANCE COMPANIES~ <br /> <br />90() Old River Road <br />Bakorafteld OA 93311 <br /> <br />DATE OF NOTICE: APR 08 200 <br /> <br />39A <br /> <br />A <br /> <br />A -;¡,oD3- .;)Ji3 <br /> <br />CITY OF SANTA ANA CT <br />ATTN; CITY CLERK <br />26 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701-4658 <br /> <br />11.1,,,,1.11111111,,,,,,11.1,,111,,,,1.1.1,,1,,,1.111111,,1.11 <br /> <br />ADDITIONAL INSURED'S t.lOllCE OF COVERAGE <br /> <br />Slate Farm Mutual Automol¡lle Insurance Company <br />NAMED INSURED: POLICY NO: V541083-AI8-75M <br />~ HARTL, DAVID E VRIMAKEiMODEL: 1993 LEXIJS 4DR <br /><:' 3808 E LARKSTONE DR VIN/CAMPER: JT8UF11E7P0151684 <br />:!: ORANGE GA 92869-5368 AGENT NAME: TANYA PEARSON <br />j AGENT PHONE: (714)269-1226 <br />~ ENDORSEMENT NO: 6028AU <br /> <br />COVERAGE: <br />Sl AND PD LlABILlTV <br />$1 MIL1$1 MIL 1$ 1 MIL <br />$100 OED COMP <br />$250 DED COlL <br />POLlOY EFFEOTlVE <br />MAR 23 2004 UNTIL TERMINATED <br /> <br />-¡¡- <br />¡;¡ POLICY MESSAGES: Thi8 polioy thown above 8uperoede. polloyf VM 1083- 75L <br />¡ The policy includes 1.1018 payable ctau8e proteoting the additional insured', interl!lat in the delorlbed car to the extent 01 the inaurance <br />...... provided and &ubjeotto all policy proviûone. The additional in'un~d will be given.20 day. notice 11 the policy 18 terminated. Until 6uoJh notice <br />~ is provid«1, it ahalJ be presumed that the required renewal premiums hO\le been paid. The additional inçured mua.t notify us within 10 daya of <br />~ any çhange o1ln1erelt or owneranip coning to their attention. Failure to do '10 will render thl. polio)' null and void. <br />~ <br />~ <br /> <br />~//~ <br /> <br />/lI <br /> <br /> <br />