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<br />6037F.I1 CERTIFICATE OFlNSURANCE <br /> <br />35996-4-2 - 4 ~ <br />Agent 8549 <br />AFO 418 <br /> <br />Tlù$ i. to certifY that: <br />State 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 tenoinated we will give 10 <br />days written 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 of V ehiele: <br /> <br />1993 <br /> <br />LEXUS <br /> <br />JT8UFIIE7P0151684 <br /> <br />UABILITY - COVERAGE A <br />Limits of LiabiIily <br /> <br />Bodily Injury <br />each person I $eachaCCident <br /> <br />IOOooOO 1000000 <br /> <br />Property Damage <br />each accidem <br /> <br />Bodily Injury and Property Damage <br />Single Limit <br /> <br />$ <br /> <br />$ <br /> <br />1000000 <br /> <br />$ <br /> <br />each accident <br /> <br />~ <br />, <br />, <br />, <br />. <br /> <br />This Certificate of Insurance does not change the coverage provided by the described policy. <br /> <br />ò <br /> <br />Named In$ured <br /> <br />HARTL, DAVID E <br /> <br />Policy Number <br /> <br />V5410113-AI5-75M <br /> <br />~\{~.\S~/. <br /> <br />Chief Executive Officer <br /> <br />Effective Date <br /> <br />MAR 23 2004 <br />12:01 A.M. Standard Time <br /> <br />Countersigned <br /> <br />(y...} <br /> <br />6037F.ll <br /> <br />By <br /> <br />AU1horized ReJresentative <br /> <br />~ ~/<- <br /> <br />