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<br />09/1if2005 14:55 FAX 3105467812 <br /> <br />SNYDER STATE FARM <br /> <br />~003 <br /> <br />: ..~ . <br /> <br />.~~ ~:. <br />.J CERTIFICATE OF INSURANCE <br /> <br />, at 0 STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, IIlInols <br />~ LlSl STATE FARM GENeRA~ INSURANCE COMPANY, Bloomington, illinois <br />~ D STATE FARM FIRe ANO CASUA~TY COMPANY, Scarborough, Ontario <br />. . ..~:~~~~~~ 0 STATE FARM FLORIOA INSURANCE COMPANY, Winter Haven, Florida <br />~ 0 STATE FARM LLOYDS, Dallas, Texas <br />insures the following policyholder for the coverages Indicated below: <br /> <br />Policyholder TIlLFORDS ATTN LARSON, LINDA I( <br /> <br />Address afpolicyholder 1256 19TH ST HERMOSA BEACll; CA 9025~-3309 <br />Location or opemtlane SAME <br />Description of operstlons 'l'IlLi'ORDS <br />The po'icles listed belOW have been issued 10 the policyholder tor the poiloy periods shown. The Insuranoe d.sorlbed In these policies Is <br />subject to all the terms exclusions, end conditions of those policies. The limits of lIaMlty shown may have been reduced by any paid claims. <br /> <br />/f..-d-C(J L/-:J-s? <br /> <br /> POLICY PERIOD l.IMlTS OF l.IABILlTY <br />POLICY NUlI'Il.'IER TYPE OF INSURANCE Effective Date i Expiration Date I <br /> (at baglnnlng of policy period) <br /> Comprehensive , BODILY INJURY AND <br /> , <br />. ,_~? :_~?,-_?J. ~ ?,~ ?_.~........ Business Liability APR-2S-0S i' APR-25-06 PROPERTY DAMAGE <br />. Thi~ insurance Includes; .Cjprodiicts:'COmplet'e"d"operai!One......'..-_..... ,'....,.... <br />, o Contractual Liability <br /> o Underground Ha<:ard Coverage Each Occurrence $1,000,000 <br /> o Personal Injury <br /> o Advertising Injury General Aggregate $ 2,000,000 <br /> o Explosion Hazard Coverage <br /> o Collapse Hazard Coverage Products - Completed $ <br /> I8IS1.loine.. ~roperty $2400 Operations Aggregate <br /> 181 Medical paymanto $5000 <br /> pO~lcY PERIOD BODILY INJURY AND PROPERTY DAMAGE <br /> EXCESS LIABILITY Effective Date ExpIration Dale (Combined Single Limit) <br /> o Umbrella Eaoh Ocourrence $ <br /> o Other Agaregate $ <br /> Part 1 STATUTORY <br /> Part 2 BODILY INJURY <br /> Workers' Compensation <br /> and Employers Liability Each Accident $ <br /> Disease - Each Employee $ <br /> Disease. Policy Limit $ <br /> POLICY PERIOD lIMlTS OF LIABILITY <br />POLICY NUlVlal:R TYPE OF INSURANCE EffecltVe Date i ExpIration Date (at beginning of policy periOd) <br />094 3644-A29-75 AUTO 07-29-05 , 01-29-06 250 1500 1100 <br />I <br /> , <br /> . , <br /> , <br /> : <br /> <br />TEE C!~Y OF SANTA ANA <br />2G C!V!C CENTER PLZ <br />5_~~~A .~~A, CA 927Ql-4056 <br /> <br />THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY <br />A.\ilENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. <br />If any of the described policies are oanceled before <br />lis expiration dale, stale Farm will try 10 mail a written <br />notice to the certificate holder 10 days before <br />cancellation. If however, we fail to mail such notice, <br />no obll~ation or liability will be imposed on State <br />Farm or its agents or representatives_ <br /> <br />Si9~~ <br /> <br />A!1ent 0.9/15/05 <br />Title Date <br />Agenfe Code Stamp <br />CYNTHIA SNYIJ~ti <br />AFO Code F4J.2 <br /> <br />Name and Address 01 Certificate Holder <br /> <br />,-pRO V ~1J AS TO FORM <br /> <br />--~ura Stitt <br />. . <br />'H~[a'nf~Cit <br /> <br /> <br />L- <br /> <br />15.3049 <br />F412 <br /> <br />55S~J9.1,:a.4 11-~ 2-2002 Printed !n U.S.A. <br />