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<br />'Jan' OS 04 01: 5Sp <br />FROM: L.A.CHA MAINTENANCE CO. <br /> <br />Teg1 <br /> <br />. <br /> <br />p.2 <br /> <br />FAX NO. : 18183668403 <br /> <br />Jan. 09 2004 1l:43AM P2 <br /> <br />t' <br /> <br />PLEASE AE4D YOUf'l POl'C'( <br />T~l$ det1aralions PaWAmOOc1Cd DfltCtllitcti(. <br />Prrvlo~:or oohey no, <br /> <br />t. . .POt.ICYNUM6fA CA 0-20-68-$IQ-1 <br />'Ig. with 'he Doll(:'( ,Iaeket ldenllflerl Dy lh~ form ana@d,(.on daUt .ndlCiJffd completes the ahoy. nl,,nribcr8d poticy. <br />F",., 1050 Ed. 1194 <br /> <br />DECLARATIONS <br />NAMEDINSUREO <br /> <br />L.A. CH~ MAINTENANCE <br />18816 SN FRNNOO MSSM <br />NORTHRIOGE CA 91326 <br /> <br />PAGE I OF 3 <br /> <br />,4.-)..003-009 <br />A-OlbO+ 003 <br /> <br />A <br />G <br />E <br />N <br />T <br /> <br />JOHN KIM INS SERV <br />3807 WILSHIRE aVDIIOO <br />LOS ANGELES CA 90010 <br /> <br />PROGREDlVEe <br /> <br />POLICY TERM: SEP 25. 2003 TO MAR 25. 2004 <br />Thi$ pOlICY mr.eots 11'lQ teler of: 1. me time the &DpIic&lion!Of inSutanc-e if VUCulad On <br />the fi#$l day ot 'Mtil polley Period: or 2 12:01 a,m, on the liral day oIl~ POlley ~d. <br />Thi& p(If.q shall elq)q at 12:01 ".m. on 'J\e 1&$\ dsy ut fl'te Policy pe'iod <br />CA-26390 <br />PROGRESSIVE CASUALTY INS. CO. <br />P.O. BOX 94739, CLEVELANO, OHIO 44101 1-800-444-4487 <br /> <br />CD"''''''_u..,. \tlIrrqcu; ,..~""..Cl:' <br /> <br />the I~I..".. ,.""... "". 'mllS '""IV I. ,.. '''''ibed ..,",I. .. $hoW" b.~. c...."O..... .",,.,, in "'l>Ol~Y an" ... 'vbie<' I. 'he'''m. en. o""",.i.", <br />(."OftIeim!d i... the policy, ineiU(jinQ 8rT1enOtn~nts i:md 9ndol'S8menls. No change! will be lO:rrecl~ IlliOt 10 tna 11m(! che"U89 /!lIB rl!Quelted. <br /> <br />SCHEDULE OF COVERAGES AND LI~ITS Of LIABILITY <br /> <br />COVERAGES <br />A SINGLE LIMIT aODILY INJURY <br />PROPERTY DAMAGE liABILITY <br />C MEDICAL PAYMENTS <br />I UHIUNOERINSURfO MOTORIST <br />UM PROPERTY DAMAGE <br /> <br />ANO <br />~1.000.000 EACH ACC <br />S Is?ggo E:~~R~~C~Oj~;ooo IACC. <br />$ 3,500 IOcc. <br /> <br />FULL TERM PREMIUM <br /> <br />CHARGES <br />$ 1141 <br />f18 <br />47 <br />40 <br /> <br />Al'FROVED AS TO FORM <br />-;Lg . nt / //~ __,. <br />----F6t~?7shOedY <br /> <br />AssistaLlCi[y At10rnev <br /> <br />FiliNG FEES <br />TOTAL POLICY PREMIUM <br /> <br />so.OO <br />$1.246.00 <br /> <br />ATTACHMENT IDENTIFIED BY FORM NUMBER <br />7886 (10-01) 6212 (05-97) 1197 (08-93) 3644 (12-01) 4792A (01-03) <br /> <br />DRIVERS <br /> <br />PAGE <br /> <br />2 <br /> <br />. COVERED VEH PAGE <br /> <br />3 <br /> <br />ICC-N MCS90-N <br />PUC-N OTH-N <br /> <br />An,y (oss undCf Pall I I I is fh")ilbrto u inlCfQ$l may ap(l~'r to ,l&ftled ins",'ed' and "lxllIV Jou p&vee: <br />'lcId l=olWIlnlll- I Clqt' No. <br />Fio"'"" G2 BGO 03213 XXXX 8.0 CAICS lC <br /> <br />PrOI;l Ptemium Bl,ldg8" C I <br />FVF\0203,..Factor Used: FIR 06.2002 <br /> <br />:':o...n'eISlon~c:I <br /> <br />"'3 (12.92) <br /> <br />INSURED COpy <br /> <br />CVVVE0917011217L111301 <br />