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8-31-2005 4=38PM FRQ'a <br />CERTIFICATE OF INSURANCE <br />This certifies that ❑ STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois <br />® STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois <br />❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario <br />❑ STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida <br />❑ STATE FARM LLOYDS, Dallas, Texas <br />insures the following policyholder for the coverages indicated below; <br />Name of policyholder CASA DE SALUD FAMILY HEALTH CLINIC <br />Address of policyholder 1515 S BROADWAY <br />Location of operations SANTA ANA CA 92707-2211 <br />Description of operations <br />P-2 <br />The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is <br />subject to all the terms exclusions, and conditions of those policies. The Limits of liability shown may have been reduced by anv oaid claims <br />POLICY NUMBER <br />TYPE OF INSURANCE <br />POLICY PERIOD <br />Effective Date ; Expiration Date <br />LIMITS OF LIABILITY <br />(at beginning of policy period) <br />Comprehensive <br />BODILY INJURY AND <br />— : -- - --- -- -- <br />This Insurance includes: <br />Business Liability <br />❑ Products - Completed Operations <br />PROPERTY DAMAGE <br />❑ Contractual Liability <br />�] Underground Hazard Coverage <br />Each Occurrence $ <br />Cl Personal Injury <br />❑ Advertising Injury <br />General Aggregate $ <br />C7 Explosion Hazard Coverage <br />❑ Collapse Hazard Coverage <br />Products -- Completed $ <br />❑ <br />Operations Aggregate <br />❑ <br />EXCESS LIABILITY <br />POLICY PERIOD <br />Effective Date , Expiration Date <br />BODILY INJURY AND PROPERTY DAMAGE <br />(Combined Single Limit) <br />[] Umbrella <br />Each Occurrence $ <br />❑ Other <br />Aggregate $ <br />Part 1 STATUTORY <br />Part 2 BODILY INJURY <br />92 -EU -8930-2 F <br />Workers'Compensation <br />05/01/2005 05/01/2006 <br />and Employers liability <br />05/01/2005 I 05/01/2006 <br />Each Accident $ 1,000,000 <br />Disease Each Employee $1,000,000 <br />Disease - Policy Limit $ 1, 000, 000 <br />POLICY NUMBER TYPE OF INSURANCE <br />POLICY PERIOD <br />Effective Date Expiration Data <br />LIMITS OF LIABILITY <br />(at beginning of policy period) <br />111L UEK I IF1CAI t Ur INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY <br />AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. <br />If any of the described policies are canceled before <br />its expiration date, State Farm will try to mail a written <br />notice to the certificate holder 60 <br />Name and Address of Certificate Holder days before cancellation. If however, we fail to mail <br />such notice, no obligation or liability will be imposed <br />on State Farm or its agents or representatives, <br />)'r Lia /;' 'vo uORM <br />Stitt s1wedy <br />"a -9t 8,3 04•te88 P11nte01n U.$A. <br />Signature of Authorizeo Representative <br />SCOTT CAMPOS, AGENT 08/31/2005 <br />Agent's Code Stamp <br />AFO Code F419 <br />