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Policy Number DECLARATIONS PAGE COVERAGE SUMMARY <br />92.92-2579-2 AUG 13 2004 <br />STATE FARM GENERAL INSURANCE COMPANY <br />31303 AGOURA RD, WESTLAKE VILLAGE,CA 91363-0001 <br />A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS <br />Agent Copy <br />Named Insured and Mailing Address <br />1308-F412 S <br />CLIFFORD, SUSAN SAXE DR <br />A PROFESSIONAL CORPORATION <br />16530 VENTURA BLVD STE 203 <br />ENCINO CA 91436-4535 <br />BUSINESS POLICY -SPECIAL FORM 3 <br />Cov A -inflation Coverage Index: N/A <br />Cov B -Consumer Price Index: 185.2 <br />AUTOMATIC RENEWAL - If the POLICY PERIOD is shown as 12 MONTHS, this policy will be renewed automaticall} <br />subject to the remiums, rul s and forms in effect for each succeedingg policy period. If this olicy Is terminated, we wi I <br />give you and tie Mortgageel~ienholder written notice In compliance wrlh the policy provlslon~or as required by law. <br />Policy Period: 12 Months The policy period begins and ends at 12:01 am standard time at the <br />Effective Date: APR 18 2004 premises location. <br />Expiration Date: APR 18 2005 <br />Requested By: Additional Insured <br />Location of Covered Premises: <br />16530 VENTURA BLVD STE 203 <br />ENCINO CA 91436-4535 <br />Coverages & Property <br />Section I <br />4 Buildings <br />3 Business Personal Property <br />C Loss of Income - 12 Months <br />Section II <br />_ Business Liability <br />vt Medical Payments <br />~rotlucts-Completed Operations <br />(PCO) Aggregate <br />aenerai Agg9grega~e (Other <br />Than PCO) <br />Limits of insurance <br />Excluded <br />5 119,700 <br />3 Actual Loss <br />s l,oao,ooo <br />5 5,000 <br />5 2,000,000 <br />2,000,000 <br />'i)iicy Endorsement <br />Terrorism Insurance Cov Notice <br />4mendatory Endorsement <br />debris Removal Endorsement <br />3usiness Poticy Endorsement <br />'amendatory Collapse <br />FP-6143 <br />FE-6506.2 <br />FE-6999 <br />FE-6205 <br />FE-6451 <br />FE-6464 <br />FE-6551 <br />an <br />Deductibles -Section I <br />$ 500 Basic <br />In case of loss under this policy,, the deductible will bE <br />applied to each occurrence and WIN be deducted from the <br />amount of the loss. Other deductibles may apply -refer tc <br />Premium <br />Discounts Applied: <br />Renewal Year <br />Years in Business <br />Encbsed Building <br />Protective Devices <br />Sprinkler <br />Claim Record <br />~PPROVEllA,SJTO rvi<~. <br />___~~3 sl <br />' Laura; .';tits Sheerly ~-~ <br />Asns[an,. ~,i~ nttorney <br />:ontinued on Reverse Side of Page + <br />OTHER LIMITS AND EXCLUSIONS MAY APPLY • REFER TO YOUR POLICY <br />prepared <br />JG 13'2004 Countersigned <br />~-8030.2C BQL3 BY <br />i/1993 ER <br />cur policy consists of this page, any endorsements (ar <br />id the policy Corm. PLEASE KEEP THESE TOGETHER- <br />(ott2172b <br />