QUINN, SUSAN 2 - 2001 - Laserfiche WebLink

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. CERTIFICATE OF INSURANCE SUCH 'INSURANCE AS RESPECTS THE 'TEREST OF THE CERTIFICATE HOLDER W'LL NOT BE CANCELED OR OTHERWISE TERft/lINATED WITHOUT GIVING 10 DAVRIOR WRITTEN NOTltE TO THE CERTIF...,JrE HOLDER NAMED BELOW, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE Yi1R1TTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW, This certifies that: [j[] STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois, or o STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois has coverage in force for the following Named Insured as shown below: Named Insured QUINN, GERALD & SUSAN 246 VIA PRESA, SAN CLEMENTE, CA 92672 Address of Named Insured POLICY NUMBER P41 3074-F19-7~A EFFECTIVE DATE 6/19/00 OF POLICY DESCRIPTION OF VEHICLE 98 TOYOTA CAMR, UABIUTY COVERAGE [iJ YES DNa o YES DNO DYES DNo DYES DNa LIMITS OF LIABILITY a. Bodily Injury 100000 Each Person Each Aocident b. property Damage ~vvvvv Each Accidellt 25000 c. _~ I~"'Y & ~ Oamlge ~ngIe Umt ---- Each Accident PHYSICAL DAMAGE [X] YES DNO '-.J YES DNO DYES DNO DYES DNO COVERAGES a. Comrv-<>h<>nsive $ 100 Deductible $ Deductible $ Deductible $ Deductible CiJ YES DNO DYES DNO DYES DNO DYES DNO b. Collision $ 250. Deductible $ Deductible $ Deductible $ Deductible EMPLOYER'S Q9 YES DNO DYES DNO DYES DNO DYES DNO NON.OWNERSHIP COVERAGE HIRED CAR COVERAGE [Xl YES DNO DYES DNO DYES DNO DYES DNO n,~~ Signature of Authorized Representative Name and Address of Certificate Holder a..~ Title '7795 9/.at/oo Agent's Code Number Date Name and Address of Agent ,- -, ,- -, CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA, CA 92702 APPROVED AS Stale Farm Insurance ..e Miller -lie. No. 0360139 31882 Camino Capistrano, #1058 San Juan Capistrano, CA 92675 (949) 493-3888 (949) 831-9811 L L ~ CERTIACATE HOLDER COPY