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<br />r&l <br />~ <br /> <br />STATE FARM INSURANCE COMPANIES <br /> <br />RENEWAL CERTIFICATE <br /> <br />State Farm General Insurance Com~ <br />31303 Agoura Road ).of <br />We.Uake Vmage,CA 91363.0001 <br /> <br />BUSINESS.OFf'Iooool <br />JAN 16 2002 to JAN 16 2003 <br /> <br />'J <br /> <br />D-7795-F416 FU 3 <br /> <br />DATE DUE <br /> <br /> <br />PLEASE PAY THIS AMOUNT <br /> <br />, <br /> <br />" <br /> <br />THE CITY OF SANTA ANA <br />ITS OFFICERS, EMPLOYEES, <br />AGENTS & VOLUNTEERS <br />ATTN: JIM STIKELEATHER <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4010 <br />11,1""1,11",111111,"11,1,,111,,""1111",,,1,111""1"11 <br /> <br />Coverages and Limits <br />Section I <br />A Buildings <br />B Business Personal Property <br />C Loss of Income <br /> <br />Excluded <br />13 400 <br />Actual Loss <br /> <br />Deductibles . Section I <br />Basic <br />Other deductibles may <br />apply - refer to policy <br /> <br />500 <br /> <br />Insured: QUINN, SUSAN & GERALD <br />DBA THE QUINN COMPANY <br />Location: 246 VIA PRESA <br />SAN CLEMENTE CA <br /> <br />Section II <br />L Business Liability <br />M Medical Payments <br />Gen Aggregate (Other than PCO) <br />Products-Completed Operations <br />(PCa Aggregate) <br /> <br />$1,000,000 <br />5,000 <br />2~000,000 <br />txcluded <br /> <br />Add Ins-II: THE CITY OF SANTA ANA <br />Add Ins-II: COUNTY OF LOS ANGELES <br /> <br />Forms, Options, and Endorsements <br />Special Form 3 <br />Business Policy Endorsement <br />Amendatory Endorsement <br />Debris Removal Endorsement <br />Policy Endorsement <br />Glass Deductible - Section I <br />Advertising Injury Excl <br />Products/Operations Liab Excl <br />Personal Injury Exclusion <br />Additional Insured <br />Testing/Consulting E&O Excl <br /> <br />FP-6143 <br />FE-6464 <br />FE-6205 <br />FE-6451 <br />FE-6506.1 <br />FE-6538.1 <br />FE-6345 <br />FE-6312 <br />FE-6346 <br />FE-6320 <br />FE-6510 <br /> <br />Annual Premium <br />Bus Liability - Cov L <br />Total Amount <br /> <br />$197.00 <br />5.00 <br />$202.00 <br /> <br />Premium Reductions <br />Your premium has already been reduced <br />by the following: <br />Claim Record Discount <br />Yrs in Business Discount <br /> <br />Cov. A - Inflation Index: N/A <br />Cov. B - Consumer Price: 178.3 <br /> <br />APPROVED AS TO FORM <br /> <br />~odj j <br /> <br />Laura Sheedy / <br />poputY CItY A\lafll~Y <br /> <br />Tkvrb~~fJS~F'" <br />Agent ~IKE MII~LER <br />Telephone (949) 493-3888 <br /> <br />See reverse side for impcrtant information. <br />Please keep this part for your record. <br /> <br />Prepared NOV 07 2001 <br /> <br />nATI.UfO <br />.. <br /> <br />IF YOU HAVE MOVED PLEASE CONTACT YOUR AGENT. 7795-F416 F <br />INSURED IaUINN, SUSAN & GERALD <br />POLICY NUMBER I 92-S6-8207-2 BUSINESS-OFFICE <br /> <br />NOTE: DO NOT PAY. THE PREMIUM IS <br />BEING PAID BY THE INSURED. <br />"AT"""" <br /> <br />THIS IS FOR INFORMATION ONLY <br /> <br />246 VIA PRESA <br />SAN CLEMENTE CA <br /> <br />'NI~UN" <br /> <br />2309000006 <br />State Farm Insurance Companies <br /> <br />138-3016 f.5 Rev. 02-2001 Printed in U_S.A. 01100811 <br />FOR OFFICE USE ONLY 9130 401 M <br /> <br />Prepared NOV 07 2001 <br />N <br /> <br />REB <br /> <br /> <br />0000 <br />