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<br />IA-,I <br />L3 <br /> <br />.. I. State Farm Generalll\8urance OOIT,-,' <br />31303 AgOlUll Road <br />We.~akO Village,eA 91363-0001 <br /> <br />nCI..c.vwA.L. vt=.H III'"I\"'" It: <br />POLICY NUMBE..... ~ 92-S6-8207-2 <br />BUSINESS-OFFK:E <br />JAN 162003 to JAN 162004 <br /> <br />U <br />:1 <br /> <br />D'7795-F416 F U 3 <br /> <br />DATE DUE PLEASE PA V THIS AMOUNT <br />TO BE PAID BY INSURED <br /> <br />Ii <br /> <br />THE CITY OF SANTA ANA <br />lITS OFFICERS, EMPLOVEES, <br />AGENTS 8 VOLUNTEERS <br />ATTN: JIM STIKELEATHER <br />~O CIVIC CENTER PLZ <br />'SANTA ANA CA 92701-4010 <br />11,1""1,11",111",,"11,1"111",,"1111"1"1,111,,"1,.11 <br /> <br />Insured: QUINN, SUSAN & GERALD <br />DBA THE QUINN COMPANY <br />Location: 246 VIA PRESA <br />SAN CLEMENTE CA <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 />Speoial 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 />Produots/Operations Liab Excl <br />Personal Injury Exclusion <br />Additional Insured <br />Testing/Consulting E&O Excl <br /> <br />.-i- <br /> <br />r <br /> <br />7kLr r.fdtifa.S'JWW~.. <br />Agent IVIIKE MilLER <br />Telephone (949) 493-3888 <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 />13,700 <br />Actual Loss <br /> <br />Deductibles . Section I <br />Basic <br />Other deductibles may <br />apply. refer to policy <br /> <br />500 <br /> <br />Section (I <br />L Business Liability <br />M Medical Payments <br />Gen Aggregate (Other than PCO) <br />Products-Completed Operations <br />(PCO Aggregate) <br /> <br />$1,000,000 <br />5,000 <br />2~000,000 <br />txcluded <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 />CA Surcharge <br />Total Amount <br /> <br />$244.00 <br />6.00 <br />5.00 <br />$255.00 <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: 181.0 <br /> <br />,~ <br /> <br />~.. . <br />" <br /> <br />, <br />"". <br />" y ".~" .. <br />'.-1.... . <br />~-~ ( <br /> <br />~ <br /> <br />D\"'t'~~.. .....,... :'.l'Uliley <br /> <br />-- <br /> <br />APPROYED AS:'~ FORM <br /> <br />., \ ~ ' '. " <br /> <br />4-z 8031106404 <br /> <br />See reverse side for important information. <br />Please keep this part' for your record. <br /> <br />Prepared NO" 04 2002 <br /> <br />IF YOU HAVE MOVED, PLEASE CONTACT YOUR "GENT. <br /> <br />NOTE: DO NOT PAY. THE PREMIUM IS <br />BEING PAID BY THE INSURED. <br /> <br />A <br /> <br />INSURED <br /> <br /> <br />''''UU''C1. <br /> <br />POliCY NUMBER <br /> <br />92-S6-8207-2 <br /> <br />\ <br /> <br />138-30761_5 AlIv.02-2001 Printed in U.S.A. (oH00811) <br />OR OFFICE USE ONLY 7834 401 M <br />Prepared NOV 04 2002 <br />N <br /> <br />n95-F416 F <br /> <br />DATE DUE <br /> <br />PLEASE PAY THIS AMOUNT <br /> <br />BUSINESS.OFFICE <br /> <br />THIS IS FOR INFORMATION ONL V <br />246 VIA PRESA <br />SAN CLEMENTE CA <br /> <br />2309000006 <br />Slate Farm Insurance Companies <br /> <br />RES FIRE REN <br /> <br /> <br />0000 <br />