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<br />. FEB 2'4,2006 12:06 <br /> <br />. <br /> <br />000-000-00000 <br /> <br />. <br /> <br />Page 2 <br /> <br />,..., .~". <br />.. <br /> <br />CERTIFICATE OF INSURANCE <br /> <br />'MI~'~.(~, <br /> <br />SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE <br />CANCELED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE <br />CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM <br />THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY <br />ANY POLICY DESCRIBED BELOW. <br />This certifies thaI: ~ STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloominglon. illinOIs <br />o STATE FARM FIRE AND CASUALTY COMPANV of Bloomington, Illinois <br />o STATE FARM COUNTY MUTUAL INSURANCE COMPANV OF TEXAS of Dallas, Texas <br />o STATE FARM INDEMNITY COMPANV of Bloomington, Illinois. or <br />o STATE FARM GUARANTY INSURANCE COMPANV of Bloomington, Illinois <br />has coverage In force forthe followi"-9_N_a.rned Insured as shown below.. .______ ____.___ <br /> <br />NAMED lNSW~ED: ^1L'~Tl'Y l'1.i'\NAGl::MEtvT <br />.----- <br /> <br />AODRESSOFNAMEDINSURFD: __~,.!...II~~~._J.,~ CI~:NM~J\ ~'\I,VD. l,()~; ^N(;jl':l,j"~: C^ 9n(J.-~,rl~4.~,~! <br />POLICY NUMBER C6:,.'06:n-A16-7J <br />-.......,,-,.----- --_._.~-- <br />EFFECTIVE DATE <br />OF ~Q~Il::'f: en:!H/()" <br /> <br />DESCRIPTION or <br />VEHICLIo (lncJuo,ng VIN) <br /> <br />ENOL <br /> <br />LIABILITY COVERAGE [gl VES <br /> <br />DNa <br /> <br />DYES <br /> <br />DNa <br /> <br />DVES <br /> <br />DNa <br /> <br />DVES <br /> <br />DNa <br /> <br />LIMITS OF LIABILITY <br />.. Bodily Inlury <br />Each Person <br /> <br />Eo.ch Accident <br /> <br />b. Property Damage <br />Each Accident <br />c. Bodily Injury & <br />Property Damage <br />Single Lunit <br />Each Accident <br />, PHYSICAL DAMAGE <br />COVeRAGeS <br />,,~~~~~_e!~~iv~, _.. <br /> <br />1 Ml~L":'(jN <br /> <br />b. Collision <br /> <br /> , <br /> i <br /> I <br /> .__._n..___._... HJ <br />DYES rgJ NO DVES DNa DVES UNO DYES DNa I <br />$ Deductible $ Deductible $ Dedul;tibte $ Deductible <br /> .__....,M~___..,.__ ! <br />DVES rgJ NO DYES DNa DYES DNa DVES DNa <br />$ Deductible $ DeductiblEl $ Deductible $ Deductible <br /> .-.--.----....".-.. <br />IZI VES DNa DVES DNa DVES DNa DYES DNa <br />:~~S .....---..----...-.- ---- <br />rgJ NO DVES DNa DVES DNO DYES []NO <br /> <br /> <br />rgJ NO <br /> <br />DYES <br /> <br />DNa <br /> <br />DYES <br /> <br />DNa <br /> <br />[)VES <br /> <br />DNa <br /> <br />II": 1P) <br /> <br />~.;T^~'~' A(3FNT /frlJ.1:l9 0;1/;>11/00 <br />Titlo Agent's Code Numbe'r- Date <br />i'J~me and Address of AQent _________ <br />WII,I,iN'" 11^MMONi.l!.l. ^CI~NT <br />:";'j'ATE FAHM '::N~HJHANCE COMr'AN.TF'.~; <br />IJ!-U~ W.Ol.YMI'IC HI.VIJ :-;'1'1< fL-l() <br />.i./,l~; ANr.;I.~l,l:,:;';. CA 90()6<1 <br /> <br />INTERNAL STAl'[ "'ARM USE {)NL.Y U Request permanent CertificalQJ of Insu(ance for lIal::nhtv (;.overaga <br />122420.:} H.S'i 07-26-2005 0 Request Certific:at~ Holder 10 be o,.k1ed .IS"O Adclitior1id IrlOllrod <br />