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<br />MAY-03-2001 14:08 FROM:ERIC W GRUVERPH 0 <br /> <br />7145444996 <br /> <br />TD:714 245 8094 <br /> <br />P.003/003 <br /> <br />-- <br /> <br />""'" <br /> <br />DfCLARA TlONS <br />SPECIAL <br />SENTINEl <br />PACKAGE <br />SUPER <br /> <br />BTRUCK IHSURAHCE E~"?Gi' I!J FARMERSIIfSURAHCE EXCHANGE 0 FIRE IHSURANCE EXCHANGE <br />MEMBERS 01 FARMERS INSURANCE GROUP OF COMPANIES ~ <br />HOME OFFICE: 4680 WILSHIRE BlVO. LOS ANGelES. CALIFORNIA 90010 ~ <br /> <br />1. Named <br />tnslll'efl <br />~iting <br />AddIoSs <br /> <br />. ERIC GRUVER <br /> <br />97-15-P26 01S0~-~0-07 <br />Agent Policy Number <br />Type 01 <br />o Parlnersl1ie.. 0 Corp. 8usiness PSYCHOLOGY OFFICE <br />o JoInt Venlure U OIganlzation (Other than Parlnetship or joInt Venlu"'l <br />2. Policy Period rrom 081'25/00 \notllrior to time applied lor) <br />to 081'25/01 2:0\ a.m. Standalll Time. <br />II this policy replocos other coyorageo lhat end at noon $landalll time on the same day this policy beeins. this polley will not ta~e effect until tile other <br />COverage ends. Thl. polley wlIleeoUnue lor IU"...ln policy perlodl .. 101lowI: II we elecllo contillUllthts Insurance. we will "new this polley if <br />you pay the required renewal premium for each successlve policy period subject \0 out premiums. rules and forms then In effect <br />3. Insured tocation same as mail/ng addl8SS unless oUlerwis. slated: 17772 SEVUlTEtHTH STREET <br />SUITE 106 <br />TUSTIN CA 92780 <br /> <br />: 17772 SEVENTEENTH STREtT <br />. SUITE 106 <br />TUSTIN <br /> <br />Plllmalic Acc't No. <br /> <br />Prod. <br />Count <br /> <br />CA 92780 <br /> <br />TIle Ilimed Insured is an Individual unless OthC1Wise slated: <br /> <br />4. Mortgage Hofdcts <br /> <br />Loan # <br /> <br />Loan # <br /> <br />5. Premium $ 500.00 0 -x- W MoI1Qage Holder Pays <br />6. Policy Fonns and EndOlSCmtl.1s aUached al inception: 25-2611. 25-2880 <br />E6036-ED1 E~168-ED1 E400q-en1 Eq216-ED1 E3026-ED1 <br />7. We omvlde insurance onIv lor those COVetaaes indicated bv a _cmc Ilm~ or bv an -rif <br />COVERAGES <br /> <br />25-2191 S90Q3-ED1 <br />EQ103-ED2 <br /> <br />SECTION 1 <br /> <br />A.8uildlllll <br />Il-Businoss Personal Property <br /> <br />tMfTS OF INSURANCE <br /> <br />22,000 <br /> <br />DfOUCTIBlE <br />2&0 .pplles U'Ut=. os'*' <br />~on """ea1ecl..Qy anCil <br />lJS100OsSOO Us <br />NONE <br /> <br />Property <br />and <br />less 0' <br />Incom. <br /> <br />C.Loss allncome (Not ex <br /> <br />12 consecutive months! <br />OPTIONAL COVERAGES <br />Swimming PooIlF.nces and Walkways <br />Building Glass(B1an~e\) <br />OUtdoor Sign Coveraae <br />Valuable Papers (In addition to S 1 000 included.) <br /> <br />OCTUAllOSS SUSTAlN[O <br /> <br />SECTION II <br /> <br />~ <br /> <br />o EaJthquak. Oamag. <br />ll-8uslness Liability. InclUding Producls and Completed IMllS \If LlA8ILrlI <br />Operations. (Annual aggregate applies lor all ~nces Annual AGan:catel <br />durina the '0Il.l S 1 000 000 <br />Hire Legal Liability 575.000 Included unless olIIer option Indicated by an I!I <br />05100,0000 $150.000 each OCCUllence 'Subiecl \0 \he annual aoareaoal. sh <br />f.Medic31 payme~ls to ~ (Subjeclto the annual aggregate <br />shown for Cover.me D.l <br /> <br />EPlACEMENT COST <br />$ <br />:a <br /> <br />_uealJCo <br />UllI, 'ppllo1 <br />lInJaa orner E <br />S <br /> <br />opUoft I",,~ <br /><_. <br />$ <br /> <br />LIability <br />and <br />Modicars <br /> <br />lor Cov. OJ <br />5.000 each person <br /> <br />o Prnress~labl!1ty ls,", attached .ndom:m.nll <br />1iI1'VCOV~ <br />SECTION III AGreement '.Emalovee DishollCSlY <br />_AIl""""'nt If.8road Form Mone. and Sccurilles~nSlde <br />Aarccmenllll.8road Form Monev and SecurllieSoOulSlde <br />Clime Aurccmelll tV-Med.cal Pa rnents <br />Agre~ IteIlIions . <br /> <br />......." ... ...TION.... \~ t~ 1 \ Counl~ned <br />\ 1L......u <br />~ iChaol Yigliotta <br />Deputy City I~, t1nrnev <br /> <br />limIt of liability <br />Annual Aggregate) <br /> <br />....-.. <br /> <br />( J . <br />V <br /> <br />5 000 <br />1 000 <br />1 000 <br />500 each person <br />2 500 <br /> <br />DEDUCTIBLE <br />NONE <br />1250 <br />$250 <br />NONE <br />NONE <br />--- <br /> <br />Representative <br />