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<br />q <br /> <br /> <br />· STATE FARM INSURANCE COMPANIES~ <br /> <br />900 Old River Road <br />Bakersfield CA 93311-0001 <br /> <br />DATE OF NOTICE: JUN 232006 <br />CODE: <br /> <br />23 39A <br /> <br />A <br /> <br />CITY OF SANTA ANA CT <br />ATTN; CITY CLERK <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701-4058 <br /> <br />NOTE: PLEASE NOTIFY STATE FARM AT THE <br />ADDRESS LISTED AT THE TOP, LEFT CORNER <br />OF THIS PAGE REGARDING ANY CHANGE OF <br />ADDRESS INFORMATION. <br /> <br />11.1....1.11...111......11.1..111....1.1.1..1...1.111.....1.11 <br /> <br />---.----- <br /> <br />LA- rZ()()d; -0<2// <br /> <br />-1 <br />/ <br /> <br />I <br />J <br /> <br />~ <br /><:> <br /><:> <br /><::> <br /><.:l <br />ti <br /> <br />I ADD!TIONAL INSURED'S NOTICE OF COVERAGE <br /> <br />State Farm Mutual Automobile Insurance Company <br />NAMED INSURED: POLICY NO: V541083.A15-750 <br />g HARTL,DA VID E & JOHNSON,JERENE YR/MAKE/MODEL: 2000 LEXUS 4DR <br />ClI 3808 E LARKSTONE DR VIN/CAMPER: JT8BH28F3Y0177545 <br />~ ORANGE CA 92869-5355 AGENT NAME: TANYA PEARSON <br />AGENT PHONE: (714)289-1226 <br />ENDORSEMENT NO: 6028AU <br /> <br />8549- F419- M <br />COVERAGE: <br />BI AND PD LIABILITY <br />$1 Mil 1$ 1 Mil 1$ 1 Mil <br />$100 DED CaMP. <br />$250 DED. CalL. <br /> <br />iii.....! <br />.. <br /> <br />'If! <br /> <br />,; <br />G> <br />a: <br /> <br />POLICY EFFECTIVE <br />JUN 142006 UNTIL TERMINATED <br /> <br />~ <br />N POLICY MESSAGES: This policy shown above supersedes policyl V541 083-75N. <br />~ The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance <br />.!!.. <br />.... provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminated. Until such notice <br />!2 is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of <br />~ any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. <br />.; <br />C') <br />.... <br /> <br />~ <br /> <br />FRT <br /> <br />