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~,JUn*17 03 10:26a STHTE FARM INS 3103792436 p.2 <br />4 • • <br />CERTIFICATE OF INSURANCE <br />T ~SrC~ItF ~ at ^STATE FARM FIRE AND CASUALTY COMPANY, 131oomington, Illinois <br />®STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois <br />(d"~ ^STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario <br />„:,,,,„r, ^STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida <br />^ STATE FARM LLOYDS, Dallas, Texas <br />insures the following policyholder for the coverages indicated below: <br />POIiCyh0lder TELFUAnS <br />Address ofpoligh0lder C/0 LINUA K. CARSON, 1255 19r" ST.,aEAMOSA aEACN,CA. 90254-3309 <br />Location of operations <br />Description of operations <br />The policies listed below have bP.en issued to the policyholder for the policy periods shown. The insurance described in these policies is <br />subject to atl the terms exclusions, and condlBOns of those policies. The limds of liability shown may have been reduced by any paid <br />Calms. <br /> POLICY PERIOD LIMITS OF LIABILITY <br />POLICY NUMBER TYPE OF INSURANCE Effective Date i lion DaCa (at beginning of policy period) <br /> Comprehensive BODILY INJURY AND <br /> BusinessLiabilitY_________ _,,,.___._..______~_ PROPERTY DAMAGE <br />_____________________________ <br />This insurance includes: _ <br />^ Products -Completed Operations <br /> ^ Contractual Liability <br /> ^ Underground Hazard Coverage Each Occurrence $ <br /> ^ Personal Injury <br />/ ^ Advertising Injury General Aggregate $ <br /> ^ Explosion Hazard Coverage <br /> ^ Collapse Hazard Coverage Products -Completed $ <br /> ^ Operations Aggregate <br /> <br /> POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE <br /> EXCESS LIABILITY Effective Date ; ERtiratiotl Date (Combined Single Limit) <br /> ^ Umbrella Each Occurrence $ <br /> ^ Other Aggr ate $ <br /> Part 1 STATUTORY <br /> Part 2 BODILY INJURY <br /> Workers' Compensation <br /> and Employers Liability Each Accident $ <br /> Disease -Each Employee$ <br /> Disease -Policy Limit $ <br /> <br />- POLICY PERIOD LIMITS OF LIABILITY <br />POLICY NUMBER TYPE OF INSURANCE Effective Date i Etq~lrat+on Data Iat beginning of policy period) <br />92-QS-0209-7 G k1USTNESS 09!25/03 04/25/04 51,000,000//GEN AGG-52,000,000 <br /> <br /> <br />THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITtIER AFFIRMATIVELY NOR NEGATIVELY <br />AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. <br />If any of the described policies are canceled before <br />ita expiration date, State Farm shall mail a <br />written notice to the certificate holder 30 days before <br />Name and Address of Certificate Holder cancellation. If however, we fail to mail such notice, <br />no obligation or liability will be imposed on State <br />THE CITY OF SANTA ANA Farm Or it agents or representatives. <br />20 CIVIC CENTER 1?7,A7,A ~p~ <br />SANTA ANA, CA. 92701-4010 --Cl "'~ <br />'(~(~ }• ~)K ~ 9lgnatwe or Authorized Reprrraonfatiw <br />=',, 4'[-tC (J'J L' L? 1\S AGENT 06/17/03 <br />Tllle Date <br />~ r~~' ~~~ _-.,___~__.- Agent's Code 3temp <br />3 u , ply _//7. <br />}~~ „IV r ,lb Attukncy AFO Code F776 <br />edO~He~ a~~ 11-12-2002 Pelnlee In U.8.A. <br />