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CERTIFICATE OF INSURANCE <br />This certifies that ^ STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois <br />® STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois <br />^ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario <br />^ STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida <br />^ STATE FARM LLOYDS, Dallas, Texas <br />insures the following policyholder for the coverages indicated belovr. <br />Policyholder ONG, ALFREDO DBA CHESS PALACE <br />__ <br />Address ofpolicyhnlder 12872 VALLEY VIF'W ST STE 5 <br />LofxtionofOpOrafiOflS GARDEN GAOVE CA 92895-2518 <br />Description of operations CHESS <br />The policies listed below have been issued to the policyholder for the polity periods shown. The insurance described in these polities is <br />subject to all the terms extrusions, and conditions of those polities. The limits of liability shown may have been reduced by env paid claims <br /> POLICY PERIOD LIMITS OF LU161LITY <br />POLICY NUMBER TYPE OF INSURANCE EtTacUve Date <br />Expiation Date <br />(at beginning of policy psdod) <br />92-D9-OSO8-1 c Comprehensive 6-i-06 coxTINUOUS BODILY INJURY AND <br />-------- Business Liability---___--• ------------- PROPERLY DAMAGE <br />This insurance includes: ^ Products -Completed Operetions <br /> ^ Contractual Liability <br /> ^ Underground Hazard Coverage Each Occurrence $ i, 000, 000 <br /> ^ Personal Injury <br /> ^ Advertising Injury General Aggregate $ 2, OoO, 000 <br /> ^ Explosion Hazard Coverage <br /> ^ Collapse Hazard Covenrge Products -Completed $ z, 000, 000 <br /> ^ Operations Aggregate <br /> ^ <br /> POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE <br /> EXCESS LIABILITY Effecflw Deco ~ Expiration Data (Cotnbirted Single Limit) <br /> ~ U <br />m~ la Each Occurrence E <br /> O Aggregate $ <br /> Part t STATUTORY <br /> Part 2 BODILY INJURY <br />NONE Workers' Compensation <br /> and Empbyers Liability Each Accident $ <br /> Disease -Each Employee $ <br /> Disease -Policy Limit $ <br /> <br />POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD <br />Effective Date ; 'cotton Gate LIMITS OF LUIBILIIY <br />(at beginning of policy period) <br /> <br /> <br />THE CERTIFICATE OF INS URANCE JS NOT A CONTR ACT OF INSURANCE eNe NEtTN FR er:r:tQUernct v unr? uer_ernici v <br />AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED <br />If any of tht <br />its expi ' <br />no' o <br />Name and Address of Certificate Holder cel <br />t <br />ADDITIONAL INSURED: rILSE <br />CITY OF SANTA ANA; ITS OFFICERS, EMPLOYEES,AGENTS,VOLUNTEERS <br />AND REPRESENTATIVES <br />20 CIVIC CENTER PLAZA SANTA ANA, CA. 92701 Signature otA <br />' ~ ::.JOHN FULKL <br />STATE FARM INSURANCE CG'S - ~ Tale <br />JOHN FULWILER INSURANCE AGENCY, INC. ~rn,s <br />(714) 895-7882 `..,' 1 <br />G/ ~~/ . <br />AFO Code <br />558-984 a.4 11-12-2002 Printed el U.SA <br />policies are can led before <br />to Farm o mail a written <br />trtifi der 30 days before <br />er, we tai! to mail such notice, <br />liability will be imposed on State <br />or representatives. <br />