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~Yan no <br />~s~ <br />SUCH INSURANCE A5 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 TH18 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 that: ®STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois <br />^ STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois <br />^ STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas, Texas <br />[] STATE FARM INDEMNITY COMPANY of Bloomington, Illinois, or <br />^STATE FARM GUARANTY INSURANCE COMPANY of Bloomington, Illinois <br />has coverage in force for the fDllowinc Named Insured as ~h~wr, hohw• <br />' NAMED INSURED: GARY E JOHNSON ENDORSEMENT EFFECTIVE 6-5-D8 <br />ADDRESS OF NAMED INSURED: 120 3R0 STREET sEA2, BEACH CA 90790 <br />POLICY NUMBER L35 e237-C03-75 <br />EFFECTIVE DATE <br />OF POLICY 03-03-CB TO 03-03 -08 <br />DESCRIPTION OF <br />VEHICLE (Including VIN) 2002 MERCEDES <br /> WDBJF70J52B408360 <br />uABILITY COVERAGE ®YES ^ NO ^YES ^ NO ^YES ^YES ^ NO <br />LIMITS OF LIABILITY .,n <br />~ <br />a. Bodily Injury 1, Doa, Doo Ap <br />1 <br />" " <br />Each Person ~ h <br />Each Accident 1, Doo, ooD 5t0 o<~y <br />b. Property Damage ~ <br />Each Acddent I, ODD,ODO 3 <br />c. Bodily Injury 8 <br />Property Damage 7- <br />Single Limit <br />Each Accident <br />PHYSICAL DAMAGE <br />COVERAGES ®YES ^ NO ^YES ^ NO ^YES ^ NO ^YES ^ NO <br />a. Com rehensive $ soD Dedudible $ Deducible $ Deductible $ Dedudible <br /> ® YES ^ NO ^YES ^ NO ^YES ^ NO ^YES ^ NO <br />b. Collision $ 1000 Dedudible $ Deduditrle $ Dedudible $ Dedudible <br />EMPLOYERS NON-OWNED <br />CAR LIABILITY covERAGE <br />^YES ®NO <br />^YES <br />^ NO <br />^YES <br />^ NO <br />^YES <br />^ NO <br />HIRED CAR LIABILITY <br />COVERAGE <br />^YES ®NO <br />^YES <br />^ NO <br />^YES <br />^ NO <br />^YES <br />^ NO <br />FLEET-COVERAGE FOR <br />ALL OvMlEDAND LICENSED <br />MOTOR VEHICLES <br />^YES ®NO <br />^YES <br />^ NO <br />^YES <br />^ NO <br />^YES <br />^ NO <br /> <br /> <br />~~-~-"' ~`~~' v AGENT 7797 OE-05-2008 <br />re of Authorized Represenhative Title Agent's Code Number Data <br />ame and Address of Certificate Holder Name and Address of ent <br />CITY OF SANTA ANA JIM CONRAD <br />P.O. BOX 1988 1066 BOLSA AVENUE <br />SANTA ANA, CA 92702 SEAL BEACH CA 90790 <br />INTERNAL STATE FARM USE ONLY: ^ Request permanent Cer~cate of Insurance for liability wverage. <br />122029.9 Rev. 07-26-zoos ®Request Certificate Holder to be added as an Addkionat Insured. <br />