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Stateftm <br /> State Farm Mutual Automobile Insurance Company 92918-4-A MATCH 01013 MUTL VOL <br /> 4M, PO BBi Box ngf n8L 61702-2068 DECLARATIONS PAGE <br /> NAMED INSURED 01013 PAGE 1 OF 2 <br /> 75-2EDB-4 A A POLICY NUMBER 776 3587-F22 75E — <br /> 401013 LU 0° POLICY PERIOD 0CT 912025 to DEC 22 2025 <br /> SLS PROPERTY SOLUTIONS, INC 12:01 A. .Stan ar Time <br /> 875 IRON HORSE DR STE A271 <br /> PARK CITY UT 84060-5158 STATE FARM PAYMENT PLAN NUMBER <br /> 1256610923 <br /> AGENT _ <br /> JOSE GASTELUM <br /> 1780 E MCFADDEN AVE STE 114 <br /> SANTA ANA,CA 92705-4648 — <br /> PHONE:(714)557-3344 <br /> DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. <br /> IF AN AMOUNT IS DUE,THEN A SEPARATE STATEMENT IS ENCLOSED. <br /> YOUR CAR <br /> ELM- <br /> 2018 FORD F150 PICKUP 1 FI'MFi EP9JKF18146 003HOXI O <br /> -ram -- �_s -- <br /> Limit-Each Accident <br /> -M <br /> i - <br /> , <br /> C Medical Payments Coverage $15 48 <br /> F <br /> Mow <br /> G Collision Coverage-$500 Deductible $212 03 <br /> U Uninsured Motor Vehicle Coverage _ _ $32 38 <br /> ERE <br /> Each .`E <br /> Each Person, Each Accident <br /> Ui Uninsured Motor Vehicle Propedy Damage Coverage $2.57 <br /> IMPORTANT NOTICE <br /> For your protection California law requires the following to appear with this policy: Any person who knowingly presents <br /> false or fraudulent information to obtain or amend Insurance coverage or to make a claim for the payment e f a loss is <br /> guilty of a crime and may be subject to fines and confinement in state prison. <br /> Replaced policy number 7763587-75D. <br /> Notice of insurance information collection practioes-personal,family,or household insurance transactions: <br /> We may collect customer information from persons other than the individual or individuals appplying for coverage.Such customer <br /> information as well as other personal or privileged information subsequently collected may,in certain circumstances,be disclosed <br /> to third parties without your authorization as permitted by law. <br /> You have the right to submit a written request to access,earreot amend,or delete your personal information and the right to <br /> receive a response within 30 days of submitting your request. It we deny your request,you have the right to file.a statement <br /> with us containing the information you feel is accurate and fair along with the reasons you disagree with our denial.Instructions <br /> on how to file such request and our full privacy notice can be found www.statefarm.00Woustomer-earelprivacy�secudty!privacy <br /> or contact your State Farm Agent. <br /> Your total renewal premium for JUN 22 2025 to DEC 22 2025 Is$2,104,23. <br /> Location used to determine rate charged-019 E SANTA ANA BLVD,SANTA ANA CA 92701.3920. <br /> CONTINUED <br /> 21733 185 See Reverse Side <br /> ri o s05 aU(o1Mfo) <br />