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StateFarm <br /> AState Farm Mutual Automobile Insurance Company 15114-4-A MATCH 01815 MUTL VOL <br /> ID PO Box 2368 <br /> Bloomington IL 61702-2368 DECLARATIONS PAGE <br /> PAGE 1 OF 2 <br /> NAMED INSURED 01815 <br /> 75-2EDB-4 A A POLICY NUMBER 776 3587-F22-75F <br /> 001820 0058 POLICY PERIOD OCT 01 2025 to JUN 22 2026 <br /> SLS PROPERTY SOLUTIONS INC 12:01 A.M. Standard 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 /> YEAR...:: MADE: MODEL:: ...._E. OY..ST'1fLE........ .... EHILE ID=_NtMEfER........ CAS <br /> 2018 FORD F150 PICKUP 1 FTMF1 EP9JKF78146 003HCX10 <br /> YMIOi.S OERAGE S� 1M1TS PFEIII[1UM <br /> A .. Lilrty overe174 <br /> Limit-Each Accident <br /> $2,0C1000C1 <br /> C Medical Payments Coverage $49.89 <br /> ......Li I Each Person . <br /> $10,000 <br /> 13 OProh'ersvo'Ovrgo Odc� bl5. <br /> G Collision Coverage - $500 Deductible $673.42 <br /> H Ergery Road Sorsaoe Coer €g 5. <br /> U Uninsured Motor Vehicle Coverage $104.33 <br /> o1[1y 1nf [ry L im�ts <br /> Each Person, Each Accident <br /> U1 Uninsured Motor Vehicle Property Damage Coverage $8.28 <br /> Tgrt [ mtum fr500.011.4096 <br /> C'1' ff1 to JC1I 212E € l This rat YII <br /> C1{IjROFfTANT At�� IW ........ <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 of a loss is <br /> guilty of a crime and may be subject to fines and confinement in state prison. <br /> Replaced policy number 7763587-75E. <br /> New Policy Form <br /> Notice of insurance information collection practices - personal, family, or household insurance transactions: <br /> We may collect customer information from persons other than the individual or individuals applying 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, correct, amend, or delete your personal information and the right to <br /> receive a response within 30 days of submitting your request. If 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.00m/customer-care/privacy-security/privacy <br /> or contact your State Farm Agent. <br />