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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 2 OF 2 <br /> 01815 <br /> NAMED INSURED 75-2EDB-4 A A POLICY NUMBER 776 3587-F22-75F <br /> SLSoolszo POLICY PERIOD OCT 01 2025 to JUN 22 2026 <br /> 875 IRON HORSE DR STE A271 PROPERTY SOLUTIONS INC 12:01 A.M. Standard Time <br /> 75 <br /> PARK CITY UT 84060-5158 STATE FARM PAYMENT PLAN NUMBER <br /> 1256610923 <br /> F EI Tt 3t � �LET�EF#SEM i. p � y ...................................................fircrI�II <br /> ------------------------ <br /> FORM 9805BY CONSISTS OF <br /> IACLUDINGLTHOSEOOISSUED TO YOU <br /> WITH ANY SOBSEQUENT RENEWAL NOTICE. <br /> CREDITOR— FORD MOTOR CREDIT — LIEN INSURANCE SERVICE CENTER, PO BOX 390858, <br /> MINNEAPOLIS MN 55439-0858. <br /> 01 6028BU ADDITIONAL INSURED—CITY OF SANTA ANA PUBLIC WORKSAGENCY <br /> GIP/DESIGN ENGINEERING 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4658. <br /> 02 6028BU ADDITIONAL INSURED—CITY OF ONTARI6, 303 E B ST, ONTARIO CA <br /> 91764-4196. <br /> 03 6028BU ADDITIONAL INSURED—CITY OF SANTA ANA ATTENTION: PLANNING & <br /> BUILDING20 CIVIC CENTER PLAZA SANTA ANA CA 92M1-9999. <br /> 04 6028BU ADDITIONAL INSURED—CITY OF SANTA ANA, ISAOA, 20 CIVIC CENTER PLZ, <br /> SANTA ANA CA 92701-4058. <br /> 603OGF BUSINESS NAMED INSURED. <br /> 6125A AMENDATORY ENDORSEMENT. <br /> 6126MD EXCESS COVERAGE FOR PERSONAL VEHICLE SHARING. <br /> 6129J AMENDATORY ENDORSEMENT. <br /> 6289DW SINGLE LIMIT LIABILITY COVERAGE. <br /> 6196AA — WAIVER OF SUBROGATION UNDER THE LIABILITY COVERAGE FOR — CITY OF <br /> SANTA ANA PUBLIC WORKS AGENCY; GIP DESIGN ENGINIEERING; CITY OF SANTA ANA, <br /> ISAOA. <br />