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StateFarm STATE FARM <br /> • <br /> • •. <br /> PO Box 853922 <br /> Richardson, TX 75085-3922 <br /> CITY OF SANTA ANA <br /> ITS CITY COUNCIL, OFFICERS, OFFICIALS, <br /> EMPLOYEES, AGENTS, NOTE: PLEASE NOTIFY STATE FARM AT THE <br /> AND VOLUNTEERS ADDRESS LISTED AT THE TOP, LEFT CORNER <br /> OF THIS PAGE REGARDING ANY CHANGE OF <br /> 20 CIVIC CENTER PLAZA ADDRESS INFORMATION. <br /> SANTA ANA CA 92701,M-36 <br /> 0 <br /> S <br /> ADDITIONAL INSUREDS NOTICE OF COVERAGE <br /> State Farm Mutual Automobile Insurance Company 2408-FA71-A <br /> NAMED INSURED: POLICY NO: 730 1 128-AO1-75 COVERAGE: <br /> SANTOLUCITO DORE GROUP,INC BI AND PD LIABILITY <br /> 31600 RR CYN RD 2 MIL <br /> S <br /> N 100 DIED.COMP. <br /> CANYON LAKE CA 92587-9462 AGENT NAME: GOODE INS AND FIN SVCS INC S500 DIED.COLL. <br /> 4 AGENT PHONE: (951)501-1000 <br /> o ENDORSEMENT NO: 6028BU POLICY EFFECTIVE <br /> c DEC 14 2021 UNTIL TERMINATED <br /> POLICY MESSAGES: This policy shown above supersedes policy#4287450-75Q. <br /> The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance <br /> o provided and subject to all policy provisions.The additional insured will be given 30 days notice if the policy is terminatedUntil such notice <br /> is provided,it shall be presumed that the required renewal premiums have been paid.The additional insured must notify us within 10 days of <br /> o any change of interest or ownership coming to their attention.Failure to do so will render this policy null and void. <br /> 0 <br /> N <br /> FRT <br />