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CERTIFICATE OF INSURANCE <br />SUC6fiiN8UI2ANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE <br />�RMCCtE`73 OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE <br />CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS 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 following Named Insured as shown below <br />N,AN1ED INSURED - <br />ADDRESS OF NANIED INSURED <br />' <br />I <br />POLICY NUMBER <br />Q NO <br />YES <br />NO <br />Deductible <br />i $ <br />F PEC. IIVE DATt_ <br />t - <br />j C) YES <br />E] NO <br />Deductible <br />` $ <br />O F POLICY <br />- - <br />L YES <br />----- <br />Q NO <br />-..-- <br />UIESCRIPTION OF <br />- �i-• <br />- , _ _ _, <br />t <br />-- <br />----- <br />VEHICLE (Including VIN) <br />LIABILITY COVERAGE <br />.��- YES <br />01,10 <br />E--] YES <br />Q NO <br />i YES <br />LIMITS OF LIABILITY <br />a. Bodily Injury <br />k <br />Each Person <br />! <br />Each Accident <br />b Property Damage <br />i <br />I <br />- <br />i <br />r Each Accident <br />Bodily Injury 8---- <br />-- <br />Property Damage <br />Single Limit <br />11 <br />Each Accident <br />I <br />PHYSICAL DAMAGE <br />_ <br />-- --- --- <br />i <br />COVERAGES <br />I L7", YES <br />0 NO <br />1 YES <br />Q NO <br />1 YES <br />I a Comprehensive <br />S ', -; r <br />Deductibfa <br />$ <br />Deduclrbla <br />{_ <br />r] YES <br />(� NO <br />Q YES <br />0 NO <br />_$ <br />YES <br />l b Collision <br />(� $ <br />Dedueubie <br />$ <br />D.:duct <br />FNIPLOYERS NON -10V4 NED <br />�A <br />AR LIABILITY COVER -AGE <br />I !_ , YES <br />L] NO <br />V YES <br />_ _�ble—$ <br />- - <br />0 NO <br />r -- - <br />[� YES <br />t itRED CAR LIABILITr <br />EJ YES <br />[] NO <br />L7 YES <br />0 NO <br />Ej YES <br />COVERAGF <br />i 1 -FT c:DVER•1 C;E Fr,R <br />� <br />I <br />"kl t 01PINED AND LICENSED YES <br />MOTCJR vEr-f , �-- <br />�� NO <br />' <br />L� YES <br />=1 NO <br />EIYES . <br />�i•�rran�r Aidho d ,5 s=r d a <br />tat a alld Address Of CC r.. rtifi to I folder <br />1`] NO ] YES r ]] NO <br />T tie Agents Code Number Date <br />Name and Address of Aaent <br />i <br />i <br />N G?NAI.___. <br />,i 1 F�Tr t ,1RM1:1 tl ,E ONLY i J t eq uc.s; rvrrnaa _nt Cert;eii,ate ut for habitdy ;-overage <br />_ __ s . , .•,ir;n F, Re -.1u --st Curt:fic'al• Holder :o be ada_d as :gin ArlCit'-o-1 Insured <br />' <br />I <br />Q NO <br />YES <br />NO <br />Deductible <br />i $ <br />Deductible <br />[_] NO <br />j C) YES <br />E] NO <br />Deductible <br />` $ <br />Did uc:61.� <br />[_] NO <br />L YES <br />NO <br />Q NO <br />I L1 YES <br />Fj NO <br />1`] NO ] YES r ]] NO <br />T tie Agents Code Number Date <br />Name and Address of Aaent <br />i <br />i <br />N G?NAI.___. <br />,i 1 F�Tr t ,1RM1:1 tl ,E ONLY i J t eq uc.s; rvrrnaa _nt Cert;eii,ate ut for habitdy ;-overage <br />_ __ s . , .•,ir;n F, Re -.1u --st Curt:fic'al• Holder :o be ada_d as :gin ArlCit'-o-1 Insured <br />