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State Farm General Insurance Company <br />A Stock Company with Home Offices in Bloomington, Illinois <br />i 900 Old Rivar Rd <br />L- 8akar 0.1.1, CA 93311-6000 <br />ATI C-23- 8290-F418 L F <br />001611 <br />KILEY, ELIZABETH M <br />2681 DOW AVE STE E <br />TUSTIN CA 92780-7244 <br />Forms and Endorsements <br />Personal Liability Umbrella <br />Amendatory Endorsement <br />Fuel Oil Exclusion <br />FP -7950.2 <br />FE -5835.1 <br />FE -5837 <br />RENEWAL CERTIFICATE <br />POLICY NUMBER- '.75-C.13-24: <br />Personal Liability Umbrella Policy <br />AUG 02 2010 to AUG 02 2011 <br />DATE:DUE -" SEE <br />AUG 02 2010 <br />COVERAGES AND LIMITS <br />L Personal Liability <br />Self -Insured Retention <br />l-5-- 00 <br />$1,000,000 <br />None <br />UNDERLYING EXPOSURES <br />Our records show the following underlying <br />information. This information was used in <br />determining the rate of the policy. <br />AUTOMOBILE EXPOSURES <br />AutOmobile(s) 3 <br />Automobile Operator(s) 3 <br />Inexperienced Operator 2 <br />OTHER LIABILITY EXPOSURES <br />Personal Residential <br />Office <br />Annual Premium <br />Amount Due <br />a *Notify your agent immediately if the above listed Coverages and/or Underlying Exposures are incorrect. <br />Your Coverages and/or bill can be affected if this information is not correct. <br />Required Underlying Insurance on reverse side <br />iu <br />$695.00 <br />$695.00 <br />77—y4 -d-- ur St?i`u>° . - _ tf yo u have moved, please con tact yo ur agen t. <br />6869 2011 I Agent JOHN LUITHLY See reverse side for important information. <br />001) Pt Telephone (949) 727-4442 RE13 Prepared JUN 072010 i <br />