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,�teFalfsa <br /> State Farm Mutual Automobile Insurance Company 38145-4-A MATCH 00854 MUTL VOL <br /> PO Box 2368 <br /> Bloomington 1L 61702-2368 DECLARATIONS PAGE <br /> NAMED INSURED 00854 PAGE t OF 2 <br /> 75-a327-4 A A POLICY NUMBER 628 3607-E09-75VODOMS —' <br /> 00W POLICY PERIOD FEI3 09 2026 to MAY 09 2026 <br /> AND DIVERSIFIED <br /> MAR IA 8 PATRIC, 12-01 A.M.Standard Time <br /> AND DIVERSIFIED WATERSCAPES, <br /> INC <br /> STE 213 STATE FARM PAYMENT PLAN NUMBER <br /> 27324 CAMINO CAPISTRANO 1346356522 <br /> LAGUNA NIGUEL CA 92677-1118 AGENT <br /> GARY BLACKBURN <br /> 23881 VIA FABRICANTE STE 506 <br /> MISSION VIEJO,CA 92691-3139 <br /> PHONE:(949)581-0800 <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 MAKE MODEL BODY STYLE VEHICLE ID.NUMBER � CLASS <br /> NONOWNED AUTO 670ADP0102 <br /> SYMBOLS COVERAGE&LIMITS PREMIUMS <br /> A- Liability Coverage "r -m,. M; .. k r ., $108,64..: <br /> Hodiiy Injury Limits <br /> Each Person, Eachn -:r <br /> $1,000,000 $1;noo'Do0 <br /> Property Damage Limit, <br /> Each Accident <br /> $1,000;000 <br /> L Physical Damage Coverage-$500 Deductible 25.do <br /> U Uninsured Motor Vehicle Coverage <br /> Bodily Injury Limits <br /> Each Person, Each.Accident <br /> $100 000 $300,000__ <br /> Total m2rhilurn''for FEB 09 2026 tto MAYs002026, <' $139.14 This is n <br /> IMPORTANT MESSAGES <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 6283607-75U. <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. Ii 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.statefarrn.com/customer-care/privacy-seourity/privacy <br /> or contact your State Farm Agent. <br /> Your total renewal premium for NOV 09 2025 to MAY 09 2026 is$278.28. <br /> Location used to determine rate charged-29641 VIA CEBOLLA,LAGUNA NIGUEL CA 92677. <br /> CONTINUED <br /> 08654/05613 See Reverse Side <br /> 155.3M CA2 OS2O02(a1aO1"Ac) <br /> JIMN (0.025t.) <br />