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51afttafnf <br /> State Farm Mutual Automobile Insurance Company 77452-4-A MATCH 01302 MUTL VOL <br /> • PO Box 2368 DECLARATIONS PAGE <br /> Bloomington IL 6 1 702-23 68 <br /> PAGE 1 OF2 <br /> NAMED INSURED 01302 <br /> 75-8127-4 A A POLICY NUMBER 628 3607-EO9-75W — <br /> °0"0' °0� POLICY PERIOD MAY 09 2026 to NOV 09 2d26 <br /> ANDSIM DIVERSIFIED <br /> ED WA & PATRICK 12-01 A.M.Standard Time <br /> AND DIVERSIFIED WATERSCAPES, <br /> INC <br /> STE 213 STATE FARM PAYMENT PLAN NUMBER <br /> 27324 CAMINO CAPISTRANO 1346356523 <br /> LAGUNA NIGUEL CA 92677-1118 AGENT <br /> GARY RLACKBURN <br /> 23861 VIA FABRICANTE STE 506 <br /> MISSION VIEJO,CA 92e91-3139 <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 fD.NUIIIIBER CLASS <br /> NONOWNED AUTO 670ADPOl02 <br /> 5YMBflLS COVERAGE 81 LIMITS PREMIUMS <br /> A Liability C5 ver-ge <br /> Bodily injury Limits <br /> Each Person, Each A. <br /> $1,000,000 $1,O00,Do0 <br /> Property Damage Limit <br /> Each Accident <br /> L Physical Damage Coverage-$500 Deductible 00.4, 0 <br /> i' Uninsured Motor Vehicle Coverage <br /> Bodily Injury Limits <br /> Each Person, Each Accident <br /> $100 00D $300 060 <br /> Total premium for MAY ill; .10 <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 o a loss is <br /> guilty of a crime and may be subject to fines and confinement in stale prison. <br /> Replaced policy number 6283607-75V. <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. It 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 witll the reasons you disagree with our denial. Instructions <br /> on haw to file such request and our full privacy notice can be found www.statefann.com/customer-care/privacy-security/privacy <br /> or contact your State Farm Agent. <br /> Location used to determine rate charged-29641 VIA CEBOLLA,LAGUNA NIGUEL CA 92677. <br /> CONTINUED <br /> 08713/05772 See Reverse Side <br /> 155 sesb CA 2 W20r2 01-0251o1 <br /> IMON (010025te) <br />