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State Farm Mutual Automobile Insurance Company 20623-1-A MATCH 00803 MUTL VOL <br /> PO Box 2368 <br /> 3loomington IL 61702-2368 DECLARATIONS PAGE <br /> PAGE I OF 2 <br /> NAMED INSURED 00803 <br /> 75-6AE8-1 A A POLICY NUMBER 711 6928-B01-75D — <br /> 0008 0058 POLICY PERIOD AUG 13 2025 to FEB 01 2026 <br /> ALL CITY MANAGEMENT SERVICES,INC 12:01 A.M.Standard Time <br /> 10440 PIONEER BLVD STE 5 SANTA STATE FARM PAYMENT PLAN NUMBER <br /> SANTA FE SPGS CA 90670-8238 <br /> 1348377123 <br /> AGENT — <br /> FLORENCE HARRISON — <br /> 227 S LA BREA AVE <br /> INGLEWOOD,CA90301-2317 — <br /> PHONE:(310)330-8220 <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 DGEMBF&E VENICLEIO.NUMBER <br /> 2017 HYUNDAI SANTA FE SPORT WG 5XYZU3LB5HG487101 100HCV10 <br /> —__ _ <br /> Bodily Injury Limits _r__----.W,r---__---_ ---__---- —______—_______��-- <br /> - _ __ __ _ <br /> $1,000,000 $1,000,000 <br /> Each Accident <br /> -- - ---- ----—---- - - -- -----_ ------ -- - - _ <br /> C Medical Payments Coverage $40 28 <br /> -- — _ <br /> — — <br /> $10,000 <br /> G Collision Coverage-$1,000 Deductible $297.24 <br /> I €terms Rofad rice overage <br /> R1 Car Rental and Travel Expenses Coverage $46.04 <br /> Each Day, Each Loss <br /> ____ �__� —_� ----- - __- <br /> U Uninsured Motor Vehicle Coverage $109 55 <br /> ---__---__---__---- ____---____ ______ ____---____ _ ____ ____ _________ ______ _____ _ ____ ____ _ <br /> Each Person, Each Accident _ <br /> U1 Uninsured Motor Vehicle Property Damage Coverage $12.82 <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 7116928-750. <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. If 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.statefarm.com/customer-oare/privacy-security/privacy <br /> or contact your State Farm Agent. <br /> Your total renewal premium for AUG 012025 to FEB 012026 is$1,885.96. <br /> Location used to determine rate charged-10440 PIONEER BLVD STE 5,SANTA FE SPGS CA 90670. <br /> CONTINUED <br /> 11049/08636 See Reverse Side <br /> 155-3866 CA.2 Qr2002(ola025fo) <br /> 11SXON (ola025te) <br />