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<br />p.2 <br /> <br />Jan' O!! 04 01:56p T.~l <br />, <br />FROM : L.A.CHA MAINTENANCE CD. <br /> <br />FAX NO. : lB183668403 <br /> <br />. <br />J ~ 2004 11: 43AM P2 <br />an. "'., <br /> <br />PLEAS,; AEA.D YOU~ POlICY <br />T~I$ declaration! Page/AmondQd OIK:~~ullti(. <br />Jl,evlOU!l DQlicy rIO. <br /> <br />\ POUCVNUMBfR CA 0-20-68-5 I Q-) <br />.Jg" with 'I'll! Dalicy jaCket icts"'ltlf(i by thl: larm a~ Itdlllon dale .nO'l{i:I(lrf comple1es lhe above "lIITl:~ftd pol~ <br />Fll'm 1050 Ed. 119~ <br /> <br />O€CUlAATIONS <br />"'AMEnlNSUREO <br /> <br />L.A. CHA MAINTENANCE <br />18816 SN FRNNDO HSSN <br />NORTHRIDGE CA 91326 <br /> <br />PAGE I OF 3 <br /> <br />Ih).oo3- 00'1 <br />A _ ,;wo4- 003 <br /> <br />A <br />G <br />E <br />N <br />T <br /> <br />JOHN KIM INS SERV <br />3807 WILSHIRE BVDIIOO <br />lOS ANGELES CA 90010 <br />PROIJ/JHfJVE'" <br /> <br />POLICY TERM: SEP 25. 2003 TO HAR 25. 2004 <br />Thi5 polICY mr.eS)ts thQ "ler ol~ t. rhIf time the &OPlication 101 insur8ttC8 i, 8ld!Cutlld 0r1 <br />tne fi6sl ~y Q' .Iw policy pet'iod: Of 2_ 12:0t ..m. on the ''''1 day 01 I~ pollcv ~iod. <br />Thi& POlICY sholl! ~ et 12:ot a.m. on I"" last dIIy uf rtte policy pe,lod <br />CA-26390 <br />PROGR~SSIVE CASUALTY INS. CO. <br />P.O. 80X 94739, CLEVELANO, OHIO 44101 1-8oo-~44-~487 <br /> <br />CD....IPtC...... ~u: 'I'ISURAJ1u <br /> <br />'rhe IOI/owlI'tll COYel'~C oand limirs IlJP#Y ta 1M' described I/&hIcle ItS lShQWr'l below C0V8lages are Olllln'" iro thi poIlc;y al'lCf are $ubjacllD lhe terms IJOd car'l<blions <br />CClllltiMd i" the Poficy, inclUdino 8rf1E!nOtnfl\~ ;:rnd lJf\dor$8fMn\l. No &h""Q~n w;., be ~lfect~ PfiOt 10 rhg.I,MCl:hanue, 8118 rf!QuIIlted. <br /> <br />SCHEOUlE OF COVERAGES AND LIMITS OF LIABiliTY <br /> <br />COVERAGES <br />A SINGLE LIKIT BOOILY INJURY <br />PROPERTY DAMAGE LIABILITY <br />C HEDICAL PAYKENTS <br />I UMIUNOERINSURED HOTORIST <br />UM PROPERTY DAMAGE <br /> <br />fULL TERH PREMIUM <br /> <br />CHARGES <br /> <br />S 111~~ <br />47 <br />40 <br /> <br />AND <br />~1.000.000 EACH ACC <br />1.000 EACH ACCIDENT <br />15.000 IPERS. S 30,000 IACC. <br />S 3.500 loce. <br /> <br />;"! " <br /> <br />/~A/ / j:L <br /> <br />; :"."p . <br />,;:,:;:;:;l I <br /> <br />FILING FEES <br />TOTAL POLICY PREMIUH <br /> <br />so.OO <br />$1.246.0D <br /> <br />ATTACHMENT IDENTIFIED BY FORH NUM8ER <br />7886 (l 0-0 1) 6212 (05-97) 1197 (08-93) 3644 (12-01) 4792A (01-03) <br /> <br />DRIVERS <br /> <br />PAGE <br /> <br />2 <br /> <br />. COVERED VEH PAGE <br /> <br />), <br /> <br />ICC-N HCS90-N <br />PUC-N OTH-N <br /> <br />A.rrf ~s UC'4ec Pa.l I I I i!; pl'y.,bff IS interOst m~ a~t to t\'"led inlUfed and ./I~N~U ptyd, <br />na Fll8d 1=ot 'Whllll" 8 I CS 11 CC",IJI. ' <br />Fin ~'" G2 BGO 03213 XXXX .0 CA <br /> <br />PtoO Pt~.... BudQe1' C \ <br />",~0203"F''''''' u...'.... 062002 <br /> <br />:':OIJ"19l.ronli'l:! <br /> <br />n'~ ('242~ <br /> <br />INSUREO copy <br /> <br />CV~E09'7011217~'1'301 <br />