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<br />"':'i{., <br />, <br /> <br />';: f~lf1~:lU~O/IO <br />(' . <br /> <br />oate: lJtlr~2t2UU' Time: 4:W:2U t"M <br /> <br />'.11'"'''''''''' <br /> <br />~1st Century Insurance Company <br />owensmouth Avenue Wocdand Hinsl~a1iforniIl91367 <br />DECLARATIUN PAGE <br />I!RSONAL UMBRELLA POLICY <br />..ffACHDllO THi PiRSOllAL UlolellELLA POlICY, THESE DECLARATIONS COWPIJ:Ti TIC POLICY AtfD <br />~ THE CLltRCNT SlTATUSII OF' YOUI CmlERAQES! AND LHITSII or LIA8II.lT'f ACCORDING TO OUR RECORDS <br />,. : . .. - ,. . <br />1t.t1....,...6TIl AIlDTlMI <br />lQ <br /> <br />PEP 902 42 GO *** COUPAHY COPY *** <br /> <br />IJI <br />Br <br /> <br />RElIEWAL DECLARATIOH OI'I'ER <br />EFFECTIVE 06/01/01 <br /> <br />rHE !lYEllr PAl!KI:IIT :IS 1I0r RECIlIWIl <br />'rHE DR DA'I& HOlED BELOW IH 'rHE <br /> <br /> <br />"010 <br /> <br /> <br />ST.M':EIII:ER1' M' ACCOUHt' ~ YOUR DOLICY <br /> <br />HJllll:D IlfSUltED >>II) JmDUSS <br /> <br />I <br /> <br />ROBERT J ASH <br />GER1U .asH <br />13361 PROSPECT AVE <br />S1\IITA lIHA CA 92105 <br /> <br /> <br />,i~;tp!\l~*t~!\M19M <br />$ 160.00 <br /> <br />POLICY PREMIUMS <br />~~9~E!mI\~~iii::;mm:m;mmi <br />$ 20. 0 <br /> <br /> <br />YOU AGREE THAT PRIMARY INSURANCE IS IN FORCE AND V'IILLCONTINUE TO BE IN FORCE FOR ALL EXPOSURES <br />COVERED BY THIS POLICY FORAT LEASTTHE LIII1 rrs SHOWN BELOW. <br /> <br />AU TOllOBILB LIABILITY <br />REC REATlOHAlVEHlCLE UASIUTY <br /> <br />BODILY INJURY <br /> <br />$ 100.000 EACH PERSOH <br />1300.000 EACH OCCURRENCE <br />, t50,OOO EACH OCCURRENCE <br />'1oo.om EACH OCCURRENCE <br /> <br />COMPREHENSIVE PERSONALUA91UTY <br /> <br />PROPERTY DAMAGE - <br />BODILY INJURYAHD PROPERTY <br />DAr,AAOE C OUBIN ED <br /> <br />-------- ADDITXORAL <br />AUTIDIOBILES <br />RESIDDCES <br />1-4 FAMILY REHrALS <br />RECREATIONAL VEHICLES <br />YOUTHFUL OPERATORS <br /> <br />CHARGES <br />2 <br />1 <br /> <br />10.00 <br />IHCLUDED <br />.00 <br />10.00 <br />.00 <br /> <br />1 <br /> <br />....... RDlIHDER: ALL PRDlARY LIJ(IIS IlUSI BE <br />IN I'ORCE AS HOlED ABOVE ... <br /> <br />r5.....-L<~ <br /> <br />'" U - PRESIDENT <br /> <br />n...In?/n" <br />DATE <br /> <br />FOR POLICY SER~CE CALL (800) 443-3100CLAIHS SER~CK PHONE: (800) 322-8200 <br /> <br />_ StATEMENT OF ACCOURT FOR POLICY 9024260 02 - <br />TOTAL PREKI~ ................ $ 180.00 <br /> <br />AYOUHr DUE 06/01/01 .... .... $ 180.00 <br /> <br /> <br />APPROVED M TO FORM <br /> <br /><,,', 1~._,....__. !r~~ <br /> <br />'-.' , .t1: " '~.' .1.. . ,'~.'~ <br />iet A::;:;15 .:11:1 (;Ilt ~fl~)n'J~Y <br /> <br />TCU-248 (01-00) <br />