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<br />CERTIFICATE OF INSURANCE <br />SUCH IfI\SURANCE AS RESPECTS THf" ....TEREST OF THE CERTIFICATE HOLDEI'ilo...i"I.L NOT BE CANCELED OR OTHERWISE <br />TERMTNATED WITHOUT GIVING 10 DA'L....fPRIOR WRITTEN NOTICE TO THE CERTIFiOTE HOLDER NAMED BELOW, BUT IN NO <br />EVENT SHALL THIS CERTIFICATE BE II'lrrID MORE THAN 30 DAYS FROM THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE <br />DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. <br />This certifies that: [X] STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington. Illinois. or <br />D STATE FARM FIRE AND CASUALTY COMPANY of Bloomington. Illinois <br />has coverage in force for the following Named Insured as shown below: <br /> <br />Named Insured <br /> <br />DAVID E. HARTL <br /> <br />Address of Named Insured 3808 E. LARKS TONE DRIVE <br /> <br />ORANGE. CA. 92869-5355 <br /> <br />POlICY NUMBER V541083-A15-75 <br />EFFECTIVE DATE JULY 15, 2002 <br />OF POLICY <br />DESCRIPTION OF 1993 LEXUS "LS" 4DR <br />VEHICLE <br />LIABILITY COVERAGE [X] YES DNO DYES DNo DYES DNo DYES DNO <br />UMITS OF UABIUTY <br />a. Badly Injury $1.000,000.00 <br />Eacn Pe<son <br />Each Accident $1,000,000.00 <br />b. property Damage $1 000 000.00 <br />Each Accident -- ----.. <br />c.ecx>lyl~'-'Y&_ <br />Ilan1lgeSingleumt $1,000,000.00 <br />Each Accident <br />PHYSICAL DAMAGE [Xl YES DNO DYES DNo DYES DNo DYES DNO <br />COVERAGES <br />a. Comoretlensive $ 100. OODeduclible $ Deductible $ Deductible $ Deductible <br /> [J9 YES DNO DYES DNo DYES DNo DYES DNo <br />b. Collision $ 250 . 0 Cbeouclible $ Deductible $ Deductible $ Deductt:lle <br />EMPLOYER'S [X] NO DYES DNo DYES DNo DYES DNO <br />NON-OWNERSHIP DYES <br />COVERAGE <br />HIRED CAR COVE~AGE ~YES [Xl NO DYES DNo DYES DNO DYES DNo <br />~ '/\ .. .. "~~....e.a At ,A ""-^ 8549/F418 <br /> AGENT AUGUST 9. 2002 <br /> Signat~ of Authorized Representative Title Agent's Code Number Date <br /> ;me and Address of Cert~icate Holder Name and Address of Agent <br /> <br />I I <br /> <br />I I <br /> <br />CITY OF SANTA ANA COURT TANYA PEARSON, AGENT <br />ATTN: CITY CLERK 7622 E. CHAPMAN AVE. <br />20 CIVIC CENTER PLAZA APPROVED AS TO FORQaANGE, CA. 92869 <br />SANTA ANA, CA. 92701-4010; PHONE# (714) 289-1226 <br />~ FAX# (714) 289-0491 <br /> <br />(r: ura Sheedy <br />Deputy City Attorney <br />...J <br /> <br />LICII0646857 <br />SUITE liB <br /> <br /> <br />L <br /> <br />..J <br /> <br />L <br /> <br />CERTIFICATE HOLDER COPY <br />