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<br />A <br /> <br />state Firm MutuII Automoblll Inlul'lnol Com piny <br />31303 ""oura Road <br />WI.Oake Vlllagl CA 91363 ,.., <br /> <br />65352.4.F MATCH 00501 MUTL VOL II <br />I .CC~ DECLARATIONS PAGE .cOPY" I <br />PAGE 1 OF2 <br /> <br /><f4Tl ...... <br /> <br />INS U JA N C~" <br /> <br />POLICY NUMBER <br />V541083.A15-75H <br /> <br />Polloy Plrlod from APR 18 2001 to JAN 15 2002 <br /> <br />00501 75-8549-448F <br />CITY OF SANTA ANA CT <br />ATTN: CITY CLERK <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701.4010 <br /> <br />DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. <br />SEPARATE STATEMENT ENCLOSED IF AMOUNT DUE. <br />AGENT <br />TANYA PEARSON <br />7622 E CHAPMAN AVENUE SUITE B <br />ORANGE, CA 92869.4505 <br /> <br />NAMED INSURED: HARTL, DAVID E <br /> <br />PHONE: (714)289.1226 <br /> <br /> <br />1993 <br /> <br />LEXUS <br /> <br />LS 400 <br /> <br />4DR <br /> <br />JT8UF11E7P0151684 <br /> <br />6H300X12 <br /> <br /> <br />1993 <br /> <br />Llm,~ovlra;;.~ <br />~lIIIIIlm,.{ .~. L____~ <br />Ii ---~ <br />Eaoh Aooldlnt <br />~~I..ml_I'FI'TI-II~II~lll~~~ <br />C Mldloal pa $18.88 <br />~1~lIIIfIlI1" mnliJl__!~'!I'I~~~~ <br />Eaoh Plreon <br /> <br />0100 $100 Dlduotlbll Com~hln.lvl $56.32 <br />~ J1l_,,~IIl_ ,,1J'~liP I!Iliilll~!!!!!~!!~HI~.'''~''~!~II! 11_1~!.~Ii~!~!lr] 1 'UWI~I~~Il..L1:....ldl~lfl " <br />H Eml!.Q!I!..~_!'Ioad Service $4. 7S <br />__liPIJifiPll~___lJINIIIII"...,jIIIIIIIIL,_'" U 11111 nmIIIIIIIIU!1I E1f------'1.1!1nlllnlillll..iUlIUmnIIUilU!f.liIlIIIJIII <br />U Unln,ul'ld Motor Vehlole $24.14 <br />~[llnl"'--'r1.--__~ <br />Eaoh Pereon Eaoh Aooldent <br />!IIIIIl.~___~___UI___~ill~ <br />U1 Unlnau...d Motor V.hlcl. Prooertv Damaae $2.17 <br /> <br /> <br /> <br /> <br /> <br />Your p,olloy oon.l.t. of thl. deolaratlon. page, the polloy booklet -form 9805.5, and any endorelmente that apply, Inoludlng <br />tho.e IlIued to you w~h any .ub.equlnt renewal hotloe. <br />Replaoed polley number V541 083.7513. <br />Your total ourrent 6 month premium for JUL 15 2001 to JAN 1520021. $398.47. <br /> <br />APPROVblJ AI> IV 1 <br /> <br />J:F!;~'V?t L" <br /> <br />Deputy CllY Attorney <br /> <br />CONTINUED <br /> <br />155-3861\ CA.1 01-2000 lah02!tbl <br />'n .O~5r1'lI) <br />