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<br />. <br />. <br /> <br />6037F.ll CERTIFICATE OF INSURANCE <br /> <br />58230-4-M 4 M <br />Agent 8549 <br />AFO 419 <br /> <br />This is to certify that: <br />State Farm Mutual Automobile Insurance Company <br />Illinois has coverage in force as shown below for the named insured. <br />days written notice to: <br /> <br />, of Bloomington, <br />If the coverage is changed or temlinated we will give 10 <br /> <br />CITY OF SANTA ANA CT <br />ATTN: CITY CLERK <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701-4058 <br /> <br />DesCllption of Vehicle: 2000 <br /> <br />LEXUS <br /> <br />JT8BH28F3Y0177545 <br /> <br />LIABILITY - COVERAGE A <br />Limits ofLiability <br /> <br />Bodily InjUlY <br />each person I $eaCh accident <br /> <br />$ 1000000 1000000 <br /> <br />Property Damage <br />each accident <br /> <br />Bodily InjUlY and Property Damage <br />Single Limit <br /> <br />$ 1000000 <br /> <br />$ <br /> <br />each accident <br /> <br />This Certificate oflnsurance does not change the coverage provided by the described policy. <br /> <br />'6' <br />~ <br />~ <br />~ <br />o <br />. <br />S <br />'" <br />o <br />o <br />N <br />N <br />o <br />~ <br /> <br />Named Insured HARTL, DA VID E <br /> <br />Policy Number <br /> <br />V54I083-A15-75P <br /> <br />~~\<.--\9/. <br /> <br />Chief Executive Officer <br /> <br />Effective Date <br /> <br />AUG 282006 ,/ <br />12:01 A.M. Standard Time <br /> <br />Countersigned <br /> <br />~ <br />'" <br />o <br />~ <br />"- <br />'" <br /> <br />(Year) <br /> <br />6037F.ll <br /> <br />By <br /> <br />Authorized Representative <br /> <br />r7) <br /> <br />