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<br />6037F.ll CERTIFICATE OF INSURANCE <br /> <br />12212-4-M - 4 M <br />Agent 8549 <br />AFO 418 <br /> <br />\ <br /> <br />Tllis is to certify that: <br />State Farm Mutual Automobile Insurance Company , of Bloomington, <br />Illinois has coverage in force as shown below for the named insured. If the coverage is changed or terminated we will give 10 <br />days written notice to: <br /> <br />CITY OF SANTA ANA CT <br />ATTN: CITY CLERK <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701-4058 <br /> <br />Description ofVehic1e: 2000 <br /> <br />LEXUS <br /> <br />JT8BH28F3YOI77545 <br /> <br />LIABILITY - COVERAGE A <br />Linlits of Liability <br /> <br />Bodily Injury <br />each person each accident <br /> <br />Property Damage <br />each accident <br /> <br />Bodily Injury and Property Damage <br />Single Linlit <br /> <br />$ <br /> <br />1000000 <br /> <br />$ <br /> <br />1000000 <br /> <br />$ <br /> <br />1000000 <br /> <br />$ <br /> <br />each accident <br /> <br />This Certificate of Insurance does not change the coverage provided by the described policy. <br /> <br />'6' <br />'" <br />"- <br />0> <br />o <br />C1l <br />:2- <br /> <br />'" <br />o <br />o <br />N <br />N <br />o <br />'" <br /> <br />Named Insured HARTL,DA VID E & JOHNSON,JERENE <br /> <br />Policy Number V541083-A15-75N <br /> <br />~~~~~$;>,. <br /> <br />Chief Executive Officer <br /> <br />~ <br />o <br />CD <br />~ <br />'" <br /> <br />Effective Date JAN 10 2005 ~~OVED AS >, ,Countersigned <br />12:01 A.M. Standard Time <br /> <br />-' <br /> <br />. .~ :!_, <br />.~:-" ( ) J/'\JJ"-- ~ <br /> <br />(Year) <br /> <br />I trq By==_ <br /> <br />6037F.ll <br /> <br />Assistalll ;,_. <br /> <br />Authorized Representative <br /> <br />