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I his docume <br />STANDARD <br />t is merely for the convenie a Of the Insured. It is not a policy andreonfers ights on the holder. <br />FIRE INSURANCE POLI EMORANDUM COPY <br />ST. AUL FIRE AND MARINE INSURANCE COMPANY <br />Renewal of number: <br />H r:. N, <br />Insureds OiiANGi: EMPIRE Cm LR "IC ; <br />Name AGENT <br />and P.O. BOX 5045 <br />Address FULLEiTONI, CALIFORNIA 92632 AND <br />CODE <br />Porky 4 -1 -82 4 -1 -83 1 <br />Term: INCEPTION (MO. Day Year) EXPIRATION (MO. Day Year) YEARS <br />E <br />R.W. 'L ORTIMER & ASSOCIATES <br />P.O. BOX 5609 <br />BUENA PARK, CA. 90620 :Q <br />J <br />.o <br />J <br />ro= <br />It is important that the written portions of all policies coverin 9 the same Property { <br />p perty read exactly alike. If they do not, they should be made uniform at once. <br />-ra <br />C ' <br />INSURANCE IS PROVIDED AGAINST I tl <br />Item <br />No. <br />1. <br />NLY THOSE AND FOR ONLYTHOSE AGAINST OTHER PERILS AND FOR PERILS COVERAGES ONLY WH NE ENDOR EDI HEREON BELOW <br />OR ADDED HERETOCHARGE AND01 <br />N <br />f5 <br />DESCRIPTION AND LOCATION OF PROPERTY COVERED: Show address (NO., Street, City, County, State, Zip <br />Code) construction, type of roof and occupancy of building(s) Covered or containing pro Dwelling Business Only n• <br />pmtY coveted. If Occupietl Pro - <br />asa dwelling state if building is a seasonal m farm dwelling. If commerCidl state enact nature of tectlOn Fe<I Miles Ib <br />manufacturer, wholesaler Or retailer) Or the service or activity involved. Product (and whether o I S V<ar No' of From From n <br />Families Zone <br />Hydrant Fire Dept <br />ON THE CLASS "C" BUILDING OCCUPIED AS S 1° <br />EQUIPMENT STORAGE AND SNACK BAR, SITUATE: I -2 <br />2001 S. FLKER, SANTA ANA, CALIFORNIA <br />Item PERIL(S) INSURED AGAINST <br />No. AND COVERAG E(S) PROVIDED <br />(INSERT NAME OF EACH) <br />1. 1FIRE AND LIGHTNING <br />EXTENDED COVERAGE <br />Subject to Form No(s) <br />Pee Cent of <br />Co-Im.omee <br />Applicable <br />80% <br />R.W. MORTIMER & ASSOC. <br />Amount of <br />Insurance <br />$40,000 <br />Insurance Agents & Brokers <br />6300 Beach Blvd., Box 5609 <br />ZEE- <br />Buena Park, CA 90620 <br />THE MiNczI1RANCE�AGEN MPAy <br />$ <br />Pee Cent of <br />Co-Im.omee <br />Applicable <br />80% <br />Deductible <br />Amount <br />$100. <br />Amount of <br />Insurance <br />$40,000 <br />Rate <br />.339 <br />Phmuitl or Installment <br />Premium Due <br />At Inception <br />Installment <br />Premium Due At <br />Each Anniversary <br />$ 136.00 <br />$ <br />XXXXXX <br />,080 <br />32.00 <br />.010 <br />4.00 <br />06 <br />24.00 <br />- <br />1.00 <br />TOTAL PREMIUM FOR POLICY TERM PAID IN INSTAI I hr) <br />c r 0013 (9 -79) CF 1201 ) <br />ewln.h w u.CFP4����41a77�.a) <br />attached hereto. <br />Mortgage Clause: Subject to the provisions of the mortgage clause attached hereto, loss, if any, on building items, shall be payable to: <br />Provisions Required by Law to be Stated in this .R'r..Me(4) OF ,.R an. a,A1�rNp x..uass(ee) <br />relating to Guaranty Surplus and Special Reserve Funds." 437, General Laws dof 1909n pursuance of the laws of the State of Minnesota, <br />APRIL 7 1982 BUENA PARK. CALIFORNIA <br />Countersignature Date Agency at <br />rd:EM,CRANL'UAi CG�--y <br />