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~ CERTIFICATE OF INSURANCE <br />0 <br />SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE <br />CANCELED OR OTHERWISE TERMINATED WITHOUT GNING 70 DAYS PRIOR WRITTEN NOTICE TO THE <br />CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM <br />THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY <br />ANY POLICY DESCRIBED BELOW. <br />This certifies that: ®STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois <br />^ STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois <br />^ STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas, Texas <br />^ STATE FARM INDEMNITY COMPANY of Bloomington, Illinois, or <br />^STATE FARM GUARANTY INSURANCE COMPANY of Bloomington, Illinois <br />has coverage in force for the following Named Insured as shown below: <br />NAMED INSURED: GARY E JOHNSON ENDORSEMENT EFFECTIVE 6-5-08 <br />ADDRESS OFNAMEDINSURED: 120 3R0 sTREET SEAL BEACH cA 907 90 <br />POLICY NUMBER L35 ez37- co3-75 <br />EFFECTIVE DATE <br />OF POLICY 03-03-OB TO 09-03 -08 <br />DESCRIPTION OF 2002 MERCEDEs <br />VEHICLE (Including VIN) WDBJF70J5 2B408360 <br />LIABILITY COVERAGE ®YES ^ NO ^YES ^ NO ^YES ^YES ^ NO <br />LIMITS OF LIABILITY ~`~ <br />a. Bodily Injury 1, ooo, ooo $ <br />9 g. <br />Each Person <br />Each Accident 1, 000, 000 5~0 ~gCnOy <br />b. Property Damage ~.~ Pt G <br />s~ \ <br />3 <br />Each Accident 1, 000, ooo st ) <br />c. Bodily Injury 8 ,~ <br />Property Damage <br />Single Limit <br />Each Accident <br />PHYSICAL DAMAGE <br />COVERAGES <br />®YES <br />^ NO <br />^YES <br />^ NO <br />^YES <br />^ NO <br />^YES <br />^ NO <br />a. Com rehensive $ 500 Deductible $ Deductible $ Deductible $ Deductible <br /> ® YES ^ NO ^YES ^ NO ^YES ^ NO ^YES ^ NO <br />b. Collision $ 1000 Deductible $ Deductible $ Deductible $ Deductible <br />EMPLOYERS NON-OWNED <br />CAR LIABILITY COVERAGE YES <br />^ ®NO ^YES ^ NO ^YES ^ NO ^YES ^ NO <br />HIRED CAR LIABILITY YES <br />^ ®NO ^YES ^ NO ^YES ^ NO ^YES ^ NO <br />COVERAGE <br />FLEET-COVERAGE FOR <br />ALL OJUNED AND DCENSED YES <br />^ ®NO ^YES ^ NO ^YES ^ NO ^YES ^ NO <br />MOTOR VEHICLES <br />c <br />AGENT 7797 06-05-2008 <br />azure of AUtnonzea rcepresenranve Title i+genrs voce rvumoer uace <br />ame and Address of Certificate Holder Name and Address of Aaent <br />CITY OF SANTA ANA <br />P.O. BOX 1988 <br />SANTA ANA, CA 92702 <br />1066 BOLSA AVENUE <br />SEAL BEACH CA 90740 <br />INTERNAL STATE FARM USE ONLY: ^ Request permanent Cert~cate of Insurance for liability wverage. <br />tzzazs.s Rev. o7-2s-zoos ®Request Certificate Holder to he added as an Additional Insured. <br />