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<br />N ~ d-(j)0~ 0'/1 <br /> <br />STATE fARM <br /> <br />&> <br /> <br />INSURANCE <br /> <br />JOHNSON, GARY E <br />120 3RD ST <br />SEAL BCH CA 90740-6007 <br /> <br />H PHONE: <br />MUTL L35 8237-C03-75C <br /> <br />OCTOBER 20, 2008 <br /> <br />(562) 596-7317 <br />IRG: 24 LRG: 03 <br />ZIP: 90740 <br />CLASS: 6B30CV1M <br />ACC FREE: MAR-03-82 <br />BIRTH: APR-10-47 <br /> <br />AUTO POLICY STATUS <br /> <br />02 MERCEDES E430 <br />4DR <br />VIN: WDBJF70J52B408360 <br /> <br />STATUS: PAID <br />AMT DUE: <br /> <br />DUE DATE: TERM DATE: TOT PREM: <br />0.00 OXD:MAR-03-82 COV DATE:JUN-05-08 PREV PREM: <br /> <br />358.23 <br />356.74 <br /> <br />A 1MM /lMM /lMM <br />C5000 <br />D500 <br />G1000 <br />H <br /> <br />175.38 U 30 /60 <br />11. 98 U1 <br />37.96 <br />110.30 <br />2.99 <br /> <br />16.27 <br />3.35 <br /> <br />AMT PAID: 358.23 DATE PAID: AUG-15-08 <br />YLR 45, GRP 06/14/96, CDR SR 345.44, MCD 82.75, <br />LD 6 78.00, CGDD 89.57, VSD 20% 3.00, ODM 8 09-01, <br />MLD 22% $100.21 HOMEOWNERS & PLUP. <br /> <br />NAME: JOHNSON,GARY E <br />REPLACED POLICY: L358237-75B <br /> <br />H PHONE: (562) 596-7317 <br />POLICY FORM: 9805A <br /> <br />EXCEP. & <br />92702. <br />DRVR <br />GARY <br /> <br />END: ADD'L INSURED - CITY OF SANTA ANA PO BOX 1988 SANTA ANA CA <br /> <br />DT OF LIC RL NXT RL-DT <br />04/10/1963 SR <br /> <br />ACC/CONV DATE INFORMATION <br /> <br />REC CHG: <br /> <br />cov. S & Z NAMES <br /> <br />S AMT <br /> <br />Z <br /> <br /> <br />INSUIANCI <br />8 <br /> <br />JIM CONRAD <br />1066 BOLSA <br />SEAL BEACH. CA 90740 <br />562598-2415 <br />714 827-9642 <br /> <br />Q.,'I) 'tlW.\A -3'~'09 <br /> <br />C'Sc..P <br /> <br />.IATI 'AaM <br /> <br />.tit <br />