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St fCF81m State Farm Mutual Automobile insurance Company pa Y 92918-4-A MATCH 01012 MUTL VOL <br /> 0*0 PO ° 66 <br /> Bloomington <br /> L 61702-2368 DECLARATIONS PAGE <br /> NAMED INSURED 01012 PAGE 1 OF 2 <br /> 76-2EDB-4 A A POLICY NUMBER 473 3354-F13-750 <br /> 5 PROPERTY SOLUOLUTIO <br /> o SOLUTIONS, <br /> POLICY PERIOD OCT 012025 to DEC 13 2025 <br /> 875 IRON HORSE DR STE A271 NS, INC, i2:01 A.M.Standard Time <br /> PARK CITY UT 84060-5158 <br /> STATE FARM PAYMENT PLAN NUMBER <br /> 1256610923 <br /> AGENT _ <br /> JOSE GASTELUM — <br /> 1780 E MCFADDEN AVE STE 114 <br /> SANTA ANA,CA 92705-4648 — <br /> PHONE:(714)557-3344 <br /> DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. <br /> IF AN AMOUNT IS DUE,THEN A SEPARATE STATEMENT IS ENCLOSED. <br /> YOUR CAR <br /> 2018 FORD F150 PICKUP 1 FfMF1 CB3JKE76591 000HCX10 <br /> Limit-Each Accident <br /> =t=:!! <br /> Pa menfs Coverage $14 95 <br /> G n� Collision Coverage,p 500 Deductible $217.04 <br /> U Uninsured Motor Vehicle Coverage $37.46 <br /> Each Person, Each Accident <br /> U1 _ Uninsured Motor Vehicle Property Damaae Cgveraae $2 97,•- <br /> - <br /> IMPORTANT NOTICE <br /> For your protection California law requires the following to appear with this policy: Any person who knowingly presents <br /> false or fraudulent Information to obtain or amend insurance coverage or to make a claim for the payment of a loss Is <br /> guilty of a crime and may be subject to fines and confinement in state prison. <br /> Replaced policy number 4733354 75N. <br /> Notice of insurance information collection practices-personal,family,or household insurance transactions: <br /> We may collect customer information from persons other than the individual or individuals applying for coverage.Such customer <br /> information as well as other personal or privileged information subsequently collected may,rn certain circumstances,be disclosed <br /> to third parties without your authorization as permitted by law. <br /> You have the right to submit a written request to access,correct amend,or delete your personal information and the right to <br /> receive a response within 30 days of submitting your request. l#we deny your request,you have the right to fits a statement <br /> with us containing the information you feel is accurate and fair along with the reasons you disagree with our denial.Instruotions <br /> on how to file such request and our full privacy notice can be found www.statefarm.com/customer-care/privaoy-securitylprivacy <br /> or contact your State Farm Agent. <br /> Your total renewal premium for JUN 113 2025 to DEC 13 2025 Is$2,342.36. <br /> Location used to determine rate charged-919 E SAWA ANA BLVD,SANTA ANA CA 92701-3920. <br /> CONTINUED <br /> 21729116184 See Reverse Side <br /> 11S 155 {o1aU.205�Z(old2bfo) <br />