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SfateFarm <br /> State Farm Mutual Automobile Insurance Company 93234-4-A MUTL VOL <br /> PO Box 2368 DECLARATIONS PAGE <br /> Bfoomington!L 61702-2368 <br /> PAGE 1 OF 2 <br /> NAMED INSURED <br /> AT2 75-61F8-4 A A POLICY NUMBER 661 2954-El3-75U <br /> 111174 Dose POLICY PERIOD JUL 28 2025 to NOV 13 2025 <br /> 1592 N BATAVIA ST STE 2 <br /> WESTERN A INC 12:01 A.M.Standard Time <br /> ORANGE CA 92867-3554 <br /> STATE FARM PAYMENT PLAN NUMBER <br /> 1031434923 <br /> AGENT <br /> JAVIER MISIEGO <br /> 227 20TH ST STE 103 <br /> NEWPORT BEACH,CA 92663-4343 <br /> PHONE.V14)772-3838 <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 /> YEAR MAKE MODEL BODY STYLE VEHICLE ID.NUMBER CLASS <br /> 2024 FORD RANGER PICKUP 1 FTER4131-18RLE20753 000HCX10 <br /> SYMBOLS COVERAGE&LIMITS PREMIUMS <br /> A.-. . . Liability Coverage. $411.55 <br /> Bodily Injury Limits <br /> mxm�- Each Person, Each Aecident - <5 <br /> $1,000,000 $1,000,000 <br /> _ =;;Property Damage Limit u. <br /> Each Accident <br /> Vr <br /> $1,000,000 D Comprehensive Coverage-$2,000 Deductible $18.49 <br /> G ,.. Collision Coverage-$2,000 Deductible _ �, <br /> H Emergency Road Service Coverage $2,99 <br /> Car Rental and Travel Expenses Coverage <br /> Limit-Car Rental Expense <br /> Each Day, Each Loss - <br /> $25 $600 <br /> .`...Uninsured Motor Vehicle CoveragQ <br /> Bodily Injury Limits <br /> Each Person Each Accident <br /> $30,000 $50,000 <br /> U1 Uninsured Motor Vehicle Property Damage Coverage $$ 43 " <br /> Total premium for JUL 28 2025 to NOV 13 2025. $716.16 This is not a Nlf. <br /> IMPORTANT MESSAGES <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 6612954-75T, <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 persona,or privileged Information subsequently collected may,in 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. If we deny your request,you have the right to file a statement <br /> with us containing the information you feel is accurate and fair along with the reasons you disagree with our denial. Instructions <br /> on how to file such request and our full privacy notice can be found www,statefarm.com/customer-caretprivacy-security/privacy <br /> or contact your State Farm Agent. <br /> Your total renewal premium for MAY 13 2025 to NOV 13 2025 is$1,228.40. <br /> Location used to determine rate charged-6353 CORTE DEL ABETO STE 106,CARLSBAD CA 9 2 011-1 437. <br /> CONTINUED <br /> 21350/16091 See Reverse Side <br /> 155-3866 CA.2 05.2002(otaO251c} <br /> 11 MON (o1 a0251e� <br />