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SfateFarm <br />State Farm Mutual Automobile Insurance Company <br />AO Box 2368 <br />Bloomington !L 61702-2368 <br />NAMED INSURED <br />AT2 75-61 F8-4 A r <br />016114 6058 <br />WESTERN A/V INC <br />1592 N BATAVIA ST STE 2 <br />ORANGE CA 92867-3554 <br />93234-4-A MUTL VOL <br />L DECLARATIONS PAGE <br />PAGE 1 OF 2 <br />POLICY NUMBER 661 2954-El3-75U <br />POLICY PERIOD JUL 28 2025 to NOV 13 2025 <br />12:01 A.M. Standard Time <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 />Liability Coverage . <br />$4i1.5S <br />Bodily Injury Limits <br />mxm�- <br />Each Person, Each Aecident-<5 <br />$1,000,000 $1,000,000 <br />-_ � <br />f=sProperty Damage Limit <br />u. <br />Each Accident <br />$1,000,000 <br />D <br />Comprehensive Coverage-$2,000 Deductible <br />$18.49 <br />- G ,.. <br />Collision Coverage - $2,000 Deductible_ <br />�, <br />H <br />Emergency Road Service Coverage <br />$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 <br />Uninsured Motor Vehicle Property Damage Coverage <br />$$ 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 personal 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 92011-1437. <br />CONTINUED <br />21350/16091 See Reverse Side <br />155-3866 CA.2 05.2002 �ota0251c} <br />11 MON (u1 a0251e) <br />