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StateFarm <br /> State Farm Mutual Automobile Insurance Company 93234-4-A MUTL VOL <br /> PO Box2368 DECLARATIONS PAGE <br /> Bloomington!L 61702-2368 <br /> PAGE 2 OF 2 <br /> NAMED INSURED 75-61F-8-4 A A POLICY NUMBER 661 2954-E13-75U <br /> o1st�4 nose POLICY PERIOD JUL 28 2025 to NOV 13 2025 <br /> 1592 N BATAVIA <br /> VIA 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 /> EXCEPTIONS,POLICY BOOKLET&ENDORSEMENTS(See policy booklet&individual endorsements for coverage details.) <br /> YOUR POLICY CONSISTS OF THIS DECLARATIONS PAGE THE POLICY BOOKLET - <br /> FORM 9805ANY S�JBAND ANY <br /> ENDORSEMENTS <br /> NDORSRENEWAEMN TICTHAT APPLY, IACLUOING THOSE ISSUED TO YOU <br /> WITCREDITOR- FORD MOTOR CREDIT - LIEN INSURANCE SERVICE CENTER, PO BOX 390858, <br /> MINNEAPOLIS MN 55439-0858. <br /> 01 6028BU ADDITIONAL INSURED-BRE CERRITOS OFFICE OWNER LLC, 3100 BRISTOL ST <br /> STE 200 COSTA MESA CA 92626-7316. <br /> 026028NUABOITI VLY CA NA8INN0SU ED-HYUNDAI MOTOR AMERICA, 10550 TALBERT AVE, <br /> FOUNTAI03 6028BU ADDITIONAL INSURED-STRUCTURAL GROUP INC, 11800 MONARCH ST, GARDEN <br /> GROVE CA 92841-2113. <br /> 04 6028BU ADDITIONAL INSURED-CITY OF TEMECULA: MARGARITA RECREATION CENTER <br /> 05S6028BUTAD(}ITIONALMINSURED-THE'CITYEOFLCORONA, ITSIDIRECTORS, OFFICIALS, <br /> OFFICERS , 400 5 VICENTIA AVENUE 400 S VICENTIA AVE, CORONA CA 92882-2187. <br /> 06 6028BOJ ADDITIONAL INSURED-CASCO CONTRACTORS LLC, 9850 IRVINE CENTER DR, <br /> IRVINE CA 92618-4353. <br /> 07 6028BU ADDITIONAL INSURED-CKE RESTAURANTS HOLDINGS INC, 6700 TOWER CIR <br /> 08E6028BL AUTOMOBILENLIABILITY-ADDITIONAL INSURED ENDORSEMENT CITY OF LOS <br /> ANGELES-DEPARTMENT OF WATER AND POWER-HARPER CONSTRUCTION COMPANY, INC., <br /> 9. <br /> 09 6028BUNADDITINALAINSURED-CBGgBUILDERS, 24 EXECUTIVE PARK STE 150, <br /> IRVINE CA 92614-2753. <br /> 10 6028BU ADDITIONAL INSURED-SOLANA BEACH CITY HALL, 635 S HIGHWAY 101, <br /> SOLANA BEACH CA 92075-2215. <br /> 11 6028BU ADDITIONAL INSURED-CITY OF GLENDORA RISK MANAGEMENT, 116 E <br /> FOOTHILL BLVD GLENDORA CA 92741-3380. <br /> 12 6028BU ADDITIONAL INSURED-SOUTH ORANGE COUNTY COMMUNITY COLLEGE DISTRICT, <br /> 13D6028BU ADDITIONALYINMISSION <br /> URED DLSIBBUOILDERS GENERAL9CONTR, 1975 N BATAVIA ST, <br /> ORANGE CA 92865-4107. <br /> 14 6028BU ADDITIONAL INSURED-1541 AND 1545 WILSHIRE SEIU 1721 HOLDINGS LLC, <br /> 1545 WILSHIRE BLVD STE 100 LOS ANGELES CA 90017-4510. <br /> 15 6028BU ADDITIONAL INSURED-1541 AND 1545 WILSHIRE SEIU 721 HOLDINGS LLC, <br /> 1545 WILSHIRE BLVD STE 100 LOS ANGELES CA 90017-4510. <br /> 16 6028BU ADDITIONAL INSURED-DLS BUILDERS GENERAL CONTRACTOR, 1975 N <br /> BATAVIA ST ORANGE CA 92865-4107. <br /> 17 6028BU ADDITIONAL INSURED-CITY OF MANHATTAN BEACH, 1400 HIGHLAND AVE, <br /> MANHATTAN BCH CA 90266-4756. <br /> 18 6028BU ADDITIONAL INSURED-CITY OF SAN MARCOS, I CIVIC CENTER DR, SAN <br /> MARCOS CA 92069-2918. <br /> 19 6028BU ADDITIONAL INSURED-2H CONSTRUCTION INC, 2653 WALNUT AVE, SIGNAL <br /> HILL CA 90755-1830. <br /> 20 6028BU ADDITIONAL INSURED-THE CITY OF SAN MARINO, 2200 HUNTINGTON DR, <br /> SAN MARINO CA 91108-2639. <br /> 21 6028BU ADDITIONAL INSURED-KILROY REALTY CORPORATION, 3780 KILROY ARPRT <br /> 22Y6028BU1AbDITIONALAINSURED-CIITY2OF8IRVINE, C/O EXIGIS RISK MANAGEMENT <br /> SERVICES PO BOX 947, MURRIETA CA 92564-0947. <br /> 23 6028BU ADDITIONAL INSURED-CITY OF INDIAN WELLS, 44950 ELDORADO DR, <br /> INDIAN WELLS CA 92210-7497. <br /> 24 6028BU ADDITIONAL INSURED-CITY OF SANTA & ATIMA, M85220 S DAISY AVE BLDG <br /> 663OGFTA ANBUSINESSONAMED INSURED. <br /> 6125A AMENDATORY ENDORSEMENT. <br /> 6126MD EXCESS COVERAGE FOR PERSONAL VEHICLE SHARING, <br /> 6129J AMENDATORY ENDORSEMENT. <br /> 69-6196AB- WAIVER OF SUBROGATION UNDER THE LIABILITY COVERAGE FOR CITY OF <br /> IRVINE C/O EXIGIS RISK MANAGEMENT SERVICES; CITY OF SANTA ANA & ATIMA. <br /> Agent: JAVIER MISIEGO <br /> Telephone: (714)772-3838 <br /> 21351116091 Prepared OCT 03 2025 61 F8-B92 <br /> 155.3855 CA,2 05-2002(a1an25fe) (o1a0254c) <br /> 13SX8 (n1W25W) <br />