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StateFarm <br />State Farm Mutual Automobile Insurance Company <br />PO Box 2368 <br />Bloomington !L 61702-2368 <br />NAMED INSURED 75-61F-8-4 A A <br />016174 uu58 <br />WESTERN A/V INC <br />1592 N BATAVIA ST STE 2 <br />ORANGE CA 92867-3554 <br />93234-4-A MUTL VOL <br />DECLARATIONS PAGE <br />PAGE 2 OF 2 <br />POLICY NUMBER 661 2954-E13-75U <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 />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 />WITHCREDITOR- 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 NAL8INN0SU 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 , TIO <br />400 5 VICENTIA AVENUE 400 S VICENTIA AVE, CORONA CA 92882-2187. <br />06 6028BOJ ADDINAL 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 />96AB- <br />E C/O <br />ERSONAL VEHICLE SHARING, <br />T. <br />UNDER THE LIABILITY COVERAGE FOR CITY OF <br />NT SERVICES; CITY OF SANTA ANA & ATIMA. <br />21351116091 <br />155.3855 CA,2 a5-Z802 (a1.WN.) (o1a0254c) <br />13SX8 (n1W25vd) <br />Agent: JAVIER MISIEGO <br />Telephone: (714)772-3838 <br />Prepared OCT 03 2025 61 F8-B92 <br />