Laserfiche WebLink
;c) State Farm Mutual Automobile Insurance Company 96788-4-A MATCH 01000 MUTL VOL <br /> PO Box 2368 <br /> Bloomington IL 6f 702-2368 DECLARATIONS PAGE <br /> PAGE 1OF2 <br /> NAMED INSURED 0101D0 <br /> 75-8127-4 A A POLICY NUMBER &M 3607-E09 75USIM MAR IA POLICY PERIOD JUL 17 2025 to NOV 09 2025 <br /> AND DIVERSIFIED <br /> MD WA & PATRICK 12:01 A,M Standard Time <br /> AND DIVERSIFIED WATERSCAPES, <br /> INC STE 213 STATE FARM PAYMENT PLAN NUMBER <br /> 27324 CAMIND CAPISTRANO 1346356623 <br /> LAGUNA NIGUFL CA 92677-1118 AGENT — <br /> GARY BLACKBURN <br /> 23881 VIA FABRICANTE STE 506 <br /> MISSION VIEJO,CA 92691.3139 <br /> PHONE:(949)661.0800 <br /> DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. <br /> IF AN AMOUNT IS DUE,THEN A SEPARATE STATEMENT IS ENCLOSED- <br /> ----- _ YOUR CAR YEAR MAKE AWDEL I _ CLAW <br /> yUM� <br /> NONOWNED AUTO 670A[)PG002 <br /> SYMBOLS. COVERAGE'&UMITS PREMIUMS_ <br /> A Liability ooverage':<. <br /> Bodily Injury Limits <br /> Each Person, Each A660erti <br /> $1,000,000 $1,000,000 <br /> Property Damage Limd <br /> Each Accident <br /> S1,Dbb.bDD <br /> Li Limnsured Motor Vehicle Coverage 6.84 <br /> Bodily Injury Limits <br /> Each Person, Each Acc dent <br /> Totslpremiu n for JULL17 2025 to NOV 09 2025. $141.99 INS as not a bill. <br /> IMPORTANT MESSAGES <br /> IMPORTANT NOTICE <br /> For your protection California law requires the fallowing 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 6283607-75T. <br /> Notice of insurance information collection practices-personal,family,or household insurance transactions: <br /> We may ooilect 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 yyour request,you have the right to file a statement <br /> with us containing the information you feel is accurate and fair along with tko reasons you disagree with our denial.Instructions <br /> on how to file such request and our full privacy notice can be found www statefarn_comlcustomer.carelprivacy-securitylprivacy <br /> or contact your State Farm Agent. <br /> Your total renewal premium for MAY 09 2025 to NOV 09 2025 is$228.28. <br /> Location used to determine rate charged-29641 VIA CEBOt L a LAGUNA NIGUEL CA 92677. <br /> CONTINUED <br /> 087W07456 See Reverse Side <br /> tss-ara cAz 0&,VW a ra} <br /> nsxn» Sat�eS <br />