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5tateFarm <br /> State Farm Mutua'Automob°e nsurance Company 20994 4 A MUTL VOL <br /> PO Box 2358 DECLARATIONS PAGE <br /> Bloomington!L 61702 2358 <br /> PAGE 10F2 <br /> NAMED-NSURED <br /> AT2 75-2DE3-4 A A POLICY NUMBER 0193103-F22-75J <br /> EST °:0996 Ow POL`CY PER OD DEC 22 2025 to JUN 22 2026 <br /> 909 RIV IERA DR; JAMIE 12 01 A M Standard Tme <br /> 09 IV <br /> 5ANTA ANA CA 92706-1527 <br /> AGENT <br /> ALEX MORA=NSURANCE AGENCY'-NC <br /> 1111 E KATELLA AVE STE 230 <br /> ORANGE,_CA 92867-5060 <br /> APPROVED <br /> By Tu Tran Nguyen at 4:07 pm,May 07.2026 <br /> PHONE:(714)635-8000 <br /> DO NOT PAY PREM=UMS SHOWN ON THIS PAGE: <br /> =F AN AMOUNT=S DUE-_THEN A SEPARATE STATEMENT:S ENCLOSED: <br /> YOUR GAR <br /> YEAR MAKE MODEL BODY STYLE VEH`--CLE-D_NUMBER CLASS <br /> 2017 HONDA ACCORD 4DR 1 HGCR2F55HA013528 6030CV11 <br /> SYMBOLS COVERAGE&L M'TS PREM'UMS <br /> A L ab ty Coverage <br /> Body=njury L m is <br /> ...... .__ Each Person, Each Aocdent � ,. -._;—----T._ T <br /> $50,000 $100.000 <br /> :Property Damage L m A _ .._ _. <br /> Each Acc dent <br /> $50-000 <br /> C Med ca=Payments Coverage $36.97 <br /> L'mi Each Person - <br /> $5,000 <br /> Comprehens ve Coverage-$500 Deductb:e <br /> �G Co--son Coverage-$500 Deduct'b'e $388,86 <br /> —._._... _..._. Emergency Road Service Coverage -- --- _ $4-74 <br /> R1' Car Renta.and Trave Expenses Coverage _ $30 99 <br /> L m't-Car Rents Expense ' <br /> Each Day Each Loss <br /> $50 $1.500 <br /> U Un nsured Motor Veh c e Coverage <br /> s~� $47.47 <br /> Bod y'njury Umts W _4 <br /> Each Person Each Ace'dent <br /> � ;,$3o 000 $60 000 <br /> U1 Un nsured Motor Veh o e Property Damage Coverage $5,49 <br /> Tata= rem-um for DEC 22 2025 to JUN 22 2026- 995 83 This is nor a Lill- <br /> MPORTANT MESSAGES <br /> WPORTANT NOT.GE <br /> For your protect on Ca=Porn a aw requ res the fo=ow ng to appear w=th th-s po=cy= Any person who know-ng-y presents <br /> fa=se or fraudu=ent-nformat-on to obta`n or amend`nsurance coveragge or to make a c°a=m for the payment of a-ass-s <br /> gu f°.ty of a cr me and may be subject to nes and oonf-nement`n state pr-son, <br /> Rep aced po;cy number 0193103-75= <br /> Not°ee of nsurance nformat on co==ect-on pract-ces-persona-_fam y_or househo`d`nsurance transact'ons° <br /> We may correct customer'nformaton from persons other than the-ndv dua:or'nd v'dua s app y'ng for coverage Such customer <br /> nfonnaton as we'as other persona or pry eged nformaton subsequent'y coiiected may.'n certan c rcumstances. be d'seosed <br /> to th`rd part`es w1hout your authorzat'on as perm`tted by`.aw <br /> You have the rght to subm t a wr ten request to access-correct-amend-or delete your persona--nformat`on and the r ght to <br /> race`ve a response wth'n 30 days of submit`ng your request f we diegg your request_you have the rght to f e a statement <br /> wth us conta'n'ng the'nformat'on you fee 's accurate and fa'r song wtfi the reasons you d'sagree wth our den a nstrucYons <br /> on how to f'a such request and our fu• pr vacy not ce can be found www statefarm com/customer care/prvacy securty/prvaey <br /> or contact your State Farm Agent. <br /> CONT NUED <br /> 00915/10566 See Reverse S de <br /> -ss ca.2 os M2 ,:_,its. <br />