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51 <br />STATE FARM GENERAL INSURANCE COMPANY <br />A G POCK COMPAN Y wing HomE oFmc--s iN BL acmwc, ToN, xt iNols <br />R kaId <br />j� <br />Mfle <br />oo 3311-9501 <br />R -23- 3036 -"=C16 F U <br />000502 3123 <br />Named Insured <br />ARELLANO, TERESA <br />DBA SANTA ANA PROFESSIONAL <br />SERVICES <br />1082 "E' 17TH ST STE R <br />SANTA ANA CA 92701-2501 <br />1 TqWTT-.7-'TiI4]Tk9 <br />Policy Number 92.C7 �590-1 <br />Policy Period Effectift Date Ex' fration Date <br />12 Months NOV 12 2015 12 20116 <br />The il i" J bnIns and ends at 12:01 am standard <br />time NIC Rrellm"isds oraton, <br />Agent and Mailing Address <br />ROBERT R MACHADO INS AGCY INC <br />109 62 WARNI.R: AVg - – I <br />FOLJNTAIN. VLY CA-92768-3853 <br />PHONE: (7145 964-1161 <br />Office poflc� <br />Auk alk'6ijaWal_-...1flhq polici. period is shown as 12 months, thisppicywill be renewed automatically . subjeutth the premiums, rules and <br />forms � in off ectfor cz ig policy period. If this ternimpted, tte <br />icy s wewfli I uive you an4th-e Wo�6ageeklo-nfioldeirwrl nnoticein <br />Go.mplianz,e wl,tfi the poky prdvlislarmor as required Eby iaw. <br />Entity: Individual <br />NOTICE:: Information concerning changes in your policy Ian uage is included. Please call your agent <br />. ... ....... . . <br />If you ha�:e any ques . tio r,,,, <br />POLICYPREMIUM $ 500.00 "V W\ <br />Minimum Premium <br />Discounts. Applied: <br />Renewal Year <br />Years in Business <br />Protective Disvioes <br />Sprinkler <br />claim Record <br />Prepared <br />AUG 19 2016 CD Copyright State For irMutuaJAL1t0MUbjIV Inspraric a Company, zoos <br />OMP-4000 Includes copyrighted miteriol of Insurance Services office, 111c,, with its permission. <br />0 11878 291 1 Continued on Reverse Side of Page <br />E 0R,1 R,A1 <br />Page I of 6 <br />530-696a.2 q5.3i-7011 (O1P3231c) <br />