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<br />Rug 06 04 11:45a Jerr::¡ Verdi 415-705-6533 p.2 <br /> ~.' j4Sn <br />i,... u ~lEKsE P~ES~FIRr\{LY - ~OU 'ÃRE IVÍAKI~G.SEVERÄL COPIES --" ~ <br />-..,.-..,........,.....-.~......_.....-.--_...........--_._----_._---------_.-._---...._-----------------------~----------------_.--------- <br /> . CERTIFICATE OF INSURANCE <br />SUCH INSURANbE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERWISE <br />TERMINATED WtlliOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT IN NO <br />EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRmEN. THIS CERTIFICATE OF INSURANCE <br />DOES NOT CHANGE THE COVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. <br />This certifies that: I ~ STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of BloOmington. Illinois, r;,- <br /> o STATE FARM FIRE AND CASUALTY COMPANY of BloOmington. Ilinois <br />has coverage in fe rce for the following Named Insured as shown below: <br />Named Insured Daniel Bay <br /> - <br />Address of Namec Insured 65 Vallejo Way <br /> - <br /> San Rafael, CA 94903 <br /> G22 6473-F20-05E <br />POUCY NUMBER ! <br />EFFECTIVE DATE I 6/20/04 - 12/20/04 <br />OF rouC· ( <br />DESCRIPTION OF I 2000 Volkswagen Golf <br />VEHICLE I 9BWGF21 J6Y 4029304 <br /> , ~YES ONO DYES rJ NO DYES ONO DYES <br />UABlUTY COVERAGE! DNO <br />UMlTS OF UABlUTY ¡ <br />a. Bodily Injury <br />EaCh Person <br /> i <br />Each Aocident i -.. <br />b. Property Damage i <br />Each Accident i <br />c. 9cxi1y rr;.y &~~ 1,000,000 <br />cørage Si1gIe Lirrit <br />Each Accident <br />PHYSICAL DAMAGE i ŒJ YES ONO DYES DNe DYES D ~«> DYES DNO <br /> ! <br />COVERAGES $ 100 <br />B. Ca/lprehensille I Deductible $ Deductible $ Deductible $ DEductible <br /> i ~Yes DNO DYES DNO Dyes ONO DyES ONO <br />b. Collision S 500 Deductible $ Deducti;)le $ DeQJct" $ Deductible <br />EMPLOYER'S I ONO DYES DNo DYES ONO <br />NON-OWNERSHJP ! DYES o yes DNO <br />COVERAGE <br />HIRED CAR COVERAG~ DYES ONO DyES DNO D YES DNO DYES DNO <br /> ~ß~Â- '¿;1a" Agent 2089 8/6/04 <br /> Tof'~- _ta'" Title Agent'S Code Number Date <br /> Name and Address of Certificate Holder Name and Address of Agent <br /> r -, r I <br />The City of RedWO¡d City <br />its officials. emplo es, and volunteers VERDI INSURANCE AGENCY <br />1017 Middlefield RÞad 8 California Street, Suite 200 <br />Redwood City, CA! 94063 San Francisco, CA 94111 <br /> I (415) 705-6530 Fax (415) 705-6533 <br /> I Uc. 0493338 <br /> i <br /> ; <br /> I <br /> L I -' L .-I <br /> I <br /> I CERTIFICATE HOLDER COpy - <br />Check if a perm:!! CertiflC8te of InSLnnce for liability coverage is needed: LJ <br />Check if the Certifi ate Holder should be added as an Additional Insured: E8J <br /> I <br />Remarks: I <br /> . - <br /> T· r· & <br /> 1 <br />