2022/05/27 Roger K. Kobata Associates, Inc.StateFarm STATE FARi,l GENERAL INSUFANCE COMPANY
A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS
E?"Flla€if,! ?* r s oa s. s s z s
Addl lnsured-Sectlon ll Only
^r2 M-23-7993-FA2D F U004829 3125CITY OF TENIFEE29714 HAUN RD
]{EN I FEE CA 9?5e6-65q0
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RENEWAL OECLARATIONS
Policyl{umber 92-84-1995-6
Policv Period Eltoclive DatB Exoiralion Date
12 Mbnths MAY 27 2022 MAY 27 2023
The oolicv oeriod beoins and ends at l2:01 am standardtime'at $6 premises Tocaton.
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ffiE Named lnsured
ROGER K KOBATA &
ASSOCIATES INC
9
6
5
Office Policy
Aubmatic Bonewal - lf tre policy period is shown as 12 months , his policy will be renewed automatically su bject to $e premiums, rules and
forms in etfect for each sucieedini policv period. lf $is policy is terminated, we will give you and the Mortgagee/Lienholder written notjce in
comp Itance witr the policy provisions or as required by law
Entity: Corporation
NOTICE: lnformation concerning changes in your policy language is included. Please call your agent
il you have any questions.
POLICY PREMIU|\il
Discounts Applied:
Benewal Year
Years in Business
Claim Record
$ 569.00
Pre p ared
MAR 14 2022
cMP-4000
O Copyrigh! StrtE Frrm Mulu.l Automobilr lnlur!nc6 Complny,2m
Includgs copyrightsd nrtEri!l 0f ln!urrncs S0ruicos oflicr, lnc.. with its pormisiion
Continued on Fleverse Side of Page Page 1 ot 7030974 294
N
A
RENEWAL DECLABATIONS (CONTINUED)
Oltics Policv lor CITY OF MENIFEE
Policy Number 92-8+1995-0
SECTION I . PBOP RTY SCHEDULE
Location
Number Location ofDescribedPremises
Limit of lnsurance'
Coveraoe A -Buildi'ngs
Limit ol lnsurance'
Coveraoe B -
Buslness Fersonal
Property
Seasonal
lncrease-
Business
Personal
Property
002 15417 CORNET ST
SANTA FE SPRINGS CA 90670.553
No Coverage $ 11,200
- As of the eflective date of this policy, t e Limit of lnsurance as s own tnc des any increase in t
SECTION I - I
e imlt due to n on erage
FLATION COVERAGE INDE ES)
N/A
281 .1
SECTION I .DUCTIBLES
Basic Doduclible
Speclal Oeductlbles:
Money and Securities
Equipment Breakdown
$1,000
$250
$1,000
Employee Dishonesty $2s0
Other deductibles may apply " refer to policy
Prepared
MAR 14 2022
cMP-4000
030974
O Copyrighl Stote F6rm Mutu6l Automobrle ln!ur!nc0 Comprny, 2m8
lncludes copyrightsd m6tEri6l of lnsu16ncs Ssrvic6s offioe, lnc., with its 0srmission
Continued on Nexl Page Page 2ot 7
Cov A - lnflation Coverage lndex:
Cov B - Consumer Price lndex:
StateFarm6)@
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RENEWAL DECLARATIONS (CONTINUED)
Oflice Pollcv for CITY OF MENIFEE
Policy Num6er 92-8+1995-6
SECTION I - EXTENSIONS OF COVEBAGE - LIMIT OF INSURANCE . EACH DESCRIBED PREMISES
!
8 The coverages and corresponding limits shown below apply separately to each doscribed premises shown in theseh DeclaratlonC, unless indicated by "Soe Schedule." ll a covorago does not have a correspondlng llmil shown below,H but has "lncluded" indicated, please reter to that policy provision lor an oxplanallon ot that coverage.
LIMIT OF
INSUBANCECOVERAGE
Accounts Receivable
On Premises
Olf Premises
Arson Reward
Back-Up O{ Sewer Or Drain
Collapse
Damage To Non-Owned Buildings From Thelt, Burglary Or Robbery
Debris Removal
Equipment Breakdown
Fire oepartment Service Charge
Fire Extinguisher Systems Rocharge Expense
Forgery Or Alteration
Glass Expenses
lncreased Cost O, Construction And Demolition Costs (applies only when buildings are
insured on a replacement cost basis)
Money And Securities (Ofl Premises)
Money And Securities (On Premises)
Money Orders And Counterleit Money
Newly Acquired Business Personal Property (applies only if this policy provides
Coverage B - Business Personal Prop6rty)
Newly Acquired Or Conslructed Buildings (applies only if this policy provides
Coverage A - Buildings)
$s0,000
$15,000
$5,000
$15,000
lncluded
Coverage B Limit
250lo of covered loss
lncluded
$5'000
$5'000
$10,000
lncluded
10%
Prepared
MAR 14 2022
cMP-4000
030975 294
N
o copyrioht stats F!rm Mut!01 Automobils lnsurlnce Comp!ny,2008
lnclud€9 copyri0htsd mltori!l of lnturonce SBrvicss offi0e, lnc., with ils psrmisrion
Continued on Reverse Side of Page
$s,000
$10,000
$1,000
$100,000
$250.000
Page 3 of 7
BENEWAL DECLABATIONS (CONTINUED)
Oflice Policv lor CITY OF MENIFEEPolicy Num6er 92-8+1995-6
Ordinance Or Law - Equipment Coverage
Outdoor Property
Personal Effects (applies only to those premises provided Coverage B - Business
Personal Property)
Personal Property Ofl Pr€mises
Pollutant Clean Up And Removal
Preservation Ol Property
Property Of Others (applies only to those premises provided Coverage B - Business
Personal Property)
Signs
Unauthorized Business Card Use
Valuable Papers And Records
On Premises
Off Premises
lncluded
$s,000
$5,000
$1s,000
$10,000
30 Days
$2,500
$2,500
$s,000
$s0,000
$15,000
SFCTION I - F NSIONS OF COVERAGE .LIMIT OF INSURANCE - PEP POLICY
The cov€rages and corresponding limits shown below are the most we will pay regardless ol the number otdescribed premises shown in thes€ Declarations.
COVERAGE
Dependent Property - Loss Of lncome
Employee Dishonesty
Utility lnterruption - Loss Of lncome
Loss Ot lncome And Extra Expense
O Copyrilh! Stlte F.rm illtu rl Altomobile lnsur!nce Comp.ny, 2008
lncludsr copyrightsd mat€rinl of lnsurrncs SBrvices 0ffice, lnc., wath its p€rmssion
Continued on Next Page
LIMIT OF
INSURANCE
ss,000
$10,000
$10,000
Actual Loss Sustained - 12 Months
Prepared
MAB 14 202?
cMP-4000
030975 P age 4of 7
StateFarm(-)oo RENEWAL DECLARATIONS (CONTINUED)
Otlice Pollcv lor CITY OF MENIFEE
Policy Num6er 92-8+1995-6
SECTION II - LIABILITY
I
I
COVERAGE
Coverage L - Business Liability
Coverage M - Medical Expenses (Any One Person)
Damage To Premises Rented To You
AGGHEGATE LIMITS
Products/Completed Operations Aggregate
General Aggregate
Each paid claim for Liability Coverage reduces tho amount of insurance we provide during
annual period. Please refer to Section ll - Liability in the Coverage Form and any attached
LIMIT OF
INSURANCE
$1,000,000
$5,000
$300,000
LIMIT OF
INSURANCE
Excluded
$2,000,000
the applicable
endorsements.
Your oolicv consists of these Declarations, the BUSINESSOWNERS COVEBAGE FORM shown below, and any other
forms and'endorsements that apply, including those shown below as well as those issued subsequent to the
issuance of this policy.
FORMS AND ENDOBSEME
Cl\ilP-4101
FE-6999.3
cMP-4786.1
cMP-4845
cMP-4819.1
cMP-4698
ctvlP-4704.1
cMP-4710
cMP-4709
cMP-4703.1
cMP-4705.2
cMP-4787
cMP-4260.1
Businessowners Coverage Form.Terrorism lnsurance Cov Notice
Addl lnsd Owners Lessee Sched
Excl Product Comp Operatn Liab
Unauthorized Business Card Use
Back-Up of Sewer or Drain
Dependent Prop Loss of lncome
Employee Dishonesty
Money and Securities
Utility lnterruption Loss lncm
Loss of lncome & Extra Expense
Waivsr of Trans Flgt of Becov
Amendatory Endorsement-CA
Prepared
MAR 14 2022
cMP-4000
030976 294
N
@ Copyright St.te F6rm Muturl Automobil€ ln3uruncs Comprny.20(n
lncludes copyrightod mlt€riol of lnsur!ncs Sorvic0s officr, lnc., with rt! pormission
Continued on Rgverse Side of Page Page 5 of 7
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RENEWAL DECLABATIONS (CONTINUED)
Oflico Policv lor CITY OF MENIFEEPollcy Num6er 92-8+1995-6
cMP-4261
FD-6007
Amendatory Endorsement
lnland lvlarine Attach Dec
" New Form Attached
This policy is issued by the State Farm General lnsurance Company.
Participating Policy
You are entitled to paltcipate in a. distribulion of th€ €arnings of the company as determined by our Board of Directors inaccordance with the Company's Articles of Incorporation, as amended.
ln Witness Whereof, he Stat€ Farm General lnsurance Company has caused this policy to be signed by its president andSecretary at Bloomington, lllinois.
$r'-*ny-'r"t
Secretafi
-il*e b/ry
President
IMPOBTANT NOTICE:
Caltromla bw requlrcs ue-to provlde you vrllh lnrormatlon tor llllng complolmg whh the Stote lngurance Deparmrem regardlng thecovcrage and $ryico provlded undor this policy.
Your aged's name and contact ldomation ar€ provided on the trolll o{ thb docume , Another optbn i! to teoch out bymsilor phon€ dhoctly lo:
Statg Farm@ Ercc]ltlve Customst Ssryice
PO 8ox 2320
Bloomlngton lL 61702
Phone t |-8oO-STATEFAR (1-800782-8332)
Oepartment-of lnrulance comPlslnt! should be liled only alter you and State Farm or your lgEm or sther comparryropreEedatlvo hlvo l.lled to toach o ssti8loclory rorsemqnt on a problem,
Caliromia DepErtnent o, lnsurEnce
Consumor Eorylces DlyBlrn
300 Sourh Sprlm Streer
LoS Angah8, CA 90013
Phone t 1€00-927-HELP (4357) or vbit vrr/y.insumnce,ca.qov/oI-corlErmers
Prepared
MAR 14 2022
cMP-4000
030976
O Copyriohl Strts Fsrm lvlutu!lAutomobils lnsurrncs Comprny,20Oo
lncludss copyightod msterill of lnsurEnce Servics! Offics, lnc., widl its Dermi!sion
Continu6d on Next page Page 6 of 7
StateFarm !(-@
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NOTIGE TO PC'LICYHOLDER:
For a comprehensive description o[ coverages and Iorms, please reler lo your policy.
Policy changes requested before hs 'Dale Prepared", which appear on this notice, are effective on the Renewal Date
of lhis policy unless oherwise indicated by a separate endorsement, binder, or amendod declarations. Any coverage
forms attached to lhis notice are also elfective on the Benevral Date of this policy.
Policy changes requ€sled afler lh€ "Dat6 Prepared" will be senl to you as an amond€d declarations or as an
endo'rsemeit to your policy. Billing lor any additional premium for sirch changes will be mailed al a later date.
lf, during the past year, youle acquired any valuabl€ property items, made any improvements to insured property,
or have any questions about your insuranc€ coverage, contiact your State Farm agent
Please keep lhis with your policy.
RENEWAL DECLABATIONS (CONTINUED)
@ Copyright StEte Farm Muturl Automohile lnsurlncs Comp0ny, 2008
lncludes copyright€d mrtoriol ol lni!r![ce Ssrvicas offio8. Inc , with its psrmission
I
q
3
Prepared
MAR 14 2022
cMP-4000
030977 294
N
Page 7 ol 7
O{flce Pollcv lor CITY OF MENIFEE
Policy Num6er 92-84-1995-0
STATE FABM GENEFAL INSURANCE COMPANY
A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MAFINE ATTACHING DECLARATIONS!
Policyl{umbor 92-84-1995-6
Policv Pariod Etlectivo Dats Exoiration Dab
12 Mbnths MAY 27 2022 MAY 27 2023
Ihe polipy period beoins and ends at I2:0'l am standardtme atfie premlses locatron.
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Named lnsured
ROGER K KOBATA &
ASSOCIATES INC
tvl-23-7993-FA2 D F U
ATTACHING INLAND MARINE
Aubmalic Re[ewal -lf thepolicypa odisshownas12monlhs,thispolicywill be renewed automatically subiectto $e premiums,rules and
lorms in effect for each sucLeedin! policy period. lf dris policy is terminated, we will give you and the Mongagee/Lienholder written notice in
compliance witr the policy provisions or as required by law.
Annual Policy Premium lncluded
The above Premium Amount is included in fre Policy Premium shown on $e Declarations
Your policy consisb of these Declarations, dre INLAND MARINE C 0NDlTl0NS shown below, and any other forms and endorsements that
apply, including $ose shown below as well as $ose issued subsequentto th€ issuance ofthis policy.
Foms, 0ptions, and Endorsomcnts
FE-8739
FE-6271
FE-8745
lnland Marine Conditions
Amendatory Endorsement
lnland Marine Computer Prop
See Reverse for Schedule Page wi6 Limis
Prepared
MAR 14 2022
FD-6007
030978
O Copyri0ht, Strt€ Form Mutu6l Automobilo lnsurrnce Comp!nv, 2008
lncludes copyrightod m0t6ri6l ol lnsuranc€ SqrvicEs olfic6, lnc., with its psrmission
530 0lt r 2 05 31 201 I ro I l32rc i
StateFarm
h!-!4I
l*Y,d
EI;
I
92€4-1995-6
ATTACHING II{LAND MARII{E
ATTACHING INLAND MABINE SCHEDUTE PAGE
ENOORSEMENT
NUMBEB
FE-8745
COVERAGE
lnland Marine Computer Prop
Loss of Income and Extra Expense
s
$
25,000
25,000
s 500 Included
Included
Lr[4tT 0F
INSURANCE
DEDUCTIBLE
AMOUNT
ANNUAL
PREIVIIUM
Prepared
MAR 14 2022
FD-6007
030978
0THERLll\4lTsANDExcLUsl0NSMAYAPPLY.REFERT0Y0URP0L|CY-
@ Copyriqhl Stote F.rm l\4utu!lAutomobilE lnsur6nce Comp.ny, Z00B
lncludss copyrightod m6t8ri.l of lns0r!nce Sorvi6E! otlioe, lnc., with iti pormission
513 635.2 05ll l0ll loll3zlScr