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2023/07/01 Danis Bechter1004361 142987.4 04-24-2020 listed herein by policy number(s). Select one of the following: A request has been submitted to add the additional interest described below to the policy(ies) The additional interest described below has been added to the policy(ies) listed herein by policy number(s). SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CANCELLATION AUTHORIZED REPRESENTATIVE FINANCEDVEHICLE / EQUIPMENT INTEREST: LENDER'S LOSS PAYEE LOSS PAYEEADDITIONAL INSURED DESCRIPTION OF THE ADDITIONAL INTERESTLEASED ADDITIONAL INTEREST NAME AND ADDRESS OF ADDITIONAL INTEREST LOAN / LEASE NUMBER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. This form is used to report coverages provided to a single specific vehicle or equipment. Do not use this form to report liability coverage provided to multiple vehicles under a single policy. Use ACORD 25 for that purpose. INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : INSURER(S) AFFORDING COVERAGE NAIC # NAME: CONTACT (A/C, No): FAX E-MAIL ADDRESS: CUSTOMER ID #: PRODUCER PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES CLAIMS MADE OCCURRENCE GENERAL LIABILITY $ $ $EACH OCCURENCE GENERAL AGGREGATE $ $ VEHICLE LIABILITY COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE DATE (MM/DD/YYYY) SERIAL NUMBERDESCRIPTION BODY TYPEMAKE / MANUFACTURER VEHICLE IDENTIFICATION NUMBERMODELYEAR DESCRIPTION OF VEHICLE OR EQUIPMENT THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HAS/HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD(S) INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICY(IES) DESCRIBED HEREIN IS/ARE SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). ADD'L INSRD INSR LTR POLICY EXPIRATION DATE (MM/DD/YYYY) POLICY EFFECTIVE DATE (MM/DD/YYYY)TYPE OF INSURANCE POLICY NUMBER LIMITS REMARKS (INCLUDING SPECIAL CONDITIONS / OTHER COVERAGES) (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ACORD 23 (2016/03)The ACORD name and logo are registered marks of ACORD © 1997-2015 ACORD CORPORATION. All rights reserved. DED$ LIMIT$ DED$ LIMIT$ STATED AMT AGREED AMTACV DED$ LIMIT$ RC SPECIAL BROADBASIC EQUIPMENT LOSS PAYEE INSR LTR STATED AMT AGREED AMTACV VEH OTC LIMITS / DEDUCTIBLE STATED AMT AGREED AMTACV POLICY EXPIRATION DATE (MM/DD/YYYY) POLICY EFFECTIVE DATE (MM/DD/YYYY)POLICY NUMBER VEH COMP TYPE OF INSURANCE VEH COLLISION LOSS VEHICLE/EQUIPMENT VALUE $ ALEX CROSS 7424 JACKSON DR SUITE 7 SAN DIEGO CA 92119 DANIS BECHTER 41548 BLUE CANYON AVE, UNIT 3 MURIETTA CA 92562 ALEX PETERSON-CROSS 619-567-2752 619-326-9016 alex.peterson-cross.vaaj79@statefarm.com CA License #0H29819 State Farm Mutual Automobile Insurance Company 25178 2014 FORD F150 PICK-UP 1FTFX1EF6EKG32862 X X 300 0968-A01-55B 07/01/2023 01/01/2024 1,000,000 1,000,000 1,000,000 City of Menifee, its Officers, Agents and Employees named as Additional Insured. CITY OF MENIFEE 29844 HAUN RD MENIFEE CA 92586 06/09/2023 DocuSign Envelope ID: EED28DF3-4C1E-433C-AF09-4C6B9ECED82A