PROOF OF INSURANCE (2005) CLOSEDi.ir.r.r.rr
ALLSTATE LIENHOLDER SERVICE CENTER
PO BOX 660349
DALLAS,TX 75266 -0349
EL SEGUNDO CITYCLERK
350 MAIN ST
EL SEGUNDO CA 90245-3813
CERTIFICATE OF INSURANCE
Date: 07/03/04
EFFECTIVE DATE
OF CERTIFICATE
ALLSTATE INSURANCE COMPANY AUGUST 25, 2004
Northbrook,Illinois, certifies that the following insurance is in force:
POLICYHOLDER POLICY NUMBER POLICY PERIOD
DENISE & PETE BOTHE 0 67 698216 02/25 AUGUST 25, 2004
3453 KALLIN FEBRUARY 25, 2005 S wduATim
LONG BEACH CA 90808 -3002
The person or organization designated below is described in the policy as:
EL SEGUNDO CITYCLERK
350 MAIN ST LIENHOLDER
EL SEGUNDO CA 90245 -3813 (Loss Payable Clause)
X ADDITIONAL
INTERESTED PARTY
AGENT BRIAN STOEBE
PHONE (310) 834 -2883
Coverages designated below are afforded for each described vehicle:
BI $30,000 EA.PERS.- $60,000 EA.00C. 1930 FORD
PD $50,000 EA.00C. A3433339
Collision- DED. Comprehensive -No Comprehensive Coverage
See reverse side for provisions concerning Loss Payable Clause and Additional Interested Party.
This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage
afforded by the policy referred to above.
DI697
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