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Uate Farm STATE FARM FIRE AINI[) �CA!SUAII TY COUP, k - NY <br />A STOCK GOMPW� 1'1( VIS 1H HO: W (:)FF1W..-.-."S W B&..0 &bm& ''m'.Cyq, &j 1,jt�01S DECLARAT1i()F,IIS, AM11:..:.P0ED NOV 5%VT8 <br />v Pnfic.q Number 96 4311IJ 282.3 4.1 <br />IE <br />....... ................. . .......................................... . . . . .... . . ............. <br />Wiley f:lefliicW Weethro Date ExIlifirafion 110h%to <br />A,A 210-2388 IFA65 IF U '12 Months t11K)'V 16:201118 t�,,IOV 16 2019 <br />('412734 3112) The polify 1period hpims rind ends at'12:0'1 anistandard <br />Adlirill firtsured-SectiOn 11 Oni, time at III, ii <br />e premisens ori'abon, <br />1:111"Y W" RIVERSIDE INS Nomad linsii.iired <br />I'T'S OFF'ICIERS, EMPLOYEES K INN KrIONDN AL RESEARCH C.ENTIER ll"H('�' <br />A'13'Eff'rs 'IRI IK MANAGER 29!:6 VNILNIDINT IR ID S"III" 300 <br />319100 IHAIINN S'T' 13011A DEIIR ('10 IS110:3101 . ...... US 16 10 <br />IRIV' EIRS.LDIC's CA 92522 .00101 <br />A 5 <br />rlim- V <br />TM=10377-7- =i - <br />I L I I I IN WZWO1411KTAF11 11#11161101 IR241 W44144!111 -' R 5 1 1 <br />Entity: Corporation <br />Reason for Declarations: Your policy is amended NOV 5 2018 <br />ADDITIONAL INSURED ADDED <br />PREMIUM ADJUSTMENT <br />FORM CMP -4786 ADDED <br />7ROMR-MT-NWOM77=1 <br />i)OX 0 <br />, 07-5. <br />Other items shown are effective <br />with the policy's 2016 renew ll <br />TIM <br />rlIre pain,.,M <br />DE(,,', 12 201 '�B 10 CdDjpyri,Uht, ShAS l:61FIM Insuraincia Company, 2BOD <br />C14f:1-401010 Inidluidas C0117vinig1hiteld uTmtairiiaI oil insu; rence Servicos Tice,Olinc . .Kith b:piairinniksion. <br />023529 2'90 M Goirftinlueld oin f:i1eveil-se S�Ide of Pagp <br />Flialge 1 of G <br />hill <br />