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<br />1. <br />Named <br />Insured <br />Mailing <br />Address <br /> <br />NAFOOSI, KAIFAH <br />6951 FLIGHT RD t 214 <br /> <br /> <br />Cl <br />]/ <br /> <br />-- <br /> <br />FARMERS INSURANCE EXCHANGE <br />MEMBERS OF THE FARMERS INSURANCE GROUP OF COMPANIES <br />HOME OFFICE: 4680 WILSHIRE BLVD" LOS ANGELES, CALIFORNIA 90010 <br />COMMON POLICY OeCLARA TIONS <br />RETAIL SERVICE - PRIMARY <br /> <br />" <br /> <br />EasyPay Acct. No. <br />30-54-395 <br /> <br />Agent No. <br /> <br />RIVERSIDE <br /> <br />CA 92504 <br /> <br />Prod. Count <br />09414-60-85 <br /> <br />Policy Number <br /> <br />The named insured is an individual unless otherwise stated: <br />o Partnership 0 Corporation 0 Joint Venture 0 Organization (Any other) <br />Type of Business ACCOUNTING SERVICE <br /> <br />2. Policy Period from 08/03/04 (not prior to time applied for) to 08/03/05 12:01 a.m. Standard Time <br /> <br />If this policy replaces other coverage that ends at noon standard time of the same day this policy begins, this policy will not take effect <br />until the other coverage ends. This policy will continue for successive policy periods as follows: If we elect to continue this <br />insurance, we will renew this policy if you pay the required renewal premium for each successive policy period subject to our premiums, <br />rules and forms then in effect. <br /> <br />THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS LISTED BELOW AND FOR WHICH A PREMIUM IS INDICATED. THIS <br />PREMIUM MAYBE SUBJECT TO CHANGE. <br /> <br />BUSINESSOWNERS POLICY $505.00 <br />CERTIFIED ACTS OF TERRORISM - SEE IL0985 INCLUDED <br /> - <br /> -'-'___~___m___.,.____ .~ <br />TOTAL SEE INVOICE ATTACHED <br /> <br />Premium After Applicable Discount and Modification <br /> <br />Forms applicable to all Coverage Parts: <br /> <br />IL00030498 56-5166 <br /> <br />IL00171198 <br /> <br />IL09850103 <br /> <br />NANCY K.l. RASMUSSEN <br />INSURANCE AGENCY <br />Ucense # 0557400 <br />3848 E. Colorado Blvd. <br />Pa~adena, CA 91107 <br /> <br />Office: (626) 795-95t7 . Fax: (626) 795-4473 <br /> <br />Count'<S;Qned ~/I \ 'I:, 'i By <br />( ate) <br />Agent: NANCY RASMUSSEN <br />Agent Phone: 626 -795 - 9517 <br /> <br />~ <br /> <br /> <br />FARMERS <br /> <br />56-5990 6-00 <br />565990-ED2 <br /> <br />C599020 1 <br /> <br />Page 1 of 1 <br />