CALIFORNIA EVIDENCE OF LIABILITY INSURANCE DOCUMENT CALIFORNIA EVIDENCE OF LIABILITY INSURANCE DOCUMENT

Address of sales office: Address of sales office:

555 ST CHARLES DR STE 106 555 ST CHARLES DR STE 106

THOUSAND OAKS CA 91360 THOUSAND OAKS CA 91360

For Customer Service Call: (805) 497-2899 For Customer Service Call: (805) 497-2899
For Claims Call: (800) 225-2467 For Claims Call: (800) 225-2467
Roadside Assistance: 1-800-426-9898 Roadside Assistance: 1-800-426-9898

COMPANY CODE NUMBER NAIC NUMBER COMPANY CODE NUMBER NAIC NUMBER
LIBERTY MUTUAL FIRE INSURANCE CO. 23035 LIBERTY MUTUAL FIRE INSURANCE CO. 23035
Certifies that it has issued a liability insurance policy with Certifies that it has issued a liability insurance policy with
compulsory coverage as required by the California financial compulsory coverage as required by the California financial
responsibility law, to the policyholder named below with respect to responsibility law, to the policyholder named below with respect to
the vehicle described. the vehicle described.
NAME OF INSURED NAME OF INSURED
PHILP KOK Name and address of office issuing this card: PHILP KOK Name and address of office issuing this card:
555 ST CHARLES DR STE 106 555 ST CHARLES DR STE 106
5158 CLARETON DR THOUSAND OAKS CA 91360 5158 CLARETON DR THOUSAND OAKS CA 91360

AGOURA HILLS CA 91301-4522 AGOURA HILLS CA 91301-4522

POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE
AO2-268-389658-40 0 03/26/2010 03/26/2011 AO2-268-389658-40 0 03/26/2010 03/26/2011
CARD EFFECTIVE DATE CARD EXPIRATION DATE CARD EFFECTIVE DATE CARD EXPIRATION DATE
03/26/2010 03/26/2011 ____________________________________________ 03/26/2010 03/26/2011 ____________________________________________
Applicable with respect to the following vehicle: Authorized Representative Applicable with respect to the following vehicle: Authorized Representative
1989 MERC GRMARCOLLS 2MEBM79F8KX712966 1989 MERC GRMARCOLLS 2MEBM79F8KX712966
YEAR MAKE MODEL VEHICLE IDENTIFICATION NUMBER YEAR MAKE MODEL VEHICLE IDENTIFICATION NUMBER

PMKT 510 01 08 SEE IMPORTANT MESSAGE ON REVERSE SIDE PMKT 510 01 08 SEE IMPORTANT MESSAGE ON REVERSE SIDE

THIS CARD NOT FOR THIS CARD NOT FOR

DISTRIBUTION DISTRIBUTION