CRAIG D JOSES P.O. BOX 416 SAN ANDREAS CA,95249

Transcripción

1 Policy Number : P.O. BOX 416 SAN ANDREAS CA,95249 MUSA 21090_

2

3 PERSONAL AUTO POLICY DECLARATIONS CA SELECT AUTO (CA) These are your Declarations. Please Read and Attach to Your Policy. Your Producer: 168 ATHENA INSURANCE & FINANCIAL SERVICES P.O. BOX 390 PINE GROVE CA Named Insured: P.O. BOX 416 SAN ANDREAS CA,95249 Customer Since: 10/21/2010 Notes for Policy or, if applicable, Endorsement Reason ADD DRIVER Insurance Provided By: COMMERCE WEST INSURANCE COMPANY,, POLICY INFORMATION Policy Number: Declaration Type: ENDORSEMENT Transaction Effective Date: 01/19/2016 Policy Period From: 04/21/ :01 A.M. Standard Time at the address of the Named Insured, but not prior to the time applied for or, if this is a replacement declarations, not prior to the time coverage change was requested. To: 04/21/ :01 A.M. Standard Time at the address of the Named Insured INFORMATION VEH # YEAR MAKE AND MODEL DODGE RAM 2500 QUAD DODGE D-350 DODGE RAM 3500 QUAD ST/SLT DODGE CHARGER SXT GARAGE VIN ZIP 3B7KF2368XG B6KE36C2PS D7MU48653G C3CDXHG1DH VEH USE COMMUTE < 30 PLEASURE PLEASURE COMMUTE < 30 EXPIRING ANNUAL MILEAGE NEW OR RENEWAL ANNUAL MILEAGE RATED DRIVER ID COVERAGES AND LIMITS OF LIABILITY Coverage is provided only where a premium and a limit of liability are shown for the coverage. Limits of Liability Coverage BODILY INJURY PROPERTY DAMAGE MEDICAL PAYMENTS UM BODILY INJURY Coverage for Damage to Your Auto UM PROPERTY DAMAGE COMPREHENSIVE COLLISION UM COLL DEDUCTIBLE WAIVER RENTAL REIMBURSEMENT TOWING & LABOR SPECIAL EQUIPMENT Premiums Each Person Each Accident Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 $250,000 $500,000 $ $ $ $ N/A $100,000 $ $ $ $ $2,000 N/A $11.80 $17.23 $9.84 $15.74 $250,000 $500,000 $23.61 $24.03 $18.69 $30.49 Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 $3,500 $3,500 $7.87 $7.99 $250 $100 $100 $ $ $ $500 $500 $ $ $500 $500 $1.97 $3.93 $30/$900 $30/$900 $47.21 $47.21 $35 $3.93 Total Fees (Included in Total Amount) ANTI-FRAUD FEE REINSTATEMENT FEE POLICY FEE = $51.04 = $7.04 = $20.00 = $24.00 Total Premium Per Vehicle Change in Premium = $ $ $ $ TOTAL AMOUNT (For all Vehicles on the Policy, Including Surcharges) $1, $3, PA CA (07/14) Page 1 of 2

4 DRIVER INFORMATION Driver ID Name CRAIG JOSES TANNER JOSES JENNIFER JOSES Date of Birth 03/29/ /19/ /17/1973 Gender M M M Marital Status MARRIED SINGLE MARRIED Policy Number: Name: Years of License Experience Operator Type PRINCIPAL PRINCIPAL PRINCIPAL Assigned to Veh # Driving Record Points DRIVING RECORD INFORMATION Driver ID Incident Date Incident PTS Driver ID Incident Date Incident PTS EXCLUDED DRIVER(S) There is no coverage provided by this policy while the following individual(s) operate a motor vehicle: Name DOB Name DOB Name DOB LOSS PAYEE(S) / ADDITIONAL INTEREST(S) Veh # Type* Name Address * L = Financed, A = Additional Interest/Lessor, A,L = Leased, C = Certificate Holder FORMS AND ENDORSEMENTS MADE PART OF THIS POLICY CWI-1004,WPI-1033,WPI-125,CWI-134,CWI-130 POLICY DISCOUNTS Discount Vehicle(s) Discount Vehicle(s) Anti Theft Device Good Driver Multi Car Passive Restraint Discount Persistency Discount 4 1, 3, 4 1, 2, 3, 4 1, 3, 4 1, 2, 3, 4 Commerce West Insurance Company and MAPFRE Insurance Company offer automobile insurance through multiple programs with various coverage options. If you would like additional information or a quotations, please contact Commerce West and MAPFRE Insurance at (877) MAPFRE1. Page 2 of PA CA (07/14) 2

5 1999 DODGE RAM 2500 QUAD 3B7KF2368XG DODGE RAM 2500 QUAD 3B7KF2368XG DODGE D-350 1B6KE36C2PS DODGE D-350 1B6KE36C2PS DODGE RAM 3500 QUAD ST/SLT 3D7MU48653G DODGE RAM 3500 QUAD ST/SLT 3D7MU48653G831800

6

7 2013 DODGE CHARGER SXT 2C3CDXHG1DH DODGE CHARGER SXT 2C3CDXHG1DH612791

8 3. Obtenga informaci n de los otros implicados. 4. Intercambie informaci n de compania de seguro y el 3. Obtenga informaci n de los otros implicados. 4. Intercambie informaci n de compania de seguro y el 3. Obtenga informaci n de los otros implicados. 4. Intercambie informaci n de compania de seguro y el