Evidence of Auto Insurance

Transcripción

1 Evidence of Auto Insurance Insured: If this address is incorrect, Please call Master Policyholder/Dealership: Printed: Initial Coverage Period: From: To: *Continuation Coverage Period: From: To: Coverage provided by: Western General Insurance Company THE COVERAGE LISTED HEREON APPLIES ONLY IF THE COST LISTED BELOW HAS BEEN PAID Listed below are the names of the scheduled driver(s) 1. Listed below is the vehicle covered under your policy YEAR MAKE MODEL VEHICLE ID NUMBER Listed below are your coverages and deductibles COVERAGE LIMITS Comprehensive Actual Cash Value Less Deductible Collision Actual Cash Value Less Deductible Cost: IMPORTANT INFORMATION ABOUT YOUR AUTOMOBILE INSURANCE Approximately three (3) to five (5) business days after commencement of the Initial Coverage Period, you will be offered continuation coverage under a separate Western General Insurance Company private passenger automobile insurance policy. *Continuation Coverage Period only valid if offer accepted and required premium paid. NO PERSON IS REQUIRED, AS A CONDITION OF FINANCING THE PURCHASE OR LEASING OF A MOTOR VEHICLE, TO PURCHASE OR NEGOTIATE ANY INSURANCE THROUGH A PARTICULAR INSURANCE COMPANY, AGENT OR BROKER. You consent to the dealer securing the above listed coverage and to the Dealer/Lender/Lessor at its sole discretion, paying the cost for such coverage purchased in conjunction with your Motor Vehicle Contract and Security or Lease Agreement. You authorize the Dealer/Lender/Lessor to transmit information about you and the vehicle listed above to Insure Express and authorize Insure Express to order your motor vehicle record for the purpose of quoting continuation coverage under a Western General Insurance Company private passenger automobile insurance policy. You fully acknowledge and accept the coverage and the information listed. STATEMENT OF UNDERSTANDING I fully understand that only Automobile Comprehensive and Collision Coverage has been selected. This coverage does not provide Bodily Injury or Property Damage Liability Insurance and will not fulfill the requirements of any Financial Responsibility Law. Liability Insurance is NOT included. I have read the Important Information above and insurance warning notice on the following page. Vehicle Purchaser Signature Date DEALER COPY CA-FR PD NB 1016 D (12-01) PLEASE HAVE CUSTOMER SIGN, DATE AND RETAIN IN YOUR DEAL FILE Page 1 of 2

2 Insured: Insurance Warning: The motor vehicle physical damage insurance policy you are buying does not allow you to legally drive on the streets of California. Generally, in order to legally drive on the streets of California, you must either purchase a type of insurance called liability insurance or deposit a bond with the Department of Motor Vehicles. If you drive this or any other motor vehicle without liability insurance or a bond, a police officer may request evidence of liability insurance or a bond at the time of a traffic stop. If you do not have evidence of liability insurance or a bond during a traffic stop, the fines can be from several hundreds of dollars to an amount that exceeds $1,000. If you get into an accident and do not have liability insurance or a bond, you will lose your driver s license for one year. If you cause the accident and do not have liability insurance or a bond, you may have to pay the injured person yourself and these costs may be substantial. Liability insurance as well as the insurance needed to obtain a loan for your motor vehicle may be purchased through a licensed insurance agent or broker. The price for both types of insurance may be more or less than the price for the insurance you are being offered by the dealer. The State of California advises you to shop for insurance because prices may vary substantially. I have read this notice and understand that I am about to buy a type of insurance that is available elsewhere and that does not allow me to drive the motor vehicle legally on the streets of California. I also understand that if I drive on the streets of California without liability insurance or a bond, then I may be subject to severe financial penalties, including fines and personal payment for any damage to others that I may cause while driving. Advertencia Sobre Seguro: La póliza de seguro de auto que usted está comprando para amparar daños materiales a su vehículo motorizado no le permite manejar legalmente en las calles de California. Generalmente, para manejar legalmente en las calles de California, usted tiene que comprar un tipo de seguro llamado en inglés liability insurance (seguro de responsabilidad civil) o depositar una fianza en el Departamento de Vehículos Motorizados. Si usted conduce este o cualquier otro vehículo sin seguro de responsabilidad civil o fianza, un policía puede solicitar evidencia de seguro de responsabilidad civil o de fianza durante una parada de tráfico. Si usted no proporciona tal evidencia durante la parada de tráfico, las multas pueden ser desde cientos de dólares hasta una cantidad que excede los $1,000. Si tiene un accidente y no tiene seguro de responsabilidad civil o fianza, perderá su licencia de manejar por un año. Si usted causa el accidente y no tiene seguro de responsabilidad civil o fianza, es posible que usted mismo tenga que pagarle a la persona lesionada y estos costos pueden ser muy considerables. Usted puede comprar seguro de responsabilidad civil así como el seguro necesario para obtener el préstamo para su vehículo motorizado por medio de un agente o corredor de seguro con licencia. El precio de ambas clases de seguro puede ser mayor o menor que el precio del seguro que el concesionario le está ofreciendo. El Estado de California le aconseja que se informe sobre los precios en diferentes compañías aseguradoras ya que los mismos pueden variar considerablemente. He leído este aviso y entiendo que estoy a punto de comprar una clase de seguro que está disponible en otras partes y que no me permite manejar legalmente vehículos motorizados en las calles de California. Asimismo, comprendo que si conduzco en las calles de California sin seguro de responsabilidad civil o sin fianza, entonces es posible que yo esté sujeto a sanciones financieras severas, incluyendo multas y pagos personales por cualquier daño y perjuicio a otros que yo pueda ocasionar mientras manejo. LIABILITY INSURANCE WARNING WARNING - IT IS YOUR RESPONSIBILITY UNDER CALIFORNIA LAW TO OBTAIN LIABILITY INSURANCE OR BE SUBJECT TO PENALTIES FOR VIOLATING SECTION OF THE VEHICLE CODE, WHICH MAY INCLUDE LOSS OF LICENSE OR A FINE. THE INSURANCE ACQUIRED BY THE LIENHOLDER DOES NOT PROVIDE LIABILITY COVERAGE AND DOES NOT SATISFY YOUR RESPONSIBILITY UNDER CALIFORNIA LAW. CA-IE 1016 PD D (07-06) N/F Page 2 of 2

3 INSURANCE COVERAGE NOTICE AN INITIAL DEPOSIT HAS BEEN MADE TOWARD YOUR AUTOMOBILE INSURANCE COVERAGE. YOUR CONDITIONAL QUOTE AND MONTHLY BILL WILL BE MAILED TO YOU IN 3 TO 5 BUSINESS DAYS. IF YOU HAVE ANY QUESTIONS, CONTACT INSUREEXPRESS AT (800) Aviso de la Cobertura de Seguro EXISTE UN DEPOSITO INICIAL HACIA SU POLIZA DE SECURO DE AUTOMOVIL. USTED RECIBIRA SU PROSUPUESTO CONDICIONAL Y COBRO MENSUAL POR CORREO DENTRO DE 3 A 5 DIAS DE NEGOCIO. SI TIENE PREGUNTAS, LLAME A INSUREEXPRESS AL (800) Customer Copy CA POS (08/08)

4 Evidence of Auto Insurance Insured: If this address is incorrect, Please call Master Policyholder/Dealership: Printed: Initial Coverage Period: From: To: *Continuation Coverage Period: From: To: Coverage provided by: Western General Insurance Company THE COVERAGE LISTED HEREON APPLIES ONLY IF THE COST LISTED BELOW HAS BEEN PAID Listed below are the names of the scheduled driver(s) 1. Listed below is the vehicle covered under your policy YEAR MAKE MODEL VEHICLE ID NUMBER Listed below are your coverages and deductibles COVERAGE LIMITS Comprehensive Actual Cash Value Less Deductible Collision Actual Cash Value Less Deductible Cost: IMPORTANT INFORMATION ABOUT YOUR AUTOMOBILE INSURANCE Approximately three (3) to five (5) business days after commencement of the Initial Coverage Period, you will be offered continuation coverage under a separate Western General Insurance Company private passenger automobile insurance policy. *Continuation Coverage Period only valid if offer accepted and required premium paid. NO PERSON IS REQUIRED, AS A CONDITION OF FINANCING THE PURCHASE OR LEASING OF A MOTOR VEHICLE, TO PURCHASE OR NEGOTIATE ANY INSURANCE THROUGH A PARTICULAR INSURANCE COMPANY, AGENT OR BROKER. You consent to the dealer securing the above listed coverage and to the Dealer/Lender/Lessor at its sole discretion, paying the cost for such coverage purchased in conjunction with your Motor Vehicle Contract and Security or Lease Agreement. You authorize the Dealer/Lender/Lessor to transmit information about you and the vehicle listed above to Insure Express and authorize Insure Express to order your motor vehicle record for the purpose of quoting continuation coverage under a Western General Insurance Company private passenger automobile insurance policy. You fully acknowledge and accept the coverage and the information listed. STATEMENT OF UNDERSTANDING I fully understand that only Automobile Comprehensive and Collision Coverage has been selected. This coverage does not provide Bodily Injury or Property Damage Liability Insurance and will not fulfill the requirements of any Financial Responsibility Law. Liability Insurance is NOT included. I have read the Important Information above and insurance warning notice on the following page. CUSTOMER COPY PLEASE KEEP FOR YOUR RECORDS CA-FR PD NB 1016 C (12-01) Page 1 of 2

5 Insured: Insurance Warning: The motor vehicle physical damage insurance policy you are buying does not allow you to legally drive on the streets of California. Generally, in order to legally drive on the streets of California, you must either purchase a type of insurance called liability insurance or deposit a bond with the Department of Motor Vehicles. If you drive this or any other motor vehicle without liability insurance or a bond, a police officer may request evidence of liability insurance or a bond at the time of a traffic stop. If you do not have evidence of liability insurance or a bond during a traffic stop, the fines can be from several hundreds of dollars to an amount that exceeds $1,000. If you get into an accident and do not have liability insurance or a bond, you will lose your driver s license for one year. If you cause the accident and do not have liability insurance or a bond, you may have to pay the injured person yourself and these costs may be substantial. Liability insurance as well as the insurance needed to obtain a loan for your motor vehicle may be purchased through a licensed insurance agent or broker. The price for both types of insurance may be more or less than the price for the insurance you are being offered by the dealer. The State of California advises you to shop for insurance because prices may vary substantially. I have read this notice and understand that I am about to buy a type of insurance that is available elsewhere and that does not allow me to drive the motor vehicle legally on the streets of California. I also understand that if I drive on the streets of California without liability insurance or a bond, then I may be subject to severe financial penalties, including fines and personal payment for any damage to others that I may cause while driving. Advertencia Sobre Seguro: La póliza de seguro de auto que usted está comprando para amparar daños materiales a su vehículo motorizado no le permite manejar legalmente en las calles de California. Generalmente, para manejar legalmente en las calles de California, usted tiene que comprar un tipo de seguro llamado en inglés liability insurance (seguro de responsabilidad civil) o depositar una fianza en el Departamento de Vehículos Motorizados. Si usted conduce este o cualquier otro vehículo sin seguro de responsabilidad civil o fianza, un policía puede solicitar evidencia de seguro de responsabilidad civil o de fianza durante una parada de tráfico. Si usted no proporciona tal evidencia durante la parada de tráfico, las multas pueden ser desde cientos de dólares hasta una cantidad que excede los $1,000. Si tiene un accidente y no tiene seguro de responsabilidad civil o fianza, perderá su licencia de manejar por un año. Si usted causa el accidente y no tiene seguro de responsabilidad civil o fianza, es posible que usted mismo tenga que pagarle a la persona lesionada y estos costos pueden ser muy considerables. Usted puede comprar seguro de responsabilidad civil así como el seguro necesario para obtener el préstamo para su vehículo motorizado por medio de un agente o corredor de seguro con licencia. El precio de ambas clases de seguro puede ser mayor o menor que el precio del seguro que el concesionario le está ofreciendo. El Estado de California le aconseja que se informe sobre los precios en diferentes compañías aseguradoras ya que los mismos pueden variar considerablemente. He leído este aviso y entiendo que estoy a punto de comprar una clase de seguro que está disponible en otras partes y que no me permite manejar legalmente vehículos motorizados en las calles de California. Asimismo, comprendo que si conduzco en las calles de California sin seguro de responsabilidad civil o sin fianza, entonces es posible que yo esté sujeto a sanciones financieras severas, incluyendo multas y pagos personales por cualquier daño y perjuicio a otros que yo pueda ocasionar mientras manejo. LIABILITY INSURANCE WARNING WARNING - IT IS YOUR RESPONSIBILITY UNDER CALIFORNIA LAW TO OBTAIN LIABILITY INSURANCE OR BE SUBJECT TO PENALTIES FOR VIOLATING SECTION OF THE VEHICLE CODE, WHICH MAY INCLUDE LOSS OF LICENSE OR A FINE. THE INSURANCE ACQUIRED BY THE LIENHOLDER DOES NOT PROVIDE LIABILITY COVERAGE AND DOES NOT SATISFY YOUR RESPONSIBILITY UNDER CALIFORNIA LAW. CA-IE 1016 PD C (07-06) N/F Page 2 of 2