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86698-4-P MATCH 00534 MUTL VOL <br />StafeFarm State Farm Mutual Automobile Insurance Company <br />^ PO Box 853922 <br />Richardson, TX75085-3922 <br />NAMED INSURED 00534 <br />75-7501-4 P <br />000sas ocse <br />NANCV k BOHL INC <br />DBA THE COUNSELING TEAM <br />INTERNATIONAL <br />PO BOX 10427 <br />SN BERNRDNO CA 92423-0427 <br />DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. <br />IF AN AMOUNT IS DUE. THEN A SEPARATE STATEMENT IS ENCLOSED. <br />DECLARATIONS PAGE <br />PAGE 1 OF 2 <br />POLICY NUMBER 441 4187-F24-75W — <br />POLICY PERIOD OCT 31 2019 to JUN 24 2020 <br />12:01 A.M. Standard Time <br />AGENT <br />SKALA INSURANCE AGENCY INC <br />4214 N SIERRA WAY <br />SN BERNRDNO, CA 92407-3896 <br />PHONE. (909)883-8861 <br />YOUR CAR <br />YEAR MAKE MODEL BODY STYLE VEHICLE ID, NUMBER CLASS <br />2017 BMW X5 SPORT WG 5UXKR6C36HOU13705 600HCV1I <br />SYMBOLS COVERAGE & LIMITS PREMIUMS <br />A <br />Liability Coverage <br />$702.61 <br />Bodily Injury Limits <br />Each Person, Each Accident <br />$1,000,000 $1,000,000 <br />Property Damage Limit <br />Each Accident <br />$1,000,000 <br />D <br />Comprehensive Coverage-$1,000 Deductible <br />$139.21 <br />G <br />Collision Coverage-$1,000 Deductible <br />$508.25 <br />R1 <br />Car Rental and Travel Expenses Coverage <br />$44.33 <br />Limit - Car Rental Expense <br />Each Day, Each Loss <br />$50 $1.200 <br />U <br />Uninsured Motor Vehicle Coverage <br />$75.91 <br />Bodily Injury Limits <br />Each Person, Each Accident <br />$100,000 $300,000 <br />U1 <br />Uninsured Motor Vehicle Property Damage Coverage <br />$10.37 <br />Additional Use of NonaDwried Car Coverage <br />BIPD Liability <br />$5.18 <br />Physical Damece <br />$25.88 <br />Total pramilum for OCT 312019 to JUN 24 2020. $1,511.74 This is not a bill <br />IMPORTANT MESSAGES <br />Replaced policy number 4414187-75V <br />Your total renewal premium for DEC 24 2019 to JUN 24 2020 is $1,160.84. <br />Location used to determine rate charged-36442 WILDWOOD CANYON RD, YUCAIPA CA 92399-5274. <br />CONTINUED <br />06813/07236 See Reverse Side <br />15 3366 C .2 052002 Io,e02610 <br />H S%ON (o1e0251e1 <br />Risk Managanmt DlAsicn <br />REVIEWED & APPROVED BY: <br />- Risk Management Analyst <br />