Laserfiche WebLink
rage t ul z <br />O <br />((21Nst Century <br />insurance - <br />Named Insured and Mailing Address <br />SCOTT WELDY <br />22671 REVERE RD <br />EL TORO, CA 92630-5000 <br />E-mail: BIGBIRDDOG®AOL.COM <br />Vehlale(s) and DAver(s) <br />Veh ell - 'MatwliVlodel :: -- <br />4 98 TOYT RAV4 ar - <br />5 18 FORD F150 RAPTOR PK <br />vdr <br />Rifted driver <br />PERSONAL AUTO <br />POLICY DECLARATION <br />AMEND - POLICY CHANGE <br />EFFECTIVE 07/24/19 <br />Account: <br />21 ST CENTURY INSURANCE <br />Customer Service Center: <br />21st CENTURY INSURANCE <br />21ST CENTURY PLAZA <br />P.O. BOX 15510 <br />WILMINGTON, DE 19850-5510 <br />Policy No: 8377 29 50 <br />Policy Period: From 04130119 <br />To: 10/30/19 12:01 AM Standard Time <br />Vehlcle ID Number llae Vehicle Dlaco "WC-ommerrts: zip.,- I Mileage <br />o <br />JT3HP10VOW7096930 W MGM 92630 7,201 <br />1 FTFW 1 RG3JFA96316 P MCD4ATD 92630 9.999 <br />D WHERE A PRC-MI[1M <br />yearsTlakets Chergeable Acoidents Driver Discounts <br />Llcvnsvdne <br />nF I IARII ITV ARF CHr1WKl FnR TWF r.nVr-QA <br />- Coverage; <br />__. <br />Lhrllt of Llnbllity <br />Premium <br />Veh4 <br />Vah 5 <br />A. Badi1 Injury t €ability <br />includes 0. 8 per fraud fee <br />_-- _ __- <br />B. Property Damage Liabitity _ <br />Medical Payments <br />$100, 000 each person <br />Saoo, 000 each accident <br />c <br />� 9s.00 <br />S 149.00 <br />_ <br />sloo 000 . _ _e ch_accident _ _. <br />$S 000 _ Wch perawn <br />$,_ 93.00 <br />$ 22.00 <br />122.00 <br />S s3. 00 <br />Uninsured Motorist <br />D. Badl_Injury _ <br />DAMAGE TO YOUR VEHICLE <br />Actual Cash Value Less Deductible <br />$100, 000 each person <br />.5300, 000 each accident <br />Veh 4 Vet+ 6 <br />S 45.00 <br />$ 1-1.00 <br />_$ 84.00 <br />�! <br />$ '10.00 <br />Dad. <br />Ded. <br />E. Comprehensive <br />$100 <br />$500 <br />F. Collision <br />Uninsured <br />Property Damage <br />$100 $500 <br />L)E:!l wAxvir DEL) WATVC <br />$75 each disablement <br />$25 $25 ' <br />$150 $750 <br />$ 79.00 <br />$ 307.00 <br />- <br />I <br />$ 2.00_ <br />included <br />$ 5.00 <br />Included <br />- <br />_ <br />21st Century <br />G. Roadside Assistance_ <br />Rental -- Per day <br />H. Reimbursement_ _ I max <br />J. Additional Equipment <br />The first $1000 is automatically <br />Included with coverage E or F. <br />Additional coverage Is optional, <br />If the installment bill plan is used, a service <br />$ 19.00 <br />$ 19.00 <br />Included <br />Additional <br />Total <br />Total0.00 <br />$1-, 000 <br />$1, 000 <br />$1.1000 <br />$1, 000 <br />S 0.00 <br />Total Premium Per Vehicle <br />354.00 $ 808.00 <br />Total Premium $ 2,401.00 <br />charge may apply. <br />Endorsement(s)/Agreement(s) Applicable: <br />Drivers Not Rated <br />07124/19 <br />THE FOLLOWING FEES) MAY APPLY: <br />LATE: $5.00 PAYMENT RETURNED (NSF): $10.00 . <br />CANCEL: $50.00 INSTALLMENT BILL PLAN SERVICE CHARGE,."00 <br />�uAhOifmr! Cwrvnny gntuoeeminllvo {wlxuu m�pdrrnlj <br />WHEN ATTACHED TO THE PERSONAL AUTO POLICY, THESE DECLARATIONS COMPLETE THE POLICY AND REPRESENT <br />THE CURRENT STATUS OF YOUR COVERAGES AND LIMITS OF LIABILITY. <br />Visit 21st.com to make policy changes, pay your premium, and more. Register online today! For Customer Care call 800-241-1188. <br />TCU41CA (12114) 21s1 Cenlury Insurance Company, P.O. Box 15510, Wilmington, DE 10886-5292 <br />A- q_q-r <br />