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F LE Nationwide is on your side Your Policy Declarations Nationwide Auto Policy Policy Period Apr 13, 2021 - Jan 31 2022 Policy Number 7204J 241301 Insured Vehicle(s) and Schedule of Coverages (continued) 2002 Toyo Sienle/Xle VIN 4T3ZF13C82U506983 Coverages Limits of Liability Premium Bodily Injury Liability $ 250 000 Each Person $ 500,000 Each Occurrence $ 299.66 Property Damage Liability $ 100,000 Each Occurrence $ 24806 Medical Payments $ 5 000 Each Person $ 48.80 Uninsured Motorists Bodily Injury $ 250,000 Each Person Ln $ 500,000 Each Occurrence $ 113.04 0 0 See Endorsement 141) Damage To Your Auto Actual Cash Value Less $ 500 $ 42.40 01 cn Other Than Collision (Comprehensive) o With Full Safety Glass See Endorsement N N Collision Actual Cash Value Less $ 500 $ 245.54 U% C 3 Waiver Of Collision Deductible $ 6.26 Custom Equipment $ 3,000 Included Total for this Vehicle $ 1,003 76 2015 Benz E350 VIN WDDHF5KB5FB128136 Coverages Limits of Liability Premium Bodily Injury Liability $ 2-S0,000 Each Person $ 500,000 Each Occurrence $ 245.06 Property Damage Liability $ 100,000 Each Occurrence $ 14056 Medical Payments $ 5,000 Each Person $ 22.58 Uninsured Motorists Bodily Injury $ 250 000 Each Person $ 500,000 Each Occurrence $ 92.46 See Endorsement Damage To Your Auto Actual Cash Value Less $ Soo $ 105.10 Other Than Collision (Comprehensive) With OEM With Full Safety Glass Collision With OEM Waiver Of Collision Deductible Custom Equipment Rental Reimbursement See Endorsement See Endorsement Actual Cash Value Less $ Soo See Endorsement $ 3.000 $ 30 Per Day $ 900 Per Accident See Endorsement $ 701.16 $ 626 Included $ 28,76 Total for this Vehicle $ 1,341.94 �oRaN 3 Risk MmWmentDiAsiun REVIEWED & APPROVED SY.- z a p R. Risk Management Analyst