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t) Nationwide" <br />is on your side <br />For coverage definitions and descriptions, <br />visit Nationwide.com <br />Rated Driver(s) <br />F-PIDared on December 29, 2020 Page 2 of 4 <br />Your Policy Declarations <br />Nationwide Auto Policy <br />Policy Period: Jan 31, 2021 - Jan 31, 2022 <br />Policy Number: 7204J 241301 <br />Name Date of Birth Marital Status <br />Michael V Gamburg 11/04/46 Married <br />Celia L Gamburg 02/28/46 Married <br />Daniel Gamburg 09/22/69 Married <br />Insured Vehicle(s) and Schedule of Coverages <br />2003 Benz E320 <br />VIN WDeuP65J43A179385 <br />Coverages <br />Bodily Injury Liability <br />Property Damage Liability <br />Medical Payments <br />Uninsured Motorists Bodily Injury <br />Damage To Your Auto <br />Limits of Liability <br />$ 250,000 Each Person <br />$ 500,000 Each Occurrence <br />$ 100,000 Each Occurrence <br />$ 5,000 Each Person <br />$ 250,000 Each Person <br />$ 500,000 Each Occurrence <br />See Endorsement <br />Actual Cash Value Less $ 500 <br />Other Than Collision (Comprehensive) <br />With Full Safety Glass See Endorsement <br />Collision Actual Cash Value Less $ 500 <br />Waiver Of Collision Deductible <br />Custom Equipment <br />Rental Reimbursement <br />$ 3,000 <br />$ 30 Per Day <br />$ 900 Per Accident <br />See Endorsement <br />Total for this Vehicle <br />Le <br />Premium <br />$ 311.74 <br />$ 206.42 <br />$ 30.52 <br />$ 109.98 <br />$ 49.24 IN <br />$ 267.00 <br />$ 6.26 <br />Included <br />$ 28.76 <br />$ 1,009.92 <br />��oRaN <br />RAMmWmentDMsian <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />