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Paperless Discount <br />Paid in Full Discount <br />Package Discount <br />Surcharges Applied <br />Policy Level <br />Excluded Operator Surcharge <br />Important Notice <br />Our Company offers multiple programs in California to eligible insureds. A lower rate or better coverage may be available <br />to you. If you are a member of an association and would like your policy reviewed to assure you are receiving the best <br />possible rate, please contact your agent or our call center at 1-877-4683466. <br />Additional Policy Information <br />Insured email: videotb@aol.com <br />Tier 10 <br />Disclosure of Possible Additional Charges <br />The amounts below are authorized for use in this state. However, they are only charged if they apply to your policy. <br />Acquisition Expense $20.00 <br />Additional Insured Charge $25.00 <br />Additional Insured Charge - Blanket $1,000.00 <br />CA Vehicle Assessment and Fraud $1.76 <br />Fee <br />Cancellation Charge <br />$10.00 <br />Convenience Fee <br />$5.00 <br />-Federal F!Fng Fee <br />$75.00 <br />FR Filing Charge <br />$25.00 <br />Late Charge <br />$10.00 <br />Nonsufficient Funds Charge <br />$25.00 <br />Reinstatement Charge - Federal Filing <br />$75.00 <br />Reinstatement Charge - No Federal <br />$25.00 <br />Filing <br />UIIA Fee <br />$75.00 <br />Waiver of Subrogation <br />$25.00 <br />Waiver of Subrogation - Blanket <br />$1,000.00 <br />Forms and Endorsements <br />Form Edition Form Name <br />10150 01012014 <br />NUCLEAR ENERGY LIABILITY EXCLUSION <br />07594 12012018 <br />EXCLUSION OF NAMED DRIVER <br />11332 03012018 <br />COMMERCIAL AUTO POLICY <br />Authorized Signature <br />R1,1 Management DMslan <br />&�yAPPRovm BY; <br />rrREmEWED <br />10039CA(06012014) <br />M' Risk Management Analyst <br />