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State Farm Mutual Automobile Insurance Company <br />Auto Insurance Binder <br />California <br />Policy Number: 583 7885-D15.55 <br />Agent <br />Named Insured(s) <br />Lazaro Neto <br />JORGE B MELGOZA, ANNA MELGOZA <br />3924 El Cajon BLVD <br />San Diego CA 92105 <br />Mailing Address <br />(619) 229-6799 <br />6867 Golfcrest Or Apt 51 <br />San Diego CA 92119-2444 <br />Vehicle <br />Year: 2012 <br />Make: HONDA <br />Model: ACCORD <br />Body Style: "LX" 4D SED GAS <br />Vehicle Identiflication Number: 1 HGCP2F32CA082366 <br />COVERAGES AND LIMITS <br />No coverage is provided for your lending institution or leasing company if Comprehensive and Collision coverages are not included on <br />the policy. If you did not select those coverages, you may need to contact State Farm® to discuss adding those coverages to your <br />policy. <br />The premium shown on this binder must be in compliance with the Company's rules and rates and is subject to revision. The premium <br />amounts do not include the additional fees required if the monthly payment plan was selected. <br />Coverages Applied For <br />Limits/Deductibles <br />Six -Month Premium <br />Liability -Bodily Injury Property Damage <br />$11001 M1V$1 Mil <br />$411.86 <br />Comprehensive Deductible <br />$500 <br />$19.38 <br />Collision Deductible <br />$500 <br />$131.81 <br />Emergency Road Service <br />Included <br />$3.69 <br />Uninsured Motor Vehicle -Bodily Injury <br />$500,000/$1Mil <br />$123.70 <br />Uninsured Motor Vehicle -Property Damage <br />Included <br />$3.87 <br />Total Six -Month Premium <br />$694.31 <br />PREMIUM ADJUSTMENTS <br />California Good Driver Discount <br />Driving Safety Record Discount <br />Multiple Automobiles Discount <br />Policy Number: 583 7885-D15-55 Page 1 of 3 <br />Named Insured(s): JORGE B MELGOZA, ANNA MELGOZA <br />Effective date: 10-15-2021, Application date/time:10-15-2021/06:22 PM CDT <br />10041e4 9CAA2(rev iorzan) RIAMucgemeitDivi9nn <br />[{ <br />RavlaW &APPR�O�V�EDBr,/r <br />®'. <br />® Risk management Analyst <br />