MELGOZA, JORGE dba ARDENT ERGONOMICS

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AStateFarm- DRIVING SAFETY RECORD RATING PLAN Your driving safety record, along with other rating factors, determines what you pay for liability, medical payments, comprehensive, collision, and uninsured motor vehicle coverages. Policyholders with no accidents and convictions pay less than those with accidents and convictions. The Driving Safety Record Rate Level that is assigned to your policy moves up, down, or stays the same every policy renewal, depending upon your driving record. If the policy is assigned to Rate Level 2 or higher, has been at the same level for 12 months, and has no chargeable accidents or convictions that have not been previously considered, the Rate Level is reduced by 1 level. The Rate Level is increased if there are subsequent chargeable accidents or convictions. A policy may qualify for our best (superior) rate level if all drivers assigned to the policy have had no chargeable accidents or convictions in the last 6 years. DEFINITION OF CHARGEABLE ACCIDENTS - Chargeable accidents for new business are those which resulted in death, or damage to any property in the amount of more than $1,000*. Chargeable accidents for renewal business are those for which State Farm paid more than $1,000* under the Property Damage Liability and Collision Coverages combined. *$750 or more if the accident occurred prior to December 11, 2011. For more information about the rating plan, please contact your State Farm agent. IMPORTANT NOTICE: THE MINIMUM AUTO LIABILITY COVERAGE LIMITS REQUIRED UNDER CALIFORNIA LAW ARE $15,000 PER PERSONI$30,000 PER ACCIDENT FOR BODILY INJURY AND $5,000 FOR PROPERTY DAMAGE. WE ARE LEGALLY REQUIRED TO FURNISH THESE LIMITS AND WILL, IF REQUESTED. Policy Number: 583 7885-D15-55 Named Insured(s): JORGE B MELGOZA, ANNA MELGOZA Effective date: 10-15-2021, Application dateltime:10-15-2021106:22 PM CDT 1R041N Ie CA.12 (m 10201]) Page 3 of 3 1tIAMn Wg dDlAsIml RenEwEo&Arw4ovm Bv: ® Risk Management Malyst