Laserfiche WebLink
BUSINESS AUTO SCHEDULE <br />POLICY NUMBER: PHPK2635616 <br />SCHEDULE OF COVERED AUTOS YOU OWN <br />Covered <br />DESCRIPTION <br />TERRITORY <br />Auto <br />No. <br />Year Model; Trade Name; Body Type <br />Serial Number (S); Vehicle Identification Number (VIN) <br />Town or City & Zip where the Covered Auto <br />will be principally garaged <br />1 <br />2004 FORD F250, 1FTNF20LO4EA57687 <br />042 Ramona, CA 92065 <br />2 <br />1990 TOYOTA PICKUP, JT4RN81P7L5055474 <br />042 Ramona, CA 92065 <br />3 <br />1989 TOYOTA PICKUP, JT5VN94TOK0004306 <br />042 Ramona, CA 92065 <br />Covered <br />CLASSIFICATION <br />PURCHASED <br />Auto <br />No. <br />Radius of <br />Operation <br />Business Use <br />s = service <br />r = retail <br />c = comml. <br />Size GVW, CGW <br />or Vehicle <br />Seating Capacity <br />Age <br />Group <br />Primary Rating Factor <br />Sec. Rating Factor <br />Code <br />Original Cost New <br />Stated Amount <br />Liab. <br />Ph .Dam. <br />Liab. <br />Ph .Dam. <br />1 <br />LOCAL <br />S <br />5,000 <br />12 <br />1.000 <br />01199 <br />22,390 <br />2 <br />LOCAL <br />S <br />5,000 <br />12 <br />1.000 <br />01199 <br />22,390 <br />3 <br />LOCAL <br />S <br />5,000 <br />12 <br />1.000 <br />01199 <br />22,390 <br />Total <br />Premium <br />Covered <br />LIABILITY <br />AUTO. MED. <br />MEDICAL EXPENSE AND INCOME LOSS <br />BENEFITS VA ONLY <br />Auto <br />No. <br />Limit <br />(in thousands) <br />Premium <br />Limit <br />Premium <br />Limit Stated In Each Med. <br />Exp. And Inc. Loss Ben. <br />End. For Each Person <br />Premium <br />1 <br />100 <br />520.00 <br />5,000 <br />58.00 <br />2 <br />100 <br />520.00 <br />5,000 <br />58.00 <br />3 <br />100 <br />520.00 <br />5,000 <br />58.00 <br />Total <br />Premium <br />1 560 .00 <br />174.00 <br />Covered <br />PERSONAL INJURY PROTECTION <br />P.P.I. (Mich, Only) <br />UNINSURED/UNDERINSURED <br />Auto <br />No. <br />Limit stated in each P.I.P. <br />end. <br />Premium <br />Limit stated in each <br />P.P.I. end. <br />Premium <br />Limit <br />in thousands)Premium <br />UM <br />UIM <br />1 <br />100/3.5 <br />33.00 <br />X <br />X <br />2 <br />100/3.5 <br />33.00 <br />X <br />X <br />3 <br />100/3.5 <br />33.00 <br />X <br />X <br />Total <br />Premium <br />99.00 <br />Page 1 of <br />oR, RiskManagmumtDMslcrn <br />REVIEWED & APPROVED BY. <br />o � <br />`I A� Aceve�c; <br />Risk Management Specialist <br />