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<br />-----"- --"."".".. <br /> <br />, ,,~,,- ,~. . ,.~JJU.JU. <br /> <br />r"L>'~::>""""+l";"~HMt-';;S <br /> <br />'.. . . INTERINSURANCE EXCHANGE of the Automobile Club <br />~ <br /> <br />AUTO CLUB MEMBERS' PREFERRED PERSONAL UMBRELLA POLICY RENEWAL DECLARATIONS <br />PLEASE REAO; 'rhese daoIarallol>S constltulo our olle' 10 renew this ln~urÐnce for lhe policy period shOwn below. Ronowal is contingent upon <br />your payment otthe Balance Due belo,e or on the Due Date shOwn in the detaahable Insurance G~ling bolow. Fa«ure ra oay the Balanc. Duo <br />before or on the Due Dot. shah mean that you rojo<:tod this renewel oIfer. AU coverago allorøoø by this poIioy w¡' 111sn \Ofmlna'o at 12:01 8.m.. <br />. Paaifro SlandarØ rom. on tho Ef!ecUve Dete shown in these doclaraUon. under .policy Poriod.' The.. d.cl.,.r;on.. roo.rh.' ",ilh Ihe con"a.'."" <br />the endorsements In .Uoc~ comploto your policy. <br />ITEM 1. YOUR NAME AND ADDRESS <br />A <br /> <br />AVERY. CARROL AND DORIS <br />1331 LIMERICK DR <br />PLACENTIA. CA 92870 <br /> <br /> <br />POLICY NUMBER <br />UP 6831867 <br /> <br />ITEM 2. lIMfT OF lIASIUTY: $ 1.000.000 <br />IN EXOESS OF THE LIMITS OF LIABILITY OF PRIMARY INSURANCe <br /> <br />POLICY PERIOD: <br />Pacific $10_'" Tin'e <br />FROM 10/10/03 ~2~\o10/10/04 Á.~~' <br />EFFECTIVE DATE EXPIRATION DATE <br /> <br />DEDUCTIBLE: $250 <br /> <br />ITEM 3. SOHEDULE OF REQUIRED MINIMUM PRIMARY INSURANCE <br /> <br /> LIMITS OF LIABILITY <br />DESCRIPTION &ODIL Y INJIJIIY t'ROI'ER'rv OAMAGI: LIAbiLITY <br />COMPREHENSIVE PERSONAL LIABILITY $500,000 <br />(OR HOMEOWNERS LIABILITY) <br />AUTOMOBILE LIABIL!TY $500,000/500,000 $100,000 <br />~ATERCRAi:r lIA8lUTY $500,000 <br /> <br />WARNING: THE "MAINTENANCE OF PRIMARY INSURANOE" PROVISION OF YOUR POlICY INVOKES COVERAGE LIMIT ATION$ IF PRIMARY <br />INSURANCE IS NOT MAINTAINED. PL£.6.SE REVIEW YOUR POlIOY CAREFULLY. <br /> <br />TEM 4. ENDORSEMENTS IN EFFECT PREMIUM <br /> <br />2355 - AMENDA:rORY ENDORSEMENT <br /> <br />s <br /> <br />0 <br /> <br />TEM 5. POliCY PREMIUM <br /> <br />!XI'OSuRf PAEMIUM <br />BASIC - <br />eIlEOlTNO. TEAPJTORY ëXPOSlJ!OE PREMI\}M '""OOIU~, )' PII!!MIUM HIGH LfMrr PREMIUM CA SUFICHARGE TOT At POlICY PReMIUM <br />1593-19 1 $ $ $ ~ $ <br />,. I SEE REVERSE I - <br />,.. FOR QUESTIONS OR CHANGeS. CALL TOLL-FREe <br /> <br />V DETACH HERE AND RETURN WITH PREMJUMPAYMENT V <br /> <br />1-800.924-6141 <br /> <br />'~ <br /> <br />t'o-"" <br /> <br />'."0.' <br />