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StateFarm, <br />Other Household Driver(s) <br />In addition to the Principal Driver(s) and Assigned <br />Driver(s), your premium may be influenced by the <br />drivers shown below and other individuals permitted to <br />drive your vehicle. This list does not extend or expand <br />coverage beyond that contained in this automobile <br />policy. The drivers listed below are the drivers reported <br />to us that most frequently drive other vehicles in your <br />household. <br />ANNA MELGOZA <br />Principal Driver & Assigned Drivers premium may be influenced by the information shown for <br />For each automobile, the Principal Driver is the individual these drivers. <br />who most frequently drives it. <br />Each driver is designated as an Assigned Driver on the <br />household automobile that they most frequently drive. Your <br />COVERAGE AND LIMITS see yourpolicy for an explanation of these coverages <br />Bodily Injury 1,000,000/1,000,000 <br />Property Damage 1,000,000 $465.71 <br />D 500 Deductible Comprehensive <br />$38.64 <br />G 500 Deductible Collision <br />$163.86 <br />H Emergency Road Service <br />$4.74 <br />U Uninsured Motor Vehicle <br />Bodily Injury <br />500,000/1,000,000 <br />$160.94 <br />U1 Uninsured Motor Vehicle <br />Property Damage $5.05 <br />Total Premium $838.94 <br />If any coverage you carry is changed to give broader <br />protection with no additional premium charge, we will give <br />DISCOUNTS These adjustments have already been applied to your premium. <br />you the broader protection without issuing a new policy, <br />starting on the date we adopt the broader protection. <br />Multiple Line <br />✓ <br />Multicar <br />✓ <br />Driving Safety Record <br />✓ <br />California Good Driver <br />✓ <br />Loyalty <br />✓ <br />Total Discounts <br />$2,175.25 <br />Policy Number: 583 7885-D15-55A Page number 3 of 5 <br />Prepared August 23, 2024 <br />