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A Interinsurance Exchange of the Automobile Club <br />Automobile Insurance Policy Coverage and Limits <br />s <br />Renewal Declarations <br />We are pleased to offer you a renewal for your auto insurance policy, To renew your policy, send at least the <br />minimum payment on or before the due date. Insurance is in effect only for the vehicles, coverages, and limits of <br />liability shown on this declarations page and as set forth in the insurance policy and endorsements. These declara- <br />tions, together with the contract and the endorsements in effect, complete your policy. <br />NAMED INSURED (Item 1.) <br />AUTO POLICY NUMBER G 6162548 <br />BOLDR I CK, LORR I E <br />Vehicle 4 Vehicle Vehicle Vehicle Vehicle <br />'�, POLICY PERIOD (PACIFIC STANDARD TIME) <br />2387 N FLANDERS ST <br />(Less Deductible) <br />$100 <br />Collision <br />ACV <br />(Less Deductible) <br />EFFECTIVE DATE <br />5- 5- 0512:01 A.M. <br />ORANGE CA 92865 -2836 <br />(Per Day) <br />NA <br />'i EXPIRATION DATE <br />5- 5 -06 12:01 A.M. <br />VEHICLES <br />VEHICLE YEAR MAKE MODEL <br />NUMBER <br />IDENTIFICATION <br />VEHICLE GARAGE <br />ANNUAL <br />NUMBER <br />USE ZIP CODE <br />MILES LEASED FINANCED <br />4 1998 FORD EXPLORER <br />1FMZU32EOWZB33895 PLEASURE 92865 <br />7.501 - 10,000 NO NO <br />COVERAGES AND LIMITS <br />Covers Ia not in effect unless a <br />9e � _ premium or the wortl <br />tinclutletl" is shown <br />ANNUAL <br />PREMIUMS <br />COVERAGES LIMIT OF LIABILITY <br />Vehicle 4 Vehicle <br />Vehicle Vehicle Vehicle <br />Liability <br />Bodily Injury $1,000,DOO each person/ 51,000,000 <br />each occurrence <br />! t 352 <br />Property Damage $50,000 each occurrence <br />f 179 <br />Medical <br />Excess Medical Payments $5,000 each person <br />Physical Damage (Actual qsh Value unless otherwise slated less CeEUCtele <br />Uninsured Motorist <br />Bodily Injury $15,000 each person/ $30,000 each occurrence <br />Uninsured 8 Underinsured Vehicles <br />Uninsured Deductible Waiver <br />Total Premium <br />PREMIUM DISCOUNTS <br />Please refer to the enclosed document entitled <br />"Premium Discounts Applied to your Automobile Policy. <br />- -�% AS TO FORM <br />,tut Shcedy <br />City Attorney <br />s 18 <br />$ 38 <br />$ 245 <br />NA <br />$ 24 <br />Included <br />$ ass <br />"NA" indicates coverage not purchased <br />Total Annual Premium" $856 <br />j Less Policyholder's Dividend $ gg <br />Net Premium $767 <br />Includes all aoDllcaNe Discounts <br />Vehicle 4 Vehicle Vehicle Vehicle Vehicle <br />Comprehensive <br />ACV <br />(Less Deductible) <br />$100 <br />Collision <br />ACV <br />(Less Deductible) <br />$250 <br />Car Rental Expense <br />(Per Day) <br />NA <br />Uninsured Motorist <br />Bodily Injury $15,000 each person/ $30,000 each occurrence <br />Uninsured 8 Underinsured Vehicles <br />Uninsured Deductible Waiver <br />Total Premium <br />PREMIUM DISCOUNTS <br />Please refer to the enclosed document entitled <br />"Premium Discounts Applied to your Automobile Policy. <br />- -�% AS TO FORM <br />,tut Shcedy <br />City Attorney <br />s 18 <br />$ 38 <br />$ 245 <br />NA <br />$ 24 <br />Included <br />$ ass <br />"NA" indicates coverage not purchased <br />Total Annual Premium" $856 <br />j Less Policyholder's Dividend $ gg <br />Net Premium $767 <br />Includes all aoDllcaNe Discounts <br />