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<br />- <br /> <br />\.; III 82 39 .. INSURED'S COPY l~ <br />RENEWAL DECLARATION OFFER <br />EFFECTIVE 03/03/01 <br />~:taM~,"~,"~,,"!e.~~!~c~~l.~IC~.r~"~.!IN THE EVENT PAYMENT IS NOT RECEIVED <br />-iE CuRFleNT STATUS OF YOU,IIi COvERAGeS ,,"to LIMITS OF t..IASllITV ACCOFlCI~O TO QUF! FlECOADS.BV THE DUE DATE NOTED BELOW IN THE <br />STATEMENT OF ACCOUNT, YOUR POLICY <br />BECOMES NULL AND VOID. <br /> <br />121stCENTURY <br />INSURANCE <br /> <br />AP <br /> <br />I '0' ....,lot S~A!\.OARD TIM! <br />1118239 .. 03/03/01 09/03/01 <br />NAflED INSURED AND ADDRESS <br /> <br />JAMES D OTTERSON <br />211 INDIANAPOLIS AVE <br />HUNTINGTON BCH CA 92648 <br /> <br /> <br />Zlt:z.!u>> ! <br />(~r. NO. <br />~ 380.00 <br /> <br /> <br /> <br />E ....0. IS PROVIDED WHERE A PAEMIU..... AN A L.IMIT OF LIA I ITV ARE SH <br /> <br />'800IL't'I/liJUA'/ . <br />) PAOPERTY DAMAGE I <br />;.MI!ClCALMYMEN....S . <br />;) UNlNSUREO MOtORIST . <br />CWMOI! 'TO 'r'OUFl CAR <br />~(A.Soo/E.COfoIPfl~i"'S1ve <br />~'.COI.I.ISION <br />)1 ur..INSlJFleO MOTCAISi. PO <br />J. 'l'OWNQ I .AIOFl COST $ <br />.. FlENTA:.. AIIMIUASEME"IT <br /> <br /> <br /> w, <br />.OOC EACH PERSON . ,OOOu.CHACCIot:NT .. 143 <br />.ooo!ACH ACCIDENT 79 <br />,000E.6CI"IPEP.SOH 28 <br />,000 EACI"I PERSON .000 EACH ACCIDENT 18 <br />CAll' CAA' CAA' CA.' <br />oeD, ceo . oeD . D'O 22 <br />oeD . DlD . oeD. DE<> 86 <br /> 4 <br />!.loCI-! ~I&A8LWENT U ome ce nc u e INCL <br /> <br />iCJ.Fl2 <br /> <br />"'"' <br /> <br />iWl.. <br /> <br />l <br /> <br />TCE-78 <br /> <br />01/99 TCE-76 <br /> <br />01198 <br /> <br /> <br />380.00 <br /> <br />(b-::S~il_- <br /> <br />02106/01 <br />DATE <br /> <br />.1'.!1-RPQLICY sERVJCE CALL (800) 443-3100 <br /> <br />.. Known Drivers of your V.hicl.~ - STATEMENT OF ACCOUNT FOR POLICY 1118239 <br />4 TOTAL PREMIUM . . . . . . . . . . . . . . .j. . 380.00 <br /> <br />.. JAMES D OTTERSON <br /> <br />CHOOSE THE PAYMENT PLAN YOU PREFER, <br />PAY IN FULL . 380.00 DUE 03/03/01 <br />2-PAY PLAN , <br />.. 193.00 DUE 03/03/01 . 193.00 DUE 05/03/01 <br />4-PAY PLAN , <br />.. 98.00 DUE 03/03/01. 98.00 DUE 04/03/01 <br />.. 98.00 DUE 05/03/01. 98.00 DUE 06/03/01 <br />· INCLUDES .3 PER PAYMENT SERVICE CHARGE <br /> <br />~ <br />~ <br /> <br />Imllllllllllllllllllllll <br />