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Insurance <br />1 -800 -211 -SAVE <br />Additional Insured and Mailing Address <br />City Of Santa Ana <br />20 Civic Center Piz Suite #M-87 <br />Santa Ana, CA 92701 <br />PERSONAL AUTO Amendment <br />POLICY DECLARATION EFFECTIVE 12/22/2006 <br />MEMORANDUM COPY <br />Named Insured and Mailing Address <br />Joe Larosa <br />Marie Larosa <br />9199 Poinsettia Ave <br />Fountain Valley, CA 92708 <br />Policy No: 3493189 <br />Pnliry Perind- Frnm- 12/15/2006 To: 06/15/2007 12:01 AM Pacific Time <br />Vehicle(s) and Driver(s) <br />Veh <br />Year <br />Make/Model <br />Vehicle ID Number <br />Use <br />Vehicle Discounts/Comments <br />Zip <br />Mileage <br />3 <br />2006 <br />TOYOTATUNORA OOU <br />5TBET341X6S552072 <br />B. Property Damage Liability <br />$ 100,000 each accident <br />$ 93 <br />$ <br />Veh <br />Rated Driver <br />L7 <br />Tickets <br />Chargeable Accidents <br />Driver Discounts <br />1 <br />Joe Larosa <br />Uninsured Motorist <br />D. Bodily Injury <br />$ 100, 000 each person <br />$ 300 000 each accident <br />$ 40 <br />$ <br />Coverage <br />Limit of Liability <br />Premium <br />eh 3 <br />A. BodilyInjuy Liability <br />er vehicle fraud fee <br />$ 1o0,000 each personIncldes50.90 <br />$ 3oo, o00 each accident <br />EV <br />128 <br />$ <br />$ <br />$ <br />B. Property Damage Liability <br />$ 100,000 each accident <br />$ 93 <br />$ <br />$ <br />$ <br />C. Medical Payments <br />$ each person <br />$ <br />$ <br />$ <br />$ <br />Uninsured Motorist <br />D. Bodily Injury <br />$ 100, 000 each person <br />$ 300 000 each accident <br />$ 40 <br />$ <br />$ <br />$ <br />DAMAGE TO YOUR VEHICLE <br />Veh 3 <br />$ S5 <br />$ <br />$ <br />$ <br />Actual Cash Value Less Deductible <br />Ded. Ded. Ded. Ded. <br />E. Comprehensive <br />$ 500 $ $ $ <br />F. Collision <br />$ Soo S $ $ <br />S 147 <br />S <br />$ <br />S <br />Uninsured Motorist <br />D1. Property Dama a <br />DED WAIVE <br />$ S <br />$ <br />$ <br />$ <br />G. Towing & Labor <br />$ So each disablement <br />Included <br />Included <br />Included <br />Included <br />_ H. Rental Reimbursement _ <br />J. Additional Equipment <br />First $1000 is automatically <br />included with coverage F or F. <br />Additional coverage is optional. <br />$ ep rday__._ $ max <br />Included $1,000 $ $ $ <br />Additional $ 0 $ $ $ <br />Total $1, 000 $ $ $ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />$ <br />Total Premium Per Vehicle $ 468 <br />$ <br />$ <br />$ <br />Total Premium $ 1,257 <br />Endorsements) /Agreements Applicable: <br />a <br />Loss Payee (LP), Additional Insured (AI), Evidence of Insurance (EI) <br />Veh 3 LP Toyota Motor Credit Corp <br />Veh 3 Al City of Anaheim <br />Veh 3 Al City Of Santa Ana <br />For Loss Payee information call 1-888-841-8233 <br />Address inquiries to 21 st Century Insurance Company <br />6301 Owensmouth Ave., Woodland Hills, CA 91367 <br />Drivers Not Hated <br />Marie Larosa <br />01/22/2007 <br />President <br />WHEN ATTACHED TO THE PERSONAL AUTO POLICY, THESE DECLARATIONS COMPLETE THE POLICY AND REPRESENT THE CURRENT STATUS OF <br />YOUR COVERAGES AND LIMITS OF LIABILITY. <br />TCU4AICA (01105) 21st Century Insurance Company, 6301 Owensmouth Ave., Woodland Hills, CA 91367 <br />