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1 Interinsurance Exchange of the Automobile Club — <br />Automobile Insurance Policy Coverages and Limits <br />Renewal Declarations <br />Ne are pleased to offer you a renewal for your automobile insurance policy. To renew your policy, send at least the minimum. <br />;ayment on or before the due date. Insurance is in effect only for the vehicles coverages . and limits of liability shown on this <br />ieclarations page and as set forth in the insurance policy and endorsements. Thase declarations, together with the contract and <br />he endorsements in effect, complete your policy if any change to your policy or to the information we have on file results In a <br />cremium decrease during the policy period, the Interinsurance Exchange reserves the right to apply any refund due to your <br />;utstanding balance <br />NAMED INSURED (Item 1.) <br />BOLDRICK, LORRIE AUTO POLICY NUMBER: G 6162616 <br />2387 N FLANDERS ST POLICY PERIOD (PACIFIC STANDARD TIME) <br />ORANGE CA 92865 -2836 EFFECTIVE DATE: 5.5-06 1201 A.M. <br />EXPIRATION DATE: 5 -5 -07 1201 A.M. <br />VEHICLES <br />VEHICLE IDENTIFICATION <br />YEAR WAKE MODEL <br />VEHICLE <br />GARAGE <br />ANNUAL <br />LEASED FINANCE <br />NUMBER NUMBER <br />USE <br />ZIP CODE <br />PALES <br />4 1998 FORD EXPLORER 1 FMZU32EOWZ533895 <br />PLEASURE <br />92865 <br />7,501 - 10.000 NO NO <br />(Less Deductible) $250 <br />Car Rental Expense <br />COVERAGES AND LIMITS <br />NA <br />Uninsured Motorist <br />ANNUAL PREMIUMS <br />Coverage is not in effect unless a Premium or the word "Included- b shown. <br />$ 24 <br />Uninsured 8 Underlrrured Vehicles. <br />COVERAGES LIMITS OF LIABILITY VehkJe4 Vehkde Vehicle Vehicle Vehicle <br />Liability <br />bodily Injury $1,000.000 eachpertl $1,000,000 each occurrence .5762 <br />Property Damage $50000 each occurrence S 179 <br />Excess Medical Payments 55,000 each person <br />`S 16 <br />Physical Damage, (Adll.l c..'� vaw. wu.., wh.— e..ua.4, . J.. Wel <br />Vance, 4 Vehicle Vela re Vehide <br />Vehicle <br />Comprehensive ACV'', <br />S 76 j <br />(Less Deductible) $100 <br />Collision ACV <br />11245 <br />(Less Deductible) $250 <br />Car Rental Expense <br />Per Day) NA <br />NA <br />Uninsured Motorist <br />Bodily Injury $15,000 each person; S30 000 each occurrence <br />$ 24 <br />Uninsured 8 Underlrrured Vehicles. <br />Uninsured Deductible Waiver <br />! Included <br />Total Premium $ B56 <br />"NA" Indicates coverage not purchased <br />PREMIUM DISCOUNTS (Total Annual Premium' S 851 <br />Please refer to the enclpsed document enbl ed Less Policyholder's Dividend S 111 <br />"Premium Discounts Applied to Your Automobile Policy." rr^^ <br />1'tiet Premium $ 74! <br />�/ 'Include. aN apPlica"A diarcune <br />J �G )"� <br />PROCESS DATE 341-06 GGG. PLEASE ATTACH TO YOUR POLICY (SEE REVERSE) <br />