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I 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 automoone insurance poi icy. Toren evv 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 />federations page and as set forth in the insurance policy and endorsements. 1 hose 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 />:remium decrease during the policy period, the Interinsurance Exchange reserves the right to apply any refund due to your <br />;utstanding balance <br />NAMED INSURED (hem 1.) <br />AUTO POLICY NUMBER: 00162648 _ <br />BOLDRICK, LORRIE POLICY PERIOD (PACIFIC STANDARD TIME) <br />2387 N FLANDERS ST <br />ORANGE CA 92865 -2836 EFFECTIVE DATE: 5.5 -06 1201 A.M. <br />EXPIRATION DATE: 5-5 -07 12:01 A.M. <br />VEHICLES <br />"NA" indicate; coviaralle not purchased. <br />Bodily Injury $1,000.000 each person:' S1,00D.000 each occurrence <br />.3362 <br />_ <br />VEHICLE YEAR MANE MODEL <br />IDENTIFICATION <br />VEHICLE <br />GARAGE <br />ANNUAL LEASED "NANCE <br />NUMBER <br />NUMBER <br />USE <br />ZIP CODE <br />MILES <br />4 1998 FORD EXPLORER <br />1 FMZU32EOWZ833B95 <br />PLEASURE <br />92895 <br />7,501- t0.0DD NO NO <br />COVERAGES AND LIMITS ANNUAL PREMIUMS <br />coverage is not in allot[ Unitas a p.emiore oethevrord "Inclulai' M shown. <br />COVERAGES LIMITS OF LIABanY VeMCle4 Vehicle Vehicle Vehicle Vehicle <br />LiabBily <br />"NA" indicate; coviaralle not purchased. <br />Bodily Injury $1,000.000 each person:' S1,00D.000 each occurrence <br />.3362 <br />Property Damage $50.000 each occurrence <br />: S ITS <br />Medical <br />Less Policyholder's Dividend <br />It 16 <br />Excess Medical Payments 55,000 each person <br />Physical Damage (Anvm c...n Valve wee.. aenw...owa, L.. aw 1e 1 <br />$ 74' <br />Venda 4 Vehicl. vehicle Vehicle <br />Vehicle <br />Comprehensive ACV'',. <br />$ $6 <br />;less Deductible) $100 <br />Colbsion ACV <br />S 245 <br />(Less Deductible) f:50 <br />Car Rental Expense <br />_ <br />(Per Day) NA <br />NA <br />Uninsured Motorist <br />Bodily Injury $15,000 each, person% $W,000 each occurrence <br />$ 24 <br />Uninsured 8 Underinsured Vehicles <br />Uninsured Deductible Waiver <br />! Included <br />Total Premium <br />$ 666 <br />PREMIUM DISCOUNTS <br />Please refer to the enclosed document entilled <br />"Premium Discounts Applied to Your Automobile Policy. <br />4;4•;"• PROCESS DATE 3-51 -06 PLEASE ATTACH TO YOUR POLICY ISEE REVERSE) <br />"NA" indicate; coviaralle not purchased. <br />Total Annual Premium' <br />S s5c <br />Less Policyholder's Dividend <br />S I l l <br />et Premium <br />$ 74' <br />-Include. all applicable di..N.. <br />l� _r_.6?L l/ <br />4;4•;"• PROCESS DATE 3-51 -06 PLEASE ATTACH TO YOUR POLICY ISEE REVERSE) <br />