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<br />Auto Club <br /> <br />11/9/2007 11:46:09 AM <br /> <br />PAGE <br /> <br />3/005 <br /> <br />Fax Server <br /> <br />Interinsurance Exchange of the Automobile Club <br /> <br />Automobile Insurance Polley Coverages and Limits <br />Ching" ta Decllrltlon. (continued) <br /> <br />AUTO POLICY NUMBE:Fl: G 6131001 <br />CIWIIII (UN"" L~TtC A' EXCLUDED) <br />ORMiR <br />NUMBER NAA'II: <br />1 VERCHES, RAY <br /> <br />POLICY CHANGE: E:FFECTIVE: DATE:: 1o-~e-c7 <br /> <br />IJI:NOER <br />MALE <br /> <br />MA~ITAL. STATue <br />SINC)LE <br /> <br />VEAR F RST <br />L.ICcNSElJ <br />M <br /> <br />ORMiR <br />NUMBER <br /> <br />NUMBER (I <br />PRI~C:IP"'~~Y <br />AT-FAUL." ACCIDENTS <br /> <br />ORIVING RECORO <br />1 NUMIER OIiUFFIC CONVIO'l'ION8 <br />MINOft II"IOJI MAJO" nv!ft! <br /> <br />ORIVER BrAT,s <br /> <br />RATeo <br />VEH CLE <br />NJM8!~ <br /> <br />IUfiiF'!NIICNI <br /> <br />PRIMARY <br /> <br />E_EMEMTB ANl CERTlP1CATEI <br /> <br /> 'PiCIAL IOUtcIIQIlIPMINT' <br /> iQlJlPMiNT" <br />V!H. CAMPI!'" CI1\iE~ '1.JNAV TEL&:. ~CIO CI1\iE~ <br />NO. VANCO/'N. MellO PHON! <br />1 <br />3 <br /> I <br /> <br />NUM8liR TI~L.E <br />2Cil2 LOSS PAYABLE: - NOTICE: TO LIE:NHOLDE:Fl <br /> <br />"O:>oerllllllolncllodcl bya "YE:S' Intnl IIpPfCllrlate Iqulprrorrt <br />ooIumn. c:o..raglllmltaijO'1o opp'y unl... CCNlrage was purohMed <br />opocl!k)allylor ~n equipment <br /> <br />AN'( I'HYlICAL DAMAGI LOIS MAY. MAIlII'AYAILI TO YOU AND AN'( INTlIUIT UlTlD IILCIW: <br /> <br />VEiH NO.3 <br />HSBCAUTO FINANCE: <br />P.O. BOX 301e <br />OOAAOPOLlS PA 15108 <br /> <br />. <br /> <br />For Queltlonl or Changes Ca" <br />1-177422-2100 <br />