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21st Century Insurance PERSONAL AUTO Renewal <br />2W•CO1p 1 -800 -211 -SAVE POLICY DECLARATION EFFECTIVE 06/1512008 <br />Named Insured and Mailing Address <br />Joe Larose q,y�- A_91m-) <br />Marie Larose / <br />9199 Poinsettia Ave <br />Fountain Valley, CA 92708 <br />��t�nu�n��un���ut�u�ur�r�n�t�rin��lutlt�ulr�n�ulr� <br />Policy No: 3493189 <br />Policy Period: From: 06/15/2008 <br />To: 12/1512008 12:01 AM Pacific <br />ran rwr ._.�_---- - <br />1 2004 HONDA PILOT LX 2HKYF18134H568983 W MCO <br />2 2006 TOYOTATUNDRAGOO 5TBET341=552072 W MCD <br />tens TicChargeable Accidents <br />/eb Rated Driver Licene <br />1 Marie Larose 40 0 1 PDlCOLL GDD <br />2 Joeiarosa 42 0 GOD <br />92708 4,000 <br />92708 9,000 <br />COVERAGE IS PROVIDED WHERE <br />A PREMIUM AND A LIMII Ur LI ADILII , <br />Ptemium <br />Ve <br />Coverage _ <br />Lirnit of Liability <br />A. Bodily Injury Liability <br />$ 100, o0o each person <br />$ 154 <br />$ 81 <br />S <br />$ <br />Include, 80-90 per vehicb fraud fee <br />$ 300,000 each accident <br />$ 8o <br />$ <br />$ <br />B. PropertyDamage LiabilityS <br />100, Oo0 each accident <br />$ 98 <br />$ <br />S <br />C. Medical Payments <br />$ each person <br />$ <br />$ <br />Uninsured Motorist <br />$ 100, oo0 each person <br />$ 40 <br />$ 35 <br />$ <br />S <br />D Bodo In' u <br />$ 300,000 each accident <br />DAMAGE TO YOINi VEHICLE <br />Veh 1 Veh 2 <br />Acnwl Cash Valve Less Deductible <br />Ded. Ded. Ded. Ded. <br />$ 30 <br />$ 45 <br />$ 132 <br />$ <br />$ <br />$ <br />$ <br />E. Com rehensive <br />$ 500 $ 500 $ $ <br />F. Collision <br />$ 500 $ Soo $ $ <br />S 123 <br />Uninsured Motorist$ <br />5 <br />$ S <br />S <br />$ <br />01. Pro Dama a <br />DED WAIVE DED WAIVE <br />Included <br />Included <br />Included <br />Included <br />G. Towing& Labor <br />$ 50 each disablement <br />$ <br />$ <br />H. Rental Reimbursement <br />$ r day; S max <br />$ <br />S <br />J. Additional Equipment <br />Included $1,000 $1,000 $ $ <br />The first $1000 is automatically <br />Additional $ 0 $ 0 $ $ <br />included with coverage E or F. <br />$ $ <br />S <br />$ <br />$ <br />S <br />Additional coverage is optional. <br />Total $1,000 $1, 000 <br />$ <br />$ <br />Total Premium Per Vshid'o <br />S 450 <br />$ 378 <br />If the installment bill plan is used, a service charge may apply. <br />rsement(s)/Agreement(s) Applicable: <br />1 (06/04) TCU511CA (05105) <br />Loss Payee (LPI, Additional insured (Ai, Evidence of Insurance (Ell <br />Veh 1 EI CITY OF SANTA ANA PD <br />Veh 1 EI City of Anaheim PD <br />Onvers Not NateO <br />0 511 612 00 8 <br />President <br />DECLARATIONS COMPLETE THE POLICY AND REPRESENT <br />WHEN ATTACHED TO I nc rcnavnnr. n., r.. ..�•.. • , • • THE CURRENT STATUS OF YOUR COVERAGES AND LIMITS OF LIABILITY. <br />Visit 21 st.com to make policy changes, pay your premium, and more. Register online todayl For Customer Care call 11800)443-3100. <br />TCu41CA 109/0al 21st Century Insurance Company, 6301 Owensmouth Ave., Woodland Hills, CA 91367 <br />