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Oct 29 07 04:07p JOE LA ROSA <br />1st Century Insurance <br />21st.com 1 -800 -211 -SAVE <br />Named insured and Mailing Address <br />Joe Larosa <br />Marie Larosa <br />9199 Poinsettia Ave <br />Fountain Valley, CA 92708 <br />Ilrl����I�Ilnrlll���l�rltr�l�l��lrlrlrrlll���l�lrrl�lrrtt,lrl <br />714-847-8950 <br />la <br />PERSONAL AUTO Renewal <br />POLICY DECLARATION EFFECTIVE 06/15/2007 <br />M N10V - 6 AN 9= 02 <br />C;IT`` AI'IA <br />CL..= '"CIL <br />Page 1 of 2 <br />COVERAGE IS PROVIDED WHERE A PREMIUM AND A LIMIT OF LIABILITY ARE SHOWN FOR THE <br />Covera <br />9e <br />DED WANE IDED WAIVE <br />G. Towing & Labor <br />Policy No: 3493169 <br />A. Bodily Injury Liability <br />$ <br />200, 000 <br />Policy Period: From: 06/15/2007 <br />Vehicles) and Driver(sl <br />$ <br />To: 12115/2007 12:01 AM Pacific Time <br />Veh <br />1 <br />Year Make/Model <br />2004 HONDA PILOT LX <br />Vehicle 10 Number <br />Use <br />each accident <br />Vehicle Discounts/Comments Z, Mlles e <br />2 <br />2006 TOYOTA TUNDRA DOU <br />2HKYF18134H568983 <br />5TBET341X65552072 <br />W <br />N <br />MCD 92708 4,000 <br />100, 000 <br />Rerson <br />each person <br />Bodily Injury <br />$ <br />MCD <br />92708 9,000 <br />Veh <br />1 <br />Rated Driver <br />Marie Larosa <br />$ <br />Licensed Tickets <br />Chargeable Accidents Driver Discounts. <br />2 <br />Joe Larosa <br />Ded. <br />38 0 <br />GDD <br />$ <br />41 0 <br />GDD <br />COVERAGE IS PROVIDED WHERE A PREMIUM AND A LIMIT OF LIABILITY ARE SHOWN FOR THE <br />Covera <br />9e <br />DED WANE IDED WAIVE <br />G. Towing & Labor <br />imit of Liab)fity <br />A. Bodily Injury Liability <br />$ <br />200, 000 <br />each person <br />includes $0.90 per vehicle fraud tee <br />$ <br />300, C00 <br />each accident <br />B. Property Dama a Liability <br />$ <br />100, 000 <br />each accident <br />C. Medical Pa marts <br />$each <br />$ $ <br />$ <br />Uninsured Motorist <br />D. <br />$ <br />100, 000 <br />Rerson <br />each person <br />Bodily Injury <br />$ <br />3 0c, 000 <br />each accidenr <br />F <br />DAMAGE TO YOUR Vf <br />Actual cash Value Less De <br />Uninsured Motorist <br />2 <br />Ded. I Ded. I Ded. <br />500 $ 500 $ <br />0C$ 500 1 $ <br />cit uuma a <br />DED WANE IDED WAIVE <br />G. Towing & Labor <br />$ 50 each disablement <br />H. Rental Reimbursement <br />$ per A.— <br />e <br />J. <br />J. Additional Equipment <br />The first $1000 is automatically <br />Included $1,00a $1, 000 $ <br />included with coverage E or F. <br />Additional $ 0 $ D $ <br />Additional coverage is optional. <br />Total <br />61 <br />Total Premium Per Vehicle <br />If the installment bill plan is used, a service charge <br />may apply. <br />Endorsement(s)/Agreement(s) Applicable: <br />TCU -1 (06104) TCU51 1 CA (05105) <br />Loss Payee (LP), Additional Insured (All, Evidence of Insurance (Ell Drivers Not Rated <br />Veh 1 EI CITY OF SANTA ANA PD <br />Veh 1 EI City of Anaheim PD <br />Veh 2 LP Toyota Motor Credit Corp <br />THE FOLLOWING FEE(SI MAY APPLY: <br />LATE; $ <br />5.00 PAYMENT RETURNED ZNSFI: $10.00 � _Q <br />CANCEL; $50.00 INSTALLMENT BILL PLAN SERVICE CHARGE: $4.00 \ i '— ""'�, 0512112007 <br />WHEN ATTACHED TO THE PERSONAL AUTO POLICY, THESE DECLARATIONS COMPLETE THE POLICY AND REPRESENT <br />THE CURRENT STATUS OF YOUR COVERAGES AND LIMITS OF LIABILITY. <br />Visit 23st.com to make policy changes, pay your premium, and more. Register online todayi For Customer Care call 1 18001443-3 1 00. <br />cuglcq ros,bsl 21st Century Insurance Company, 6301 Owensmouth Ave., Woodland Hills, CA 91367 <br />Veli <br />Premium <br />Veh- 2 <br />S <br />103 <br />$ 81 $ <br />$ <br />$ <br />61 <br />$ 81 $ <br />$ <br />$ $ <br />$ <br />$ <br />19 <br />$ 35 $ <br />$ <br />Ded. <br />$ <br />S <br />16 <br />$ 45 $ <br />$ <br />$ <br />$ <br />65 <br />$ 132 $ <br />$ <br />$ <br />5 <br />S 5 $ <br />$ <br />Included <br />Included Included <br />Included <br />max <br />$ <br />$ $ <br />$ <br />$ <br />$ <br />$ <br />S $ <br />$ <br />$ <br />269 <br />$ 379 S <br />$ <br />$ <br />Total Prernkan <br />Loss Payee (LP), Additional Insured (All, Evidence of Insurance (Ell Drivers Not Rated <br />Veh 1 EI CITY OF SANTA ANA PD <br />Veh 1 EI City of Anaheim PD <br />Veh 2 LP Toyota Motor Credit Corp <br />THE FOLLOWING FEE(SI MAY APPLY: <br />LATE; $ <br />5.00 PAYMENT RETURNED ZNSFI: $10.00 � _Q <br />CANCEL; $50.00 INSTALLMENT BILL PLAN SERVICE CHARGE: $4.00 \ i '— ""'�, 0512112007 <br />WHEN ATTACHED TO THE PERSONAL AUTO POLICY, THESE DECLARATIONS COMPLETE THE POLICY AND REPRESENT <br />THE CURRENT STATUS OF YOUR COVERAGES AND LIMITS OF LIABILITY. <br />Visit 23st.com to make policy changes, pay your premium, and more. Register online todayi For Customer Care call 1 18001443-3 1 00. <br />cuglcq ros,bsl 21st Century Insurance Company, 6301 Owensmouth Ave., Woodland Hills, CA 91367 <br />