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Page 1 of 2 <br />62-1- -Century PERSONAL AUTO Renewal <br />insurance POLICY DECLARATION EFFECTIVE 12/15/2009 <br />Famed Insured and Mailing Address <br />Joe Larosa <br />Marie Larosa <br />9199 Poinsettia Ave <br />Fountain Valley, CA 92708 Od <br />I lilt 111111113111nis111111111 Policy No: V93 1 89 <br />Policy ParioP From: 12/1512009 <br />To: 06/15/ 10 12:01 AM Pacific Time <br />Vehiclels) and Driver(s) <br />Veh <br />Year <br />IVltfke(Maclel <br />Vehicle ID .Number <br />OF - LIABILITY ARE SHOWN <br />Use <br />Vehicle Discounts /C ants <br />Zi <br />iUlilea e <br />1, <br />2004 <br />HONDA PILOT LX <br />Premium <br />2HKYF18134H568983 <br />W <br />MCp , <br />92708 <br />8,170 <br />2 <br />200 <br />TOYOTA TUNDRA DOU <br />5TBET341 X6S552072 <br />A. Bodily Injury Liability <br />W <br />MCD <br />92708 <br />7,449 <br />Includes $0.90 per vehicle fraud fee <br />$ 300,000 each accident <br />$ 155 <br />$ 78 -= <br />$ <br />Veh <br />Rated Driver <br />YeafiS <br />License <br />Tickets <br />Chargeable Accidents <br />Driver Discounts <br />1 <br />Marie Larosa <br />42'" <br />0 <br />1 POICOLL <br />6DD <br />$ <br />2 <br />,)ae Larosa <br />43 <br />0 <br />Uninsured Motorist <br />GOD{SO5 <br />COVERAGE IS PROVIDED WHERE A PREMIUM AND A LIMIT <br />OF - LIABILITY ARE SHOWN <br />FOR THE COVERAGE. <br />Premium <br />Coverage <br />Limit of Liability <br />Veh - '1 <br />Veh 2' <br />A. Bodily Injury Liability <br />$ 100, 0oo each person <br />Includes $0.90 per vehicle fraud fee <br />$ 300,000 each accident <br />$ 155 <br />$ 78 -= <br />$ <br />$ <br />B. Property 'Dame Liability <br />$ loo, 000 each accident <br />$ 103 <br />$ 85 <br />$ <br />$ <br />C. Medical Payments <br />$ each person <br />$ <br />$ <br />$ <br />Uninsured Motorist <br />$ loo, 00o each person <br />D. Bodily, Injury <br />$ 300,000 each accident <br />$ 39 <br />$ 25 <br />$ <br />$ <br />DAMAGE TO YOUR VEHICLE '' <br />Veh 1 <br />Veh 2 <br />Actual Cash Value Less Deductible <br />Ded. <br />Ded. <br />Ded. <br />Ded. <br />E Comprehensive <br />$ Soo <br />$ 500 <br />$ <br />$ <br />$ 20 <br />$ 33 <br />$ <br />$ <br />F. <br />$ 500 <br />$ 500 <br />$ <br />$ <br />$ 81 <br />$ 88 <br />$ <br />$ <br />Uninsured Motorist <br />D,1. Propert ' Damage <br />DED WAIVE <br />DED WAIVE <br />$ 5 <br />$ 5 <br />$ <br />$ <br />21 st Century <br />G'_ Security Advantage <br />$ 75 each disablement <br />Included <br />Included - <br />Included <br />Included <br />Rental <br />per day <br />$ _. <br />$ <br />$ <br />H. Reimbursement <br />max <br />$ <br />$ <br />$ <br />$ <br />S <br />$ <br />$ <br />$ <br />J. Additional Equipment <br />Included $1 000 $1, 040 $ $ <br />The first $1000 is automatically <br />Additional $ 0 $ 0 $ $ <br />included with coverage ,E or F. <br />Additional coverage is optional. <br />Total $1,000 $1, 000 $ $ <br />$ <br />$ <br />$ <br />Total Premium Per Vehicle <br />$ 403 <br />$ 314 $ <br />$ <br />If the installment bill' plan is used, a service charge may apply. <br />Total Premium' <br />$� <br />Endorsement(s)/Agreement(s) Applicable: <br />TCU -1 (01 /09) TCU511CA (05105) <br />A D <br />S TO FORM <br />ITCU531CA (03MSI) <br />& � <br />Loss Payee (LP); Additional Insured (AI), Evidence of Insurance 1EI) Drivers Not Rated <br />_, y <br />Hodge <br />Veh 1 El CITY OF SANTA ANA PD <br />eputy <br />Ity Attorney <br />Veh 1 El City of Anaheim PD <br />Veh 2 LP Toyota Motor Credit Gory <br />I THE FOLLO FISI MAY APPLY. <br />� <br />i Lip TE: $5-00 PAYMENT RETU€i�ED (NSFI- � 010.00 <br />11/1312009 <br />,1,150.:: Ir`�"�.T 7 RsSENT BILL Pf Arty SER14CE f°LyAPSE., e4 ,0n <br />RJsl:r , °t[:s1t1t?i "� .I <br />".HEN Rl I I AUNEO T O , HE Y---O I A.L. r: x. 3li °iti '�L,... ` . '_ - `=- ,r.`a. 3d."',: t...a.., :�o.`� AM � <br />4 »[)CFG A)i'C 3'APi��.e"'1 uA RAT. <br />., <br />i.m <br />_.. __ <br />f;nrn. £nf! <br />1 5.?;f3f 44 S, ' <.. 31QA <br />