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AMENDED DECLARATIONS PAGE— CALIFORNIA <br /> ILI a. s i re PERSONAL AUTO PROGRAM <br /> t3rNERAt.sN��3kantCfi. <br /> Aspire General Insurance Services - CA Cell LIGrk 010876 <br /> underwritten by ASPIRE GENERAL INSURANCE COMPANY <br /> PO l3o, -126 * Ranclio Cttramonsga,CA 91729.2426 (916)503 6313 � A�1�5� <br /> T <br /> Prl1I>aFeci On a1t8 r1p2S a._. ---- <br /> THIS DECLARATIONS PACA IS PART OF YOUR POLICY,PI..FASE READ CAREFULLY. <br /> AMENDED €ERSONAL AUTO POLICY DECLARATIONS <br /> policy InforrriatIon: Policy Premium <br /> I'011CY Number 6PSY-ODS71721.00 Total Premiums: $73000 <br /> Inception 4/18/2025 12 01 AM Total Fraud Fees: SO.88 <br /> Expiration ? g/2025 12.01 AM SR filing Foe; $0 00 <br /> Ti11)0 Applied roo. 4/1812025 2AS PM policy Fee: $28.00 <br /> •inr-ePti0n time shall Will be prior to the time applied for,or if this <br /> is a retitartment declarations,not prior to the time of coverage change <br /> Named Insureclls): Additional Feet;when applicable, <br /> MAIGALI ALARCON Cancellation$SO,Reinslatement$10,SR22 Filing$15,5R22 Reinstalemerit S25, <br /> 7Z S L�'IY� tnt Funds 3Z5, rrarserrent$S (FT installment S t1.Non-EFT <br /> fi <br /> Anaheim,Californis mas.47-n In5tallment'$14,Roturn Mail$5,Fraud Fee$0 88 per vehicle semi-annual,Policy <br /> Cell 1A g21.4558 Eniall., Fee$ir <br /> Broker.17 Su S'eguro Insurance <br /> 't�i_0..�.f�tcteclden AWa Suil, <br /> +arttr!Al Cntirornia 92705 <br /> 7 i�t3- 6-A7 <br /> Credits/Surcharges: <br /> caltforni;}Good Cover <br /> Forms and endorsernonti, <br /> GPSV•001.GPSV-002,GP5V-003,GPSV•004,GBI-00;15BL-006,GPSV•015/CPSV-017;GPSV•030;GOL-932i GPSV•200,GBL-250 <br /> Driver Information, <br /> insured Driver Narne DOB Marital J Gender Driver's Lic/State/Status Points Yrs Driving Exp Intl 10thet Yrx <br /> MAGALI ALARCON XX/XX/1978 Single/Fernale XX0(XX2517/Cafifrwnla'/Valid 0 30 0 <br /> MADI5SON ROMERO XX/W2005 Single/Fernale XX3(XX5527/California/Valid 0 0 1 <br /> ALARCON <br /> Excfuded Drivers. <br /> Excluded Driver Name DOB Relation Driver's Lic/Status <br /> Vehicle Inforrriation <br /> Alt vehicles on this policy must be garaged in the some residential location <br /> Garaging Address 702 S Fri St Anaheirn,California 92805 4735 <br /> vehicle VIN usago Zip Vehicle Age <br /> 2015 BMW 3201 W8A3B1 C53FK137870 Corninute Tolf-rorn 92805 10 <br /> Work/School <br /> lJonholder/Additional Interest Vehicle <br /> �,,, .�•.-.n � n , , ., ., a r9hrr n.vea�nn nn <br />