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~s Interinsurance Exchange of the Automobile Club ~~~ : Automobile Insurance Policy Coverages and Limits Renewal Declarations We are pleased to offer you a renewal for your automobile insurance policy. To renew your policy, send at least the minimum payment on or before the due date. Insurance is in effect only for the vehicles, coverages, and limits of liability shown on this declarations page and as set forth in the insurance policy and endorsements. These declarations.. together with the contract and the endorsements in effect, complete your policy. If any change to your policy or to the information we have on file results in a premium decrease during the policy period. the Interinsurance Exchange reserves the right to apply any refund due to your outstanding balance. NAMED INSURED Item 1.) AUTO POLICY NUMBER: G 7104636 SUTARIA, TC AND TARULATA POLICY PERIOD (PACIFIC STANDARD TIME) PO BOX 26363 N-2009-140 POLICY EFFECTIVE DATE: 01-15-10 12 01 A M SANTA ANA CA 92799-6363 ~ POLICY EXPIRATION DATE: 01-15-11 12 01 A M VEHICLES VEHICLE YEAR MAKE MODEL IDENTIFICATION VEHICLE GARAGE ANNUAL LEASED NUMBER NUMBER USE ZIP CODE MILES FINANCED 1 1998 TOYO SIENNA LE/XLE 4T3ZF13C9W0002464 COMMUTE 92707 7.501 - 1QOD0 NO NO 3 2006 TOYO CAMRY LE/XLE/SE 4T18E32K36U664722 PLEASURE 92707 7,501 - 10,000 NO YE5 COVERAGES AND LIMITS Coverage is not in effect unless a premium or the word "included" is shown. ANNUAL PREMIUMS COVERAGES LIMITS OF LIABILITY Vehicle 1 Vehicle 3 Vehicle Vehicle Vehicle Liability 3odily Injury $500.000 each person/ $500,000 each occurrence $ 160 $ 182 property Damage $100,000 each occurrence $ 130 ' $ 125 Medical - NA NA 'hysieal Damage (Actual Cash Value unless otherwise stated.. less deductible) Vehicle 1 Vehicle 3 Vehicle Vehicle Vehicle :omprehensive ACV ACV ; $ 29 $ 43 Less Deductible) $100 $100 ;ollision ACV ACV $ 155 $ 323 Less Deductible) $250 $250 ;ar Rental Expense Per Day) NA $30 NA ~ $ 31 Ininsured Motorist ;~t,.Jl V ~~.i A~ TO FORM iodily Injury $30,000 each personi $60,000 each accident $ 23 $ 38 Jninsured & Underinsured Vehicles , ', I i d D d i ~~ n nsure e uct ble Waiver „m~ :Included :Included Jninsured Collision Lau a Stitt She dy NA NA (otal Premium ssxs ant ,qty t orney ; $ 497 $ 742 'REMIUM DISCOUNTS "NA" indicates coverage not purchased. ' lease refer to the enclosed document entitled "Premium Discounts Applied to Your Automobile Policy " . Total Annual Premium' "If at any time you choose to pay less than the full balance outstanding, (Includes all applicable discounts.) $ 1239 ~ i finance charges of up to 1.5% per month of the balance outstanding wilt apply Less Policyholder's Dividend $ ~ 02 as explained in your billing statements, which are part of these declarations ` . Net Premium $ 1137 ooso ze PROCESS DATE 12-10-09 PLEASE ATTACH TO YOUR POLICY fSEE REVERSE)