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~: <br />Interinsurance Exchange of the Automobile Club <br />~~~ _ t <br />Automobile Insurance Policy Coverages and Limits <br />Renewal Declarations <br />We are pleased to offer you a renewal for your automobile insurance policy. To renew your policy, send at least the minimum <br />payment on or before the due date. Insurance is in effect only for the vehicles, coverages, and limits of liability shown on this <br />declarations page and as set forth in the insurance policy and endorsements. These declarations, together with the contract and <br />the endorsements in effect, complete your policy. If any change to your policy or to the information we have on file results in a <br />premium decrease during the policy period, the Interinsurance Exchange reserves the right to apply any refund due to your <br />outstanding balance. <br />ED (ttem 1 <br />SUTARIA, TC AND TARULATA <br />PO BOX 26363 <br />SANTA ANA CA 92799-6363 <br />AUTO POLICY NUMBER: G 7104636 <br />rvucr rtrcwu (PACIFIC STANDARD TIME) <br />POLICY EFFECTIVE DATE: 01-15-09 12:01 A.M. <br />POLICY EXPIRATION DATE: 01-15-10 12:01 A.M. <br />VEHICLES <br />VEHICLE YEAR MAKE MODEL <br />NUMBER IDENTIFICATION VEHICLE GARAGE ANNUAL <br /> NUMBER USE ZIP CODE MILES LEASED FINANCED <br />1 1998 TOYO SIENNA LE/XLE 4T3ZF13C9W0002464 COMMUTE 92707 7,501 - 10,000 NO NO <br />3 2006 TOYO CAMRY LE/XLE/SE 4T1 BE32K36U664722 PLEASURE 92707 7,501 - 10,000 NO YES <br />COVERAGES AND LIMITS <br />Coverage is not in effect unless a premium or the word "included" is shown. ANNUAL PREMIUMS <br />COVERAGES LIMITS OF LIABILITY Vehicle 1 Vehicle 3 Vehicle Vehicle Vehicle <br />Liability <br />Bodily Injury $500,000 each person/ $500,000 each occurrence <br />Property Damage $100,000 each occurrence <br />Medical <br />' $ 178 <br />$ 121 <br /> <br />NA <br />$ 206 <br />$ 118 <br /> <br />NA <br />pl7ySical Damage (Actual Cash Value unless otherwise stated, less deductible) <br />Vehicle 1 Vehicle 3 Vehicle Vehicle Vehicle <br />Comprehensive ACV ACV $ 33 '• $ 55 <br />(Less Deductible) $100 $100 <br />Collision ACV ACV ~ $ 146 ~ $ 314 <br />{Less Deductible) $250 $250 <br />Car Rental Expense <br />(Per Day) NA $30 NA $ 33 <br />Uninsured Motorist <br />Bodily Injury $30,000 each person/ $60,000 each occurrence $ 27 ` $ 48 <br />Uninsured & Underinsured Vehicles <br />Uninsured Deductible Waiver <br /> <br />Uninsured Collision '. Included ~ Included <br /> NA NA <br />Total Premium <br /> $ sos ; $ 774 . <br />PREMIUM DISCOUNTS <br />Please refer to the enclosed document entitled "Premium Discounts Applied to Your Automobile P~lir:v " <br />*If at any time you choose to pay less than the full balance outstanding, <br />finance charges of up to 1.5% per month of the balance outstanding will apply <br />as explained in your billing statements, which are part of these declarations. <br />"NA" indicates coverage not purchased. <br />Total Annual Premium* $ 1279 <br />(Includes all applicable discounts.) <br />Less Policyholder's Dividend $ gg <br />Net Premium* $ 1193 <br />APPI< > '-RM <br />.~. ~~~ <br />.~_-.-. <br />Lah. <br />Es PROCESS DATE 12-11-08 PLEASE ATTACH TO YOUR POL16 <br />~SSisi~li.i ~ Y (SEE REVERSE) <br />tznoe <br />