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Safeway Insurance Company Financial Strength Rating <br /> IL <br /> P.O.BOX 5004 mew <br /> 01 <br /> SAFEWAY INSURANCE AExcellent V <br /> Monrovia, CA 91 01 7-71 04 N <br /> M� <br /> ~co <br /> N <br /> O <br /> U O <br /> Private Passenger Auto Application co o <br /> Policy Information <br /> ..................................................................................................................................................................................................................... <br /> Transaction Date: 02/20/2026 U <br /> .................................................... .. y. . .p....y................................................................................................................ <br /> Carrier: Safewa �Insurance�Com an <br /> NAIC: 12521 <br /> Phone: 800-807-2339 <br /> ....... ...... ........................................................................................................................................................................ <br /> Age.n..t/Broker:............................. ID#2129 <br /> A-MAX INSURANCE SERVICES <br /> 11330 FIRESTONE BLVD <br /> NORWALK CA 90650 <br /> Phone: 866-603-9905 <br /> ..................................................................................................................................................................................................................... <br /> Applicant: DENNYS DIAZPADILLA <br /> 2295 LIME AVE APT B <br /> LONG BEACH, CA 90806 <br /> Cell Phone: 714-809-8979 L) <br /> V Home Phone: V <br /> Bus Phone: <br /> . . . . . .............. . .................................................................................................................................................. . .. . ... ........... . ....... .............. <br /> Effective Date/Time: 02/20/2026 10:40 AM , expiring OS/20/2026 12:01 AM standard time <br /> �y . .TPolicyerm: 6Month <br /> ......................... .. .......................................................................................................................................................Pay Plan: Pay in Full nj <br /> Drivers <br /> 04 c List all drivers(licensed or not) 15 years of age and older. N <br /> CD <br /> N Name(as it appears on license) Date of Birth Sex Marital Status Relationship N <br /> o ................. .......... . . . ........................................................................................................................................................................... CDN DENNYS DIAZPADILLA 02/13/1966 Male Single Self N <br /> N Years/Months Experience:44/0 Date of License: 02/13/1982 Driver Lic.No./State:Y2391856/CA N <br /> Good Student: No Mature Driver: Good Driver: Yes <br /> O Occupation: SALES Employer: O <br /> 0 Driving History 0 <br /> Lu Accidents and Minor Convictions--last 3 years; Major Convictions--last 10 years.(Note:Your driving record is Lu <br /> Zverified with state motor vehicle department(s)and other insurers.) Z <br /> z Driver and Description Date Amount of Property Damage —a, <br /> ............... .......... . . . ... ..................................................... <br /> a DENNYS DIAZPADILLA Points: 0 a <br /> W At fault FINANCIAL RESPONSIBILITY ACCIDENT 12/07/2024 $0.00 W <br /> Coverages/Premiums <br /> QTotal Number of Vehicles in Household:2 Q <br /> Z 2004 INFINITI FX35 Garaging Address: 2295 LIME AVE APT B, LONG BEACH, CA 90806 Z <br /> VIN Registered State Odometer Reading Annual Mileage Mileage One Way �j <br /> JNRAS08U74X100633 CA 10000 5 - <br /> Cost'New......Symbol'Corriprefiensive/Collision Terrifory lylultiCar VefiicleLJsape <br /> 0 17/17 H 164 Yes Pleasure 0 <br /> LL <br /> p RL6.............. Salvaded ..... l esfrainfSystem.............................................ASS'S�rakes............Anfi'Th'eftDevice..... 0 <br /> 15....................NO.........................No System .,....,................................................Not Equipped <br /> .........ALARM ONLY <br /> a Limits Pre miurn a <br /> ................................................................................................................................................................................................. <br /> Q Bodily Injury Liability $30,000 each person$60,000 each accident $ 14.00 0 <br /> ................. . ......................................... ..................................................................................................... 6.'b.. <br /> Property Damage Liability 15,000 each accident 56.00 <br /> ............................................................................................ .................................................................................................... <br /> Comprehensive $1,000 deduct ible from actual cash value $ 48.00 <br /> .....................................................................................................................................................................................1,1 ...... <br /> Collision $1,000 deductible from actual cash value $ 175.00 <br /> ................................................................................................................................................................................................. <br /> Discounts:Anti-Theft, Good Driver, and Multi-Car <br /> .................................................................................................................................................................................................. .. <br /> Total for 2004 INFINITI FX35 $ 35..3.....00. <br /> APPROVED <br /> By Charlene R. Muro at 10:20 am, Mar 05, 2026 <br /> �a <br /> ..a <br /> aQ <br /> Rev.01/01/2025 Policy Package for 4340849-CA-PP-001 Return signed document 0 y <br /> 66 (Page 2 of 17) to your agent/broker a o <br /> ¢CO <br />