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Safeway Insurance CompanyIL <br /> P.O.BOX 5004, Monrovia, CA 91 01 7-71 04 Auto Application (cont.) MCD <br /> �p N <br /> Coverages/Premiums N <br /> 2013 CHEVROLET TRAVERSE LTZ AW Garaging Address. 2295 LIME AVE APT B, LONG BEACH, CA 90806 U)o <br /> VIN Registered State Odometer Reading Annual Mileage Mileage One Way �N <br /> 1 GNKVLKD8DJ255806 CA 10000 5 <br /> Cosf�N6 .....Symbol Comprehensive/Collisiori Terrifor iyiiilti Car Vehicle Usage °C) <br /> 26/20 H164 Yes Pleasure ~ <br /> Eip ................S8lyaged........... l esfrainfSysfem.............................................A8S'9rakes............Arifi'Th'eftDevice..... <br /> 15 No No System Not Equipped ALARM ONLY <br /> ........................................................................... .ifiiits.................................................................................................. . ... <br /> emits remium <br /> ..............n-j-d.............................................................................................................................................................................. <br /> Bodily Injury Liability $30,000 each person$60,000 each accident $ 112.00 <br /> .................................................................................................................................................................................................. <br /> Property Damage Liability $15,000 each accident $ 84.00 <br /> .............................................................................................................................................................................................." . <br /> Comprehensive $1,000 deductible from actual cash value $ 58.00 <br /> .................................................................................................................................................................................................. <br /> Collision $1,000 deductible from actual cash value $ 191.00 <br /> .................................................................................................................................................................................................. <br /> Discounts:Anti-Theft, Good Driver, and Multi-Car <br /> ....................................................................................................................................................................................$....................D..D. <br /> Total for 2013 CHEVROLETTRAVERSE LTZ AW 445. <br /> ............................................................................................................... <br /> Subtotal Policy Premium $ 798.00 <br /> .Fees........................................................................................................................................................................................................... V <br /> ...................... ..... <br /> PolicyFee...............................................................................................................................................................$.............32.0.. <br /> a Fraud Fee 1.76 a <br /> tiTotal Fees......................................................................................................................................................................................33.76 <br /> Total Policy Premium $ 831.76 <br /> N N <br /> Additional Interest <br /> NOnly Lessees are accepted as Additional Interests N <br /> o Vehicle and Additional Interest Loan Number p <br /> N ..................................................................................................................................................................................................................... N <br /> o Prior Insurance Coverage o <br /> N Prior Carrier and Years with Company Prior Policy Number and Expiration Date N <br /> ....................................................... . <br /> 0 0 <br /> z z <br /> O O <br /> G G <br /> w w <br /> z z <br /> 2 2 <br /> a a <br /> W W <br /> Z Z <br /> C7 C7 <br /> O O <br /> u_ u_ <br /> O O <br /> a a <br /> O O <br /> U U <br /> �a <br /> ..a <br /> aQ <br /> Rev.01/01/2025 Policy Package for 4340849-CA-PP-001 Return signed document N y <br /> 66 (Page 3 of 17) to your agent/broker a o <br /> ¢CO <br />