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ROMERO, MADISSON
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ROMERO, MADISSON
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Last modified
7/11/2025 10:57:59 AM
Creation date
7/11/2025 9:39:35 AM
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Contracts
Company Name
ROMERO, MADISSON
Contract #
N-2025-184
Agency
City Manager's Office
Expiration Date
6/30/2026
Insurance Exp Date
7/29/2025
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as AMENDED DECLARATIONS PAGE — CALIFORNIA <br /> ire PERSONAL AUTO PROGRAM <br /> PQA1 1NSI,RANC.E <br /> Aspire General Insurance Services - CA DO[ LIC# 010876 <br /> Underwrillen by ASPIRE GENERAL INSURANCE COMPANY <br /> PG Got .'4'6 • Rancho Cucamonga, CA 91729.2425 • (916) 503 0313 A I <br /> QM <br /> I'rr'pa`e;t c+n r,;15'?CJ'S <br /> THIS DECLARATIONS PAGE Is PART OF YOUR POLICY,PLEASE READ CAREFULLY, <br /> AMENDED PERSONAL AVTO POLICY DECLARATIONS <br /> Policy Information: <br /> Polley Premium <br /> Policy Number GPSV-00571721.00 Total Premiums. $73000 <br /> Inception 4/18/202S 1201 AM <br /> Expiration Total Fraud Fees S088 <br /> 71291202E 12.01 AM SR Filing Fee. SO 00 <br /> Time Applied For, 4/16/2025 2 45 PM Policy Fee: S28.00 <br /> `lnrePhor time shall not be prior to the time applied for,or if this <br /> is a replacement declarations,not prior to the time of coverage change <br /> Named Insured(s): Additional Fees when applicable: <br /> MAGALI ALARCON Cancellation$50,Reinstatement S10,SR22. Fiiinr3 $15,SR22 Reinstatement WS, <br /> Nan-Suffiuent Funds$25,Endorsement$5,EFT Installment$10.Non-EFT <br /> Anaheim.California 92805-4 73 5 Installment S14,Return Mail S5,Fraud Fee SO 88 per vehicle semi-annual, Policy <br /> Cell (714)421-6558 Email Fee S35 <br /> Broker, 1T Su Segura Insurance <br /> 1210 E Mcfadaen Ave Suite A <br /> Santa Ana,=C:alrfomia 92705 <br /> (71.4) 836-4753 <br /> Credits/Surcharges: <br /> Calitomia Good Driver <br /> Forms and Endorsements: <br /> GPSV-OC1.GPSV-002,GPSV-003,GPSV-004,GBL-005,GBL-006,GPSV-016/GPSV-017,GPSV-0301-GBL-032,GPSV-200,GBL-250 <br /> Driver Information: <br /> Insured Driver Name DOB Marital/Gender Driver's Lic/State/Status Points Yrs Driving Exp Intl/Other Yrs <br /> IAAGALI ALARCON XX/XX/1978 Single/Female XXXXX2517/California/Valid 0 30 0 <br /> MADISSON ROMERO XX/XX/2006 Single/Femafe XXXXXS527/Califomia/Valid 0 0 <br /> ALARCON <br /> Excluded Drivers: <br /> Excluded Driver Name DOB Relation Driver's Lic/Status <br /> Vehicle Information <br /> All veh+ctes on this policy must be garaged in the same residential location <br /> Garaging Address 70, S Emily St Anaheim,California 92805-4735 <br /> Vehicle VIN usage Zip Vehicle Age <br /> 2015 BIAW 3201 WBA3151C53FI{137870 Commute To;From 92805 10 <br /> Work/School <br /> Lfenholder/Additional Interest Vehicle <br />
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