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0 <br /> Other Household Driver(s) <br /> In addition to the Principal Drivers) and Assigned <br /> Driver(s), your premium may be influenced by the <br /> drivers shown below and other individuals permitted to <br /> drive your vehicle. This list does not extend or expand <br /> coverage beyond that contained in this automobile <br /> policy. The drivers listed below are the drivers reported <br /> to us that most frequently drive other vehicles in your <br /> household. <br /> �o <br /> rp o <br /> SANDRA MEDINA <br /> ANTONIO R MEDINA <br /> ALEXIS MEDINA <br /> It is your responsibility to inform us of all regular For business related vehicles, also include the <br /> drivers of your vehicles and changes to those drivers business owner(s) and employee(s)that drive the <br /> throughout the life of your policy. Failure to disclose vehicle(s) in any capacity <br /> drivers may result in denial of coverage. Regular Principal Driver&Assigned Drivers <br /> drivers. regardless of their relationship to the primary For each automobile, the Principal Driver is the individual <br /> named insured or their residence address, include: who most frequently drives it. <br /> • All drivers who drive the vehicles)on the policy Each driver is designated as an Assigned Driver on the <br /> once or more in a typical month household automobile that they most frequently drive. Your <br /> • All drivers who regularly drive the vehicle(s) at premium may be influenced by the information shown for <br /> least three months of the year these drivers. <br /> COVERAGE AND LIMITS See your policy for an explanation of these coverages <br /> A Liability <br /> Bodily Injury 30,000/60,000 <br /> Property Damage 25,000 S47419 <br /> H Emergency Road Service $4 74 <br /> U Uninsured Motor Vehicle <br /> Bodily Injury 30,000I60,000 $58 70 <br /> U1 Uninsured Motor Vehicle <br /> Property Damage $17 36 <br /> Total Premium $554.99 <br /> If any coverage you carry is changed to give broader you the broader protection without issuing a new policy, <br /> protection with no additional premium charge, we will give starting on the date we adopt the broader protection. <br /> DISCOUNTS These adjustments have already been applied to your premium <br /> Multicar <br /> Driving Safety Record <br /> (continued on next page) <br /> Policy Number:737 4537-F10-75C Page number 3 of 5 <br /> Prepared October 17, 2025 <br /> 11419C <br />