Laserfiche WebLink
Generated at 02:50:36 PM CST, 11/13/2025, User: NTCSJG30INTCSJG30 <br /> 7 Policy Change Effective Date of Change: 11/13/2025 <br /> WO(iEN - Request (Manual Effective Time of Change: 2:50 PM <br /> Endorsement) Named Insured: MICHAEL T NUNEZ <br /> PERMANENT GENERAL ASSURANCE CORPORATION Policy Number: 22-CA-9032132 (quote 4516902) <br /> PO Box 305054, Nashville TN 37230 Agency Name: THE GENERAL AUTO INS SVCS, INC (998888) <br /> ADDRESS CHANGES <br /> New Address: <br /> City: County: State: Zip Code: <br /> Primary Phone: Alternate Phone: <br /> DRIVER CHANGES <br /> Driver Driver Name Marital <br /> Transaction (as shown on license) Relation Date of Birth Drivers License# State Gender Status SR-22 Social Security# <br /> VEHICLE CHANGES <br /> Vehicle Year Make,'iNodel Vehicle Identification Number Deductibles Rental Reim. Custom Annual <br /> Transaction eor prenenslve coaas:a Equipment Mileage <br /> COVERAGE CHANGES _ <br /> Liability Bodily Injury Uninsured/Underinsured nrnsure Motorist Property <br /> -Property Damage Excess Med-Pay Motorist Bodily Injury <br /> Damage <br /> $100,000/$300,000/$50,000 ; No coverage No coverage No coverage <br /> LIENHOLDER I ADDITIONAL INTEREST CHANGES <br /> Lienhaider <br /> Year Make/Model LP AlName Address City, State, Zip <br /> Transaction <br /> X <br /> Applicant's Signature DATE <br /> Insured signature required for ANY reduction and/or deletion of coverage <br /> PA039-0603-CA(E) <br />