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!OWN <br /> FARMERS <br /> Auto Insurance Declaration Page INSURANCE <br /> PolicyNumber: 52340-12-34 Premiums/Fees <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Effective: 1/7/2026 12:01 AM Full-term Premium(excluding fees) $1,560.00 <br /> Expiration: 7/7/2026 12:01 AM <br /> Named Insured(s):Viet Tien Tran Prorated Premium(1/7/2026-7/7/2026) -$2,732.00 <br /> Thuy Lam Fee for this transaction -$0.88 <br /> 3 Iris <br /> Irvine,CA92620-2212 00' Total for this Transaction -$2.732.88 <br /> e-mail victortran1973@gmail.com <br /> Address(es): tienty@gialong.vn This is not a bill. <br /> Underwritten By: Farmers Insurance Exchange <br /> 6301 Owensmouth Ave. <br /> Woodland Hills,CA91367 <br /> Household Drivers <br /> All persons who drive or will occasionally be driving any ofthe cars on the policy should be listed below.Ifanyone is missing or needs to <br /> be added,such as a newly licensed driver,you should contact your agent or the company to add that person before they begin to d rive <br /> any of the cars covered on the policy. <br /> Name Driver Status Name Driver Status <br /> Viet Tien Tran Covered Thuy Lam Excluded <br /> ----------------------------------------- ----------------------------------------------------------------- <br /> Viet Gia Khang Tran Excluded <br /> Vehicle Information <br /> Veh.# Year/Make/Model/VIN Coverage Deductible Limit <br /> 1 2022 Acura Mdx 4D 4Wd Advance Comprehensive: $1,000 <br /> 5J8YE1H8XNL019022 Collision: $1,000 <br /> Coverage Information <br /> Limits Premiums by Vehicle <br /> Coverage (applicable to all vehicles) Vehicle 1 <br /> Bodily Injury Liability $500,000 each person $425.00 <br /> $500,000 each accident <br /> Property Damage Liability $500,000 each accident $248.00 <br /> Permissive User Limit of Full(See Permissive User Included <br /> Liability** Limit of Liability in your <br /> policy) <br /> Medical Coverage Not Covered <br /> Uninsured Motorist Bodily $500,000 each person $298.00 <br /> Injury $500,000 each accident <br /> Comprehensive $96.00 <br /> Collision $364.00 <br /> Additional Equipment $1,000 Included <br /> farmers.com Policy No. 52340-12-34 Questions? Manage your account: <br /> Cal I your agent Thanh Trieu at(619) Go to www.farmers.com to access <br /> 528-9988 or email your accou nt any time! <br /> ttrieu@farmersagent.com <br /> 56-6176 2nd Edition 3-19 1/9/2026 Page 1 of 3 <br />