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ADDL INFO ON NEXT PAGE PAGE 6 <br /> W44 <br /> � USAA CASUALTY INSURANCE COMPANY <br /> ei„ (A Stock Insurance Company) State 1 q Vol POLICY NUMBER <br /> USAX 9800 Fredericksburg Road - San Antonio, Texas 78288 CA kl 53 XXr 00441 89 04C 7101 1 <br /> CALIFORNIA AUTO POLICY POLICY PERIOD' (12:01 A.M. standard time) <br /> AMENDED DECLARATIONS EFFECTIVE 1 2026 TO AUG24 2026 <br /> (ATTACH TO PREVIOUS POLICY) <br /> Named Insured and Address <br /> LAURA L HOLMGREN <br /> 912 MAGNOLIA AVE <br /> PLACENTIA CA 92870-4421 <br /> Descri tion of Vehicle s VEH USE' oRs H0°L <br /> VEH YEAR TRADE NAME MODEL BODY TYPE IDENTIFICATION NUMBER SYM e I ork <br /> 14 26 HONDA CR—V 4D 14000 5J6RS5H59TLO17455 P <br /> e e is e s escrl a he—re—in—i—s—pr—in—cl—p-a-ryFgaraged at the above address unless otherwise stated. 11'w =Work School B=B siness F=Farm P=P1 ure <br /> VEH 14 PLACENTIA CA 92870-4421 <br /> This policy provides ONLY those goveragqes where apremium ,is shown below. The limits hown <br /> m y ¢e rediced b poligy pro Yt t Ts aTid mar not a combined reaarde(ess of the number of <br /> ve ie es for which premium Is tste unless sp cifical authorized els where in this polic . <br /> COVERAGES LIMITS OF LIABILITY VEH VEH VEH VEH <br /> 14(°ACV" MEANS ACTUAL CASH VALUE) D DED 6 PREMIUMH D=DED I PREMIUM D=DED PREMIUM D=DED I PREMIUM <br /> AMOUN $ AMOUNTI $ AMOUNT $ ONMOUNTI $ <br /> PART A - LIABILITY <br /> BODILY INJURY EA PER $1, 000, 00 <br /> EA ACC $1, 000, 000 156 . 94 <br /> PROPERTY DAMAGE EA ACC $ 100, 000 87 . 55 <br /> PART B - MEDICAL PAYMENTS <br /> EA PER $ 100, 000 23 . 28 <br /> EXTENDED BENEFITS <br /> WAGE EARNER DISAB $2, 000 PER 0-DAYPERIO <br /> ESSENTIAL SVCS DISAB $45 WK 1 . 95 <br /> PART C - UNINSURED MOTORISTS <br /> BODILY INJURY EA PER $1, 000, 00 <br /> EA ACC $1, 000, 000 91 . 56 <br /> WAIVER OF COLL DEDUCTIBLE 1 . 35 <br /> PART D - PHYSICAL DAMAGE COVERAGE <br /> COMPREHENSIVE LOSS ACV LESS D1000 72 . 11 <br /> COLLISION LOSS ACV LESS D1000 371 . 82 <br /> RENTAL REIMBURSEMENT <br /> ECONOMY CLASS 32 . 23 <br /> TOWING AND LABOR 11 . 68 <br /> VEHICLE TOTAL PREMIUM 850 . 47 <br /> -------------------------------ADJUSTMENT REASON-------------------------------- <br /> CHANGE IN OPERATOR STATUS OP 03 ADDED VEH 14 <br /> TOTAL PREMIUM SEE FOLLOWING PAGE (S) <br /> „ 14 RMM43 0O H <br /> In WITNESS WHEREOF, we have caused this policy to be signed by our President and Secretary at San Antonio, Texas, <br /> on this date MARCH 31, 2026 <br /> 5000 C05-12 <br /> Tom Eck,Secretary Randy Termeer,President <br /> L�n07 1174 4 <br />