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PERSONAL AUTO Renewal <br />tj 21St Centurv, EFFECTIVE 1211512010 <br />to y <br />insurance POLICY DECLARATION <br />Named Insured and Mailing Address ?011 J,�V 27 I'M 10: 57 <br />-6kv -7 A <br />Joe Larosa <br />Marie Larosa C L <br />9 199 poinsettia Ave <br />Fountain Valley, CA 92708 <br />rehicle(s) and Driver(s) <br />teh Year Make/Model Vehiclkj]) Number <br />1 2004 -HONDA PILOT LX 2HKYFI8134H568983 <br />2 2006 TOYOTA TUNDRA DOU 5TBET341X6S552072 <br />-------- years <br />Rated Driver Licensed Tit <br />Veh M 6 <br />La 43 0 <br />i Marie Lassa <br />Joe La 44 0 <br />2 Joe Larosa <br />Policy No: 3493189 <br />Policy Period; From: 1211512010 <br />To: 06115/2011 12:01 AM Pacific Time <br />)so Vehicle Discounts/Comments Zi Mileage <br />— t92708 8,170 <br />(M <br />IN MCD 92 <br />W MCD 92708 7,449 <br />W MCD <br />(ets Chargeable Accidents Driver Discounts <br />GOD <br />GOMS05 <br />I <br />LIMIT OF LIABILITY ARE SHOWN FOR THE COVERAGE. <br />:OVERAGE IS PROVIDED WHERE A PREMIUM AND. A <br />Premium <br />Coverage <br />Limit of Liability <br />Veh 1 <br />Veh 2 <br />A. Bodily Injury Liability <br />$ loo, 000 each person <br />$ 149 <br />79 $ <br />-- <br />$ <br />4 <br />kachxleS $0.90 pef vehicle fraud fee <br />$ 3oo,000 each accident <br />$ loo <br />S 93 <br />$ <br />8, L-�rrt y Damage lability <br />100,000 each accident <br />$ <br />C. Medical Payments <br />each Person <br />$ <br />— <br />Uninsured Motorist <br />ioo,000 each person <br />$ 37 <br />$ 26 <br />D. Bodily Inju!y <br />$ 300, 000 each accident <br />_ <br />DAMAGE TO YOUR VE141CLE <br />Veh 1 Veh 2 <br />Ded. <br />Actual ash V Less Deductible <br />Ded. ad. Ded— <br />$ 19 <br />31 <br />$ <br />E, Comprehensive <br />$ Soo Soo $ <br />$ $ 78 <br />S 87 $ <br />F. Collision <br />$ 500 $ Soo <br />Uninsured Motorist <br />5 <br />$ 5 $ <br />[?1. Pro rt Dams <br />DED WAIVE QED WAIVE <br />21 st Century <br />S 7s each disablement <br />Included <br />Included Included <br />Included <br />G. Security Advanta e <br />Rental per day <br />S S $S <br />$ <br />H. Reimbursement max <br />S$ <br />J. Additional Equipment <br />Included $1,000 $1,000 <br />The first $ 1000 is automatically <br />Additional $ 0 $ 0 <br />included with coverage E or F- <br />Additional coverage is optional. <br />$1000 $ <br />Total $11000 , <br />$ <br />$ <br />Total Premium Per Vehicle_ <br />$ 321 $ <br />If the installment bill plan is used, a service charge may aPPIY- <br />Total Premium <br />Endorsement(s)/Agreement(s) Applicable: i C 0-iTrUWAITE <br />TCU -1 (01/09) TCU51 1 CA 105/101 MIL <br />TCU53 1 CA (03/091 Dcl)utN city Attorney <br />Loss Payee (LP), Additional insured (All, Evidence of insurance (Ell Drivers Not Rated <br />Veh 1 El CITY OF SANTA ANA PD <br />Veh 1 El City of Anaheim PD <br />Veh <br />Veh 2 LP Toyota Motor Credit Corp <br />THE FOLLOWING FEE(Sl MAY APPLY: 11/1312010 <br />LATE: $6.00 PAYMENT RETURNED (NSft <br />CANCEL- $50.00 INSTALLMENT W_L PLAN SERVWX CHARGE- $4.00 vice President I <br />WHEN ATTACHED To THE PERSONAL AUTO POLICY. THESE DECLARATIONS COMPLETE THE POLICY AND REPRESENT <br />THE CURRENT STATUS OF YOUR COVERAGES AND LIMITS OF LIABILITY. <br />Visit 21 st-com to make policy changes, Pay your premium, and more. Register online todayl For Customer Care call 1-800-443-3100. <br />TCU4 I CA (03)091 21 st Century Insurance company, 21st Century plaza, Wilmington, DE 19803 <br />