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OY /05/12 THU 15:47 FA% S62 902 4667 ppCSC� WH TTI�R S <br />F8X SeY-57t3Y 1 /5 /LV1G ii: =aa: iCi ev, ,�r..,�. '�.IiFi.Y � _.,,_ ��_'_- <br />Interinsurance Exchange of the Automobile Club <br />Automobile Instsranc� Policy Covsragars and Limits <br />Renewal Declafatlons <br />Wa ars plgasad to oftar you a renewal for your aubontcbi[a insurance policy. To renew your policy, sand at leas! the minimum <br />paymerd on or before the due data. [naurance is in eReot only for the vgh[cfas, coverages, and limtb of liability shown on Chia <br />dgolarations pie and as sat fot'llt in tt+a insuranoa policy and entloraernenls. These dq[darationa. together with iha eontrsct and the <br />endorsamerrts in effect comple[a your policy. ff any change to your policy a i4 the Infarmaticn � have on file rssulm in a premium <br />daereaae during the polity period, Uie Irtellnsuranee Exchange I+erarvas the rigkt to apply any refund due to your outstartding <br />balance. <br />MADRID, DIANA M AND ANDREW L <br />1321'7 LA gLINi'A ST <br />LA MIIiADA QA 9Ota'38 -3A36 <br />POLICY EFFECTIVE DATE: 70.30111 12:01 AM. <br />PDLIC1f EXPIRATION DATE: 1 O 90 -12 52:07 AM. <br />VFi�ICtF YEIAR <br />LNI� <br />MOPaL <br />IDEIV"rIF1GT10IJ <br />NUMaER <br />YF}iICLE <br />U9E <br />[3P,IiAGE ANNU/\L <br />ZIP CODA MILES <br />SrEr;:FlFD <br />MILEAGE <br />:ylAla6i <br />1 2005 <br />CiiRYS <br />TOWN 6 COUNTRY TOURING Efl 2C4GPU4L35R277590 <br />COMMUTE <br />90638 20.001 - 25.000 <br />VEF2lFIED <br />2 2006 <br />NISAN <br />6ENTRA 1.8/i.H9 <br />3N5C851 p461S9000T <br />OOMTiI[UTE <br />OOB38 55.001 - 20.000 <br />VERIFIED <br />4 2006 <br />FORD <br />p(pi.ORER XLT <br />SFMEUS3EO6ZA54033 <br />COMMUTE <br />BO6'ie 50.005 - 55,000 <br />VERIFIl9 <br />CCVE32A6E5 AI.O L1M1'LS <br />ANN[1AL PRFJVIIUNI$ <br />Cgveeeer `nai in wNr¢t eNrrw�r prranlun er rhrwo:d �neludW^ w rYwvrr} <br />COVERAGES LMIT60F L.IP.BILTY <br />Vahlde 1 VshlGe 2 Vehlefo 4 Vah.de <br />Ve151de <br />Llddrmr <br />eodlly Ir>Jury 550,000 cash peraan/ 5100,000 eaoh oceunYilc2 <br />� S 7ea� ! 3 48S � 5 152 f <br />� <br />� <br />Property Dama64 526.000 eadt occurrence � <br />: S 755 ; i 452 ; $ 178 <br />�-- <br />adica7 - � � <br />i � <br />.. <br />NA nIn NA <br />. � <br />j <br />�, <br />Physical Oamapo (nduv a.n va>ta .o5as aJ+:ns'Ir� aYrL r.e• aw:ewh)� <br />f ! j � <br />r <br />Ve1Yde 1 valid. 2- VaNde�4 � � VaHtlo vWtl� � <br />r I <br />� <br />I <br />Conpreher:elve AGY NA � AGV .: <br />; Z tp NA 541. <br />(Leas Deduatlblm) 5250 � NA 5230 <br />� � <br />. <br />NA : S 2S2 i <br />. <br />CaHlslrn � .. .qGY � P1A � AGY .: � <br />� S d25 <br />� <br />I <br />(Lees DadtlCUbla) � 5500 � NA $500: <br />j <br />Czar Rental E3cpanee � f`LR :. NA � �' <br />(Pcu r>a� � NA <br />j IVA� NA ��lVi► I <br />� t <br />li /r7SIIlVd iNOenrISS .� � <br />. <br />1 <br />I. S 31 � � $ 61 � $ 22 <br />'Badly Ilrylury $15,OD0 . e3ah person! � 330:000 each acddaM � <br />i <br />Uninsured � Undertnaumd Vehicles � � � � <br />� � <br />i i e <br />'�• Included '; N4 IndudW <br />Uninsured DaduGlble Waiver � � <br />� � <br />, <br />NA � 3 4$ i NA ! <br />1 <br />Uninsured Colllsian <br />'Total Premium � � <br />: S S5z I S 1b24 t S � I <br />__ <br />°NA• indlr�tes coverage not purCha �;ed. <br />PRE7N IUM tASCdUN'r8 <br />Pfaear rgerbo the errlosed- dowment entitled ^Prwniurn DiscwnM Applied to Ywr Automobile PdieY --^ <br />Tohl Annual Premium• S 25GB <br />�M1 at any time: you choose to�pay� lose than tl+a faill'�lsergnca out5rtandln0.. <br />ilndue.ean.appncaetsmae�nts) <br />Laaa Policyholder 8avinga Dividend <br />S 36.7 <br />finance charges of up 'to 1.5%. �per montfi of the balanca'outatanding will apply <br />as e•zplair7ed in your Wiling atatemanta, whicFr are part of tllese deelaratictta. <br />Net Premium• <br />S 2182 <br />�� PROrr1�S DATE 09 -23111 _ 1"tFA73E ATTACFI To YOUR POt.ICSr . <br />:SEE REVERSE) <br />APPRO(VE�D /A�S, TO FORM <br />e� l -`d <br />LISA E. STORCK <br />Assistant City Attorney // <br />to � <br />r�ooi <br />