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O <br />Cr2ls--t <br />PERSONAL .AUTO <br />Century <br />POLICY DECLARATION <br />Insurance <br />Vehicle Discounts/Comments <br />.zip <br />N -09:> 1`? —1514 <br />1 <br />04 HONDA PILOT LX <br />Named Insured and Mailing Address - <br />JOE LAROSA <br />CD\GD <br />MARIE LAROSA <br />8,17! <br />9199 POINSETTIA AVE <br />06 TOYOTA TUNDRA DOUBLE CAB SR <br />FOUNTAIN VALLEY, CA 92708 <br />W <br />RENEWAL <br />EFFECTIVE 12/15/11 <br />Account: <br />21 ST 7CENTURY IN RANCE <br />6�_ <br />�USt 61'�ier i�,ry �e nter: <br />21st CENTURY INSURANCE <br />21 ST CENTURY PLAZA <br />P:O, BOX 15510 - <br />WILMINGTON, DE 19850-5510 <br />Policy NO: 8349 31 89 <br />Policy Period: From 12/15/11 <br />To: 06/15/12 12:01 AM Standard Time <br />i,1/ehicla(s) and Drivar(s) :-, , <br />>Veh <br />Year--��vMake(Model- <br />Vehicle ID Numbar <br />sel <br />Vehicle Discounts/Comments <br />.zip <br />Miiaac <br />1 <br />04 HONDA PILOT LX <br />2HKYF18134H568983-W <br />1 <br />CD\GD <br />92708 <br />8,17! <br />2 <br />06 TOYOTA TUNDRA DOUBLE CAB SR <br />15TBET341 X6S552072 <br />W <br />rMCD\GD- <br />92708 <br />7,444! <br />Vel{ <br />- <br />Ratetl Urlver <br />Years:jkottsChargeable <br />Licensed <br />143. 00 <br />Accidents <br />Driver Discounts <br />2 <br />JOE LAROSA <br />45 <br />$ <br />94.00 <br />SD5 <br />1 <br />MARIE LAROSA <br />44 <br />each person <br />SD4 <br />Uninsured Motorist <br />$100,000 <br />each person <br />_— <br />C overage.,.` <br />- <br />Limit of Liability <br />y <br />319.00 <br />If the installment bill plan is used, a service charge may apply. <br />Total Premium <br />- <br />PremiumVeh <br />$ 678.00 <br />1 <br />Veh2 <br />A_Bodilyy In ury Liability <br />$100,000 <br />each person <br />includes $O.�O per vehicle fraud fee <br />$300,000 <br />each accident <br />$ <br />143. 00 <br />$ <br />79.00 <br />B. Property Damacle Liability <br />$100,000 <br />each accident <br />$ <br />94.00 <br />$ <br />93.00 <br />C. Medical Payments <br />each person <br />Uninsured Motorist <br />$100,000 <br />each person <br />D. Bodily In'u <br />$300,000 <br />each accident <br />$ <br />34.00 <br />$ <br />26-00 <br />DAMAGE TO YOUR VEHICLE <br />Veh 1 <br />Veh 2 <br />Actual Cash Value Less Deductible <br />Ded. <br />Ded. <br />E. Comprehensive <br />$500 <br />$500 <br />$ <br />16.00 <br />$ <br />31.00 <br />F. Collision <br />$500 <br />$500 <br />$ <br />67.00 <br />$ <br />85.00 <br />Uninsured Motorist <br />D1. Property Damage <br />DED WAIVE <br />DED WAIVE <br />$ <br />5.00 <br />$ <br />5.00 <br />21st Century <br />G. Security Advantage <br />$75 <br />each disablement <br />Included <br />Included <br />RentalPer day <br />H. Reimbursement max <br />J. Additional Equipment <br />included <br />$1,000 $1, 000 <br />The first $1000 is automatically <br />Additional <br />included with coverage E or F. <br />Total <br />$1,000 $ 1 O o O <br />Additional coverage is o tional. <br />, <br />$ <br />0.00 <br />$ <br />0.00 <br />Total Premium Per Vehicle <br />S 359 _ 00 <br />$ <br />319.00 <br />If the installment bill plan is used, a service charge may apply. <br />Total Premium <br />$ 678.00 <br />I=11UV1 S1:111Cnita f//'11J.ICCrI1Cn[t5f HppncaOle: <br />FPN-a 0711 TCU -1 (01/09)r <br />TCU511CA (02/11) TCU531 (01/10) <br />AU CWF9 1011 Avy"dlxf= . <br />Drivers Not Rated <br />- Laura Stitt <br />'THE FOLLOWING FEE(S) MAY APPLY: --eitornev <br />-LATE: :$5400`:`':'PAYMENT RETURNED (NSF): $10.00 V V ' 11/08/11 <br />-:CANCEL: $50.00`- `.:INSTALLMENT BILL PLAN SERVICE CHARGE:$4.00 <br />Vice President <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 21st_com to make policy changes, pay your premium, and more. Register online today! For Customer Care call 1-800-241-1188. <br />