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2013 -11- 2617:08 LONG 9495598500» <br />Insured Name MARIANN LONG <br />P 414 <br />Policy Number RB 752730 <br />VEHICLE COVERAGE INFORMATION <br />SUMMARY 00 CO FRED V.EHICILE(S),AND PRENUM(S) Term <br />.is....Premium <br />No, Year Make Model Vehicle Identification No <br />1 2007 LEXUS RX 400 AWD JTJHW31U972021753 $ 869.00 <br />Auto Assessment for Consumer Services S 1180 <br />Personal Catastrophe Liability Premium _ _ g 177, 00 <br />TOTAL AUTOMOBILE PREMIUM S 11047.80 <br />Vehicle I Annual Mileage <br />14400 <br />.Editiore <br />VEHICLE 1. INFORMATIONrar g• Laaax oar, tRVTNE,;CA <br />926ga <br />Number <br />.Year Mike,: Model <br />:.�Vehicle Identification Na. <br />:G1AS4C4d! <br />Inspect :�: <br />2007'.r.EXVS -RX - 400 - An <br />JTJHw51D97202I7S3' <br />MOTORISTS COVERAGE - CA <br />Lim ik of <br />Term <br />12 -09 <br />COV FOR DAMAGE TO YOUR AUTO EXCLUSION <br />Liability <br />Premium <br />Operat <br />Operator 7 Information <br />r <br />A. Liability <br />AK3714 <br />07 -05 <br />MARIANN nouc <br />Driver StILicense Number <br />Bodily Injury - Each Person <br />$ 250,000 <br />LIMIT OF LIABILITY COV A $1,000,000 <br />B4rlily Injury - Each Accident <br />$ Soo, 0 0 0 <br />$ <br />2 66 . 0 0 <br />Date of Birth Sex Marital Status <br />Property Damage <br />FCL AMENDMENT- DWELLING /APARTMENT RENTAL <br />07 -17 -1954 F Married <br />Each Accident <br />$ 100, 0 0 0 <br />$ <br />131 , 00 <br />Operator 2 Information <br />B. Medical Payment <br />CITY; IRVINE ST: CA ZIP; 92604 <br />JOHN HAYNEB <br />Each Person <br />ADDRESS 17 BRIDGEWOOD <br />Driver SOLicense Number <br />C. Uninsured Motorists <br />ADDRESS <br />Bodily Injury - Each Person <br />$ 25,000 <br />Date of Birth Sex Marital Status <br />07 -09 -1954 M Married <br />Bodily Injury - Each Accident <br />$ 50,000 <br />$ <br />54.00 <br />Property Damage <br />CITYi MAMMOTH LAKES ST: CA ZIPt 93546 <br />AU971 <br />Each Accident <br />AUTO CHANGES TO YOUR POLICY I <br />D. Damage To Your Auto <br />PP0305 <br />08 -96 <br />LOSS PAYABLE CLAUSE <br />Actual Cash Value (ACV) minus <br />deductible shown <br />Collision Loss <br />$ 1, 000 <br />$ <br />298.00 <br />Comprehensive Loss <br />$ 11 000 <br />$ <br />120.00 <br />Towing and Labor Cost <br />Per Disablement <br />Total Premium for Vehicle <br />multi -car Goad Driver Plus Passive Restraints <br />Ant's -Theft Devices Multi- Policy <br />VEHICLE <br />ENDORSEMENT S ':. . <br />.Editiore <br />Veh : <br />Term': <br />Number <br />"; Date <br />Qesoriptirn No :' <br />Premium <br />PF0487 <br />06 -10 <br />UNINSURED <br />MOTORISTS COVERAGE - CA <br />PP1301 <br />12 -09 <br />COV FOR DAMAGE TO YOUR AUTO EXCLUSION <br />A0741 <br />02 -07 <br />LIMITED MEXICO COVERAGE <br />AK3714 <br />07 -05 <br />PERSONAL CATASTROPHE LIABILITY $ <br />177.00 <br />LIMIT OF LIABILITY COV A $1,000,000 <br />TERR: 1, AUTOS 1, HOMES 1 <br />AR3664 <br />09 -04 <br />FCL AMENDMENT- DWELLING /APARTMENT RENTAL <br />ADDRESS 5 NORTHGROVE <br />ADDRESS <br />CITY; IRVINE ST: CA ZIP; 92604 <br />ADDRESS 17 BRIDGEWOOD <br />ADDRESS <br />CITY: IRVINE ST; CA ZIP; 92604 <br />ADDRESS 48 LARKSPUR LANE <br />ADDRESS <br />CITYi MAMMOTH LAKES ST: CA ZIPt 93546 <br />AU971 <br />10 -09 <br />AUTO CHANGES TO YOUR POLICY I <br />WAIVER OF COLL DEDUCTIBLE DOES NOT APPLY <br />PP0305 <br />08 -96 <br />LOSS PAYABLE CLAUSE <br />'Indicates a change was made to your policy. <br />AK 5034 (08 00) CONTINUED 0244,0 +2 7000535 <br />