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07/03/2013 15:37 9490551070 SAHW <br />Fax Sarver M/2013 9; 36; AR PM P& M <br />01)-, R� <br />/�"'i, PERSONAL AUTO <br />t -7St Century POLICY DECLARATION <br />Insurance <br />Named Innwod and Mai ft AddmM <br />MAR. V Vv=Y <br />SCaTT WP4.0Y <br />22a91 REVERE AD <br />EL TORD. CA O& SMO <br />PAGE 01/01 <br />41005 Fax Server <br />Pam 2012 <br />RENEML <br />EFFECTIVE 04MOV13 <br />AWeum; <br />21STCENTU Y INSU RANCE <br />Customer Sonow Carder: <br />Mat CENTURY INSURANCE <br />2161'CENTURY PLAZA <br />P,0.90X f $510 <br />IMLWNGTtSN, aE 105N5510 <br />PoOCy NU: 937729 50 <br />Poloy PoMd: from 04=112 <br />T6;1W3011012A1 AM S1wdafd Timm <br />,� <br />... Fi. 1 a�`d0g�•� EIp{`ID ''.� . N1� v r,�_� <br />M <br />0y it <br />9 <br />10 WCTSPs*0R""C= 1G9D3$MA0142tM14 Mf M$1 <br />92C+30 <br />0, w <br />t � <br />f� <br />( �" Yl�E <br />' i <br />'§�. ��la�l, <br />b�� <br />21���S�.irP <br />�1 <br />k• ty ,.IYF� �. <br />,N:,3 r ! <br />''>��, <br />00 <br />S VI WHERE A PREMLAA AND A LIMIT 6F LtABiIJiY <br />N FCJR THE GCriERA <br />F t� y n r <br />t L <br />* <br />a .i t i ': YO Y a.•ic W 10 <br />n � ^w�yw,, <br />'ja <br />r.a <br />A odlly InlIuttyyU ill <br />InOUdes 50.9J p0r Veik lmudtoe <br />riloa,pan eaohPpMon <br />,µ,fi34WWII <br />Tp 00 <br />101 up <br />�....iLp.$'SY Dr anisae lu <br />al oo. drJg each accident <br />20,00 <br />s <br />110.00 <br />C ti P me <br />irfsprr <br />as,,go rson <br />az p, nn0 a � <br />a 8100 <br />9 <br />n,bo <br />l�'1pIXA <br />1 Fiodil Inu <br />9300 000 eBCIr acuddeenR <br />& 14.00 <br />s <br />92,pp <br />DAMAGE T'O,YOUR .V6MXE <br />4 <br />van <br />�••• <br />- M - <br />a <br />119,00 <br />Co9h Vgu&Un Daduo0ft <br />0 1. <br />OM <br />i oheDs <br />«,. <br />.a <br />I11sm <br />9p Coup- <br />a <br />431,00 <br />Uninau�9-G }vtlfaist <br />„_pC'tF1p,C��lpy�(ty�Aryp�$,e <br />,D WAIVE, <br />- (1q Coy - <br />6 <br />7.00 <br />G ROAd91-0 AS91014me <br />7a dl9 t <br />Included <br />Yoalud <br />nnim4urge oil mox y <br />J. Additional0!A�pram <br />The (ir»191t7Vp10@ulgmallgeilN <br />'tnciuded <br />a oan <br />Irdudw Wth oomagt E or F. <br />AddRforiMeMefago(&O I.mmT�� <br />Adlpronal <br />$1,000 <br />6 0.00 <br />o <br />n,ad <br />TOW Fmftm ParVahlola <br />a 66.00 <br />$ <br />011.do <br />11 tha im 161IM 01 WI PIM Is used, a 9eevloe 6ha(ge may apply. <br />Tad fAgrW4m <br />$ 2, 209.00 <br />EndoF�aMC71tSa A8 m0�lei <br />�"""O <br />A Mara Not Rated <br />. 1..�7.4 ••v `n .: 1e'.`L°++6.P.:.T� ',:aihdb°kh°r w'e L44 e, <br />03IMS <br />Y�Rk21ID1.4tmmfmhBpnlNryStlnnlJpg�fytgy prentlum nntl enta. RB0'9brnnirpfMayl Rq p,IsmM1vt CAte cad11.8�29t.t1ae. <br />TouatcA {i'd11) 21,acw�xylratrca,«rcq�ark.P,a.anel�,n,wumn�un,rxaeeesra;� <br />)tt:'x°kC7V5 <br />