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the vehicle safety discount that is applied to each make and
model. In addition, we review the comprehensive, collision,
bodily injury and property damage claim experience
annually to determine which makes and models have
earned decreases or increases from State Farm's standard
DRIVER Ili li: t EIII A"Fl014
Assigned Driver(s)
The following driver(s) are assigned to the vehicle(s) on this policy,
&StatwaM
rates. If any changes result from our reviews, adjustments
are reflected in the rates shown on this renewal notice.
Driving Experience as of Marital
Name June 28, 2021 Status
SCOTT MITNICK low
Other Household Driver(s)
In addition to the Principal Driver(s) and Assigned
Driver(s), your premium may be influenced by the
drivers shown below and other individuals permitted to
drive your vehicle. This list does not extend or expand
coverage beyond that contained in this automobile
policy. The drivers listed below are the drivers reported
to us that most frequently drive other vehicles in your
household.
Principal Driver & Assigned Drivers
For each automobile, the Principal Driver is the individual
who most frequently drives it.
Each driver is designated as an Assigned Driver on the
household automobile that they most frequently drive. Your
premium may be influenced by the information shown for
these drivers.
COVEI.11 A E AND L, IM'S See your policy for an explanation of these coverages
A
Liability
Bodily Injury 250,000/500,000
Property Damage 100,000
$223.92
C
Medical Payments 5,000 ........ m. ...........................................................................................................
$10.14
...................................
D
1000 Ded Comprehensive
$16.08
G--,_.............�...--
1000 Deductible Collision
$79.09
R1
Car Rental & Travel Expense
............................_
80% Per Day, $500 Max
_....................... ........ _.....
_............... $12.88
U
Uninsured Motor Vehicle
Bodily Injury 100,000/300,000
.. ..........................................._
$46.17
....... _.................... ._.._.._._._.
U1
Uninsured Motor Vehicle ._................._.._... .........................................
...... _........................
Property Damage _
$4.43
Additional Use of Non -Owned Car Coverage
(continued on next page)
Policy Number: 015 0305-F28-75G Page number 3 of 5
Prepared May 21, 2021
COVERAGE ClE AND It,,lIlMI"'II S continue
BIPD Liab
A St ��I!ryr
m .
$4.00
Medical Payments $1.60
Amount Due $398.31
Broad form non -owned car liability coverage is included.
If any coverage you carry is changed to give broader
protection with no additional premium charge, we will give
D1 SCOtYN rs These adjustments have already been applied to your premium.
Line
Multicar
Vehicle
you the broader protection without issuing a new policy,
starting on the date we adopt the broader protection.
1/
Driving Safety Record V
...............................
California Good Driver
............................................................... ._...._.._..._._._._.._.._.. ............ ---------- ._........ . .... _.......... .....
Loyalty
Total Discounts $1,740A7
Other Available Discount(s)
You may be eligible for additional discounts
See the enclosed insert for more information.
Mature Driver
SURCtiARGl'I;Ii;S RUIII':t III''flSCftUIIN' "'r'S
Driving Safety Record Rating Plan
Your driving safety record, along with other rating factors,
determines what you pay for Liability, Medical Payments,
Comprehensive, Collision, and Uninsured Motor Vehicle
Coverages. Policyholders with no accidents and convictions
pay less than those with accidents and convictions.
The Driving Safety Record Rate Level that is assigned to
your policy moves up, down, or stays the same every policy
renewal, depending upon your driving record. For every 12
months since the renewal following the occurrence of a
chargeable accident or the conviction of a minor violation,
the initial assigned Driver Record Level for that chargeable
accident or conviction shall be lowered by 1 level. For each
12 month period since the conviction of a major violation,
the initial assigned Driver Record Level for that conviction
shall be lowered by 2 levels. The Rate Level is increased if
there are subsequent chargeable accidents or convictions.
Definition of Chargeable Accidents
Chargeable accidents for new business are those which
resulted in bodily injury or death or in payment(s) by an
insurer due to damage to any property in the amount of
more than $1000. For accidents occurring prior to
December 11, 2011, an accident shall be chargeable
provided it resulted in death or in payment(s) by an insurer
due to damage to any property in the amount of more than
$750.
For applicants without prior insurance at the time of the
accident, an accident shall be chargeable provided it
resulted in damage to any property in the amount of more
than $1000 (more than $750 if the accident occurred prior to
December 11, 2011).
Chargeable accidents for renewal business are those which
resulted in bodily injury or death or State Farm claim
payments totaling more than $1000 (more than $750 for
accidents occurring prior to December 11, 2011) under
property damage liability coverage and collision coverage
combined.
For more information about the rating plan, please contact
your State Farm agent.
Superior Driver Rate Level
Policy Number: 015 0305-F28-75G
Prepared May 21, 2021
Page number 4 of 5
All II III'TIII IIIt IL IIII'tIF'OR A'TICIII
If any information on this renewal notice is incomplete or
inaccurate, or if you want to confirm the information we have
in our records, please contact your agent. For additional
information regarding discounts or coverages, see your
State Farm agent or visit statefarm.com®.
lu°nllpr°tant° IINotte Regairdling Your Il reumiiiiu.uuuin
State Farm works hard to offer you the best combination of price, service, and protection. The amount you pay for automobile
insurance is determined by many factors including:
• The coverage you have
• Where you live
• The kind of car you drive
• How the car is used
• Who drives the car
Any premium adjustment is reflected on this Auto Renewal. If you have any questions, please contact your agent.
Buying a new (mar? Remember to contact you it a eint!
When you buy an additional car or one that replaces a car already on your policy, you need to report the change to your agent
promptly. Even though the dealership you purchased the car from may offer to notify your agent or insurance company, you, as
the named insured, are responsible for reporting all changes to your auto policy. By contacting your agent, you can help:
• avoid any complications or lack of coverage in the event of an accident or loss,
• avoid insurance verification problems with a lienholder, the police, or the department of motor vehicles, and
• ensure that you receive any new discounts you may be entitled to.
Your current State Farm policy automatically provides certain coverages for a new or replacement car for up to a specified, limited
number of days after you take possession of the car. Please refer to your policy for the number of days that applies in your state.
If you have any questions about coverage for a newly acquired car, please contact your State Farm agent.
Disclaimer: This message is provided for informational purposes only and does not grant any insurance coverage. The terms and
conditions of coverage are set forth in your State Farm Car Policy booklet, the most recently issued Declarations Page, and any
applicable endorsements.
Policy Number: 015 0305-F28-75G Page number 5 of 5
Prepared May 21, 2021