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PROOF OF INSURANCE (2019) CLOSED (2)AUTO POLICY 015 0305 -F28 -75G 2008 VOLVO XC90 SPORT WG Review your policy info or make changes. Recent policy activity may not be reflected. Contact your agent if you need help with a transaction. Policy owner(s) MITNICK, SCOTT & Renewal date 12/28/2019 Policy mailing address Vehicle premium $431.30 / 6 mos State Farm Payment Plan account number Pay a bill Annual mileage 10,000 VIN Vehicle use To work, school, or pleasure Address where principally garaged Add or replace vehicle Change garage address Change vehicle usage Liability Coverage Bodily Injury Limits What would you like to do? Select one Gc Each Person, Each Accident $250,000 $500,000 Property Damage Limit Each Accident $100,000 $247.07 / 6 mos Medical Payments Coverage Limit - Each Person $5,000 $10.26 / 6 mos Comprehensive Coverage - $1,000 Deductible $17.75 / 6 mos Collision Coverage - $1,000 Deductible $87.14 / 6 mos Car Rental and Travel Expenses Coverage Limit - Car Rental Expense Each Day, Each Loss 80%$500 $12.88 / 6 mos Uninsured Motor Vehicle Coverage Bodily Injury Limits Each Person, Each Accident $100,000 $300,000 $46.17 / 6 mos Uninsured Motor Vehicle Property Damage Coverage $4.43 / 6 mos Use of Non -Owned Car Coverage BIPD Liability $4.00 / 6 mos Payments $1.60/limos Change coverages Drivers Primary driver Scott Mitnick Age Assigned driver Scott Mitnick Age Add a driver Change primary driver Multiple Line, Driver Safety Record, California Good Driver, Multicar, Loyalty, Vehicle Safety Total: $1,890.51 / 6 mos Currently, there are no surcharges applied to your policy. Endorsements 6091Z CERTIFICATE OF GUARANTEED RENEWAL 6126MD EXCESS COVERAGE FOR PERSONAL VEHICLE SHARING 6128AC AMENDATORY ENDORSEMENT 6033BL USE OF NON -OWNED CARS - COMPREHENSIVE COVERAGE AND COLLISION COVERAGE; SCOTT MITNICK; $30,000 LIMIT. 6049CB USE OF NON -OWNED CARS -LIABILITY AND MEDICAL PAYMENTS (BROA D NAME FORM); SCOTT MITNICK. Declarations & Policy Information The information presented in this document is not a declarations page, policy, or endorsement. Recent changes to the policy may not be reflected. The coverages and descriptions are only general descriptions, and are not part of the contract. If you have any questions about this form or would like to obtain a declarations page or a copy of your policy, please contact your State Farm Agent for assistance. © Copyright, State Farm Mutual Automobile Insurance Company, 2019 State Farm, Bloomington, IL --3-