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Evidence of Insurance <br />Policy Number: 18553-66-95 <br />Policy Edition: 1 st <br />Effective: <br />6/28/2016 12:01 AM <br />Expiration: <br />Continuous until cancelled <br />Expiration Time: <br />12:01 AM <br />Insured: <br />Stephen Solomon <br />Cynthia V Lavadia <br />17853 Santiago Blvd # 107-188 <br />Villa Park, CA92861-41 13 <br />Vehicle Information <br />Year <br />2016 <br />Coverages <br />Coverage Type <br />Make <br />Model <br />GmcTruck Yukon 4D 4X2 Denali <br />Bodily Injury Liability <br />Property Damage Liability <br />Permissive User Limit of Liability <br />Medical Coverage <br />Uninsured Motorist Bodily Injury <br />Comprehensive <br />Limit/Deductible <br />$500,000 each person <br />$1,000,000 each accident <br />$100,000 each accident <br />Full (See Permissive User Limit <br />of Liability in your policy) <br />$5,000 each person <br />$250,000 each person <br />$500,000 each accident <br />$100 Deductible <br />itVA <br />FARMERS <br />INSURANCE <br />Underwritten By: Mid -Century Insurance Company <br />6301 Owensmouth Ave. <br />Woodland Hills, CA91367 <br />YourAgent: EmberjoyStites <br />PO Box 61644 <br />Irvine, CA92602-6054 <br />(949) 588-0204 <br />FAX: (949) 266-9191 <br />estites@farmersagent.com <br />VIN <br />1 G KS 1 CKJXG R261059 <br />Coverage Type <br />Limit/Deductible <br />Collision <br />$250 Deductible <br />.................................................................................................................... <br />Additional Equipment <br />..................................................................................................................... <br />$1,000 <br />Uninsured Motorist Property <br />Damage With Collision <br />..................................................................................................................... <br />Covered <br />Towing and Road Service <br />..................................................................................................................... <br />Covered <br />Other <br />Covered <br />This evidence is subject to all of the terms, conditions and limitations set forth in the policy and endorsements attached to it. It is <br />furnished as a matter of information only and does not change, modify or extend the policy in anyway. It supersedes all previously issued <br />certificates. <br />farmers.com <br />25-8976 9-13 <br />Page 1 of 2 <br />