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_ AGENCY CUSTOMERIO: 00011400 <br />AC® ® VEHICLE SCHEDULE DATEIMMIDDIYYYYI <br />07/03/2019 <br />AGENCY CARRIER NAIC CODE <br />Crescenta Valley Insurance California Auto 38342 <br />POLICY NUMBER EFFECTIVE DATE NAMED INSURED(S) <br />BA040000014964 �05/15/2019 MARK SANDERS <br />VEHICLEDESCRIPTION <br />GARAGING 51REET(R qulmd In KY) CITY COUNTY I STATE ZIP <br />ADDRESS 4758 Promenade StX <br />_ . Simi Valle _ CA 1 930630411 <br />STATE TERR GVWIGCW CLASS SIC FACTOR SEAT CP RADIUS, FARTHEST TERMINAL COST NEW <br />_ 10 000_ 1 100 I', § 39,010 <br />USE t COMML FOR HIREY HFCN �� Ar)D'I Nil 9 - t UNORIN9 F (�yf �iER'f� pEOUCTIpLES -' 7CQMPIT $PEC <br />I ) : COVERAGES �,„I FAULT 1J) MOTOR _ y X REIMU OCC VCQR <br />PLEASURE RETAIL TOWING IT IGOMPI r -r <br />I X LIAG MEO PAY S LABOR _ X OTC FG AA ) _ 1ST AMT j § 500 <br />FARM I SERVICE j NU UN1N3 SPEC FTW I GOLL <br />1V _...L.� c�w.F_'.aosal�� _ osT�.L :.�x�.__._ _ $ -- ._.1$__ 5000OL <br />DRNET(F �— <br />C <16 MAPS i6 MILE3+ 'NET VEH � ` <br />I T T P F.'. <br />VEHU 1 YEAR MAKE RAM TYPE; Trl1Ck VEHICLE TYPE SYM IAGE OTGM5YMj 90M <br />2 2015 j------ RAM TRUCK 1500 ST N.:1C6RR6FTXFS762581 �P?��sPEc F� coML �a <br />GARAGING; STREET(Rogn1nd In KY) CITY COUNTY I STATE ZIP <br />AOOR688 4758 Promenade St [Simi Valley ( CA ,93063 0411 <br />STAIR TERR GVWIGCW CLASS SIC FACTOR �SEATCPI RADIUS I FARTHEST TERMINAL COSTNEW <br />i0000 _[j ; 100 _ § 29,645 <br />USE T X I COMM'L rOR HIRE 1 ERAGR$L_ FAULTNO —t MOTTRORS . �� F LSP X M OEyOUCTIGLE6 X ACV X 1GOTC2 Tc)OF <br />PLEASURE i -�j RETAIL 3 I X s TOWING FT X- OTCCOMFO r <br />{. 1X LwB I IMEDPAY _JRLAHOR X OTC aM L.. STAMT $_ 500 <br />FARM SERVICE } NO UNIN9 ( (SPEC f i FTW GOLL <br />,FAUL$ 1�FcnsRt _t C�eL 1 _. $ ___ -., s __ 500coL <br />DRIVE TO i ) 16 —MILES 1fi MILE3 ( Cr YEd -- I <br />K/ CH GL t i R TOTAL PREM,, <br />VENft YEAR MAKE DODGE By VEHICLE TYPEm SYM I AGE Io��M SYM <br />3 120111 MODEL RAM 3500 PICKUP 6 N. 3D73M4CLXBG624553 sPEc oML <br />1 _[ �— <br />GARAGING ,STREET Roqui ad In KY) ( CITY COUNTY i STATE 1 ZIP <br />AOOREss l_4758 Promenade St _ .51 n11 Valley € CA t93063 0411 <br />-- --._ - - <br />STATE TERR GVWIGCW 4 CLg35 SIC FACTOR SEAT CP RAOIU6 FARTHEST TERMINAL t COST NEW <br />20,000 L ( 100 _ § 52405 <br />_ .. -- <br />USE COMM'L POR HIRE GHECR Nip` NP UNQWPi9 1 F LSP �iCliF DEUUCTIDLES T V L V{40MPii SPEC <br />1 GO�ERAGES _ FAUL .... MOiaR ( „1,1 REIME _ _ f� q V, Fll OTC IC OF <br />PLEASURE RETAIL TOWING RT �+ COME, IFG C <br />i x LIAD _ MEU PAV 1 & LABOR {y; OTC M _ ST ANIT $ _ 500 _ <br />FARM SERVICE RC^' tR3iNG <f G - _ <br />AS <br />_i- ��_�� u_ ALA.T UN <br />i. __ sf L FTw + cou .. 5 4IS _ 5000oL1 <br />ORitFSOHCOL� 15 MILES 1 115 MILES OR i TO ALPRCsM: <br />VEHMAKE: .NSSAN ,.,, DOtlYPCku VEHICLE TYPE .SYM, AGE: CLSYM:SOM <br />zii ,, _� <br />4 2004 mopEL:FRONTIER CREW CAB SC vIN 1N6MD27T84C451907 PP !PEC GOMI <br />_ _ _ 1 �1 _. <br />GARAGING I STREET (R qui P,d In KY) CITY ` COUNTY STATE ZIP T <br />ADORES! i4758 Promenade St [Siml Valle <br />uc _ T. ,,.._. .ley �...n. __ 93083-0411 <br />STATE TERR GVW lGCW CLg35 SIC FACTOR lEATCP RADIUS FARTHESTTERMINAL 00STNCW <br />_III <br />. _...._ .,L-._. �CNEERAGES MOTTOR ..'GGFRLGB COMP, ii}NT____ $EOUCTIaLE& 5 aOTC 10 000 100 § 24 <br />USE COMM'L FOR HIRE F LSP f ICOMPII SPEC <br />OOVERACES _ RE eMe ACV :OTC t•OF <br />1 <br />PLEASURE RETAIL LIAR _ MEOPAv FT FG M 3TAMT s _ None <br />" 3 _ &LABOR (oTc I k <br />FARM SERVICE 1 N{q�O £ �• UNINS T BPEC FINN DOLL NonecOLl <br />Drove TO 15 MILES �ffi u1GMILESr INET VEH <br />1 K45GH00 _ 1 1 C TGiY 1-PREM1 <br />VEHk YEAR (MAKE DODGE _ PICkGi - VEHICLE TYPE BY AGE IOTC SYMj SYM <br />2 ' 2003 MODE RAM 1500 PICKUP V8 1 D7HA16D53J635509 __j i sPee coML <br />i_ <br />GARAGING 3TREET(RylrPdi KY) CITY ICOUNrY <br />STATE ZIP <br />ADORE33 _ _4758 Promenade St S_iml Valle __ CA _ 93os3 0411 <br />- — — _... <br />ST TE TERR GVW/GCW CLASS I SIC 1 FACTOR iSEAT CP RADIUS FARTItE9TYEFiMlMA4 COST NEW <br />10,000 _ 00 _ ' $ 22_,040 _ <br />CHECK, TnOpLNO=-{UNORINS T � RENT bOMPI =gnu+" <br />USE GOMML FOR HIRE .&C$YErtAGE$'.v� FAULT MOTOR i F {LSPj CMpp}VgTLL16F$ V{ACV, I OTC ` 3CdFPLEASURE RENL V TOWING PT COMPIF0 S�nIIAB MEU PAV &LABOR OTCAA ( SrAMR 5 NOnE <br />NO= v u§nNR 'cOF s $ Nonecara <br />FARM SERVICE __. t1FAVLr I X MOTQtiGOhL FPN DOLL OR[VE"fC_ury i <15 MILES[ I15 MILE ttom Pi _ _ v ttltnr nRwu.s <br />AKr_v The ACORD name and logo are registered marks of AGORb IN <br />�y/�\ Printed by JAB an July 03. 2019 at 01:29PM lj�j <br />C <br />Risk Management Divisior`I <br />