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86698-4-P MATCH 00534 MUTL VOL <br />StateFarm <br />State Farm Mutual Automobile Insurance Company <br />® PO Box 853922 <br />Richardson, TX 75085-3922 <br />NAMED INSURED 00534 <br />75-7501-4 P <br />000535 0058 <br />NANCY K BOHL INC <br />DBA THE COUNSELING TEAM <br />INTERNATIONAL <br />PO BOX 10427 <br />SIN BERNRDNO CA 92423-0427 <br />DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. <br />IF AN AMOUNT IS DUE, THEN A SEPARATE STATEMENT IS ENCLOSED. <br />YOUR CAR <br />DECLARATIONS PAGE <br />PAGE 1 OF 2 <br />POLICY NUMBER 441 4187-F24-75W <br />POLICY PERIOD OCT 31 2019 to JUN 24 2020 <br />12:01 A.M. Standard Time <br />AGENT <br />SKALA INSURANCE AGENCY INC <br />4214 N SIERRA WAY <br />SIN BERNRDNO, CA 92407-3896 <br />PHONE: (909)883-8861 <br />YEAR MAKE MODEL BODY STYLE VEHICLE ID. NUMBER CLASS <br />2017 BMW X5 SPORT WG 5UXKR6C36HOU13705 600HCV11 <br />SYMBOLS COVERAGE & LIMITS PREMIUMS <br />A <br />Liability Coverage <br />$702.91 <br />Bodily Injury Limits <br />Each Person, Each Accident <br />$1 ,000,000 $1,000,000 <br />Property Damage Limft <br />Each Accident <br />$1,00.0,000 <br />D <br />Comprehensive Coverage - $1,000 Deductible <br />$139.21 <br />G <br />Collision Coverage-$1,000 Deductible <br />$508.25 <br />R1 <br />Car Rental and Travel Expenses Coverage <br />$44.33 <br />L m.A - Car Rental Expense <br />Each Day, Each Loss <br />$50 $1,200 <br />U <br />Uninsured Motor Vehicle Coverage <br />$75.91 <br />Bodily Injury Limits <br />Each Person, Each Accident <br />$1001OQQ $300n0.00 <br />U1 <br />Uninsured Motor Vehicle Property Damage Coverage <br />$10.37 <br />Additional Use of Nop-0wried Car Coverage <br />BIPD Liability <br />$5. 18 <br />Physical Damage <br />$25 , 88 <br />Total Premium for OCT 312019 to JUN 24 2020. $1,511,74 This is not a bill <br />IMPORTANT MESSAGES <br />Replaced policy number 4414187-75V <br />Your total renewal premium for DEC 24 2019 to JUN 24 2020 is $1,160.84. <br />Location used to determine rate charged-36442 WILDWOOD CANYON RD, YUCAIPA CA 92399-5274. <br />CONTINUED <br />06813/07236 See Reverse Side <br />155-3866 CA 05-2002 (ot 025tc) <br />115X0N (o1 a0251e) <br />�oRaN <br />IZAManagmerdl)Msian <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />