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PERSONAL AUTOMOBILE POLICY ,amended Declaration effective <br />AIowaMENDED DECLARATION Sep 06, 2024 <br />117SUIVIMP Supersedes any previous declaration hearing <br />the same policy number far this policy period. <br />ANTHONY H TRAM <br />KIM LE <br />6821 ACACIA AVENUE <br />GARDEN GROVE GA 92841 <br />Policy plumber Account Number <br />41095650 132790791-1 <br />Policy Period <br />From Sep 06, 2024 to Mar06, 2925 <br />WAWANESA INSURANCE <br />PO BOX 82887 <br />SAN DIEGO CA 02138-2422 <br />TELEPHONE. 800.640.2020 <br />12_01 A.M. standard time at the address of <br />the Named Insured as stated herein <br />Information effecting your insurance premium was obtained from a Motor Vehicle Record or CLUE report supplied by <br />LexisNexisO. The interpretation of the information and decision regarding an increase in premium, however, was made <br />by Wawanesa Insurance and not LexisNexisO. A copy of this report is available to you at no charge from LexisNexise <br />if requested within 60 days. You have a Fight to dispute the accuracy andlor completeness of the information contained <br />in the report directly with LexisNexisO and LexisNexis& Consumer Service Center, P.O.. Box 105108, Atlanta, GA <br />30348-5108, by phone at 1-800-456-6004 or through their website at httpsJiwww-con sumerdisclosure.ccrm. <br />You may request additional information about this decision, and the personal information used to make this decision, <br />by submitting a written request to Wawanesa General Insurance Company, P.O. Box 82867, San Diego, California, <br />92138-9492, if requested within 90 days. Additional information on your rights can be found in our Primacy Notice at <br />www.wawanesa.com. <br />Driver(s) <br />Driver Name rIncipal Operator of Vehicle Number 4acasionat Operator of Vehicle Number <br />Antl mny H Tran 1 2 <br />Jonattmn Tran <br />Kim Le <br />Amanda Tian <br />Exclusion of Named Dlrlver(s) <br />Excluded Driver(s) <br />THOI TR.AAN <br />Relationship to Insured <br />Relative <br />2 i 1 <br />POLICY AND ENDORSEMENTS THAT ARE PART OF YOUR CONTRACT WITH US. <br />REMAIN IN EFFECT (Refer to prior Policy Packet(s) for documents not attached.): <br />California - Designated Additional Person To Receive Notice of Cancellation or Nonrenewal (CA CAPE 09 21), Personal Auto Policy - <br />California (CAPAP 0 21), Community Service Statement (CSS), Available Coverages & General Coverage Descriptions (CACOV 09 <br />21), California Notice of Designated Additional Person to Receive Notice of Cancellation (CAOAP 09 21), Disclosure of Fees - California <br />Auto (CADCFA 04 22}, Minimum Liabillty Coverage Limits and Available Discounts (CADIS 09 21 }, California Roadside Assistance <br />Identity Card (RAIC), Vehicle Identification Cards (VI'O) <br />ADDED: <br />California Roadside Assistance Identity Gard (RAID 1) <br />01 <br />APPROVED <br />By Cynthia Mora at 4:48 pm, Dec 10, 2024 <br />Aug 20,202414,28cT-Wawanesa Insurance' is a trademark of WAwanesa General Insurance Company <br />