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�(/awanesa PERSONAL
<br />AUTOOr t�Ranw
<br />MOBILE POLICY Deuereuon ec«we
<br />IfiSU/dlI/Ce DECLARATION Mar O8, 2025
<br />,1 t2pt AM Pmaama na Pemwm re�,e,-ywrpM�ry r« w parka
<br />slvrvm. II ywn paymamM-ro rewieved aela,e Ma, D6. 2025 nN Oiler la Renee WI M null em veld.
<br />MTHDW H TRAN WAWAN ESA INSURANCE
<br />KIM LE PO BOX 82867
<br />882/ ACACWAVENUE SAN DIEGO CA 92138-9492
<br />GARDEN GROVE CA 92841
<br />TELEPHONE: 800440-2920
<br />Policy Number Account Number
<br />Policy Period 1201 A M. nand vo Ems m the address of
<br />41895650 132190791-1
<br />From Mar 06, 2025 W Sep 06. 2025 ms Named Insured as slaletl herein
<br />Named Ineum- P— Number. 714-722-5887 Named I.—d'e Eman Addrv--yhlran8821@9-1.wm
<br />Your 6 month premium for four (4) vehicle(.) is Refer to the breakdown of premiums bell
<br />Description of Owned Vehicles)
<br />Vehicle Year Make Motel Vehicle MaMMeatlon Number Premiunw Whlile(S)
<br />1 2D23
<br />Toyota CAMRY
<br />SE/SE
<br />4T1T11AK0PU773811
<br />NIGHTSHADE
<br />2 2D15
<br />I— RX
<br />Sep
<br />2T22K18AXFCMWW
<br />3
<br />2021
<br />Toyota COROLLA
<br />LE
<br />5YFEPMAS4MP151714
<br />4
<br />T015
<br />Toyota CAMRY
<br />LE/SE/XLEXSE
<br />4T1BFIFK4FU089834
<br />Premium Subtotal for Vehicles
<br />Insurance is provided only with respect to the coverage. for which a Premium Is stated, subject to all conditions
<br />of the policy.
<br />Coverage and Limits of Liability Premiums per Vehicle (f)
<br />See Policy ter Wvwage Details
<br />1
<br />2
<br />a
<br />4
<br />Bodily Injury Liability
<br />$100000 per must'S300,m0 exhoavmnca
<br />Property Damage Uability
<br />$100.000 eadl oa--
<br />Medical Payments
<br />85.000 each parson
<br />Comprehensive
<br />.1,000 da rotale
<br />Coal
<br />$1,000drouoible
<br />Roadside Assistance
<br />Rental Expanee
<br />$40 day181300 max each revered bee
<br />Unirrsured4)ndminsured Motorists Protection
<br />$30.000 per person/380,000 sad, aaunence
<br />Feb m,—a CT "Wawa.... Insurance' is a trademark of Wawanesa General Insurance Company
<br />Q/ar�rnesa PERSONAL Oee oRemw
<br />AUTOMOBILE POLICY De tenc on aff —
<br />/nSaronce NO DECLARATN Mar 08, 2025
<br />caee,s9a a- 2025, al 12-1 A.M. Pen,wnta Me premium nrewe yw,rparry r«uce pence
<br />nine.. nywr paymmt H „e,aramad e.N,. M.roe,an nn oar to am..:n a nMl sad Vero.
<br />ANT OW H TRAN WAWA N ESA INSURANCE
<br />KIM LE PO BOX 82867
<br />8821 (A 9-1t GROVE CA ACACMA SAN DIEGO CA 92138-9492
<br />GARDEN
<br />TELEPHONE: 800fi40-2920
<br />Policy Number Account Number Policy Period 12:01 A.M.-bnoxm timeal theaddress of
<br />41895650 132790791-1 From Mar O6, 2025 to Sep D6, 2D25 ma Named Imuee es -urea herein
<br />Information affecting your insurance premium was obtained from a Motor Vehicle Record or CLUE report supplied by
<br />LexisNexis4). The interpretation of the information and decision regarding an increase in premium, however, was made
<br />by WSwanesa Insurance and not LexaNexis®. A copy of this report Is available to you at no charge from LexisNmrle®
<br />if requested within 60 days. You have a right to dispute the accuracy and/or completeness of the information contahad
<br />in the report directly with LeAshlexil and LexisNexis® Consumer Service Center, P.O. Box 105108, Atlanta, GA
<br />30348-5108, by phone at 1-800456-6004 or through their website at hbps//—coneumordisdos.-com.
<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. You may also submit a written request to have access to your recorded personal
<br />information, or you may request to correct amend or delete your personal Information. Additional information on your
<br />rights can be found in our Privacy Notice at www.wawa resa.com.
<br />Oriver(s)
<br />Driver Name
<br />Principal Operator of Vehicle Number Occasional Operator of Vehicle Number
<br />Armory H Tren
<br />1 2
<br />Me— Tran
<br />3
<br />Kim La
<br />2
<br />1
<br />Jon -an Trm
<br />4
<br />Exclusion of Named Driver(s)
<br />Excluded Ddvolq Relationship W Insured
<br />THOI TRAN Relative
<br />POLICY AND ENDORSEMENTS THAT ARE PART OF YOUR CONTRACT WITH US.
<br />REMAIN IN EFFECT IReler to prior Policy Packed.) far documents not attached):
<br />Cal9omia - Designated Additional Person To Receive Notice of Cancellaton or Nonrenewal (CADAPE 09 21), Personal Aux, Policy -
<br />CalNomia (CAPAP 09 21), Community Service Statement (CBS), CAN— Notice of Designated Additional Penton to Receive Notice of
<br />Cancellation (CADAP 09 211
<br />ADDED:
<br />Val IdendBcatbn Came (VID 1), California Roadside Assistance Identity Card (RAIL 1), Auto Notice of Coverage Change (MCC
<br />1), Disclosure of Fees - Cal'rfomia Auto (CADCFA 1124), Minimum Liab,idy Coverage Limits and Available Discounts (CADIS 0125),
<br />CalBomla Automobile Amendatory Endorsement (CAE 01 25) AVaiable Coverages S General Coverage 0escnptiom (CACOV 01 25)
<br />Digitally signed
<br />Tu Tran byT.Tran
<br />Nguyen
<br />Nguyen 11501 30-08006
<br />Pee oo 2a25 m.22 ci "WawanesaInsurance" is a trademark of Wawanesa General Insurance Company
<br />APPROVED
<br />By Tu Tran Nguyen at 3:01 pm, Mar 06, 2025
<br />
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