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~ <br />Other Household Driver(s) <br />In addition to the Principal Driver(s) and Assigned <br />Drlver(s), your premium may be influenced by the <br />drivers shown below and other Individuals permitted to <br />drive your vehicle. This list does not extend or expand <br />coverage beyond that contained in this automobile <br />policy. The drivers listed below are the drivers reported <br />to us that most frequently drive other vehicles in your <br />household. <br />SANDRA MEDINA <br />ANTONIO R MEDINA <br />ALEXIS MEDINA <br />Principal Driver & Assigned Drivers <br />For each automobile, the Principal Driver is the individual <br />who most frequently drives it. <br />Each driver is designated as an Assigned Driver on the <br />household automobile that they most frequently drive. Your <br />A State Farm <br />premium may be influenced by the information shown for <br />these drivers. <br />CO VERA GE AND LIMITS See your policy for Bn exp/an8tion of these coverages. <br />A Liability <br />Bodily Injury 25,000/50,000 <br />Property Damage 25,000 <br />H Emergency Road Service <br />u Uninsured Motor Vehicle <br />Bodily Injury 25,000/50,000 <br />U1 Uninsured Motor Vehicle <br />Property Damage <br />Total Premium <br />If any coverage you carry is changed to give broader <br />protection with no additional premium charge, we will give <br />DISCOUNTS These adjustments have already been applied to your premium. <br />Multicar <br />Driving Safety Record <br />California Good Driver <br />Loyalty <br />Total Discounts <br />Polley Number: 737 4537-F 10-758 <br />Prepared October 18. 2024 <br />106769 <br />$364.02 <br />$4.18 <br />$34.48 <br />$1123 <br />$413.91 <br />you the broader protection without issuing a new policy, <br />starting on the date we adopt the broader protection. <br />✓ <br />✓ <br />✓ <br />✓ <br />Page m.mber 3 of 5 <br />□