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<br />'; ENCOMPASS_ <br />INSURANCE <br /> <br />ij8P Elite - Package <br />~mendedPol,jcy Cove,ra!l~Summary " <br /> <br />." "',"~.. ~":' '.- 'ii:; . i'R"i ,.,;::;" ~'-;S:(r;;;;i:::M';:~i?'::i'" , . '-',1']. <br /> <br />Policyholder: <br />KRISTIAN KRAUSE <br />21682 VINTAGE WAY <br />LAKE FOREST CA 92630-5759 <br /> <br />Policy Number: <br />261211892 <br /> <br />":;;.;; <br /> <br />Agent: <br />WALTER MORTENSEN INS <br />4701 STOCKDALE HWY <br />BAKERSFIELD CA 93309 <br />PHONE, 661-834-6222 240-007770-00'0 <br /> <br />Policy Period: <br />03/23/2005 to 03/23/2006 12:01 AM Standard Time <br /> <br />Policyholder Since: <br />03/2004 <br /> <br />This is a replacement 01 policy 218450853 <br /> <br />Insurance Provided By: <br />Encompass Insurance Company <br />2775 Sanders Rd.; Northbrook, IL 60062-6127 <br /> <br />24 HOUR CLAIM REPORTING 800-588-7400 <br /> <br />YOUR POLICY HAS BEEN CHANGED <br />A change in name of insured <br /> <br />Chg named insrd to maiden name: Kruase <br /> <br />Revised Annual Policy Premium <br />No change in premium <br /> <br />$ 2,266.00 <br /> <br />This COVerasl& Summ~rY <br />~pre5..nl$.l'9Ur *~'L_^ <br /> <br /> <br />MOTOR VEHICLE PROTECTION <br /> <br />(Coverage applies only II a premium or limit is shown) <br /> <br />Description: <br />VIN: <br />Rated Driver: <br />Use: <br />Class Code: <br />Estimated Annual Mileage: <br /> <br />c;PV~~~G~.!,!~:~"j~j!~*At~~f:'~~if:~~f~.\[lt~1; <br />BODILY INJURY <br />(per person/per accident) <br />PROPERTY DAMAGE <br />(per accident) <br />MEDICAL EXPENSE <br />UNINSURED MOTORISTS - <br />BODILY INJURY <br />(per person/per accident) <br />COLLISION DEDUCTIBLE <br />WAIVER <br />(per accident) <br />COMPREHENSIVE (Camp) <br />COLLISION (Call) <br />TOWING <br /> <br />261211892 <br /> <br />Vehicle 1 <br /> <br />Vehicle <br /> <br />2004 CHEVY TRUC TRAILBLAZER <br />lGNDT13S842117211 <br />KRISTIAN KRAUSE <br />Pleasure <br />661100 <br />15000 <br /> <br />~'M.h~~wi!~l~l~,f~~~~ i_!iMjt~~ <br />$ 250,000/500,000 $ 451.00 <br /> <br />R~l'~I\I!lf,!.;,c~ <br /> <br />$ 25,000 $ <br /> <br />139.00 <br /> <br />$ 5,000 $ <br /> <br />42.00 <br /> <br />$ 250,000/500,000 $ <br /> <br />86.00 <br /> <br />Per Endorsement $ <br /> <br />18.00 <br /> <br />$ 250 Deductible $ <br />$ 500 Deductible $ <br />Reasonable Expense $ <br /> <br />145.00 <br />430.00 <br />lncluded <br /> <br />~~,~ <br />Ch.Hl'nlln af~hfI Board S-.:r.,. <br /> <br /> <br />~OOOOOCA050JD10J031l0600000DO0004002" <br /> <br />~ <br /> <br />Continued on Next Page <br /> <br />Page 01 of 05 <br />