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Po im-Y DECLARATIC)NS <br /> NEW POLICY <br /> Account: CALIFORNIA LOW COST POLICY <br /> CA Aut-omobilc Insurancc Plan <br /> A.I.P. Casc No.: 202520900599 <br /> Insurer: 21st Century Centennial Insurance Co <br /> The Policy Period Begins and Ends at 1201 A.M. <br /> Standard Time From 07R5R5 To 07R5126 <br /> Effective Date of Change:07/25/25 <br /> DRIVER NAME LICENSE NUMBER BIRTH DATE <br /> 1) MAGALI ALARCON CANCINO <br /> 2) MADISON ROMERO ALARCON <br /> ENDORSEMENTS. <br /> AR-POLJAC(08/22) PPA 00 02.2 PPA 12 01.7 PPA 90 29.0 <br /> PPA 90 33.0 <br /> 01 08/13/25 Page 2 of 2 Form AR D-105(1/06) <br />