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FARMERS <br /> Auto Insurance Declaration Page INSURANCE <br /> Policy Number: 18488-82-32 Premiums/Fees <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Effective: 9/24/2025 12:01 AM Policy Premium $2,318.00 <br /> Expiration: 3/24/2026 12:01 AM <br /> Named Insured(s):Claudia S Perez Fees(*also see Information on Additional $1.76 <br /> 2071 S Eileen Dr Fees below) <br /> Anaheim,CA92802-3906 <br /> Policy Premium and Fees $2,319.76 <br /> e-mail claudiasperez33@yahoo.com <br /> Address(es): This is not a bill. <br /> Underwritten By: Mid-Century Insurance Company <br /> 6301 Owensmouth Ave. <br /> Digitally signed <br /> Woodland Hills,CA91367 Tu Tran byTuTran APPROVED <br /> Nguyen <br /> Nguyen Date:2025.08.27 By Tu Tran Nguyen at 7:17 am,Aug 27,2025 <br /> Household Drivers 07:18:02-07'00' <br /> All persons who drive or will occasionally be driving any of the cars on the policy should be listed below.If anyone is missing or needs to <br /> be added,such as a newly licensed driver,you should contact your agent or the company to add that person before they begin to drive <br /> any of the cars covered on the policy. <br /> Name DriverStatus Name DriverStatus <br /> Claudia S Perez Covered Felix E Figueroa Covered <br /> ..................................................................................................................... <br /> Monique Perez Excluded <br /> Vehicle Information <br /> Veh.# Year/Make/Model/VIN Coverage Deductible Limit <br /> 1 2009 Toyota Corolla Sedan 2Wd Std/Le/Xle Comprehensive: $100 <br /> JTDBL40E499070628 Collision: $1,000 <br /> -------------- - -- -- -- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 2 2003 Nissan Xterra 4Door4X2 S/C Comprehensive: $100 <br /> 5N1 MD28T03C646816 Collision: $1,000 <br /> Coverage Information <br /> Limits .........................................................................................................Premiums by Vehicle <br /> ................................ <br /> Coverage (applicable to all vehicles) Vehicle 1 Vehicle 2 <br /> Bodily Injury Liability $500,000 each person $365.00 $408.00 <br /> $500,000 each accident <br /> ---- --- ..............................__..__ - _....... ...._......_....... ..... ..... ..... ..... ..... ...._......_......_......_......_......_....................... - ..... ..... .... <br /> Property Damage Liability $500,000 each accident $238-00 $241-00 <br /> ----------------------------------------------- ----------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Permissive User Limit of Full(See Permissive User Included Included <br /> Liability— Limit of Liability in your <br /> policy) <br /> ----------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ <br /> Medical Coverage $5,000 each person $33.00 $30.00 <br /> ----- ------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> Uninsured Motorist Bodily $250,000 each person $132-00 $137-00 <br /> Injury $500,000 each accident <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> Comprehensive $69.00 $72.00 <br /> -----....._... -------------------------_._.....--------------...__.----------------------------..._._......_..._._.....-----------------------------------......_......_......_.-------------------------------------------------- <br /> Collision $235.00 $239.00 <br /> farmers.com Policy No. 18488-82-32 Questions? Manage your account: <br /> Call your agent John McIver at(714) Go to www.farmers.com to access <br /> 540-5200 or email your account any time! <br /> j mciverl @farmersagent.com <br /> 56-6176 2nd Edition 3-19 7/31/2025 <br /> Page 1 of3 <br />