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Interinsurance Exchange of the Automobile Club <br /> Automobile Insurance Policy Coverages and Limits <br /> Renewal Declarations <br /> We are pleased to offer you a renewal for your automobile insurance policy. To renew your policy, send at least the minimum payment on or <br /> before the due date. Insurance is in effect only for the vehicles, coverages,and limits of liability shown on this declarations page and as set <br /> forth in the insurance policy and endorsements. These declarations, together with the contract and the endorsements in effect, complete your <br /> policy. If any change to your policy or to the information we have on file results in a premium decrease during the policy period, the <br /> Interinsurance Exchange reserves the right to apply any refund due to your outstanding balance. <br /> n <br /> NAMED INSURED(Item 1.) <br /> AUTO POLICY NUMBER:CAA 106439778 <br /> BUSH, TAMARA POLICY PERIOD(PACIFIC STANDARD TIME) <br /> 68 GARRISON LOOP POLICY EFFECTIVE DATE: 06-06-25 12:01 A.M. <br /> LADERA RANCH CA 92694-0605 <br /> POLICY EXPIRATION DATE: 06-06.26 12:01 A.M. <br /> VEHICLES <br /> VEH, IDENTIFICATION VEHICLE GARAGE ANNUAL** VERIFIE6 <br /> NO, YEAR MAKE MODEL NUMBER USE ZIP CODE MILES MILEAGE SALVAGE <br /> 1 2013 GMC ACADIA DENALI 1GKKRTKD7DJ164026 COMMUTE 92694 12,501 -15,000 VERIFIED NO <br /> COVERAGES AND LIMITS ANNUAL PREMIUMS <br /> Coverage Is not In effect unless a premium or the word"Included"is shown. <br /> COVERAGES LIMITS OF LIABILITY Vehicle 1 Vehicle Vehicle Vehicle Vehicle <br /> Liability <br /> Bodily Injury $50,000 each person/ $100.000 each occurrence $896 ; <br /> Property Damage $25,000 each occurrence $506 <br /> Medical <br /> Medical Payments $5,000 each person $60 <br /> Physical Damage (Actua[Cash Value unless otherwise stated,less deductible) <br /> Vehicle 1 Vehicle Vehicle. Vehicle Vehicle t <br /> Comprehensive ACV l $153 I [ I <br /> (Less Deductible) $500 <br /> Collision ACV $745 <br /> , <br /> (Less Deductible) $500 <br /> Car Rental Expense <br /> (Per Day) $45 I $109 <br /> Uninsured Motorist <br /> E E <br /> Bodily Injury- $50,000 each person/ $100,000 each accident $429 <br /> Uninsured&Underinsured Vehicles <br /> Uninsured Deductible Waiver Included <br /> Uninsured Collision No Coverage; <br /> Total Premium $2897 <br /> PREMIUM DISCOUNTS "No Coverage" indicates coverage not purchased. <br /> Please refer to the enclosed document entitled"Premium Discounts Applied to Your Automobile Policy." Total Annual Premium* <br /> (Includes all applicable discounts.) 2$97 <br /> * <br /> If at any time you choose to pay less than the full balance outstanding, <br /> finance charges of up to 1.5% per month of the balance outstanding will apply Less Policyholder Savings Dividend $391 <br /> as explained in your billing statements, which are part of these declarations. Net Premium* $2506 <br /> ** To see the annual mileage for your expiring policy, please refer to the <br /> "Notice of Annual Mileage"page contained in your renewal package. <br /> CAA0200A <br /> F20210301 PROCESS DATE 04-29-25 PLEASE ATTACH TO YOUR POLICY (SEE REVERSE) <br /> 043025 <br />