Laserfiche WebLink
Binder for State Farm Automobile Insurance <br /> Applicant Agent <br /> AUSTIN QUACH Kelly Duong Insurance Ag <br /> 15911 ROCHESTER ST 14256 Beach Blvd <br /> WESTMINSTER, CA 92683-7654 Westminster, CA 92683-4562 <br /> (714) 891-5500 <br /> Vehicle <br /> Year: 2020 <br /> Make: FORD <br /> Model : TRANSIT 350 <br /> Bodystyle: MEDIUM ROOF 2WD <br /> VIN: 1FBAX2CG5LKA75214 <br /> Customized: No <br /> The premium shown below must be in compliance with the Company' s rules and rates <br /> and is subject to revision. <br /> Coverage Applied for: Semi-Annual <br /> Limits Premium <br /> BODILY INJURY AND 25/50/25 * $504 . 75 <br /> PROPERTY DAMAGE LIABILITY <br /> MEDICAL PAYMENTS COVERAGE $5000 $65 . 95 <br /> COMPREHENSIVE $250 DEDUCTIBLE $179.26 <br /> COLLISION $1000 DEDUCTIBLE $561 . 59 <br /> EMERGENCY ROAD SERVICE $3 .28 <br /> CAR RENTAL/TRAVEL EXPENSES $50/DAY, $1200 MAX $35 . 96 <br /> UNINSURED MOTOR VEHICLE 25/50 * $88 . 95 <br /> UNINSURED MTR VEH PROP DMG $14 . 90 <br /> DEATH, DISMEMBERMENT AND 1 AT $10000 $0 . 78 <br /> LOSS OF SIGHT <br /> Total $1455 . 42 <br /> Total of 6 month premium $1455 . 42 <br /> Payment received SFPP <br /> * Denotes thousands Balance due SFPP <br /> BINDERCA Continued on Page 2 <br />