Laserfiche WebLink
UNDERWRITTEN BY MID-CENTURY INSURANCE COMPANY <br />A STOCK INSURANCE COMPANY, HEREIN CALLED THE COMPANY <br />29175 NW DeaneH Si, Hillsboro, OR 97124 <br />Transaction Type: CHANGE - MULTIPLE CAR DISCOUNT REMOVED ,DELETEVEHICLE,RATECLASS <br />NAMED INSURED: <br />CHARLOTTE D WHITNEY <br />2825 S PALM CANYON DR <br />PALM SPRINGS CA 922649336 <br />YOUR AGENT; <br />MATTHEW TEHRAN INSURANCE AG ENCY IN <br />Phone: (949) 553.0813 <br />Email: mtehranl2former5ogant.com <br />9UR HOUSEHOLD DRIVERS <br />CHART OTTF D WilITIIEY <br />Year 2012 <br />Make PAW <br />Model 93514D 2WD $A <br />IVINN 1V130A96570035322 <br />Rating ZIP 92264 <br />Gureging ZIP <br />i Usage OTHER USE <br />Uenholder or <br />othal Interest <br />This IS not a bill <br />RATED <br />rWk <br />FARMERS <br />INSURANCE <br />Policy Edition Number: <br />02 <br />POLICY NUMBER: <br />16!)89-77-65 <br />Effective: 12:01 A.M. <br />on 04-12.2014 <br />Expirot€on: 12:01 A.M. <br />oa 10. 12.2014 <br />Premiuroas /Fees <br />PollcgPrgIumTotal CREDIT <br />p 5'79..,24 <br />fees (In arldPion 10 premmm above) <br />"See Information on Additional Fees on Ilia reverse <br />s, <br />SINGLE ^ . °.1995 <br />I <br />" " " " " "' "7v <br />fee Supp amental <br />n 6adoraiions Page <br />YOUR POLECY (OVERAGES FEES PREMi UMS <br />i Bodily Injury 1.0111ty S 250,000 Each Person /S 500,000 Inch Occurrence S 265.70 <br />Property Dointle liability I S 500,000 Each Occurrence INCLUDE <br />Medical I NOTCOVERED <br />Uninsured rMaArrlst Bodily Injury I S 250,000 Eudl Parson /$ 500,000 Each Occurrence S 58.60 <br />Compreheirtalve S 91.90 <br />Collision it S 280.20 <br />Additional EquOmtnt S DOD <br />Uninsured MotiProp Damage -w/ Collsiod S 6.30 <br />Glass Dedood(Lo Buyback S 9.20 <br />Fees Per yjhl a kss S an Cit AttoxngY <br />Vehicle Pe-nnic: Totol' (not including fats) 40 <br />`See Info rinllo;on Addlllonal Fees on the reverse <br />56�5797151`t:®IpaN1.l3 097111 (Continued on the reverse side) 04- 11.20 -a <br />