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fWN FARMERS <br />UNDERVIRIMN BY FARMERS INSURANCE EXCHANGE INSURANCE <br />AN INTER -INSURANCE EXCHANGE, HEREIN CALLED THE COMPANY <br />23175 NW Deposit St Hillsboro, OR 97124 <br />Transaction Type: OFFER OF RENEWAL <br />NAMED INSURED: <br />BARRY ROSS <br />33 SPRINGWOOD <br />IRVINE (A 92604-4602 <br />YOUR AGENT: <br />JOELDOUG[As <br />Phrase: (818) 996-2534nhuve <br />Empull: Fouglost0farnmusagentomn <br />YOUR HOUSEHOLD DRIVERS <br />BARRY ROSS <br />MYRA C ROSS <br />Policy Edition Number., 04 <br />- - - - - - - - --- - <br />Th I I E; I i . s n , o t a , bi , 11 POLICY NUMBER; 14867-86-01 <br />EffOctift 12:01 A.M. oil 01-z9-2015 <br />I '01"U'lo Pewm, t, M11 b, "I'a s.1111,y Expiration: 12:01 A.M. on 07-29-2015 <br />PIrarniuw#ees <br />Policy Premium Total 41. . g 9.20 <br />$ 0.88 <br />*Stat Information on Additional Fees on the reverse <br />A .4 ",l949 <br />WED MARRIED *'.4'".1949 <br />RATED MARRIED 948 <br />YOUR VE flll�(DESC I <br />it MEN <br />Year 2014 <br />Make LEXUS <br />Model 65 350 40 2VVD <br />VIN # ITHBLIBBES031714 <br />Rating ZIP 92604 <br />A E AS TO FORM <br />AS <br />Gorughro III) <br />Usage COMMUTER USE <br />Uenholder or <br />4AE <br />Other Interest <br />AN . HODGE <br />A Istant ity Attorney <br />ity <br />See <br />Decimations Page <br />YOUR POLICY COVERAGES / FEES <br />PREMIUMS <br />Bodily Injury Liability <br />$ 250,000 Each Pemn/S 500,000 Each Occurrence $ 721,00 <br />Property Dunnage Liability <br />S 1,00,000fralloccurrence INCLUDED <br />Medical <br />S 5,000 Each Person $ 32.50 <br />Uninsured Motorist Bodily injury <br />$ 259,001) Each PersoryS 500,000 Each Occurrence S 51.00 <br />Comprehensive <br />$ 59.90 <br />Collision <br />292.10 <br />Additional Equipment <br />0.00 <br />Unhanured Mot Prop Damage -w/ Collisi <br />S 3,70 <br />Towing and Road Service <br />15D Each Occurrence S 8.30 <br />Fees Per Vehicle <br />Vehicle Premium Total* (not including Its s) $ 669.30 <br />Soo Information on Add Tonal Fees on the reverse <br />565797 IST EDITION 2.13 C5791i I I <br />(Confinu6don the ravem 4) 12-03-2014 <br />