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—" REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS -- <br />SMInsurance,,, POLICY NUMBER: A2074142 <br />A Liberty Mutual. Cbmpany <br />SAFECO INSURANCE COMPANY OF AMERICA <br />AUTOMOBILE POLICY DECLARATIONS <br />NAMED INSURED: <br />MAUREEN SASSOON <br />PO BOX 2028 <br />PALOS VERDES PEN CA 90274 -8028 <br />AGENT: <br />NHC INSURANCE SERVICES INC <br />796 W 9TH ST <br />SAN PEDRO.CA 90731 -3602 <br />POLICY PERIOD FROM: SEPT 1 2015 <br />TO: SEPT 1 2016 <br />at 12:01 A.M. standard time at <br />the address of the insured as <br />stated herein. <br />AGENT TELEPHONE: <br />1- 310 -221 -0917 <br />RATED DRIVERS <br />MS MAUREEN SASSOON <br />2008 BMW <br />328I SULEV <br />4 DOOR SEDAN <br />ID# WBAVC53578FZ84867 <br />2014 HONDA <br />CR -V EX <br />4 DOOR <br />ID# 2HKRM3H59EH548165 <br />Insurance is afforded only for <br />the coverages for which <br />limits of liability or <br />premium charges <br />are indicated. <br />COVERAGES <br />2008 BMW <br />LIMITS <br />I PREMIUMS <br />2014 HOND LIMITS1 <br />PREMIUMS <br />LIABILITY: <br />Actual <br />Cash Value <br />40.30 <br />BODILY INJURY <br />$500,000 $ 177.00 <br />$500,000 $ 197.70 <br />Each Person <br />$500,000 <br />Each Occurrence <br />PROPERTY DAMAGE $100,000 <br />Each Occurrence <br />MEDICAL PAYMENTS $5,000 <br />UNINSURED AND UNDERINSURED MOTORISTS: <br />BODILY INJURY $500,000 <br />Each Person <br />$500,000 <br />Each Accident <br />COMPREHENSIVE Actual Cash Value <br />Less $250 Deductible <br />COLLISION Actual Cash Value <br />Less $500 Deductible <br />WAIVER OF COLLISION DEDUCTIBLE <br />ADDITIONAL COVERAGES: <br />LOSS OF USE $50 Per Day /$1200 Max <br />ANTI FRAUD FEE <br />ROADSIDE ASSIST <br />ORIGINAL <br />PARTS <br />REPLACEMENT <br />ENDORSEMENT <br />Each Person <br />$500,000 <br />Each Occurrence <br />103.30 $100,000 131.30 <br />Each Occurrence <br />23.80 <br />$5,000 24.50 <br />102.10 <br />$500,000 <br />113.60 <br />Each Person <br />$500,000 <br />Each <br />Accident <br />69.20 <br />Actual <br />Cash Value <br />40.30 <br />Less $250 <br />Deductible <br />233.50 <br />Actual <br />Cash Value <br />283.10 <br />Less $500 <br />Deductible <br />14.60 <br />18.10 <br />34.80 $50 Per Day /$1200 Max 34.80 <br />1.74 1.74 <br />5.80 5.80 <br />30.30 32.30 <br />TOTAL $ 796.14 <br />TOTAL EACH VEHICLE <br />PREMIUM SUMMARY <br />VEHICLE COVERAGES <br />-CONTINUED - <br />P 0 BOX 515097, LOS ANGELES, CA 90051 <br />SA- 1697/EP 9/90 <br />11� Page 1 of 2 <br />TOTAL $ 883.24 <br />2008 BMW $ 796.14 <br />2014 HOND 883.24 <br />PREMIUM <br />$ 1,679.38 <br />-1 �'^\ <br />DATE PREPARED: AUG. 18 2t�YV <br />