SASSOON, DR. MAUREEN 2 -2015 - Laserfiche WebLink

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"" REPRINI ED FROM TI IS ARCHIVE. THE ORIGINAL. IRANSACTiON MAY INCLUDE ADDITIONAL FORMS '"" Me Insurance,. :A ub""y hl ,en ltlI Camrmnu POLICY NUMBER: UA3442004 SAFECO INSURANCE COMPANY OF AMERICA PERSONAL UMBRELLA POLICY DECLARATIONS INSURED: AGENT: MAUREEN SASSODN N11C INSURANCE SERVICES INC PO BOX 2028 796 W 9TH ST PALOS VERDES PEN CA 90274 -8028 SAN PEDRO CA 90731 -3602 1- 310 - 221 -0917 SCHEDULE OF UNDERLYING INSURANCE: You, as defined in the policy contract, agree: 1) that insurance policies providing the coverages specified on the back of these declarations, if applicable, are in force and will be maintained in force as collectible insurance for at least the required minimum limits stated. 2) to insure all motor vehicles owned, leased by or used by you. 3) to insure all residence premises owned, leased by or leased to you. 4) to insure all recreational vehicles owned, leased by or used by you. 5) to insure all watercraft owned by you. COVERAGES I PREMIUM Basic premium - includes one automobile and primary residence $ 218,00 In Home Business Coverage $ 30.00 1 Additional automobile in the household $ 83.00 2 Rental units $ 26.00 TOTAL ANNUAL PREMIUM $ 357.00 You may pa your premium in full or in installments. There is no installment fee for the following billing plans: Full Pay, Annual 2 -Pay. Installment fees for all other billinec�� pplans are listed below. If more than one policy is billed on the installment bill, only the highest fee is charged. The fee is: $0.00 per installment for recurring automatic deduction (EFT) $0.00 per installment for recurring credit card or debit card $5.00 per installment for all other payment methods ENDORSEMENTS APPLICABLE TO THIS POLICY: In -Home Business Liability Coverage PLEASE SEE REVERSE OR:I:CINAL DATE PREPARED 5EPT 0 2015 P-i075 /EP 3 /14 qjA fn POLICY PERIOD FROM: JUNE 27 2015 RESIDFNrF PRFMtRFR� TO: JUNE 27 2016 RCH PALOS VRD CA 90275 -2228 CHANGED AS OFSEPT 1 2015 at 12:01 A.M. Standard time at the address of the insured as stated herein. RETAINED LIMIT: $250 LIMIT OF LIABILITY: $1,000,000 SCHEDULE OF UNDERLYING INSURANCE: You, as defined in the policy contract, agree: 1) that insurance policies providing the coverages specified on the back of these declarations, if applicable, are in force and will be maintained in force as collectible insurance for at least the required minimum limits stated. 2) to insure all motor vehicles owned, leased by or used by you. 3) to insure all residence premises owned, leased by or leased to you. 4) to insure all recreational vehicles owned, leased by or used by you. 5) to insure all watercraft owned by you. COVERAGES I PREMIUM Basic premium - includes one automobile and primary residence $ 218,00 In Home Business Coverage $ 30.00 1 Additional automobile in the household $ 83.00 2 Rental units $ 26.00 TOTAL ANNUAL PREMIUM $ 357.00 You may pa your premium in full or in installments. There is no installment fee for the following billing plans: Full Pay, Annual 2 -Pay. Installment fees for all other billinec�� pplans are listed below. If more than one policy is billed on the installment bill, only the highest fee is charged. The fee is: $0.00 per installment for recurring automatic deduction (EFT) $0.00 per installment for recurring credit card or debit card $5.00 per installment for all other payment methods ENDORSEMENTS APPLICABLE TO THIS POLICY: In -Home Business Liability Coverage PLEASE SEE REVERSE OR:I:CINAL DATE PREPARED 5EPT 0 2015 P-i075 /EP 3 /14 qjA fn