Insurance - Enrecos - 2014-03-20as N Interinsurance Exchange of the Automobile Club
Automobile Insurance Policy Change Confirmation
03/25/2014
Named Insured and Mailing Address:
Your Agent is:
ALAN AND KATHLEEN PIERCY
Ken Leslie
2023 N Linwood Ave
13331 Jamboree Rd
Sant
Santa Ana,: 92CA
Tustin, CA 92782
Policy Number: CA28/201 1889
(714)734-4498
Policy Term Dates: 06/28/2013- 0612812014
IMPORTANT NOTICE: This will confirm the policy change(s) you recently made effective 0312012014. You will be receiving a Policy Change Declaration in
the mail shortly.
DRIVER INFORMATION:
Driving Safety Record
Drivers' Names (Last, First)
Date of Birth Gender Rated Veh Year First GDD Chargeable Citations Chargeable
Licensed
Accidents
Piercy, Alan
04/24/1959 M 02 1976 Y 0 0
Piercy, Kathleen
09124/1964 F 01 1982 Y 0 0
Piercy, Elizabeth
Excluded F 0 0
VEHICLE INFORMATION:
No. Year Vehicle Garage
Annual Verified Anil. Air Deductibles Special Car Rent.
Primary
Make /Modal Zip Code Garaged Mlles Mileage Then Bag Comp. Collision Equip. Exp.
Driver
1 2004 LEXSISC 430 CONV
No 13,584 VM Yes Yes $250 $500
—
OF
2 2013 TYTA/PRIUS V HYBRID SW
Yes 15,000 VM Yes Yes $250 $500
01
3 2006 FORDIF350 CREW C PU 4X2
Yes 10,000 VM Yes Yes $1,000 $1,000
01
VEHICLE PREMIUM INFORMATION:
Coverages
Limits (5) Vehicle 1 Vehicle 2
Vehicle 3
Bodily Injury
500,0001500,000 $178 $182
$217
Property Damage
100,000 $122 $126
$150
Medical Payments
X 2000 $16 $15
$14
Uninsured/Underinsured Motorist Bodily Injury
15,000/30,000 $30 $31
$25
Comprehensive
(See Deductibles) $106 $82
$52
Collision
(See Deductibles) $468 $598
$212
Car Rental Expense
(See Above)
Uninsured Collision
Uninsured Deductible Waiver
Yes Included Included
Included
12• MONTH VEHICLE PREMIUM:
$920 $1,034
$670'1
LIMIT OF LIABILITY (IF APPLICABLE)
No. Year
Vehicle Make/Model Limit of Liability
POLICY DISCOUNTS: Please review these carefully as you are warranting that you are entitled to the folloWng discounts.
Good Good Multi - Multi - Garage
Air Ant - Mature Driving Grp -Deg. Verified
New
Driver Student Vehicle Policy Parking
Beg Theft Driver Course Persistency Professional Mileage
Driver
No No No No No
No No No No No No Yes
No
CURRENT 12-MONTH POLICY PREMIUM TOTAL:
$2,000 NEW '12-MONTH POLICY PREMIUM TOTAL after Polley Changes:
$2,624
SUBJECT(S) OF POLICY CHANGE:
THIS IS NOT A BILL
This policy change will increase your premium
l by $172 for the remainder of the term.
LCAA0203A Insurance provided to quaffied Auto Club members by the Interinsurance Exchange of the Aufomobde Club.
8010 (12/10)
E20101228
CA Dept. of Insurance Lc. #0003259
nv ?srn
P.— i �r r