Personal Auto Policy...
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APPENDIX B 656 Personal Auto Policy Declarations POLICYHOLDER: Chris and Karen Swift (Named Insured) 8110 Lake Street Lincoln, Nebraska 68506 POLICY NUMBER: 296 S 468211 POLICY PERIOD: FROM: August 1, 2007 TO: February 1, 2008 But only if the required premium for this period has been paid, and for six-month renewal periods if renewal premiums are paid as required. Each period begins and ends at 12:01 A.M. standard time at the address of the policy- holder. INSURED VEHICLES AND SCHEDULE OF COVERAGES VEHICLE COVERAGES LIMITS OF INSURANCE PREMIUM 1 2000 Toyota Corolla ID #JT2AL21E8B3306553 Coverage A—Liability: Bodily Injury Liability $100,000 Each Person $110.00 $300,000 Each Accident Property Damage Liability $ 50,000 Each Accident $ 40.00 Coverage B—Medical Payments $ 5,000 Each Person $ 36.00 Coverage C—Uninsured Motorists: Bodily Injury $100,000 Each Person $ 40.00 $300,000 Each Accident TOTAL $226.00 2 2007 Ford Five Hundred ID #1FABP3OU7GG212619 Coverage A—Liability: Bodily Injury Liability $100,000 Each Person $145.00 $300,000 Each Accident Property Damage Liability $ 50,000 Each Accident $ 60.00 Coverage B—Medical Payments $ 5,000 Each Person $ 36.00 Coverage C—Uninsured Motorists: Bodily Injury $100,000 Each Person $ 40.00 $300,000 Each Accident Coverage D—Other Than Collision Actual Cash Value Less $250 $ 50.00 —Collision Actual Cash Value Less $500 $130.00 TOTAL $461.00 POLICY FORM AND ENDORSEMENTS: PP 00 01 01 05 COUNTERSIGNATURE DATE: July 1, 2007 AGENT: Alex Rejda SAMPLE P ERSONAL AUTO P OLICY
Transcript of Personal Auto Policy...
A P P E N D I X B
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Personal Auto Policy Declarations
POLICYHOLDER: Chris and Karen Swift(Named Insured) 8110 Lake Street
Lincoln, Nebraska 68506
POLICY NUMBER: 296 S 468211
POLICY PERIOD: FROM: August 1, 2007TO: February 1, 2008
But only if the required premium for this period has been paid, and for six-month renewal periods if renewal premiums are paid as required. Each period begins and ends at 12:01 A.M. standard time at the address of the policy- holder.
INSURED VEHICLES ANDSCHEDULE OF COVERAGES
VEHICLE COVERAGES LIMITS OF INSURANCE PREMIUM
1 2000 Toyota Corolla ID #JT2AL21E8B3306553Coverage A—Liability:
Bodily Injury Liability $100,000 Each Person $110.00$300,000 Each Accident
Property Damage Liability $ 50,000 Each Accident $ 40.00
Coverage B—Medical Payments $ 5,000 Each Person $ 36.00Coverage C—Uninsured Motorists:
Bodily Injury $100,000 Each Person $ 40.00$300,000 Each Accident
TOTAL $226.00
2 2007 Ford Five Hundred ID #1FABP3OU7GG212619Coverage A—Liability:Bodily Injury Liability $100,000 Each Person $145.00
$300,000 Each Accident Property Damage Liability $ 50,000 Each Accident $ 60.00
Coverage B—Medical Payments $ 5,000 Each Person $ 36.00Coverage C—Uninsured Motorists:
Bodily Injury $100,000 Each Person $ 40.00$300,000 Each Accident
Coverage D—Other Than Collision Actual Cash Value Less $250 $ 50.00 —Collision Actual Cash Value Less $500 $130.00
TOTAL $461.00
POLICY FORM AND ENDORSEMENTS: PP 00 01 01 05COUNTERSIGNATURE DATE: July 1, 2007AGENT: Alex Rejda
SAMPLE
PERSONAL AUTO POLICY
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Copyrighted material of Insurance Services Office, Inc., with its permission.SAMPLE
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