Auto_Policy_-_Abbie_S_Fink.pdf
PDF 465 KB Posted
- Attached to
- Master Agreement AZ|CTR056869
- Contract number
- CTR056869
- Issued by
- Arizona
About this file
This document is a State Farm Mutual Automobile Insurance Company auto insurance policy declarations page for a personal vehicle insurance policy issued in Arizona. The policy is administered through Chavez Insurance Agency Inc., located in Phoenix, AZ, and covers a 2015 Toyota RAV4 for the named insured, Abie Fink, with a policy period from January 9, 2024 to July 9, 2024.
The policy includes comprehensive coverage with multiple components: Liability Coverage ($219.78) with bodily injury limits of $250,000/$500,000 and property damage limit of $100,000; Medical Payments Coverage ($12.67) with a $5,000 limit per person; Comprehensive and Glass Coverage with a $50 deductible ($56.77); Collision Coverage with a $50 deductible ($89.98); Emergency Road Service Coverage ($4.47); Car Rental and Travel Expenses Coverage ($22.98) with a $10 daily and $3,000 total limit; Uninsured Motor Vehicle Coverage ($25.99); and Underinsured Motor Vehicle Coverage ($75.14). The total premium for the six-month policy period is $507.78, with the premium determined based on driving records, consumer report information, and credit-based insurance scoring.
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Text version
POLICY NUMBER
POLICY PERIOD
(o1a025te)
DO NOT PAY PREMIUMS SHOWN ON THIS PAGE.
IF AN AMOUNT IS DUE, THEN A SEPARATE STATEMENT IS ENCLOSED.
YEAR MAKE MODEL BODY STYLE VEHICLE ID. NUMBER CLASS
I1SX0N
584 1469-A09-03
FINK, ABBIE
1217 N MILLER RD UNIT 24
SCOTTSDALE AZ 85257-3639
JAN 09 2024 to JUL 09 2024
VOL
1444517424
03521-1-A
CHAVEZ INSURANCE AGENCY INC
2816 N 16TH ST STE C
PHOENIX, AZ 85006-1260
(602)457-3825
MUTL
AAT3
005467 0058
15491/05417
IP
P
D
D E
C
A901E
CONTINUED
STATE FARM PAYMENT PLAN NUMBER
NAMED INSURED
AGENT
PHONE:
See Reverse Side
03-2269-1 A
DECLARATIONS PAGE
12:01 A.M. Standard Time
YOUR CAR
State Farm Mutual Automobile Insurance Company
PO Box 2368 Bloomington IL 61702-2368
2015 TOYOTA RAV4 JTMWFREV1FD069251SPORT WG 600H60F000
SYMBOLS COVERAGE & LIMITS PREMIUMS
A $219.78Liability Coverage
Bodily Injury Limits Each Person, Each Accident $250,000 $500,000 Property Damage Limit Each Accident $100,000
C $12.67Medical Payments Coverage Limit - Each Person
$5,000 D-WG $56.77Comprehensive and Glass Coverage - $500 Deductible G $89.98Collision Coverage - $500 Deductible H $4.47Emergency Road Service Coverage R1 $22.98Car Rental and Travel Expenses Coverage
Limit - Car Rental Expense Each Day, Each Loss $100 $3,000
U $25.99Uninsured Motor Vehicle Coverage Bodily Injury Limits Each Person, Each Accident $100,000 $300,000
W $75.14Underinsured Motor Vehicle Coverage Bodily Injury Limits Each Person, Each Accident $100,000 $300,000
$507.78 Total premium for JAN 09 2024 to JUL 09 2024.
155-3866.2 04-2005 (o1a025hd)
B10
POLICY NUMBER
POLICY PERIOD
(o1a025vd)
Telephone:
Prepared (o1a0254c)
I3SX0
584 1469-A09-03
FINK, ABBIE
1217 N MILLER RD UNIT 24
SCOTTSDALE AZ 85257-3639
JAN 09 2024 to JUL 09 2024
VOL
1444517424
DEC 19 2023
03521-1-A
CHAVEZ INSURANCE AGENCY INC
(602)457-3825
MUTL
A 005467 0058
15492/05417
IP
P
D
D E
C
A901E
STATE FARM PAYMENT PLAN NUMBER
NAMED INSURED
Agent:
2269-C16
03-2269-1 A
DECLARATIONS PAGE
12:01 A.M. Standard Time
State Farm Mutual Automobile Insurance Company
PO Box 2368 Bloomington IL 61702-2368
IMPORTANT MESSAGES
New Policy Form
State Farm works hard to offer you the best combination of price, service, and protection. The amount you pay for automobile insurance is determined by many factors such as the coverages you have, where you live, the kind of car you drive, how your car is used, who drives the car, and information from consumer reports.
Your premium was determined by the information on drivers, driving records, and other information you provided, as well as consumer report information, including: Length of time accounts have been established.
Consumer report reference numbers: 23349041419318, J576GTJ, 17446241U1716894
Credit information was obtained on: ABBIE FINK
You have the right to request, no more than once during a 12-month period, that your policy be re-rated using a current credit-based insurance score. Re-rating could result in a lower rate, no change in rate, or a higher rate.
Please refer to the enclosed insert for additional information.
Notice of insurance information collection practices - personal , family, or household insurance transactions:
We often collect personal information from persons other than the individual or individuals listed on the policy.
Such personal information may, in certain circumstances, be disclosed to third parties without your authorization.
If you would like additional information concerning the collection and disclosure of personal information - and your right to see and correct any personal information in your files - it will be furnished upon request.
EXCEPTIONS, POLICY BOOKLET & ENDORSEMENTS (See policy booklet & individual endorsements for coverage details.)
YOUR POLICY CONSISTS OF THIS DECLARATIONS PAGE, THE POLICY BOOKLET -
FORM 9803A, AND ANY ENDORSEMENTS THAT APPLY, INCLUDING THOSE ISSUED TO YOU
WITH ANY SUBSEQUENT RENEWAL NOTICE.
6128CY AMENDATORY ENDORSEMENT.
6129K AMENDATORY ENDORSEMENT.
6903A AMENDATORY ENDORSEMENT.
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