AUTO INSURANCE POLICY DECLARATIONS
MDGTrig
Policy No.:
Policy Period:
IN1036087A-00
From 08/25/2021 12:00 A.M.
02/25/2022 12:01 A.M.
To
DAELENCIA TAYLOR
6853 FARIS AVE APT 4
INDIANAPOLIS IN 46226
This Declarations Page, together with the policy book, your application, and any additional forms or endorsements listed below,
constitute the complete policy identified above. Insurance is granted only as to those coverages for which a premium charge is
indicated, or are otherwise specified as being included. Subject to the terms and conditions of the policy, the limit of the company’s
liability under any such coverage is as stated below.
VEH #
1
YEAR
2011
MAKE/MODEL
DODGE JOURNEY MAINST
BODY TYPE
SPORT UTIL
VIN
3D4PH1FG1BT514997
* * * * 6 MONTHS PREMIUM * * * *
COVERAGES
Bodily Injury Liability
Property Damage Liability
Towing and Labor Per Disablement Maximum of 6
Physical Damage
Comprehensive Actual Cash Value Less Deductible
Collision Actual Cash Value Less Deductible
Total Premium by Vehicle
Accidental Death Benefit
LIMITS OF LIABILITY
$25,000 Each Person/
$50,000 Each Accident
$25,000 Each Accident
VEH 1
$40
PREM VEH 1
$500
$500
$177
$495
$1,491
$539
$276
$4
$10,000 Each Person
Total Premium All Vehicles
$14
$1,505
ENDORSEMENTS/FORMS MADE PART OF THIS POLICY:
IN1000/0216 IN1010/1008 IN1020/0712 IN1011/1008 IN1016/1013 IN1012/1008 IN1013/1008 IN1015/0311
LIENHOLDERS
IFFC, PO BOX 25912, OVERLAND PARK, KS 66225
Please note: An SR-22 has been filed with the Indiana Indiana Bureau of Motor Vehicles for Daelencia Taylor confirming the purchase of auto insurance.
Date Issued: 08/25/2021 Form IN1020/0712