Uploaded by Swetha Anne

DeclarationsPage

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Form_SCTNID_CTGRY.NC10186489_DECPAGE
921194876 Q IC94549
INS DECPAGE
E POLWHITEFONT CRMRHITFCURDU5SAG6O4O36FYC0002 RPUID TRACWHITEFONT
PROGRESSIVE
P.O. BOX 31260
TAMPA, FL 33631
Policy Number: 921194876
Underwritten by:
Progressive Premier Ins Co of IL
September 27, 2019
Policy Period: Oct 24, 2019 - Apr 24, 2020
Page 1 of 2
SWETHA ANNE
12308 SCHOOLHOUSE ST.
RALEIGH, NC 27614
progressive.com
Online Service
Make payments, check billing activity, update
policy information or check status of a claim.
Auto Insurance
Coverage Summary
This is your Renewal
Declarations Page
1-800-776-4737
For customer service and claims service,
24 hours a day, 7 days a week.
The coverages, limits and policy period shown apply only if you pay for this policy to renew.
Your coverage begins on October 24, 2019 at 12:01 a.m. This policy expires on April 24, 2020 at 12:01 a.m.
Your insurance policy and any policy endorsements contain a full explanation of your coverage. The policy contract is form NC0001
(06/05). The contract is modified by forms NC0330 (01/14), NC0301 (07/87), NC0350 (09/04), NC0012 (10/18) and NC0013 (10/18).
Underwriting Company
Progressive Premier Ins Co of IL
P.O. Box 31260
Tampa , FL 33631
1-800-776-4737
Drivers and ………………………………………………………………………………………………………………………………………………………..
resident relatives
Additional information
Swetha Anne
Named insured
Outline of coverage
General policy coverage
Limits
Deductible
Premium
………………………………………………………………………………………………………………………………………………………..
Combined
Uninsured/Underinsured Motorist
$250,000 each person/$500,000 each accident
$34.00
………………………………………………………………………………………………………………………………………………………..
Uninsured
Motorist Property Damage
$100,000 each accident
$100
1.00
………………………………………………………………………………………………………………………………………………………..
$35.00
Total premium for general policy coverage
2014 MERCEDES-BENZ CLA250 4 DOOR SEDAN
VIN: WDDSJ4GB4EN138354
Garaging Zip Code: 27614
Primary use of the vehicle: Pleasure
Limits
Deductible
Premium
………………………………………………………………………………………………………………………………………………………..
Liability Coverage
$219.68
Bodily Injury Liability
$250,000 each person/$500,000 each accident
Property Damage Liability
$100,000 each accident
………………………………………………………………………………………………………………………………………………………..
Other
Than Collision
Actual Cash Value
$500
50.00
………………………………………………………………………………………………………………………………………………………..
Collision
Actual Cash Value
$500
233.00
………………………………………………………………………………………………………………………………………………………..
Total premium for 2014 MERCEDES-BENZ
$502.68
Total 6 month policy premium
$537.68
………………………………………………………………………………………………………………………………………………………..
Form 6489 NC (10/18)
4
Continued
921194876 Q IC94549
INS DECPAGE
E POLWHITEFONT CRMRHITFCURDU5SAG6O4O36FYC0002 RPUID TRACWHITEFONT
Policy Number: 921194876
Swetha Anne
Page 2 of 2
Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
921194876
Five-Year Accident Free, Electronic Funds Transfer (EFT), Online Quote,
Continuous Insurance: Gold, Paperless and Three-Year Safe Driving
Vehicle
………………………………………………………………………………………………………………………………………………………..
2014 MERCEDES-BENZ
CLA250
Airbag
Lienholder information
Vehicle
Lienholder
2014 MERCEDES-BENZ CLA250
WDDSJ4GB4EN138354
ALLY FIN (LOAN)
COCKEYSVILLE, MD 21030
………………………………………………………………………………………………………………………………………………………..
Company officers
President
Form 6489 NC (10/18)
Secretary
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