Form_SCTNID_CTGRY.FL01186489_DECPAGE
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PROGRESSIVE
P.O. BOX 31260
TAMPA, FL 33631
Policy Number: 952740085
Underwritten by:
Progressive Select Insurance Co
October 6, 2021
Policy Period: Oct 1, 2021 - Apr 1, 2022
Page 1 of 2
CASEY D JOHNSON
912 KLONDIKE AVE
WINTERGARDEN, FL 34787
progressive.com
Online Service
Make payments, check billing activity, update
policy information or check status of a claim.
Auto Insurance
Coverage Summary
This is a copy of your
Declarations Page
1-800-776-4737
For customer service and claims service,
24 hours a day, 7 days a week.
Your coverage began on October 1, 2021 at the later of 12:01 a.m. or the effective time shown on your application. This policy period
ends on April 1, 2022 at 12:01 a.m.
This coverage summary replaces your prior one. Your insurance policy and any policy endorsements contain a full explanation of your
coverage. The policy contract is form 9611D FL (07/17). The contract is modified by form A261 FL (05/19).
Drivers and ………………………………………………………………………………………………………………………………………………………..
resident relatives
Additional information
Casey D Johnson
Named insured
Outline of coverage
2014 KIA OPTIMA 4 DOOR SEDAN
VIN: 5XXGM4A75EG281854
Garaging ZIP Code: 34787
Primary use of the vehicle: Commute
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Limits
Deductible
Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others
Bodily Injury Liability
$10,000 each person/$20,000 each accident
$285
Property Damage Liability
$10,000 each accident
592
………………………………………………………………………………………………………………………………………………………..
Personal Injury Protection/Deductible applies to
$10,000
$1,000/person
750
Named Insured/Spouse/Dependent Resident Relatives Work Loss Excluded
………………………………………………………………………………………………………………………………………………………..
-Uninsured Motorist
Rejected
………………………………………………………………………………………………………………………………………………………..
Comprehensive
Actual Cash Value
$1,000
115
………………………………………………………………………………………………………………………………………………………..
Collision
Actual Cash Value
$1,000
310
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium
$2,052.00
Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
952740085
Electronic Funds Transfer (EFT), Home Owner, Online Quote, Continuous
Insurance: Silver, Paperless and Three-Year Safe Driving
Vehicle
………………………………………………………………………………………………………………………………………………………..
2014 KIA
OPTIMA
Form 6489 FL (01/18)
Anti-Lock Brakes, Driver and Passenger-side Airbag, Passive Anti-Theft Device
and Snapshot Participation
4
Continued
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Policy Number: 952740085
Casey D Johnson
Page 2 of 2
Lienholder and additional interest information
Vehicle
Lienholder
Additional interest
2014 KIA OPTIMA
5XXGM4A75EG281854
Af title co dba financial
Memphis, TN 38115
Af title co dba financial
Memphis, TN 38115
………………………………………………………………………………………………………………………………………………………..
Policyholder inquiries
You may call Customer Service at 1-800-776-4737 to present inquiries or obtain information about coverage, and to
obtain assistance with any complaints.
Agent signature
Company officers
Secretary
Form 6489 FL (01/18)