Form_SCTNID_CTGRY.MI09196489_DECPAGE
963662624 E IC68277
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E POLWHITEFONT 3P2D6O7VNAUKEY6MQJBN6NQHHB0001 RPUID TRACWHITEFONT
PROGRESSIVE
P.O. BOX 31260
TAMPA, FL 33631
Policy Number: 963662624
Underwritten by:
Progressive Marathon Insurance Co
December 1, 2022
Policy Period: Nov 23, 2022 - May 23, 2023
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teresha backstrom
1618 pontiac st.
flint mi, 48503
progressive.com
Auto Insurance
Coverage Summary
This is your Declarations Page
Online Service
Make payments, check billing activity, update
policy information or check status of a claim.
1-800-776-4737
For customer service and claims service,
24 hours a day, 7 days a week.
Your coverage began on November 23, 2022 at the later of 12:01 a.m. or the effective time shown on your application. This policy
period ends on May 23, 2023 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 MI (09/19). The contract is modified by forms A245 MI (10/17) and A298 MI (01/21).
Policy changes effective December 1, 2022
………………………………………………………………………………………………………………………………………………………..
Changes requested on:
Dec 1, 2022 09:09 a.m.
Requested by:
Teresha Backstrom
Premium change:
$0.00
………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………..
The changes take effect as of the date and time requested shown above.
Drivers and ………………………………………………………………………………………………………………………………………………………..
resident relatives
Additional information
Martonio Backstrom
Named insured
Eligible for PIP Medical Expense Coverage : Yes
………………………………………………………………………………………………………………………………………………………..
Teresha Backstrom
Eligible for PIP Medical Expense Coverage : Yes
Total residents: 07
The total number of resident relatives and other drivers currently residing in your household. This count should include
individuals listed in the Driver section above, and any other relatives, like young children, living in the home for 60 days or
more during the next 12 months.
Progressive Marathon Insurance Co
Form 6489 MI (09/19)
4
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963662624 E IC68277
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Policy Number: 963662624
Martonio Backstrom
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Outline of coverage
2018 CHEVROLET TRAVERSE 4 DOOR WAGON
VIN: 1GNERGKW6JJ107983
Garaging ZIP Code: 48505
Rating city: Flint
Primary use of the vehicle: Commute
Length of vehicle ownership when policy started or vehicle added: At least 1 year but less than 3 years
This vehicle is currently enrolled in the Snapshot® Program.
Limits
Deductible
Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others
$273
Bodily Injury Liability
$50,000 each person/$100,000 each accident
Property Damage Liability
$10,000 each accident
………………………………………………………………………………………………………………………………………………………..
Personal Protection Insurance (PIP)
$250,000 per person/per accident
480
Medical Expense
………………………………………………………………………………………………………………………………………………………..
Work
Loss and Replacement Services
Selected
20
………………………………………………………………………………………………………………………………………………………..
Property Protection Insurance
$1,000,000
$0
15
………………………………………………………………………………………………………………………………………………………..
Subtotal policy premium
$788.00
………………………………………………………………………………………………………………………………………………………..
Statutory
assessment recoupment
21.00
………………………………………………………………………………………………………………………………………………………..
MCCA
Deficiency Recoupment Fee
$0
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium and fees
$809.00
Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
963662624
Online Signature - First Policy Period Only, Electronic Funds Transfer (EFT),
Online Quote, Continuous Insurance: Silver and Paperless
Vehicle
………………………………………………………………………………………………………………………………………………………..
2018 CHEVROLET
TRAVERSE
Progressive Marathon Insurance Co
Form 6489 MI (09/19)
Driver and Passenger-side Airbag