PAGE
1
MAIL MCH-M-I
00001
APRIL
2023
JANUARY
26,9 2023
AUTOMOBILE POLICY PACKET
DOUGLAS STEFFANY
BRIAN
SULLIVAN
SSG USA
RET
8025
W
RUSSELL
RD APT
8025 W
RUSSELL
RD2148
APT
2148
LAS VEGAS NV 89113-1587
EFFECTIVE APR 9 2023 TO OCT 9 2023
IMPORTANT MESSAGES
To receive this document and others electronically, or manage your Auto Policy online,
go to usaa.com.
ACS1
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THIS PAGE INTENTIONALLY LEFT BLANK
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3
9800 Fredericksburg Road
San Antonio, Texas 78288
NEVADA EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE
COVERAGE MEETS REQUIREMENTS O F NRS 4 8 5 . 1 8 5 . THIS EVIDENCE OF
INSURANCE HAS BEEN APPROVED BY THE NEVADA COMMISSIONER OF
INSURANCE. THIS EVIDENCE O F INSURANCE M U S T BE CARRIED I N THE
INSURED MOTOR VEHICLE FOR PRODUCTION ON DEMAND.
Name
Policy Number 0 2 5 3 2 5 4 35G 7 1 0 2 3
DOUGLAS
STEFFANY
1/27/23
Effective Date 0
BRIAN SULLIVAN
04/09/2023
DOUGLAS STEFFANY
7/27/23
Expiration Date 0
06/09/2023
SSG USA RET
Year Make
8 0 2 5 W RUSSELL RD APT 2 1 4 8
2018
AUDI
2
0 1 6 BMW
LAS VEGAS NV 8 9 1 1 3 - 1 5 8 7
Vehicle Identification Number
WAUB4CF57JA003911
WBS8M9C52G5D30766
USAA GENERAL INDEMNITY COMPANY
18600
CONTACT US: 2 1 0 - 5 3 1 - U S A A ( 8 7 2 2 ) OR 8 0 0 - 5 3 1 - U S A A
Additional copies available at usaa.com
Automobile Insurance Identification Card
Keep a copy of the ID card in your vehicle at all times.
53NV
9800 Fredericksburg Road
San Antonio, Texas 78288
NEVADA EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE
COVERAGE MEETS REQUIREMENTS O F NRS 4 8 5 . 1 8 5 . THIS EVIDENCE OF
INSURANCE HAS BEEN APPROVED BY THE NEVADA COMMISSIONER OF
INSURANCE. THIS EVIDENCE O F INSURANCE M U S T BE CARRIED I N THE
INSURED MOTOR VEHICLE FOR PRODUCTION ON DEMAND.
Name
DOUGLAS
STEFFANY
BRIAN SULLIVAN
DOUGLAS STEFFANY
Policy Number 0 2 5 3 2 5 4 35G 7 1 0 2 3
Effective Date 0 1 / 2 7 / 2 3
Expiration Date 0 7 / 2 7 / 2 3
SSG USA RET
8 0 2 5 W RUSSELL RD APT 2 1 4 8
LAS VEGAS NV 8 9 1 1 3 - 1 5 8 7
Year
22018
016
Make
AUDI
BMW
Vehicle Identification Number
WBS8M9C52G5D30766
WAUB4CF57JA003911
USAA GENERAL INDEMNITY COMPANY
18600
CONTACT US: 2 1 0 - 5 3 1 - U S A A ( 8 7 2 2 ) OR 8 0 0 - 5 3 1 - U S A A
Additional copies available at usaa.com
PAGE
4
ADDL INFO ON NEXT PAGE MAIL MCH-M-I
AMENDMENT TO
State 06 08
Veh
POLICY NUMBER
Terr 02532 54 35G 7102 3
NV 144144
USAA GENERAL INDEMNITY COMPANY
(A Stock Insurance Company)
9800 Fredericksburg - San Antonio, Texas 78288
NEVADA AUTO POLICY
AMENDED DECLARATIONS
(ATTACH TO PREVIOUS POLICY)
POLICY PERIOD:
PERIOD
(12:01
A.M STANDARD
TIME)time)
POLICY
(12:01
A.M. standard
EFFECTIVE
APRJAN
9 202327
TO 2023
OCT 9 2023.
EFFECTIVE
TO JUL 27 2023
OPERATORS
01
DOUGLAS
STEFFANY
BRIAN M SULLIVAN
04
KATHERINE
GODINE
DOUGLAS
STEFFANY
Named Insured and Address
BRIAN
M SULLIVAN
DOUGLAS
STEFFANY
DOUGLAS
SSG USASTEFFANY
RET
8025 W RUSSELL RD APT 2148
LAS VEGAS NV 89113-1587
VEH USE* WORK/SCHOOL
Description of Vehicle(s)
VEH YEAR
TRADE NAME
06 18
AUDI
06
16 CHEV
08 16 BMW
MODEL
BODY TYPE
S5 PREMIUM
MALIBU
M3 4D
4D4 DOOR
4D
ANNUAL
MILEAGE
10,000
10000
10000
IDENTIFICATION NUMBER
Miles
One
Way
SYM
WAUB4CF57JA003911
1G11E5SA6GF168248
WBS8M9C52G5D30766
Days
Per
Week
P
P
The Vehicle(s) described herein is principally garaged at the above address unless otherwise stated. * W/C=Work/School; B=Business; F=Farm;P=Pleasure
VEH 06
VEH 08
LAS VEGAS NV 89113-1587
LAS VEGAS NV 89113-1587
This policy provides ONLY those coverages where a premium i s shown below. The limits shown
m a y b e reduced b y policy provisions and m a y not b e combined regardless o f the number of
vehicles for which a premium is listed unless specifically authorized elsewhere in this policy.
VEH
VEH
VEH
VEH
COVERAGES
LIMITS OF LIABILITY
06 6-MONTH 08 6-MONTH
("ACV" MEANS ACTUAL CASH VALUE)
D=DED
PREMIUM
D = D E D PREMIUM
D = D E D PREMIUM
D=DED
PREMIUM
AMOUNT
PART A - LIABILITY
BODILY INJURY
EA PER $
25,000
EA ACC $
50,000
PROPERTY DAMAGE EA ACC $
20,000
PART C - UNINSURED MOTORISTS
BODILY INJURY
EA PER $
25,000
EA ACC $
50,000
PART D - PHYSICAL DAMAGE COVERAGE
COMPREHENSIVE LOSS
ACV LESS D1000
COLLISION LOSS
ACV LESS D1000
TOWING AND LABOR
$
AMOUNT
$
AMOUNT
392.27
152.65
328.80
103.32
160.97
160.97
$
AMOUNT
$
54.17D1000 134.58
255.15D1000 607.00
8.78
8.78
___________________________________________________________________________________
VEHICLE TOTAL PREMIUM
1023.99
1343.45
-------------------------------ADJUSTMENT REASON-------------------------------CHANGE IN OPERATOR STATUS OP 01
ADDED VEH 08
DELETION OF VEH 07 (17 AUDI)
TOTAL PREMIUM - SEE FOLLOWING PAGE(S)
VEH
ADDNL
INTEREST
- CO-OWNER
SULLIVANKATHERINE
VEH0606
ADDNL
INTEREST
- BRIAN
CO-OWNER
LAS VEGAS, NV
GODINE,
ENDT A073 APPLIES
ENDORSEMENTS:
ADDED
NONE
ENDORSEMENTS:
ADDED
01-27-23
- NONE
REMAIN IN EFFECT(REFER TO PREVIOUS POLICY)A132(02) RSGPCW(01) 5100NV(02)
INFORMATION FORMS: 88356(01)
O2 1
06 RMM3200000
08 RMF2800000
A073(05)
A200NV(01)
A402(02)
IN WITNESS WHEREOF, we have caused this policy to be signed by our President and Secretary at San Antonio, Texas,
COUNTERSIGNED BY
26, 2023
on this date JANUARY
APRIL 9 2023
5000 G 0 5 - 1 2
53384- 05-12
MINA VULPIS
PAGE
USAA GENERAL INDEMNITY COMPANY
5
AMENDMENT TO
(A Stock Insurance Company)
State
POLICY NUMBER
Veh
9800 Fredericksburg - San Antonio, Texas 78288
NV
NEVADA AUTO POLICY
AMENDED DECLARATIONS
(ATTACH TO PREVIOUS POLICY)
POLICY
(12:01
A.M. standard
POLICY PERIOD:
PERIOD (12;01 A.M.
STANDARD
TIME) time)
EFFECTIVE
JAN
27 TO
2023
JUL 27 2023
EFFECTIVE APR
9 2023
OCTTO
9 2023
Terr
02532 54 35G 7102 3
Named Insured and Address
DOUGLAS
STEFFANY
BRIAN M SULLIVAN
SSG
USASTEFFANY
RET
DOUGLAS
8025 W RUSSELL RD APT 2148
LAS VEGAS NV 89113-1587
Description of Vehicle(s)
VEH YEAR
TRADE NAME
VEH USE*
MODEL
BODY TYPE
ANNUAL
MILEAGE
IDENTIFICATION NUMBER
SYM
WORK/SCHOOL
Miles Days
One
Per
Way Week
The Vehicle(s) described herein is principally garaged at the above address unless otherwise stated. * W/C=Work/School; B=Business; F=Farm;P=Pleasure
This policy provides ONLY those coverages where a premium i s shown below. The limits shown
m a y b e reduced b y policy provisions and m a y not b e combined regardless o f the number of
vehicles for which a premium is listed unless specifically authorized elsewhere in this policy.
VEH
VEH
VEH
VEH
COVERAGES
LIMITS OF LIABILITY
("ACV" MEANS ACTUAL CASH VALUE)
D=DED
PREMIUM
D = D E D PREMIUM
D = D E D PREMIUM
D=DED
PREMIUM
AMOUNT
$
AMOUNT
$
AMOUNT
$
AMOUNT
REVISED 6 MONTH PREMIUM...$ 2367.44 6 MONTH INCREASE...$ 1163.94
PREMIUM DUE AT INCEPTION. THIS IS NOT A BILL, STATEMENT TO FOLLOW.
THE FOLLOWING COVERAGE(S) DEFINED IN THIS POLICY ARE NOT PROVIDED FOR:
VEH 06 - MEDICAL PAYMENTS, EXTENDED BENEFITS COVERAGE, RENTAL REIMBURSEMENT
VEH 08 - MEDICAL PAYMENTS, EXTENDED BENEFITS COVERAGE, RENTAL REIMBURSEMENT
In WITNESS WHEREOF, we have caused this policy to be signed by our President and Secretary at San Antonio, Texas,
9 202326, 2023
COUNTERSIGNED BY
JANUARY
on this date APRIL
5000 G 0 5 - 1 2
53384- 05-12
MINA VULPIS
$
GIC
02532 54 35
SUPPLEMENTAL INFORMATION
EFFECTIVE JAN 27 2023 TO JUL 27 2023
EFFECTIVE APR 9 2023 TO OCT 9 2023
senior citizen
VEHICLE 06
ANNUAL MILEAGE DISCOUNT
ANTI-THEFT DISCOUNT
AUTOMATIC PAYMENT PLAN DISCOUNT
DAYTIME RUNNING LIGHTS DISCOUNT
MULTI-CAR DISCOUNT
PARTICIPATION IN SAFE DRIVING
PASSIVE RESTRAINT DISCOUNT
PREMIER DRIVER LEVEL
-$
-$
-$
-$
-$
-$
-$
-$
9.66
12.45
29.57
7.32
159.93
107.21
28.41
209.88
VEHICLE 08
ANNUAL MILEAGE DISCOUNT
ANTI-THEFT DISCOUNT
AUTOMATIC PAYMENT PLAN DISCOUNT
DAYTIME RUNNING LIGHTS DISCOUNT
MULTI-CAR DISCOUNT
PARTICIPATION IN SAFE DRIVING
PASSIVE RESTRAINT DISCOUNT
PREMIER DRIVER LEVEL
STUDENT AWAY AT SCHOOL W/O A CAR
OPERATOR 04
-$
-$
-$
-$
-$
-$
-$
-$
-$
12.90
32.55
39.45
18.20
202.13
142.70
28.41
280.00
46.45
SUPDECCW
APRIL
9 202326,
JANUARY
2023
PAGE
7102
6
02532 54 35
ACCIDENT REPORT FORM
Move to a safe location
Do not leave the scene of the accident
Call the police
Call 911
Do not discuss who is at fault
Do not disclose your policy details.
Collect as much information as you can
usaa.com
Report your claim.
Request a tow
1-800-531-8722 (USAA)
Reserve a rental
Arrange your repairs.
LOSS INFORMATION
OTHER VEHICLES AND PARTIES
7102
02532 54 35
7102