Auto Insurance Policy No.

4001187463

CO-OPERATORS
700-3080 BOUL LE CARREFOUR
LAVAL QC H7T 2R5

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CO-OPERATORS at 877-630-2667

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GUSTAVO GRASSER DE SOUZA CO-OPERATORS

C/O LES TERRASSES MARCEL-LAURIN 700-3080 BOUL LE CARREFOUR
107-900 BOUL MARCEL-LAURIN LAVAL, QC H7T 2R5
SAINT-LAURENT QC H4M 0A2

Your auto insurance

policy renewal
Your pink slips (motor vehicle liability cards) Page 3
Your declarations Page 5
Your insurance needs can change – please review your renewal
carefully and remember to replace your expired pink slips (motor
vehicle liability cards) with the ones enclosed.
Want on-the-go access to your liability slip? Download
The Co-operators Mobile app – all you need is an Online Services
account. Don't have one? Visit cooperators.ca/onlineservices to
sign-up!
Our privacy statement, disclosure and compensation can change
from time to time. To read the latest version, visit cooperators.ca or
contact our Privacy Office.

DATE PREPARED: FEBRUARY 8, 2021 PAGE 1 OF 8

COVID-19 has brought many changes - especially in the ways we interact. As always, our clients and communities
remain a top priority. We are taking steps to follow the recommendations of the Government of Canada and Public
Health, by providing safe and convenient ways to stay connected.
- Online - visit us online for helpful tips and information including access to Online Services where you can manage
your policy from the safety and comfort of home. Don’t have an account? Register today.
- Contactless payment - enjoy the convenience of our website or mobile app.
- Call or email your office - we remain focused on helping clients through this difficult time. Increased call volumes
may cause longer wait times and we appreciate your patience.
To help you get through these challenging times, we’re providing additional support with:
Flexible payment options - to help ease unexpected financial pressures, we’re committed to working individually with
our clients on a case-by-case basis to find solutions that will meet their needs.
We recognize that clients will face unique needs and challenges as risks change and evolve, we hope these temporary
measures will make a difference during this trying time. In the meantime - stay home, stay safe and if you need more
information, please visit our website for updates.

Stay connected and up to date wherever you are

With an Online Services account, you’ll have your policy

information at your fingertips. It’s safe, secure and convenient!
Visit cooperators.ca/onlineservices to:
• GO PAPERLESS and reduce clutter
• Make changes - update your coverage, add or replace a vehicle
or driver
• Submit a claim and upload photos and documents to your open
claim
• Make payments
• Access your pink slip when you download The Co-operators
Mobile app
• Stay in the know with eAlerts and more!
Already have an account? When you use Online Services to make
an eligible transaction, you’ll be entered into our monthly draw of
$500!*
*For complete contest rules visit cooperators.ca

facebook.com/TheCooperatorsInsurance @The_Cooperators youtube.com/CooperatorsInsurance

DATE PREPARED: FEBRUARY 8, 2021 PAGE 2 OF 8

 Your motor vehicle liability cards

CO-OPERATORS GENERAL INSURANCE COMPANY CO-OPERATORS GENERAL INSURANCE COMPANY

POLICE NUMÉRO / POLICY NUMBER POLICE NUMÉRO / POLICY NUMBER

4001187463 4001187463
NOM ET ADRESSE DE L'ASSURÉ / NAME AND ADDRESS OF INSURED NOM ET ADRESSE DE L'ASSURÉ / NAME AND ADDRESS OF INSURED
GUSTAVO GRASSER DE SOUZA GUSTAVO GRASSER DE SOUZA
107-900 BOUL MARCEL-LAURIN 107-900 BOUL MARCEL-LAURIN
SAINT-LAURENT QC H4M 0A2 SAINT-LAURENT QC H4M 0A2

DATE D’ENTRÉE EN VIGUEUR / EFFECTIVE DATE DATE D’EXPIRATION / EXPIRY DATE DATE D’ENTRÉE EN VIGUEUR / EFFECTIVE DATE DATE D’EXPIRATION / EXPIRY DATE
Mar 25 2021 Mar 25 2022 Mar 25 2021 Mar 25 2022
VEHICULE ASSURÉ / INSURED VEHICLE (ANNÉE, MARQUE, SÉRIE / YEAR, MAKE & SERIAL NO.) VEHICULE ASSURÉ / INSURED VEHICLE (ANNÉE, MARQUE, SÉRIE / YEAR, MAKE & SERIAL NO.)
2016 NISSAN, SENTRA 1.8 S 4P, 3N1AB7AP4GL635502 2016 NISSAN, SENTRA 1.8 S 4P, 3N1AB7AP4GL635502

CERTIFICAT D’ASSURANCE AUTOMOBILE RESPONSABILITÉ / MOTOR VEHICLE LIABILITY INSURANCE CARD CERTIFICAT D’ASSURANCE AUTOMOBILE RESPONSABILITÉ / MOTOR VEHICLE LIABILITY INSURANCE CARD

CANADA INTER-PROVINCE CANADA INTER-PROVINCE

EN VIGUEUR AU CANADA ET AUX ÉTATS-UNIS D’AMÉRIQUE / APPLICABLE WITHIN CANADA EN VIGUEUR AU CANADA ET AUX ÉTATS-UNIS D’AMÉRIQUE / APPLICABLE WITHIN CANADA
AND THE UNITED STATES OF AMERICA AND THE UNITED STATES OF AMERICA
P100009518603 P100009518603

Contact us at: Contact us at:

877-630-2667 877-630-2667

24-hour emergency claims service 24-hour emergency claims service

Call our Claims Reporting Centre Call our Claims Reporting Centre
1-877-594-2667 1-877-594-2667

Use Online Services Use Online Services

Sign in at cooperators.ca/aclickaway Sign in at cooperators.ca/aclickaway

Use our Mobile App Use our Mobile App

Download your iOS or Android app to get started Download your iOS or Android app to get started
If you’re in an accident, remember...
This certifies that the party named herein is insured against liability for bodily injury and
property damage by reason of the operation of the motor vehicle described herein, in an
amount not less than the statutory minimum requirements in any area of Canada.
(1) STOP – Never flee the scene.
(2) Ensure everyone is well clear of the accident site.
(3) Check if anyone needs medical assistance.
(4) Move your car to the roadside or set up warning signals to prevent further accidents.
(5) Call the police if injury or death has occurred, if you suspect criminal activity or if
combined damage exceeds $2,000.
(6) Record all necessary information, such as automobile make and model, license number
and telephone numbers.
(7) Contact our 24-hr Claims Reporting Centre at 1-877-594-2667 or your representative
CO-OPERATORS at 877-630-2667
Le présent certificat est assujetti aux dispositions et conditions de la police d’assurance
automobile de l’Assureur.
Ce certificat atteste que la personne susnommée est assurée contre la responsabilité pour
blessures et dommages aux biens découlant de l’usage du véhicule ci-décrit, conformément
aux limites minimales exigées par les lois d’assurance en vigueur partout au Canada.
AVERTISSEMENT–Quiconque émet ou présente un tel certificat comme preuve d’une police
d’assurance-responsabilité qui effectivement n’est pas en vigueur, est coupable d’une
infraction passible d’une forte amende et/ou d’emprisonnement et suspension de son permis.
Ce certificat doit être laissé dans le véhicule assuré afin d’être présenté comme preuve
d’assurance lorsque la police l’exige.
This certificate is subject to the terms and conditions of the insurer’s standard automobile
policy.
This certifies that the party named herein is insured against liability for bodily injury and
property damage by reason of the operation of the motor vehicle described herein, in an
amount not less than the statutory minimum requirements in any area of Canada.
WARNING – Any person who issues or produces a card to show that there is in force a policy
of insurance as indicated herein that is in fact not in force is liable to a heavy fine and/or
imprisonment and his licence may be suspended.
This card should be carried in the insured vehicle for production as proof of insurance when
demanded by police.
If you’re in an accident, remember...
This certifies that the party named herein is insured against liability for bodily injury and
property damage by reason of the operation of the motor vehicle described herein, in an
amount not less than the statutory minimum requirements in any area of Canada.
(1) STOP – Never flee the scene.
(2) Ensure everyone is well clear of the accident site.
(3) Check if anyone needs medical assistance.
(4) Move your car to the roadside or set up warning signals to prevent further accidents.
(5) Call the police if injury or death has occurred, if you suspect criminal activity or if
combined damage exceeds $2,000.
(6) Record all necessary information, such as automobile make and model, license number
and telephone numbers.
(7) Contact our 24-hr Claims Reporting Centre at 1-877-594-2667 or your representative
CO-OPERATORS at 877-630-2667
Le présent certificat est assujetti aux dispositions et conditions de la police d’assurance
automobile de l’Assureur.
Ce certificat atteste que la personne susnommée est assurée contre la responsabilité pour
blessures et dommages aux biens découlant de l’usage du véhicule ci-décrit, conformément
aux limites minimales exigées par les lois d’assurance en vigueur partout au Canada.
AVERTISSEMENT–Quiconque émet ou présente un tel certificat comme preuve d’une police
d’assurance-responsabilité qui effectivement n’est pas en vigueur, est coupable d’une
infraction passible d’une forte amende et/ou d’emprisonnement et suspension de son permis.
Ce certificat doit être laissé dans le véhicule assuré afin d’être présenté comme preuve
d’assurance lorsque la police l’exige.
This certificate is subject to the terms and conditions of the insurer’s standard automobile
policy.
This certifies that the party named herein is insured against liability for bodily injury and
property damage by reason of the operation of the motor vehicle described herein, in an
amount not less than the statutory minimum requirements in any area of Canada.
WARNING – Any person who issues or produces a card to show that there is in force a policy
of insurance as indicated herein that is in fact not in force is liable to a heavy fine and/or
imprisonment and his licence may be suspended.
This card should be carried in the insured vehicle for production as proof of insurance when
demanded by police.
 Declarations
ITEM 1
Name and address of the named insured:
GUSTAVO GRASSER DE SOUZA Auto Insurance Policy No. 4001187463
C/O LES TERRASSES MARCEL-LAURIN Underwritten by Co-operators General Insurance Company
107-900 BOUL MARCEL-LAURIN (Hereinafter called the Insurer)
SAINT-LAURENT QC H4M 0A2
ITEM 2
Contract period:
The described vehicle is and will be mainly used, stored and From March 25, 2021* to March 25, 2022*
parked in the town/city and province shown in Item 1. If not, the exclusively.
client or the named insured must so declare.
*at 12:01 A.M. standard time at the address of the named
insured.

Questions?
CO-OPERATORS at 877-630-2667
700-3080 BOUL LE CARREFOUR
LAVAL, QC H7T 2R5

Summary of Insured Automobiles

DESCRIPTION PRINCIPAL DRIVER OCCASIONAL DRIVER AMOUNT

1: 2016 NISSAN SENTRA 1.8 S 4P GUSTAVO GRASSER DE SOUZA $1,368.00

Total policy premium $1,368.00
Tax $122.22
Total policy cost $1,490.22
Due date for payment of insurance premiums: Please see your Invoice or Payment Schedule

Discounts You have saved $414.00 because of your discounts.

ITEM 3

Particulars of the described vehicle:

Creditor entitled to the indemnities under Section B, to the
Vehicle No. 1 2016 NISSAN SENTRA 1.8 S 4P extent of the creditor’s interest:
Registered owner GUSTAVO GRASSER DE SOUZA Lienholder

Serial number / V.I.N. 3N1AB7AP4GL635502 TD AUTO FINANCE

78 MANHATTAN CRES
Body type 4 DOOR
OTTAWA, ON K2C 4B8
Cylinders / C.C.
Gross vehicle weight (kg)
Purchase or list price new including $19,000
equipment

DATE PREPARED: FEBRUARY 8, 2021 PAGE 5 OF 8

The Co-operators® used with permission from The Co-operators Group Limited.
ITEM 4

OCCASIONAL
The perils covered by the insurance contract are those for LIMIT/ DRIVER TOTAL
DEDUCTIBLE PREMIUM PREMIUM PREMIUM
which an amount of insurance, a deductible or an
insurance premium is shown in the table below.
Coverage is subject to the conditions set out in the
insurance contract.

Section A: Civil Liability $2,000,000 $575 $575.00

Property damage or bodily injury to another person

Section B: Damage to insured vehicles

Deductible per loss:
Protection 1: "All perils"
Protection 2: Collision and upset $500 $589 $589.00
Protection 3: All perils other than collision or upset $250 $130 $130.00
Protection 4: Specific perils

Endorsements
QEF 23A Notice to Creditor (Section B)
QEF 33 Insurance for roadside assistance costs $20 $20.00
QEF 34 Accident benefits insurance $10 $10.00
Division 1 - Death and dismemberment benefits and reimbursement of medical
expenses
Subdivision A - Death benefits: Principle sum $10,000
Subdivision B - Dismemberment benefits:
Principle sum $10,000
Subdivision C - Reimbursement of medical
expenses per person $2,000
Division 2 - Total disability benefits Excluded
42300 Complement Insurance $44 $44.00
Total premium for automobile 1 $1,368.00

ITEM 5
The named insured is both the actual owner and the registered owner of the described vehicle. If not, the following
information must be provided:

Actual owner: GUSTAVO GRASSER DE SOUZA

Registered owner: GUSTAVO GRASSER DE SOUZA

DATE PREPARED: FEBRUARY 8, 2021 PAGE 6 OF 8

ITEM 6

Important statements for analyzing the risk:

Vehicle use Pleasure Driver
Kilometres driven 5,000 km driven each year Principal driver GUSTAVO GRASSER DE SOUZA
30 years old
11 years licensed
11 years claims free

Driving record
Principal driver Civil Liability 6
Collision and Upset 6
All perils other than collision
or upset 6

Surcharges
GUSTAVO GRASSER DE Conviction - Principal Driver 20%
SOUZA

Discounts
Owner
Multi-Product
Occupation

ITEM 7
Information for the named insured:

Name of insurance broker or agent:

CO-OPERATORS

Address of insurance broker or agent:

700-3080 BOUL LE CARREFOUR
LAVAL, QC H7T 2R5

Robert Wesseling
President and Chief Executive Officer
Authorized Signature of Insurer

For the purposes of the Insurance Companies Act (Canada), this document was issued in the course of the Insurer's insurance business in Canada.

DATE PREPARED: FEBRUARY 8, 2021 PAGE 7 OF 8

YOUR PERSONAL INFORMATION IS PROTECTED

Automobile Claims Database (FCSA)

In accordance with section 177 of the Automobile Insurance Act, all information and data regarding claims in which you are involved as well as the
named operators of your automobile is sent to the Autorité des marchés financiers. You, as well as the named operators, have a right to access and rectify
such information as provided under the Act respecting access to documents held by public bodies and the protection of personal information (R.S.Q.,
c. A-2.1).

In accordance with section 179.2 of the Automobile Insurance Act, The Co-operators General Insurance Company wants to inform you, as well as all the
drivers named to the present contract, that information had been asked and obtained from the Fichier Central des Sinistres Automobiles at the Autorité
des marchés financiers, according to the article 179.1 of the Automobile Insurance Act (R.S.Q., c. A-25), in order to determine the applicable rates.

DATE PREPARED: FEBRUARY 8, 2021 PAGE 8 OF 8