Root Insurance Co.

80 E Rich Street
Suite 500
Columbus, OH 43215
support@joinroot.com
(866) 980-9431

Policy number FRJVBZ

Auto insurance policy amended declarations

Your coverage begins on June 10, 2021 at 11:43pm CDT. It expires on December 10, 2021 at 12:01am CST.

Named insured Vehicles

Nicholas Edwards 2013 Lincoln Navigator (5LMJJ3H55DEL00962)
21602 Grand Bay Ln
Katy, TX 77449

Coverage premiums, limits and deductibles

The following coverages apply to all listed vehicles unless otherwise noted.

Bodily injury liability $30,000 each person

Premium: $471 $60,000 each accident

Property damage liability $25,000 each accident

Premium: $309

Rental $50 each day

Premium: $102 $1,500 each accident

Personal injury protection $5,000 each person

Premium: $65

Uninsured/underinsured motorist bodily injury $30,000 each person

Premium: $37 $60,000 each accident

Uninsured motorist property damage $25,000 each accident

Premium: $67 $250 deductible.

Comprehensive $1,000 deductible. Limit of actual cash value.

Premium: $198

Collision $1,000 deductible. Limit of actual cash value.

Premium: $302
Roadside assistance $100 each incident (up to 3 incidents)

Installment fee Total: $8.00

Lienholder information
2013 Lincoln Navigator Smart Choice Auto Group (Lease)*
5LMJJ3H55DEL00962 17650 Northwest Fwy
Houston, TX 77065

* Signifies that the lienholder is also an additional insured for that vehicle

Policy Changes

Cancellation
Effective from: 09/24/2021 12:00AM
Requested on: 09/24/2021 09:06AM

Endorsement
08/09/2021 04:06AM

Updated based on test drive results

Policy documents
Your insurance policy and any policy endorsements contain a full explanation of your coverage. These are available for
review in your Root App or you may contact us for a copy. The policy contract is Form 1, August 2017. You’ll see the
form number at the bottom of the pages in your contract. The contract is modified by Form 01, Form 02, Form 03, Form
3, Form 07, Form 7, Form 08, Form 09, Form 11, and Form 15, which you’ll find included in your contract.