Form_SCTNID_CTGRY.

XX0713VOI_OTHER

<docindex><index>VOI</index></docindex>

SSB INS SRVCS

6350 LAUREL CYN BLVD
NORTH HOLLYWOOD, CA 91606
NAIC Company Code: 38628
Policy Number: 910299699
Underwritten by:
Progressive Northern Insurance Co
Policyholder :
Elizabeth M Salazar Campos
Page 1 of 1
August 12, 2021
SSB INS SRVCS
1-888-672-6999
Contact your agent for personalized service.
Customer Service
1-800-876-5581
24 hours a day, 7 days a week
Verification of Insurance for
Elizabeth M Salazar Campos
This verification of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by
the policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with
respect to which this verification of insurance may be issued or may pertain, the insurance afforded by the policies
described herein is subject to all the terms, exclusions and conditions of the policies.

Please accept this letter as verification of insurance for this policy.

Policy and driver information

……………………………………………………………………………………………………………………………………
Policy number: 910299699
……………………………………………………………………………………………………………………………………
Policy state: Iowa
……………………………………………………………………………………………………………………………………
Policy period:
…………………………………………………………………………………………………………………………………… May 28, 2021 - Nov 28, 2021
There was no lapse in coverage during this policy
…………………………………………………………………………………………………………………………………… period.
Effective date:
…………………………………………………………………………………………………………………………………… May 28, 2021
Drivers: Elizabeth M Salazar Campos
William Talamante JR
Andrea M Salazar
……………………………………………………………………………………………………………………………………
Address: 503 W 8th St
Trailer D
Storm Lake, IA 50588
Vehicle information
……………………………………………………………………………………………………………………………………
Vehicle: 2015 JEEP WRANGLER SAHARA
……………………………………………………………………………………………………………………………………
Vehicle identification number: 1C4BJWEGXFL727832
……………………………………………………………………………………………………………………………………
Lienholder: 414 Green State Credit Union
PO Box 800
North Liberty, IA 52317

Coverage information
……………………………………………………………………………………………………………………………………
Liability To Others
Bodily Injury Liability $20,000 each person/$40,000 each accident
Property Damage Liability $15,000 each accident
……………………………………………………………………………………………………………………………………
Comprehensive Actual Cash Value Deductible: $1,000
……………………………………………………………………………………………………………………………………
Collision Actual Cash Value Deductible: $1,000

Form VOI (07/13)