Evidence of Property Insurance

AAA Insurance
underwritten by CSAA Insurance Exchange
PO Box 22221 Oakland, CA 94623-2221 (800) 922-8228

General Information
This is evidence that insurance as identified below has been issued and is in force. This Evidence of Insurance does not expand, diminish or
change any of the coverages, exclusions, terms or conditions of the policy. The coverages, exclusions, terms and conditions are expressed in the
declarations, policy booklet and endorsements. This is not a contract between the issuing insurer, authorized representative or producer, and the
Certificate holder(s). This does not confer to any holder(s) any additional rights under the Policy. Without limiting the generality of the preceding,
this Evidence of Insurance is not a waiver of the insurer's right to subrogate against the Certificate holder(s).

Agent: Phone: (510) 360-3368 Company: Notice Date/Time: 03/04/2020 at 12:01 PM

AAA NCNU AAA Insurance

39600 Balentine Dr PO Box 22221
Newark, CA 94560 Oakland, CA 94623-2221
CSAA Insurance Exchange - NAIC # 15539
Agent Name: Erick Crawford
Insured: Ahmed Buhari Policy Number: CAH4-212136724
SAMEER MOHAMED BUHARI Policy Period: 03/04/2020 - 03/04/2021
4200 Bay St Location of Insured Property:
Apt 250 4200 Bay St
Fremont, CA 94538 Apt 250
Fremont, CA 94538

Coverage and Premium Information

Coverage/Perils/Forms Amount of Insurance Policy Type/Deductible/Premium

Coverage C - Personal Property 15,000 Policy Type: Renters

3,000 Deductible: $1,000
Coverage D - Loss of Use
100,000 Annual Premium: $147.00
Coverage E - Personal Liability
Coverage F - Medical Payments to Others 1,000/25,000
(Each Person/Each Accident)

Remarks

Cancellation
The policy is subject to the premiums, forms and rules in effect for each policy period. Should the policy be terminated, the company will give the
additional interest identified below 30 days written or electronic notice, and will send notification of any changes to the policy that would affect that
interest, in accordance with the policy provisions or as required by law.

Mortgagees and Other Interests

None

Authorized
Representative:

62 6500 CA 05012013 Page 1 of 1

 AAA Insurance
Payment receipt
underwritten by CSAA Insurance Exchange
PO Box 22221 Oakland, CA 94623-2221 (800) 922-8228

March 04, 2020

AHMED BUHARI
SAMEER MOHAMED BUHARI
Receipt number 96105120
CUSTOMER INFORMATION
Address 4200 BAY ST
Thank you for your renters insurance policy payment. It will be APT 250
reflected on the next bill we send you. Please keep this receipt FREMONT, CA 94538-4229
for your records. Preferred (408) 324-6521
phone number

Payment information Your policy number CAH4212136724

Type of policy renters insurance
What's covered 4200 Bay St
Amount you paid $147.00 Apt 250
Type of payment FULL PAYMENT Fremont, CA 94538

Method of payment Credit card - Master Card

Cardholder name AHMED M BUHARI AGENT INFORMATION
Agent’s name Erick Crawford
Card number ****9749
Agency AAA NCNU
Expiration date 01/2024
Phone number (510) 360-3368
Authorization date 03/04/2020 12:00:09 PM
Address 39600 BALENTINE DR
Authorization number 170583387 NEWARK, CA 94560-5376

Date March 04, 2020

Call (800) 922-8228
Monday through Friday, 4:00 a.m. to 11:00
p.m.; Saturday and Sunday, 4:00 a.m. to 7:00
Please note: p.m. Pacific Time.
Moving? Call to give us your new address.
Payments made by check, electronic funds transfer, credit card or debit
card are applied once they are cleared by your bank or credit card
company. If for any reason your bank or credit card company does not
honor your payment or they honor the payment and then later decided
not to honor the payment this means that you have not made a payment.
If that happens, it could affect the status of your policy.

AHRCTXX 0316 - Payment receipt