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Automobile Insurance Proposal

AIG Property Casualty Company


(Name of the Issuing Company)

Quote Number: AQ00603564 Proposal Date: April 11, 2016 Our Rate Guarantee Expires On: May 11, 2016
Named of Insured and Mailing address: Producer:The Sunrise Group, LLC
Michael Woodward Agency's Address: 206 N. Woodland Blvd
1018 Highgrove Dr Deland, FL 32720
Chapel Hill, NC 27516

DESCRIPTION OF YOUR COVERED AUTO(S):


CMP COL Stated
AUTO TERR SYM SYM TYPE YEAR MAKE MODEL VIN Amount CLASS

1 310 25 33 REG 2016 VOLKSWAGEN JETTA 3VW267AJ7GM286053 117100

COVERAGE LIMITS OF LIABILITY AUTO 1

Producer Proposal
Bodily Injury
Property Damage
Medical Payments
Uninsured/Underinsured
Motorists BI
$250,000/$500,000 Per Person/Accident
$250,000 Per Accident
$10,000 Each Person
$250,000/$500,000 Per Person/Accident
$258.03
$186.03
$46.00
$95.00

Property Damage $250,000 Per Accident $6.00


Less Deductible: $100 Per Accident
Other than Collision $90.00
Auto #1 $500 Deductible
Collision $605.00
Auto #1 $500 Deductible
Extended Towing & Labor $6.00
Covered Auto #1 Limits $100
Rental Vehicle Coverage $250 Deductible $4.00
Transportation Expense $1,500.00 Max. $50.00 per Day Included

Total Annual Premium Per Auto $1,296.06

TOTAL FULL TERM PREMIUM $1,296.06

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Automobile Insurance Proposal

DRIVER NAME LICENSE NUMBER DATE OF BIRTH

Michael Woodward ON FILE WITH COMPANY ON FILE WITH COMPANY

Ariadna Martinez ON FILE WITH COMPANY ON FILE WITH COMPANY

DISCOUNTS

Producer Proposal
Anti Theft Discount
Auto # 1
Passive Restraint Discount
Auto # 1
Anti Lock Brakes Discount Savings
Auto # 1

VIN ERRORS

Auto # 1
The 4th and 5th digits of VIN must be alphabetic.

COMMENTS

Authorized Company Representative

Any person who with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim
containing a false or deceptive statement is guilty of insurance fraud. The proposal is subject to all the terms and conditions of the policies and
endorsements in use. The proposal is based on the information provided; any change in the information could result in a change to the proposed terms and
or premium.

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