CALIFORNIA SPECIAL X

CALIFORNIA RSVP

Infinity Insurance Company POLICY NUMBER: 10

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2201 4th Avenue North AUTO APPLICATION VERSION: 12.01
Birmingham, AL 35203 / (800) 782-1020

APPLICANT INFORMATION PRODUCER INFORMATION

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Form Number 02300R0711 Page 1

GENERAL INFORMATION
TERM PROGRAM TYPE EFFECTIVE DATE EFFECTIVE TIME EXPIRATION EXPIRATION TIME
DATE
12 Months Special 02/10/2023 03:49:58 PM 02/10/2024 12:01:00 AM
DRIVER(S) AND/OR RESIDENT(S) OF HOUSEHOLD INFORMATION
All persons age 15 and older, LICENSED OR NOT, who reside with the applicant, and any other drivers of the vehicle(s) on this application.
DRV RELATION TO DATE OF MARITAL LIVES WITH SR22 SR22
DRIVER/RESIDENT GENDER
NO APPLICANT BIRTH STATUS APPLICANT REQUIRED CASE NO.
1 Casey Frankin Self 08/17/1990 M S Yes No

DRIVER(S) AND/OR RESIDENT(S) OF HOUSEHOLD INFORMATION(continued)

DRV DRIVER'S DATE CURRENT PRIOR STATE
DRIVER/RESIDENT POINTS
NO LICENSE NUMBER LICENSED VALID LICENSE DRV. LIC. NUM.
1 Casey Frankin E2442748 08/17/2006 CA N/A 0
ACCIDENT INFORMATION
A chargeable accident is one where a person is 51% or more responsible and results in bodily injury or death or for an accident that resulted only in
damage to property exceeding a threshold of $1,000.00 for occurrences on or after 12/11/11 or $750.00 for occurrences prior to 12/11/11.
DOES TOTAL
STATE OR AMOUNT OF
JURISDICTION DAMAGE
DRV DATE OF IS ACCIDENT
DESCRIPTION OF ACCIDENT WHERE TYPE OF ACCIDENT EXCEED
NO ACCIDENT CHARGEABLE
ACCIDENT THRESHOLD
OCCURED AMOUNT
Yes No BI Death PD Only Yes No

VIOLATION INFORMATION
All convicted violations and license suspensions or revocations for the past 60 months must be shown.
STATE OR
DRV DMV VIOLATION COUNTRY OF
VIOLATION DATE CONVICTED DESCRIPTION OF VIOLATION
NO CODE NUMBER VIOLATION
OCCURRENCE
Yes No

VIOLATION INFORMATION
All convicted violations and license suspensions or revocations for the past 60 months must be shown.
STATE OR
DRV DMV VIOLATION COUNTRY OF
VIOLATION DATE CONVICTED DESCRIPTION OF VIOLATION
NO CODE NUMBER VIOLATION
OCCURRENCE
VEHICLE INFORMATION
Losses are adjusted based on ACV not to exceed current market Value.
VEHICLE IDENTIFICATION
VEH YEAR MAKE MODEL DESCRIPTION
NUMBER (VIN)
1 2008 ACURA TL SEDAN 4 DOOR 19UUA66298A010219
* Indicates VIN is incorrect and cannot be reported to the te of California
sta

VEHICLE INFORMATION (continued)

VEH VEHICLE USE VEH USE POINTS ANNUAL MILEAGE CURRENT VALUE

1 Pleasure 16000-16999

LIENHOLDER / LESSOR INFORMATION

VEH INTEREST NAME ADDRESS PHONE NUMBER ACCOUNT NUMBER

CUSTOM & SPECIAL ADD-ON EQUIPMENT - refer to manual for rules and procedures
VE VALUE OF EACH*** DATE OF PURCHASE DESCRIPTIONS OF EACH ITEM WHERE PURCHASED
H

Form Number 02300R0711 Page 2

***MAXIMUM TOTAL VALUE OF EQUIPMENT IS $9,999 NEW (STEREO VALUE ON ANY VEHICLE CANNOT EXCEED $1,000)

PREMIUM DISCOUNTS/SURCHARGES INFORMATION

APPLIED TO: DISCOUNT/SURCHARGE DESCRIPTIONS
Policy

Vehicle 1

Driver 1 Good Driver 2 -D/

SPECIAL PROGRAM
10096496201 Casey Frankin

POLICY COVERAGE INFORMATION

COVERAGE LIMITS
BODILY INJURY $15,000 each person / $30,000 each accident
PROPERTY DAMAGE $5,000 each accident
UNINSURED MOTORIST - Bl NOT TAKEN
UNINSURED MOTORIST - PD NOT TAKEN
MEDICAL PAYMENTS NOT TAKEN
ROADSIDE ASSISTANCE NOT TAKEN
POLICY DEDUCTIBLE INFORMATION
COL COM REN RA TOW SPE
Vehicle 1 N/A N/A N/A N/A N/A N/A

POLICY PREMIUM INFORMATION

BI PD UMBI UMPD MED COL
Vehicle 1 $372.00 $293.00
* If asterisk denoted next to premium above, coverage includes the Lessor Liability Endorsement (03276R0410) with Lessor BI Limits of 100/300 and PD Limit of
50.

POLICY PREMIUM INFORMATION (continued)

COM CDW REN RA TOW SPE VEHICLE TOTAL
Vehicle 1 $665.00

PREMIUM INFORMATION
Total Premium: $665.00 Down Payment: $78.29
Processing Fee: $20.00 Down Payment Method: Agent
CA Fraud Fee Recoup $1.76 Installment Fee: $10.00
SR22 Fee: $0.00 Installments: 11
Total Charges: $686.76 Installment Amount: $65.32

SPECIAL PROGRAM
2201 4th Avenue North
02/08/2023 Birmingham, AL 35203
Infinity Insurance Company

APPLICANT ACKNOWLEDGMENT OF POLICY RATING FEATURES

Form Number 02300R0711 Page 3

By California Regulation 2632.5 (Rating Factors) all policies must be rated using 3 mandatory factors. The first is
your driving record which we obtain a copy of your motor vehicle record from the state's DMV. The second is your
annual mileage driven and the third is your years of driving experience.

For the second and third mandatory rating factors, we used the information you declared on your application and
it is shown below. Please verify the information below and inform your Agent /Broker if any of this information is
incorrect.

The coverage and terms of the policy options available to me have been fully explained and I have made my
selection for this policy and coverages based on that information.
X Rated on a Garaging Address of:
1100 S. Rose St. CERES CA 95307

X Rated on Drivers Experience of: Continuous Months Licensed

Sabrina Spears 197

X Rated on a Mileage Range of:

ACURA TL 16000-16999
OTHER COVERAGES THAT ARE AVAILABLE TO YOU:

ROADSIDE ASSISTANCE - When your vehicle is disabled, for a small charge this coverage will provide fuel
delivery, flat tire assistance, lockout service, jump start or towing. Just sign the road service invoice and drive
away with no out of pocket expenses.

Selected X Not Selected

Applicant's Signature: signer1Name Date/Time: signer1Date

SPECIAL PROGRAM
10096496201 SABRINA SPEARS

REVIEW OF UNINSURED MOTORISTS COVERAGE

1. Uninsured Motorist Bodily Injury coverage provides that if you suffer bodily injury or sickness, including
death, resulting from an accident with a hit and run driver or a person who does not carry liability insurance,
and if he or she is at fault, you may make claim against your own insurance company for general damages
and special damages rather than against the uninsured motorist.

2. Uninsured Motorists Property Damage coverage provides that if your insured car is damaged from a
collision with an identified uninsured motor vehicle, then you may make claim directly against your own
insurance company for the property damage to your insured car as long as you are legally entitled to collect
from the owner or operator of the uninsured vehicle. The limit of liability is $3,500 for one automobile
damaged in one accident. Subject to the maximum limit of liability, your insurance company will pay you the
actual cash value of your insured car or the amount necessary to repair or replace it, whichever is less.
This coverage is available only if you are covered for Uninsured Motorist Bodily Injury coverage and your
insured car is not covered for collision coverage. A $100 deductible applies.

3. Uninsured Motorists Collision Deductible Waiver coverage provides that if your insured car is damaged as
the result of direct physical contact with an identified uninsured motor vehicle then your deductible under
collision coverage will be waived. This coverage is available only if you are covered for Uninsured Motorists
Bodily Injury coverage and your insured car is covered for collision coverage.

Form Number 02300R0711 Page 4

 AGREEMENT TO COMPLETELY DELETE UNINSURED MOTORISTS COVERAGE FROM THIS POLICY
FORM #01213R1004
Section 11580.2(2) of the California Insurance Code reads: "The California Insurance Code requires an insurer
to provide uninsured motorists coverage in each bodily injury liability insurance policy it issues covering liability
arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the insurer
and the applicant to delete the coverage completely or to delete the coverage when a motor vehicle is operated
by a natural person or persons designated by name. Uninsured motorists coverage insures the insured, his or
her heirs, or legal representatives for all sums within the limits established by law, which the person or persons
are legally entitled to recover as damages for bodily injury, including any resulting sickness, disease, or death,
to the insured from the owner or operator of an uninsured motor vehicle not owned or operated by the insured
or a resident of the same household. An uninsured motor vehicle includes an underinsured motor vehicle as
defined in subdivision(p) of Section 11580.2 of the Insurance Code."
I have read and understand the above and in accordance with the provisions of Sections 11580.2 and 11580.26
of the California Insurance Code which permit me and the Company to delete uninsured motorists coverage
(reviewed above) completely from the policy, I hereby agree with the Company that the provision in the policy
covering bodily injury and property damage caused by an uninsured motor vehicle is deleted completely from
the policy and that the policy does not and will not afford any coverage for bodily injury or property damage
caused by an uninsured motor vehicle.
I also fully understand and agree with the Company that since I have elected not to accept Uninsured Motorists
coverage, the Uninsured Motorists Property Damage coverage (reviewed above) or the Uninsured Motorist
Collision Deductible Waiver coverage (reviewed above) is not available to me. CAUTION: DO NOT SIGN THIS
AGREEMENT UNTIL YOU HAVE READ AND UNDERSTAND IT. BY SIGNING HERE, I ELECT NOT TO
ACCEPT UNINSURED MOTORISTS COVERAGE.

Applicant's Signature: signer1Name Date/Time: signer1Date

MILEAGE INFORMATION
1. If your vehicle is used for commute purposes, please list the address of the workplace, school, or other destination
wherethe vehicle will be driven.

Vehicle # 1 Street N/A City N/A State N/A Zip N/A

2. List the number of days the vehicle will be used for commuting.

Vehicle # 1 N/A

3. Estimate the total number of annual miles to be driven in the next 12 months.

Vehicle # 1 16000-16999

4. Please give the reason for any difference between the estimate for the upcoming 12 months and the miles driven
for theprevious 12 months if applicable.

Vehicle # 1 N/A

Form Number 02300R0711 Page 5

 5. List the current odometer reading of the vehicle shown on the policy.

Vehicle # 1 Not Answered

6. Attach the service records that reflect the odometer reading for the most recent 12 month period. (Optional -
Thisinformation is not required, but may support a lower premium.)

Vehicle # 1 Not Answered

REMARKS OR OTHER CHANGES:

Vehicle # 1 Not Answered

I hereby certify that I have read all the questions on this questionnaire and have disclosed the requested information. I also
certify that all information contained in this questionnaire is accurate and complete. I understand these changes and
information included in this questionnaire may be endorsed and made part of my policy.

Applicant's Signature: signer1Name Date/Time: signer1Date

Acknowledgement That INFINITY Offers Multiple Programs

My broker-agent has explained to me that Infinity offers insurance policies through two programs. The two programs, Special
and RSVP, have price and coverage differences designed to meet individual needs. I understand that Infinity's explanation
below represents only some of the differences in the two programs' coverages and conditions. I understand I may ask my
broker-agent to explain any other coverage distinctions not appearing below that might apply to my situation.

Bodily Injury Limits -- Special offers Bodily Injury limits up to $100,000 per person/$300,000 per accident, while RSVP's
maximum limits are $25,000 per person/$50,000 per accident. In the Special and RSVP Programs, the Bodily Injury and
Property Damage limits will be reduced to the state statutory limits of Bodily Injury $15,000 per person/$30,000 per accident
and Property Damage $5,000 per accident in the event a permissive user is driving the vehicle.

Replacement Autos -- The RSVP and Special policies provide uninterrupted liability coverage for a replacement auto if
Infinity is notified within 30 days from the date of acquisition of a replacement auto. If the auto being replaced on the policy has
physical damage coverage, RSVP and Special policies require that Infinity is notified within 5 days from the date of acquisition
of the replacement auto for physical damage coverage to continue.

Newly Acquired Autos -- The Special Policy provides uninterrupted liability coverage for a newly acquired auto if Infinity is
notified within 14 days from the date of acquisition of the newly acquired auto. If any auto on the policy has physical damage
coverage, the Special Policy requires that Infinity is notified within 4 days from the date of acquisition of the newly acquired
auto for physical damage coverage to continue. The RSVP Policy does not provide uninterrupted coverage for newly acquired
autos.

RSVP has a provision for choosing repair shops that Infinity recommends. This is important in two respects:

(1) RSVP provides for two levels of repair cost coverage. If a policyholder chooses a repair shop, Infinity will cover
80% of the fair and reasonable charges of that shop, less the deductible. If a policyholder chooses a repair shop
that is recommended by Infinity, Infinity will cover 100% of that shop's repair charges, less the deductible.

Form Number 02300R0711 Page 6

 (2) Infinity guarantees repairs performed by recommended repair shops as long as the policyholder owns the auto.
Infinity does not guarantee repairs by repair shops they do not recommend, although such shops may offer
guarantees of their own.

Special provides for payment of 100% of the fair and reasonable repair charges less the deductible, regardless of whether a
policyholder chooses a recommended repair shop.

RSVP contains a Mandatory Binding Arbitration clause. This means that in the event of a dispute between the policy holder
and Infinity, the two parties will not sue each other, but will settle their disputes through arbitration. Special only requires
arbitration if a dispute arises under Part C of the policy.

By signing below I acknowledge that the differences in Special and RSVP coverages and costs that are important to
me have been fully explained by my broker-agent. I have been provided with premium quotes for the Special and
RSVP programs for which I qualify, and the program I have chosen is selected below. I understand that if I want other
price quotes I may make such requests to my broker-agent or to Infinity (toll free (800) 782-1020).

RSVP X
Special

Applicant's Signature: signer1Name Date/Time: signer1Date

Broker-Agent's
Signature: FRANCISCO GONZALEZ GARCIA Date/Time: 02/10/2023 03:49:01 PM CST

*By entering Broker-Agent name electronically, the Broker-Agent certifies that this constitutes his/her electronic signature.

Form Number 02300R0711 Page 7

Form Number 02300R0711 Page 8
SPECIAL PROGRAM
10096496201 SABRINA SPEARS
THIS APPLICATION BECOMES PART OF YOUR INSURANCE POLICY

PRIVACY DISCLOSURE: In connection with your application for an automobile insurance policy, we may obtain consumer reports, Motor Vehicle Reports,
Comprehensive Loss Underwriting Evaluations or other personal or privileged information about you and all other residents listed on this application from third
parties. It is not our policy to disclose this information to third parties without your authorization, but in certain circumstances we may do so. You have the right
to access and correct all personal information collected. At your request, we will provide the name and address of the consumer reporting agency that furnished
any of this information. At your request, we will provide you with more detailed information regarding our collection, use, and disclosure of personal information
and your rights to access and correct such information. For more information, call Customer Service at 1-800-782-1020.

APPLICANT'S STATEMENT - READ BEFORE SIGNING

WARNING
ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE OR SHE IS FACILITATING A FRAUD AGAINST AN
INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS COMMITTING
INSURANCE FRAUD AND WILL BE PROSECUTED TO THE FULLEST EXTENT OF THE LAW.
I hereby apply to the Company for a policy of insurance as set forth in this application on the basis of my statements contained herein. By
signing below I understand that this application becomes a part of my policy and is a legal document and I certify that:

1. I have listed all operators of the vehicles listed on this application and all information about these persons is correct. This includes
anyone that may operate my vehicle(s) on a regular or frequent basis, children away from home or away at school, and all persons
age 15 or older who live with me. I agree to notify the Company of any changes in operators or licensing of household residents. I
acknowledge that failure to notify Infinity of i. any member of my household age 15 and older, licensed or not, and ii. any
change in driving status for any person currently listed or added on my policy in the future, pursuant to my obligation to
keep Infinity informed, is a misrepresentation that may materially affect the risk accepted by the Company and may render
my policy null and void.
2. I have reported any business or commercial use of my vehicle to the Company. I understand that acceptable business use is not
covered unless I have disclosed the specific use on this application and paid a premium for the Business Use Endorsement.
3. My principal residence address and place of vehicle(s) garaging is (are) the address(es) shown in this application for ten (10) or
more months each year.
4. Any custom and special add-on equipment that I want covered has been declared on this application and A PREMIUM PAID
FOR THIS ADDITIONAL COVERAGE.

I understand that:
5. The policy I am purchasing may contain unique exclusions, conditions and restrictions I should read.
6. Coverage will not be afforded and may render my policy null and void if a regular operator is not listed on the declarations
page and a premium paid.
7. No coverage of any kind shall be provided:
a. If an operator that is specifically excluded by endorsement uses my vehicle.
b. If I allow an unlicensed person to operate my vehicle.
8. By purchasing this policy it is my obligation to give the Company prior notification of any changes in the statements and information
contained in this application. Failure to notify the Company of such changes is a misrepresentation that may materially affect the risk
accepted by the Company and may render my policy null and void.
9. The quote I have received has been developed using this application. The Company may verify certain information, and, if necessary
correct the premium in accordance with its rate filings. If I do not want to continue coverage, I understand that cancellation will be
calculated based upon the correct premium. The Company will include a cancellation charge of $20 if cancellation is at my request.
10. No coverage is provided and the policy shall be null and void from inception:
a. If any information in this application is false, misleading, or would materially affect acceptance of the risk by the Company, or
b. If my down payment, partial or full, is not honored by my bank. This applies whether my payment is by check, credit card, or by
electronic funds transfer.
11. The following payment rules apply to this policy:
a. If the Company receives my payment after the due date, I will owe a late charge.
b. If my policy is rewritten with a lapse in coverage due to late payment, I will owe a Rewrite charge, and the rates in effect at that
time shall apply.
c. If my Renewal payment is received after policy expiration, my policy will be renewed with a lapse in coverage, using rates in
effect at that time
d. The company will apply any payment I make first to any installment fee or other non premium charges that are due and then will
apply the balance of my payment to any premium due. If the balance of the payment is less than the premium due, the policy
may be canceled.
e. Any outstanding balance from the previous policy term will be satisfied first from any Rewrite or Renewal payment amount.
Page
 12. The producer named in this application is acting as my broker if so indicated in the Producer Statement.
13. Any broker fee is determined, collected, and retained solely by the Broker named on this application.
14. California Insurance Regulations require that brokers present applicants with a written fee disclosure.
15. Agents and brokers receive commission and may receive other consideration from the Company.
16. No coverage of any kind shall be provided under this policy while any driver is engaged in a ride-sharing activity, car-sharing activity,
and/or a delivery service activity for a Transportation Network Company (TNC) (e.g. Uber, Lyft, GrubHub, DoorDash, Zipcar, Flexcar,
etc.) A ride-sharing, car-sharing, or delivery service activity commences when the driver turns on the TNC’s app and ends when the
driver no longer accepts service requests and logs off the TNC’s app.

The coverage I am applying for has been fully explained to me. I certify that the statements and information in this application are
true and accurate. By signing below, I acknowledge that I have read the warnings and statements listed on this application.

Applicant's Signature: signer1Name Date/Time: signer1Date

Page
SPECIAL PROGRAM
10096496201 CASEY FRANKIN

PRODUCER'S STATEMENT

To the best of my knowledge, all information contained herein is correct, the statements herein are those of the
applicant. The applicant and I are retaining a duplicate signed copy hereof.

X I am acting as the applicant's broker in this transaction, and I am legally qualified to submit this application on
behalf of the applicant.
I am acting as Infinity's appointed agent.

Producer's
Signature: FRANCISCO GONZALEZ GARCIA Date/Time: 02/08/2023 08:09:01 PM CST

Form Number 02300R0711 9

 Page

Form Number 02300R0711 10

 ST-White

CREDIT CARD RECURRING PAYMENT AUTHORIZATION AGREEMENT

CUSTOMER INFORMATION
Insured Name: Casey Frankin Policy #: 10096496201

I authorize Infinity Insurance Company to initiate monthly deductions to my debit or credit card
account indicated on this form for payment of any amount due including premium and fees, and
any renewals thereof, as reflected on my most recent Automatic Withdrawal Schedule. I
understand that this authorization will remain in effect until the scheduled end date or until I
provide notice to Infinity Insurance Company of its termination, whichever comes first. I
understand that this authorization allows Infinity Insurance Company to adjust the monthly
deductions to reflect any premium changes and policy renewals, and to initiate credit entries to my
account to correct erroneous deductions or provide a refund of premium. Infinity Insurance
Company agrees to notify me at least ten (10) business days prior to making a deduction that is
greater than the monthly withdrawal amount or changing the scheduled debiting date on my most
recent Automatic Withdrawal Schedule. In order to stop payment, make changes to my account
information or terminate this authorization, I agree to notify Infinity Insurance Company at least
three (3) business days prior to the next billing date by contacting Infinity Insurance Company or
by logging into my account and processing the change.

If the monthy deduction is declined, a cancellaton notice for non-payment will be delivered to me
in accordance with the laws of my state. If the balance is not satisfied within the time period
specified on that notice, my policy will cancel. I acknowledge that the origination of card
transactions to my account must comply with the provisions of U.S. law. I will not dispute Infinity
Insurance Company's recurring billing with my bank or credit card company so long as the
transaction corresponds to the terms indicated in this agreement.

Card Holder's Information:

Name on Card: Casey Frankin

Account Type: Visa
Card Number: XXXXXXXXXXXX8146
Exp Date: 01/2028

X I certify that I am an authorized signer on this card account and have read and agree to the
Terms and Conditions of this payment authorization.

Applicant's
Signature: signer1Name Date/Time: signer1Date

2201 4th Avenue North, Birmingham, AL 35203 000RCCA03

(800) 782-1020, (800) 782-2218
www.infinityauto.com
1/1
 ST-White

Infinity Special
2201 4th Avenue North
Birmingham, AL 35203
Underwritten by: Infinity Insurance Company
Customer Service: (800) 782-1020 Claims Service: (800) 334-1661

AUTHORIZATION TO RELEASE TOTAL LOSS VEHICLES

POWER OF ATTORNEY

I, the undersigned, hereby grant the Infinity company underwriting my policy (“Infinity”), its employees, and its
agents full power and authority to act on my behalf and to exercise any and all legal rights as necessary for
the purpose of releasing, moving, and transferring any vehicle listed on my declarations page with
Comprehensive or Collision coverage and deemed by Infinity to be a total loss.
I hereby release from liability any vehicle storage facility, body shop or other service center that complies with
this authorization and releases any total loss vehicle at the direction of Infinity.

Applicant's
Signature: signer1Name Date/Time: signer1Date
 ST-White

000PATL01 Page 1
www.infinityauto.com
Customer Service Phone: (800)782-1020
Customer Service Fax: (800)782-2218

To: INFINITY SPECIAL Agency: FREEWAY INSURANCE SERVICES - Fresno

1 (FR1)
Fax: (800)782-2218 Phone: (800)300-0227
Sender: RE: New Policy Fax
Policy Number: 10096496201 Date: Uploaded on 02/08/2023 at 08:08:58 PM CT
Named Insured: Casey Frankin Pages:
These documents should be faxed along with this cover sheet within 72 hours of the policy upload:

Comments:

Form: CMNFAX01
Do Not Write Below This Line

If fax not available, mail to:

Infinity Insurance Companies

P.O. Box 830807
Birmingham, AL 35283-0807
 ST-White

*10096496201*

Page 1
Infinity Special
2201 4th Avenue North
Birmingham, AL 35203
Underwritten by: Infinity Insurance Company
Customer Service: (800) 782-1020 Claims Service: (800) 334-1661

Insured Receipt

Policy Number: 10096496201

Named Insured: Casey Frankin Agency: FREEWAY INSURANCE SERVICES - Fresno
1 (FR1)
Address: 3104 Aarvig Ct Address: 5410 N BLACKSTONE AVE
CERES, CA 95307 FRESNO, CA 93710-
This acknowledges receipt of $78.29 to Infinity by direct payment of cash, check, money order or credit card
to the agency. The payment is made as a down payment on the policy number noted above.

Our acceptance of your payment does not guarantee coverage. If you have paid your down payment or
installment by check and your bank returns the check unpaid, the down payment or installment will be
considered never paid to the insurance company. On a new policy, this means that your insurance never went
into force and that you are not covered. If you are making a payment on a current policy, any outstanding
cancellation will take effect and/or any new payments due will be considered unpaid. Payment of all amounts
due is necessary to be considered for reinstatement on current policies which are in the process of being
cancelled. Our acceptance of your check in no way promises continuation of coverage.

Date: 02/08/2023 Time: 08:08:58 PM CT

Agency Receipt

Policy Number: 10096496201

Named Insured: Casey Frankin Agency: FREEWAY INSURANCE SERVICES - Fresno
1 (FR1)
Address: 3104 Aarvig Ct Address: 5410 N BLACKSTONE AVE
CERES, CA 95307 FRESNO, CA 93710-
This acknowledges receipt of $78.29 to Infinity by direct payment of cash, check, money order or credit card
to the agency. The payment is made as a down payment on the policy number noted above.

Date: 02/08/2023 Time: 08:08:58 PM CT

 ST-White

Form No. CMNRCT01

 Infinity Special
2201 4th Avenue North
Birmingham, AL 35203
Underwritten by: Infinity Insurance Company
Customer Service: (800) 782-1020 Claims Service: (800) 334-1661
INVOICE
Important: Give this bill to the Applicant -- Do not submit with application.
Policy Number: 10096496201 Agency: FREEWAY INSURANCE
SERVICES
Named Insured: Casey Frankin - Fresno 1 (FR1)
Address: 3104 Aarvig Ct Address:
CERES, CA 95307 5410 N BLACKSTONE AVE
FRESNO, CA 93710-
This is your First Bill (Installment)

You may not receive another Bill (unless your Premium changes)

Kemper must receive $65.32

To: Kemper Auto

PO BOX 830189
Birmingham, AL 35283-0189

By 03/08/2023 to avoid Late Fees.

Do Not Ignore This Statement

Return The Top Portion with Your Payment

Your first installment of $65.32

Your remaining installments:

Due Date Installment Amount Fee Total Payment Due
03/08/2023 $55.32 $10.00 $65.32
04/08/2023 $55.32 $10.00 $65.32
05/08/2023 $55.32 $10.00 $65.32
06/08/2023 $55.32 $10.00 $65.32
07/08/2023 $55.32 $10.00 $65.32
08/08/2023 $55.32 $10.00 $65.32
09/08/2023 $55.32 $10.00 $65.32
10/08/2023 $55.31 $10.00 $65.31
11/08/2023 $55.31 $10.00 $65.31
12/08/2023 $55.31 $10.00 $65.31
01/08/2024 $55.31 $10.00 $65.31
You will receive bills for these amounts and due dates, but your receipt or non-receipt of this bill will not prevent
your policy from cancelling if Infinity does not receive your payment by the due date indicated. You may be
charged a late fee for payments not received by the due date.

When your Application is submitted, your first bill and the above installments may change. Watch your mail for
such changes.
For your convenience, credit card and check payments can also be made at www.infinityauto.com or by calling

Form Number: CMNINV01 Page 1

Customer Service at (800) 782-1020.

Form Number: CMNINV01 Page 2