Renewal auto policy declarations

Your policy ef{ective date is August 7,2A21 @ Allstate. You're in good hands.

Page t of 4

lnformation as of June 16, 2021

TOtal AmOUnt DUe ro, rhe poticy period

Please review your insured vehicles and verify their VlNs are correct. Summary
Veftieles covarsd Identifiration filumber Prerninm l\amed lnsured (s)
2011 Kia Optima KNAGN4A69B5063904 $579.49 Shilyn Kaufnran, Jackie Bass
2016 Kia Optima 5XXGU4L3sGGOs21'r8 748.06 Mailing address
Ca!ifornia Fraud Assessment Fee 1.76 16478 Beach BIvd Apt 249
Tota!* Westminster CA 92683"785O
$1,329.31
Policy nrrmber
* Yaur bill will be mailed separately, Before making s pqyment, please refer to yaur lgg,r lBeEAA
lilestbill,whichincludespaymentopfions andinstnllmenf fee information.tf yaudo Your poiicy provided by
not pay in full, you will be tharged on insfollnrent fee(s), Allstate Northbrook lndemnity
See the lmportant payrnent and coverage information section for details about Conlpany
installment fees. Policy period
Beginn ing August 7, 2A21 through

February 7,2A22 at 12:01 a.m. standard

DiSCOUntS (incluAed in ycur totat premium)
time
Good Driver (2Q0/o) $314,17 Multiple Policy $37.06 Your Allstate agency is
Distinguished $274,83 Heron Family Ins
Driver 30101Town Ctr #105
Laguna N iluel C A 92677 -2035
Totaldiscounts $626,O6 (949) 49s-3530
rya nherronl @al Istate,com

Oiscounts pet vehicle Some or all of the information on your

Pollcy Declarations is used in the rating
2O11Kia
of your policy or it could affect your
Good Driver (ZAa/o) 127.16 lVlultiple Policy 4.82 e!igibility for cortain coverages. Please
Distinguished $108,91 notify us immediately if you believe that
Driver
any information on your Policy
2O16 Kia 5.17 Declarations is incorrect. We r,vill make
Good Driver (2O%) .01 Multiple Folicy $22.24 corrections once you have notified us,
Distinguished $16s.e2 and any resulting rate adjustments. will
Driver he made only for the current policy
period or for future policy periods.
Please also notify us immediately if you
Listed drivers on your paliey
believe any coverages are not listed or
Shilyn Kaufman
are inaccurately listed.
Jackie Bass

Excluded drivers from yawr policy

None

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 Renewal auto policy declarations Page 2 *f 4
Policy number: 999 136 843
date:
Policy effective August 7,2fi'21

Coverage detail for 2O11 Kim Optima

forerage Limifs Deductr"6le Premiur*
Automohile Liability lnsurance Not applicable (?fiq 77
. Bodily lnjury $'15,000 each person
$30,000 each occurrence
' Property Damage $10,000 each occurrence
Auto Collision lnsurance Actual cash value $s00 $206,40
Waiver of deductible applies
Auto Co ensive lnsurance Actual cash value $soo $19,98
Rental Reimbursement up to $30 per day for a maximum of 30 lrlot applicable $23.31
days
Towing and Labor Costs l{ot purchased"
Uninsured Motorists lnsurance for Bodily $15,000 each person Nr:t ap1:licable $44.03
lnjurY $30,000 each accident
.4utornobile MedicalP Ldot purchased"
Coordinated Medical Protection F,lot purchasad*
Sound System ldot purehased*
Tape t{ot purchased"
Totalpremium for 2O11 Kia Optima $579.4e

" This coverage can provide you with vaSuable protectEon. To help you stny
*ument with your insuranee needs, contact your Allstate agent to discuss
*overage options and other products antd serviees that can help protect
ysu.-

VIH KNAGN4A59B50639O4. Rating information

Your premium is determined based on certain
inforrnation, including the following:
. This vehicle is driven 3-9 miles to work/school,
unmarried person licensed 27 years,
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Allstate usas mileage information as ons factor to help determine your premium amount. The estimated numher of rniles that
this vehicle is driven annually is 9,5OO - 9,999,
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lmporta*t f{Ete: The estimated annuafl ffii$eage tigure applieahle to this vehicie for the expiring policy period was; 9.500 -
9,999, The estirnated annua! mile*ge figure applicable te this vehicle for the current policy period is: 9,5O0 - 9t,9S9.

lf any of the inforrnation shown above ls incorrect, rnissing or changes in the future, please contart your Allstate
represemtative. P[ease ke*p in mind that * ehange in any of the information may result in an adjustment to your prernium. o
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 Renewal auto policy declarations
Policy number:
Policy effective date:
999 135 843
August 7,2fi21
Page 3 of 4
@ /illstate. You're in good hands.

Coverage detail for 2O16 Kia Optirna

eaverage Limits &educ(ible Premiurm
Automobile Liability lnsurance Nat appllcahle $26?.45
" Bodily lnjury $15,000 each person
$30,000 each occurrence
- Pri:perty Damage $10,000 each occurrence
Auto Coilision lnsurance A,ctual cash value $s00 $367.24
Waiver of deductible applies
Auto Comprehensive lnsurance Actual cash value $soo $3e.53
Rental Reirnbursement up to $30 per day for a maximurn of 30 Not applicahle $23.:3',i
days
Towing and Labor Costs Not purchased*
Uninsured Motorists lnsurance for Bodily $15,000 each person Not applicable $s5.53
lnjury $30,000 each accident
Automobile Medical Payments Not purchased*
Coordinated Medical Protection Not purchased*
Sound System Not purchased*
Tape Not purchased*
Totalpremiurm for 2O16 Kia $748.O6
* ?his eoverags ean provide you with valuable proteetion" To hetp you stay
current with your insurance needso contact your Allstate agent to discuss
€overage options and other products and services that can help proteet
ysu""

VIN 5XXGU4L35GG052118 Lienholder

Capital One Auto Finance
Rating information
Your premium is determined based on certain information, including the lnterested party
following: Capital One Auto Finance
. This vehicle is driven 3-9 miles to work/school, unmarried person
licensed 28 years.

Allstate uses mileage information as one factor to help determine your premium anrount. The estimated numher of miles that
this vehicle is driven annually is 12,5OO .12,999.

lmportant Note: The estimated annual mlleage figure applirable to this vehicle for the explning policy period raras:'t2,5O0 "
12,999. The estimated annual nrileagc figure applicable to this vehicle fon the eurrent policy period is: 12n500 ""12,999.

lf any of the inforrnation shown above is incorrect" missing or changes in the future, please €ontact your Allst*te
represemtative" Piease keep in mind that a change in any of the informatisln rmay result in an adjustnrent to your premium.

Additional coverages
Automobile Death lndemnity lnsurance Not purchased* a
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82017 i'IiltJJ:t
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 Renewal auto po licy declar tions Page ,* of 4
Policy nurnber: 999 136 843
Poliry ef{ective date: August 1,2A21

Auiornobiie Disabiiity lncr:me Prot*ction Not purchased*

ldentity Theft Expenses Not purehased*
* Thrs eoyers$e c#n proyide you wifh valuable profection,
Io hefp yor stoy
eurremt wft& your insursirce needs, eomfocf youy.Atrlsfote agent to dfscuss
($yeroS€ optr'oms cnd ot&er prodEcfs snd seryiees fhet ce n help protect yau.

Your policy documents

Your automobile policy consists of this Policy Declarations and the documents in the following list, Please keep these together,
' Allstate Automobile Policy * AU104-3 .
California Amendatory Endorsement - AU14629-3
. Amendment of Policy Provisions - AU14626-1

lmportmnt payment and (overage information

Here is some additional, helpful information related to your coverage and paying your bill:
)Your rate is lower because you are insuring multiple cars"

FYour bill will be sent to you in a separate mailing and will list any payment option(s) available to you, lf you are eligible to pay
your premiurn in installments, your first bill will reflect your available payment options, including the option to pay in full or to
pay in monthly installments. Please note that any amounts payable for the first renewal bill will not include an installment fee
(unless you have an unpaid balance from a previous policy period, in which case the Minimum Amount Due will include an
installment fee, or unless you are participating in the Allstate Easy Pay Plan). The following applies to installment payments
made after your first renewal bill.

lf you decide to pay your premiurn in installments, there will be a $3.50 installment fee charge for each payrnent due. lf you
make 6 installment payments during the policy period, and do not change your payment plan method, then the total amount of
installnrent fees during the policy period will be $21.00.

lf you are on the Allstate@ Easy Pay Plan, there will be a $1.OO installment fee charge for each payment due. If you make 6
installment payments during the policy period, and remain on the Allstateo Easy Fay Plan, then the total amount of installment
fees during the policy period will be $6.00.

lf you change payment plan methods or make additional payments, your installment fee charge for each payrnent due and the a
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total amournt of installment fees during the policy period may change or even increase. o
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Please note that the Allstate@ Easy Pay Plan allows you to have your insurance payments automatically deducted from your
checking or savings account.

Allstate Northbrook lndernn ity Company's Secretary and President have signed this poiicy with legal authority at Northbrook,
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illinois

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Susan L, Lees
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