Form_SCTNID_CTGRY.

NJ10206489_DECPAGE

912787255 Q K781599 INS DECPAGE E POLWHITEFONT KK254GRKJWGYEF2X6DUZ2O7NVF0002 RPUID TRACWHITEFONT

THE CODY GROUP INC

150 W 28TH ST #301
NEW YORK, NY 10001

Policy Number: 912787255

Underwritten by:
Drive New Jersey Insurance Company
EKATERINA FORD May 30, 2023
PETER FORD
Policy Period: Jul 4, 2023 - Jan 4, 2024
23 CAROL PLACE
BLOOMFIELD, NJ 07003 Page 1 of 4

1-212-641-0429
THE CODY GROUP INC
Contact your agent for personalized service.

agent.progressive.com
Auto Insurance Online Service

Coverage Summary
Make payments, check billing activity, update
policy information or check status of a claim.

This is your Renewal 1-800-274-4499

To report a claim.
Declarations Page
The coverages, limits and policy period shown apply only if you pay for this policy to renew.
Your coverage begins on July 4, 2023 at 12:01 a.m. This policy expires on January 4, 2024 at 12:01 a.m.
Your insurance policy and any policy endorsements contain a full explanation of your coverage. The policy limits shown for a vehicle
may not be combined with the limits for the same coverage on another vehicle. The policy contract is form 9611A NJ (10/17). The
contract is modified by forms A230 (11/16) and Z930 NJ (08/18).

Drivers and household residents

Ekaterina Ford
Additional information: Named insured
Peter Ford
Additional information: Named insured

Form 6489 NJ (10/20)

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Policy Number: 912787255

Ekaterina Ford
Peter Ford
Page 2 of 4

Outline of coverage
2019 ACURA ILX
VIN: 19UDE2F86KA003558
Garaging ZIP Code: 07003
Primary use of the vehicle: Pleasure/Personal
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others
Bodily Injury Liability $100,000 each person/$300,000 each accident $171
Property Damage Liability $100,000 each accident 96
………………………………………………………………………………………………………………………………………………………..
Personal Injury Protection (PIP) - Medical Expense $50,000 each person $250 185
………………………………………………………………………………………………………………………………………………………..
PIP - Non-Medical Expense (Extra PIP) Named insured/spouse 4
Income Continuation Benefits $100 each week/$10,400 total
Essential Services Benefits $12 each day/$8,760 total
Death Benefit $10,000
Funeral Expense Benefits $2,000
………………………………………………………………………………………………………………………………………………………..
Extended Medical Payments $1,000 each person
………………………………………………………………………………………………………………………………………………………..
included
Uninsured/Underinsured Motorist Bodily Injury $100,000 each person/$300,000 each accident
………………………………………………………………………………………………………………………………………………………..
51
Uninsured/Underinsured Motorist Property Damage $25,000 each
………………………………………………………………………………………………………………………………………………………..
accident $500 6
Comprehensive Actual Cash
………………………………………………………………………………………………………………………………………………………..
Value $500 63
Collision Actual Cash Value
………………………………………………………………………………………………………………………………………………………..
$500 206
Rental Reimbursement up to $40
………………………………………………………………………………………………………………………………………………………..
each day/maximum 30 days 15
Total premium for 2019 ACURA $797

Form 6489 NJ (10/20)

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Policy Number: 912787255

Ekaterina Ford
Peter Ford
Page 3 of 4
2021 MAZDA CX-9 4 DOOR WAGON
VIN: JM3TCBDYXM0541375
Garaging ZIP Code: 07003
Primary use of the vehicle: Pleasure/Personal
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others
Bodily Injury Liability $100,000 each person/$300,000 each accident $135
Property Damage Liability $100,000
………………………………………………………………………………………………………………………………………………………..
each accident 84
Personal Injury Protection (PIP) - Medical Expense $50,000 each person
………………………………………………………………………………………………………………………………………………………..
$250 143
PIP - Non-Medical Expense (Extra PIP) Named insured/spouse 4
Income Continuation Benefits $100 each week/$10,400 total
Essential Services Benefits $12 each day/$8,760 total
Death Benefit $10,000
Funeral Expense Benefits $2,000
………………………………………………………………………………………………………………………………………………………..
Extended Medical Payments $1,000 each person included
………………………………………………………………………………………………………………………………………………………..
Uninsured/Underinsured Motorist Bodily Injury $100,000 each person/$300,000 each accident 51
………………………………………………………………………………………………………………………………………………………..
Uninsured/Underinsured Motorist Property Damage $25,000 each accident $500 6
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $500 85
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $500 257
………………………………………………………………………………………………………………………………………………………..
Rental Reimbursement up to $40 each day/maximum 30 days 16
………………………………………………………………………………………………………………………………………………………..
Total premium for 2021 MAZDA $781
………………………………………………………………………………………………………………………………………………………..
Subtotal policy premium $1,578.00
………………………………………………………………………………………………………………………………………………………..
NJ Prop-Liab Ins Guaranty Assoc Surcharge 5.00
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium and fees $1,583.00
………………………………………………………………………………………………………………………………………………………..
Discount if paid in full -106.00
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium if paid in full and fees $1,477.00

Tort election
Limitation on Lawsuit tort option selected.
Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
912787255 Five-Year Accident Free, Five-Year Claim Free, Home Owner, Multi-Car,
Continuous Insurance: Diamond, Paperless and Three-Year Safe Driving
Vehicle
………………………………………………………………………………………………………………………………………………………..
2019 ACURA VIN Etching or Automatic Anti-Theft Device and Smart Technology Discount
ILX
2021 MAZDA Tracking & VIN Etching or Automatic Anti-Theft and Smart Technology Discount
CX-9

Smart Technology Discount ℠ is a service mark of Progressive Casualty Ins. Co.

Lienholder and additional interest information
Vehicle Lienholder Additional interest
………………………………………………………………………………………………………………………………………………………..
2019 ACURA ILX AHFC-AMERICAN HONDA AHFC-AMERICAN HONDA
19UDE2F86KA003558 HUNT VALLEY, MD 21065 HUNT VALLEY, MD 21065

Form 6489 NJ (10/20)

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Policy Number: 912787255

Ekaterina Ford
Peter Ford
Page 4 of 4
Vehicle Lienholder Additional interest
………………………………………………………………………………………………………………………………………………………..
2021 MAZDA CX-9 MAZDA AMERICAN CR MAZDA AMERICAN CR
JM3TCBDYXM0541375 MINNEAPOLIS, MN 55439 MINNEAPOLIS, MN 55439

Form 6489 NJ (10/20)