GoAuto Insurance Company

(A Stock Insurance Company)

Administered by GoAuto Management Services, LLC
533 Highlandia Dr. Suite A
Baton Rouge, Louisiana 70810
(225) 926-7000
Declarations
INSURED’S NAME AND ADDRESS Policy Number: 1519695
Williams, Oliver G. Term Number:
144 Triberg Ct Period: From 03/09/2021 09:54:14 to 04/14/2021 00:01
Henderson, NV 89074 Date Processed: 03/09/2021 10:28
The owned automobile(s) will be garaged at the insured’s physical address at 144 Triberg Ct Henderson, NV 89074
The insurance afforded is only with respect to each of the following overages as indicated by a specific premium charge. The limit of
the company’s liability for each coverage will be as stated, subject to all terms of the referenced policy.
Coverage Limits of Liability Premium
Veh1 Veh2 Veh3 Veh4 Veh1 Veh2 Veh3 Veh4
Each Person $25,000
Bodily Injury $325.00
Liability Each Occurrence $50,000
Property Damage Each Occurrence $20,000 $186.00
Each Person n/a
Uninsured Bodily Injury
Each Occurrence n/a
Motorist
Medical Each Occurrence n/a
Roadside Assistance Each Disablement n/a
Rental Reimbursement Daily Maximum n/a
Deductible
Comprehensive n/a
Collision n/a
Vehicle Totals: 511.00

Vehicle Description
Veh# Year Make and Model Identification Number Sym Terr Drv Cls
(1) 2006 Dodge Charger se/charger sxt 2B3KA43R36H314318 16 30 1W
(2)
(3)
(4)

Veh # Lienholders/Additional Insureds

( )
( )
( )
( )
Operators
Oliver G. Williams

Operators Excluded from this policy

Linda Gomez

Operators Excluded from Specific Vehicles

Endorsements:
GIC 5.0 NV (03-16) Uninsured/Underinsured Motorist Bodily Injury Coverage Form; GIC 6.0 NV (03-16) Named Driver Exclusion Endorsement
Premium and Fees
Premium 511.00
Policy Fee 40.00 By:
Authorized Representative
Total 551.00 Term: Premium is refundable but Fees are fully earned and NON-REFUNDABLE.
YOUR POLICY CONSISTS OF THIS DECLARATIONS, YOUR PERSONAL AUTO POLICY, YOUR APPLICATION FOR
INSURANCE AND ANY ENDORSEMENTS THAT APPLY INCLUDING THOSE ISSUED TO YOU AT ANY
SUBSEQUENT RENEWAL BY US.

GoAuto Insurance Company *113300642DEC*

GAIC 2.00 NV (2016-09)