Pearl Holding Group

OCEAN HARBOR CASUALTY INS. CO.
PAGE 1 OF 2 IF AMENDED,THIS DECLARATION PAGE

P.O. BOX 451119 SUPERSEDES ALL PRIOR DECLARATIONS
Sunrise, FL 33345-1119
www.PearlHolding.com OF COVERAGES
www.MyPearlPolicy.com
POLICY NUMBER NEW BUSINESS PRODUCER CODE

P0200639456-01 DECLARATIONS 7954
For a copy of the policy terms and conditions please go to www.PearlHolding.com and click on "Policy Terms & Conditions".
1. NAMED INSURED AND MAILING ADDRESS 2. PRODUCER
CHRISTIAN M SEDA VALDES UNIVISTA INSURANCE

1312 MILL SLOUGH RD 637 S. SEMORAN BLVD. STE G
KISSIMMEE, FL. 34744 ORLANDO FL 32807
(904)581-1964 (407)964-1737
The owned automobile(s) will be principally garaged in the town designated in item 1, unless otherwise stated herein: (Car No. Location)
1312 MILL SLOUGH RD KISSIMMEE, FL 34744
Effective Date
POLICY PERIOD: FROM: 06/10/2022 TO: 06/10/2023 12:01 AM STANDARD TIME of Transaction: 06/10/2022
3. DESCRIPTION OF INSURED VEHICLES RATING CLASSIFICATION
MODEL CLASS
VEH YEAR MAKE / MODEL IDENTIFICATION NUMBER PHY LIAB AGE / SYM TERR
1 2014 TOYOTA CAMRY L/LE/SE/XLE 4T1BF1FK0EU424084 7 7 6/28 66A
YOU HAVE THOSE COVERAGES FOR WHICH A PREMIUM CHARGE IS SHOWN BELOW.
ANNUALIZED PREMIUMS
COVERAGES LIMITS DEDUCTIBLES Veh1
PROPERTY DAMAGE LIABILITY $ 10,000 /Accident 338
PERSONAL INJURY $10,000/Person $ 1000 Deductible
PROTECTION Plus $5,000/Death Benefit
Note $2,500 Non-Emergency DED INS & RESIDENT RELATIVES 693
WORK LOSS EXCL INSURED & RES REL
Medical Limit/Person
CONTINUED MOBILITY $20/Occurrence 12
COLLISION ACV Deductible: 1 $ 500 2$ 3$ 4$ 500
OTHER THAN COLLISION ACV Deductible: 1 $ 500 2$ 3$ 4$ 231
MGA POLICY FEE: $ 25 SETUP FEE: $ 10 SR22 FEE: $ 0 TOW: $0 FHCF FEE: 0.00 POLICY TOTAL: $ 1809.0
REASON FOR DECLARATION: EFFECTIVE DATE PR/SR FACTOR PREVIOUS AMD PREM*
NEW BUSINESS 06/10/2022 0.000 0.00

ANNUAL PREM NEW AMD PREMIUM *
1809.00 1809.00
*AMD PREMIUM IS THE TOTAL PREMIUM TO BE PAID FOR THE TERM SHOWN
ADJUSTED FOR ALL PREMIUM AMENDMENTS THROUGH CURRENT DATE.
SURCHARGES Veh 1
PD TOTAL POINTS / TOTAL POINTS SURCHARGE 0/ 0% / / /
PIP TOTAL POINTS / TOTAL POINTS SURCHARGE 0/ 0% / / /
COMP/COLL POINTS / TOTAL POINTS SURCHARGE 0/ 0% / / /
DISCOUNTS MULTI CAR RENEWAL SAFE DRIVER ABS SRS THEFT HOMEOWNERS SAPC
VEHICLE # Liab Phys Liab Phys Liab Phys Liab Phys Liab Phys Liab Phys Liab Phys
1 - - - - 10% 10% 5% 5% 15% 10% - - - -
FORMS
OHC 001 (2016/06), OHC 004 (07/19), OHC FL-QQ (02/22), OHC Service Plan 2A (02/22)
PREMIUM FINANCE COMPANY: COUNTERSIGNATURE:
OHC 002A1 (02/22) Insured Copy Lienholder Information on Reverse Side

PAGE 2 OF 2
DRIVERS Conviction Points

No Name Accident/Conviction/Surcharge/SR22 Date Liability/Phy Dam
1 SEDA VALDES, CHRISTIAN M SEX: M DOB: 06/22/1990 Points: 0 / 0
VEHICLE POINTS
No Coverage Description Points
LIENHOLDERS
VEH
VEH
VEH
VEH
VEH
THIS POLICY DOES NOT OFFER BODILY INJURY LIABILITY OR UNINSURED MOTORIST COVERAGE OR ANY OTHER
COVERAGE FOR WHICH A SPECIFIC PREMIUM CHARGE IS NOT MADE. YOU HAVE ELECTED NOT TO ACCEPT
THESE VALUABLE COVERAGES, WHICH WERE OFFERED TO YOU UPON APPLICATION FOR THE POLICY.
OCEAN HARBOR CASUALTY INSURANCE COMPANY
P.O. BOX 451599, Sunrise, FL 33345
Phone: (954)587-2299 (561)868-2400 (305)755-4675
Fax: (954)584-9955
BILLING SCHEDULE
Insured's Name and Address Agency's Name and Address
UNIVISTA INSURANCE
CHRISTIAN SEDA VALDES
637 S. SEMORAN BLVD. STE G
1312 MILL SLOUGH RD
ORLANDO, FL 32807
KISSIMMEE, FL 34744
(407)964-1737
Any questions, contact the above listed agency.
For a copy of the policy terms and conditions please go to www.PearlHolding.com and click on "Policy Terms & Conditions".
BILLING STATEMENT
Policy Number Today's Date Due Date Balance Due
P020063945601 06/10/2022 6/28/2022 $174.69
EFT PAYMENT SCHEDULE
Installments (Subject to change based on outstanding balance)
1. Due on: 6/28/2022 - Amount: $174.69 7. Due on: 12/28/2022 - Amount: $161.19
6. Due on: 11/28/2022 - Amount: $163.44
Your payment will be automatically deducted on each "Due on" date from your EFT funding source.
Installments include a finance charge of 1.5% of the uncollected balance.
THIS IS NOT A BILL. YOUR BILL WILL BE SENT SEPARATELY.

*If the EFT funding source needs to be changed, please contact the customer service department immediately
at (954)587-2299, (561)868-2400 or (305)755-4675.
Insured Copy
Policy Number: P020063945601 Check here if different address/info.

Insured Name: CHRISTIAN SEDA VA
Issue Date: 06/10/2022
Current Principal Balance: $1,670.96
Please make payment to:
Due Date: 6/28/2022 Ocean Harbor Casualty Ins. Co.
Amount Due: $174.69 P.O Box 451599
*Late Payment: $184.69 Sunrise, FL 33345
P020063945601
OHCFL-11 (05/05)
Continued Mobility Membership Club (CMMC)
*** SERVICE PLAN OUTLINE OF COVERAGE***
THIS ADDENDUM ADDS TO YOUR POLICY. PLEASE READ IT CAREFULLY.
PLEASE RETAIN A COPY OF THIS CONTRACT FOR YOUR RECORDS AS IT IS THE ONLY NOTICE OF
CONTINUED MOBILITY BENEFITS YOU WILL RECEIVE
24 Hour Continued Mobility Coverage – Benefit
A. Continued Mobility Service:We will pay for Continued Mobility Coveragewhen you use a Transportation
Network Company (TNC) service from a commercially licensed TNC (such as UBER or LYFT) approved by
Continued Mobility Membership Club (CMMC). Continued Mobility Coverage shall only include the cost of
the actual charges paid to the TNC provider using your ClaimRide Claim Card.
B. This benefit applies only if:
1. Your covered auto is withdrawn from use for more than twenty-four (24) hours, or your covered auto is
towed; and
2. The loss is caused by an auto accident; and
3. You claim Benefits within 72 hours of your covered auto loss.
C. When your covered autois disabled, CMMC will text a benefit of $20.00 to your mobile smart phone (one benefit
per household disablement every 90 days). If for any reason the CMMC benefit cannot be dispatched, you must
receive authorization from CMMC to use a TNC provider of their choice. Upon presentation of the original paid
TNC receipt, the club shall reimburse you up to the maximum benefit allowed of $20.00 per incident.
D. **Your CMMCbenefit does not include towing and/or roadside assistance**.
E. Claim your benefits – (469) 501-5146.
F. Exclusions: This contract does not cover the following:

1. Any violation of motor vehicle traffic laws relating to the operation of your covered auto.
2. Driving under the influence of intoxicating liquors, narcotics, or illegal drugs.
3. Driving without a valid operator’s permit.
4. Leaving the scene of an accident without disclosing identity.
5. Failing to stop to ascertain injury or lend assistance, commonly known as "hit and run".
6. Your covered auto while operated without permission by the owner.
7. Service for trucks with chassis exceeding 1 ton, busses, trailers, tractors, or vehicles classified as dual wheels.
8. Any accident involving your covered autoin which a Police Report is not filed or made a matter of record.
G. NOTICE OF CLAIM:To receive your benefit, all Claims must be reported to the above phone number or
submitted to CMMC Office at 2901 Clint Moore Rd, #317, Boca Raton, FL 33496 as soon as reasonably possible.
H. This coverage is an additional benefit. No deductible applies to this coverage.
IMPORTANT NOTICE:
You are applying for an auto club membership (benefits outlined above) with:
CMMC
The insurance company and membership club are separate business entities, offering separate coverage and benefits. It is your
responsibility to maintain your insurance policy and your club membership. This membership club package can only be purchased
in conjunction with the auto policy you are applying for through Ocean Harbor Casualty Insurance Company (OHCIC). OHCIC
only offers the CMMC service to the Named Insured shown on OHCIC's application. If purchased, the Named Insured
will be enrolled as a member in the CMMC program. Your down payment or payment in full is a combination of the premium and fees for
your insurance policy and the membership dues for your auto club membership.
To terminate your benefits please contact UNIVISTA INSURANCE at (407)964-1737 or submit a request in writing to
underwriting@pearlholding.com.
OHC Service Plan 2A (02/22)

AA
PEARL HOLDING GROUP

(FORMERLY KNOWN AS JAJ HOLDING COMPANY, INC.)
Phones: (954)587-2299 (561)868-2400 (305)755-4675 Fax:(954)905-2005
Date : 06/10/2022
CHRISTIAN M SEDA VALDES Company : OCEAN HARBOR CASUALTY

1312 MILL SLOUGH RD Policy # : P020063945601
KISSIMMEE, FL 34744
We would like to thank you for purchasing or renewing your automobile insurance policy with Ocean Harbor Casualty
Insurance Company through Pearl Holding Group, its managing general agent. Hopefully, you and your family will remain
claim and accident free. However, should you experience a loss or cause loss to another's property, please report the
claim to us at (954)587-2299 (561)868-2400 (305)755-4675 as soon as possible.
Additionally, we would like to make you aware of the rampant fraudulent activity in the state of Florida. As you may know,
insurance fraud costs you, the policyholder, more money for insurance coverage, as more money is spent paying and
investigating unnecessary, fraudulent claims.
Please see reverse for an outline which illustrates our commitment to reduce this fraud. Thank you for your cooperation
and attention in this matter.
Respectfully,
Joe Celli
VP of Claims
REWARD
A) IF YOU OR ANYONE YOU KNOW HAS BEEN IN A CAR
ACCIDENT AND BEEN OFFERED MONEY OR AN
INCREASED AMOUNT OF BENEFITS TO ATTEND A
MEDICAL FACILITY FOR TREATMENT OR BODY SHOP
FOR REPAIRS.
OR
B) IF ANY REPRESENTATIVE OF AN AUTOMOBILE GLASS
REPLACEMENT COMPANY SUGGEST THAT YOU
FALSELY REPORT WINDSHIELD DAMAGE IN ORDER
TO BE AFFORDED COVERAGE WHERE COVERAGE
SHOULD NOT BE AVAILABLE.
WE AGREE TO PAY YOU THE SUM OF FIVE THOUSAND

DOLLARS ($5,000) FOR PROVIDING THIS INFORMATION
TO US IN A SWORN STATEMENT PROVIDED
1) WE TURN OVER THAT INFORMATION TO ANY

GOVERNMENTAL AGENCY.
AND
2) ANY INDIVIDUAL IS CRIMINALLY PROSECUTED AND
CONVICTED WITH THE USE OF THE INFORMATION
WHICH YOU PROVIDED TO US.
*ADDITIONALLY, CONTACT US IF ANYONE SHOULD CALL

YOU AND REPRESENT THEY ARE FROM YOUR INSURANCE
COMPANY AND WANT YOU TO BE TREATED MEDICALLY
OR GO TO A CERTAIN BODY SHOP FOR REPAIR.
PRIVACY NOTICE
This notice is provided on behalf of OCEAN HARBOR CASUALTY.
This Privacy Notice describes our practices for safeguarding personal information ('Privacy Policy') about policyholders insured by Ocean Harbor
Casualty Insurance Company
If you are a plan sponsor or group policyholder, this Privacy Notice describes our practices for safeguarding personal information about employee
benefit plan participants, beneficiaries and claimants. It does not apply to you as the plan sponsor or group policyholder.
If after reading the enclosed notice you prefer that we not share certain information, there is an opt-out form at the end that you may send to us.
We at Ocean Harbor Casualty Insurance Company are concerned about the privacy of customers who buy insurance from us for personal, family,
or household purposes. We are sending you this notice to help you understand how we may collect information about you, the type of information
we may collect, and what information we may disclose about you to our Clarendon affiliates and to non-affiliated third parties. We apply the same
rules to former customers that apply to current customers. We may amend our Privacy Policy from time to time. We will send our current customers
our Privacy Notice annually and whenever it changes. If you no longer have a customer relationship with Ocean Harbor Casualty Insurance
Company, we will continue to follow our Privacy Policy and practices, but you will not receive future notices from us.
Our Privacy Policy

We must collect customer information to sell our products but our most important asset is our customer's trust. Keeping customer information secure and
confidential, is a top priority for all of us at Ocean Harbor Casualty Insurance Company. This is our Privacy Policy:
We will maintain security measures that comply with federal and state regulations to safeguard any information you share with us.
We will limit the collection and use of your information to the minimum we require to administer our business and to deliver superior service to you (which
includes advising you about our products, services and other opportunities).
We will permit only authorized employees, who are trained in the proper handling of customer information, to have access to that information. Employees
who violate our Privacy Policy will be subject to our normal disciplinary process.
We will not reveal your information to any non-affiliate unless we have previously informed you in disclosures or agreements, have been authorized by you,
except as permitted or required by law.
We will always maintain control over the confidentiality of your information. However, we may arrange for you to receive offers from other reputable companies.
These companies shall be notified that they are not permitted to retain your information unless you have specifically expressed interest in their products or
services.
We will tell you in plain language, initially and at least once annually, how you may remove your name from marketing lists. At any time, you may direct us to
remove your name from such lists.
Whenever we hire other organizations to provide support services, we will require them to conform to our Privacy Policy and to allow us to audit them for
compliance.
For purposes of credit reporting, verification and risk management, we will exchange information about you with reputable references sources and
clearinghouse services.
We will not use or share - internally or externally - you personal medical information for any purpose other than the underwriting or administration of your
policy or claim, or as disclosed to you when the information is collected, or to which you consent. We may disclose health information to determine eligibility
for coverage, to process claims, to prevent fraud and as authorized by you, or as otherwise permitted or required by law.
We will attempt to keep customer files complete, up-to-date and accurate. We will tell you how and where to access your account information (except when
we are prohibited by law) and how to notify us about errors (which we will promptly correct).
Personal Information We may Collect and Share

The personal information we collect about you comes form the following sources:
Information we receive from you as part of the application process, such as your name, address, telephone number, social security number, e-mail address,
income and assets.
Information we obtain from third parties that may include motor vehicle reports, claims reports, credit reports, property inspection reports, medical reports and
other health information. We may exchange information with reputable consumer reporting agencies in connection with your application for insurance and/or
renewal of such insurance. Once you are a customer, your file may also contain information connected with any claims you have had, such as a damage or
loss report or a condition report of an insured property.
Information based upon our transactions and experiences with you. such as your premium payment and claims history.
Information we receive about you from other sources, such as your employer or other third parties.

Within Ocean Harbor Casualty Insurance Company, our companies use information about you to service or maintain your policy or contract, to process a
transaction that you request, or for other purposes as permitted by law.
Affiliates
We will not share with our affiliates information about you if you opt out from information sharing as provided in this notice. However, by law we may still share with
our Affiliates information based upon our transactions and experiences with you, such as your premium payment and claims history. If you are a customer of more
than one Affiliate, and you opt out of information sharing by each of such Affiliates, you must submit an opt-out form to each of such Affiliates.
Non-Affiliated Third Parties Who May Have Access to the Information We Collect
We may disclose information about you to:
third parties with your consent or at your direction.
reputable companies that market products or services that you may be interested in, unless you opt out of information sharing as provided in this notice.
without your prior permission to non-affiliated third parties(i.e. persons or companies that are not Affiliates), as permitted by law, for example to:
- Service or maintain your policy or process a transaction that you request;

- Hospitals, doctors, laboratories, and other companies that provide information about your past or present health condition;
- Perform services or marketing on our behalf;
- Protect the confidentiality or security of our records pertaining to you, our product or service;
- Assist us in responding to your inquiries or complaints;
- Comply with legal requirements.
The non-affiliated third parties mentioned above may include, but are not limited to, the following:
- Your insurance agent, broker, or agency;

- A government agency or self-regulatory organization pursuant to an examination of our records and/or practices;
- Your attorney, trustee, or anyone else who represents you in a fiduciary capacity or has a legal interest in your policy;
- Persons to whom a court requires us. by order or subpoena. to provide information;
- Third parties who perform services or marketing on our behalf, including any third party administrators;
- Claim adjusters or investigators;
- Persons or organizations that conduct actuarial or research studies, provided that no individual may be indentified in any actuarial or research study report;
- An insurance support organization or another insurer to prevent or prosecute fraud or to properly underwrite a risk or to detect criminal activity;
- Insurance rate advisory organizations;
- Consumer reporting agencies;
- Our attorneys, accountants or auditors.
How to Opt Out From Information Sharing

If you prefer that we not share certain information, please fill out the form that is part of this letter. Because we may not be able to process incomplete forms, please
make certain you complete all of the items requested. Your request will remain in effect until you notify us otherwise in writing. If you have a joint interest in one of
our products, your opt-out request will also apply to the other parties in interest.
Please remember that even if you opt out, certain information may be shared with Affiliates or non-affiliated third parties, as set forth above.
How to Review and Correct Your Personal Information

If you ask in writing to send personal information from you file to you, we will honor that request, except for certain documents related to claims and lawsuits.
However, we will not send you any medical information we have received about you from a doctor or other health care provider. Instead, you should contact the
doctor or health care provider directly to obtain the information you seek.
We will inform you, upon your written request, whether or not a consumer report was requested, and if so, of the name and address of the consumer reporting
agency that furnished the report.
If you believe any of our information about you is incorrect, please notify us in writing and we will investigate. We will correct any errors that we find. If we do not find
any errors, you may file a statement with us that disputes the information in your file. We will send the correction or statement to anyone who received or will receive
the original information. If you have any questions about the right of access to or correction of information in your file, please contact us at the address in the opt-out
notice.
Please include your name, address, policy number, daytime phone number and the best time of day for us to call.
All correspondence and information requests should be sent to the address shown below.
If you opt out, you may not receive special offers about products and services that may be of interest to you. Please allow us approximately 30 days from our receipt
to process your request. If you have any questions about the right of access to or correction of information in your file, please contact us at the address listed on the
opt-out notice below.
Our Privacy Notice clearly is our commitment to you and our other customers to keep customer information secure.
Please note that your agent, broker, consultant, or advisor may have a different privacy policy.
---------------------------------------------------------------------------------------------------- CUT HERE ----------------------------------------------------------------------------------------------------
____ Please do not share information about me with third parties.
Name CHRISTIAN SEDA VALDES Return to

UNIVISTA INSURANCE
Address 1312 MILL SLOUGH RD
637 S. SEMORAN BLVD. STE G
KISSIMMEE, FL 34744
ORLANDO, FL 32807
Phone (904)581-1964 attn: Privacy Coordinator
Policy No P020063945601
PHONE (954)587-2299 FAX (954)584-9955
PERSONAL AUTO POLICY OUTLINE
"The following outline of coverage is for informational purposes only. Florida law prohibits this outline from
changing any of the provisions of the insurance contract, which is the subject of this outline. Any endorsement
regarding changes in types of coverage, exclusions, limitations, reductions, deductibles, coinsurance, renewal
provisions, cancellation provisions, surcharges or credits will be sent separately." (SS 627.4143)
READ YOUR PERSONAL AUTO POLICY CAREFULLY
I. POLICY COVERAGES
The declarations page of "your" policy lists the principal coverage available. "You" have those for which a
premium charge is shown. The coverage is described below:
A. LIABILITY COVERAGE: Two types of liability are available. Property Damage Liability, which is
required by Florida Law, covers "your" legal liability for damage to another's property. Bodily Injury
Liability covers "your" legal liability for bodily injury sustained by others. The principal exclusions (items
not covered by "your" policy) for this coverage are: (1) autos owned by "you" or furnished or available for
the regular use of "you" or "your resident relatives", which have not been specifically covered under the
policy, (2) vehicles less than 4 wheels, and (3) claims for injuries or damages to family members or their
property.
B. PERSONAL INJURY PROTECTION: This covers "you", "your family members" and certain others, for
personal injuries resulting from auto accidents, without regard to fault. Payments are for 80% of medical
expenses, 60% for loss of income, replacement household services and $5,000 for a death benefit.
Personal Injury Protection is also required under Florida Law. The principal exclusions for this coverage
are injuries sustained in autos "you" or "your family members" own which have not been specifically
covered under the policy, and injuries to other vehicle owners required by law to have their own
coverage. This coverage is not afforded to "you" while out of the State of Florida unless "you" are
occupying the vehicle(s) on the policy.
C. UNINSURED MOTORISTS COVERAGE: Provided "you" have selected and paid a premium for this
coverage, it pays for bodily injuries to "you", "resident relatives" and certain others, resulting from the
negligence of others. It pays when the at-fault party has: no liability insurance, or liability coverage with
limits not adequate to pay for the damages incurred, or if injuries result from a hit-and-run vehicle. It can
only be purchased if "you", "yourself", have Bodily Injury Liability coverage.
OHC 004 (10/16) 1 of 2 FLORIDA

PHONE (954)587-2299 FAX (954)584-9955
D. COLLISION: This covers, provided "you" have selected and paid a premium for this coverage,
damage to "your" car resulting from upset or impact with another object.
E. COMPREHENSIVE: This provides coverage for other than "collision" losses for damage to "your" car
resulting from fire, theft, and other direct losses, which are not excluded. The principal exclusions are for
damage to certain electronic and sound equipment; tapes and other media; radar detectors; undeclared
camper bodies; and van or pickup customized equipment.
Comprehensive and Collision coverage is NOT provided for any rental vehicle or for any vehicle while
used as a "temporary substitute" for a vehicle "you" own which is out of normal use because of its
breakdown, repair, servicing, loss or destruction.
II. RENEWAL AND CANCELLATION PROVISIONS
"You" may cancel "your" policy at any time after it has been in effect for 60 days. During the first 60 days of "your"
policy, "you" may cancel only if "you" dispose of the vehicle or it is a total loss. Under conditions where the law
permits "us" to cancel or refuse renewal of "your" policy, "we" must give "you" advance notice as follows: (1) 10
days for cancellation because of nonpayment of premium; (2) 45 days for cancellation for any other reason; (3)
45 days if "we" refuse to renew.
If "you" request the policy to cancel prior to the expiration, the return premium will be subject to a short rate
factor, which is 90% of the pro-rata factor.
III. PREMIUM CREDITS AND SURCHARGES
Credits and/or Surcharges, which apply to "you", are shown on "your" policy's Declaration Page.
THIS POLICY LIMITS PAYMENT AND REIMBURSEMENT UNDER THE PIP COVERAGE AS
ALLOWABLE BY FLORIDA STATUTE.
OHC 004 (10/16) 2 of 2 FLORIDA

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FLORIDA AUTOMOBILE INSURANCE IDENTIFICATION CARD TO REVIEW A COPY OF YOUR POLICY TERMS &
OCEAN HARBOR CASUALTY INSURANCE COMPANY CONDITIONS GO TO WWW.PEARLHOLDING.COM
CLAIMS - FIRST REPORT ONLY:
Policy Number: P020063945601-02929 Effective Date: 06/10/2022
954-587-2299 / 954-656-6811
BODILY INJURY
x
PERSONAL INJURY PROTECTION /
LIABILITY
561-868-2400 / 305-755-4675
PROPERTY DAMAGE LIABILITY
TOWING AND
NAMED INSURED ROADSIDE ASSISTANCE
IN CASE OF ACCIDENT:Report all accidents to your Agent/Company
CHRISTIAN M SEDA VALDES as soon as possible. Obtain the following information:
X CONTINUED MOBILITY
MOTOR CLUB
1. Name and address of each driver, passenger, and witness
Company Code: 02929
2. Name of Insurance Company and policy number for each involved.
NOT VALID MORE THAN ONE YEAR FROM EFFECTIVE DATE
MOTOR VEHICLE INSURED MISREPRESENTATION OF INSURANCE IS A FIRST DEGREE MISDEMEANOR
YEAR MAKE VEHICLE IDENTIFICATION NUMBER RENTAL CAR COLLISION DAMAGES IS NOT PROVIDED ON POLICY
2014 TOYOTA 4T1BF1FK0EU424084
AGENT: UNIVISTA INSURANCE CONTINUED MOBILITY MOTOR CLUB PLEASE CALL (469) 501-5146
Agent Phone Number:(407)964-1737
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# CUT HERE FOLD HERE
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CONDITIONS GO TO WWW.PEARLHOLDING.COM
Policy Number: Effective Date:
BODILY INJURY
954-587-2299 / 954-656-6811
x
PERSONAL INJURY PROTECTION /
LIABILITY
561-868-2400 / 305-755-4675
PROPERTY DAMAGE LIABILITY
TOWING AND
NAMED INSURED ROADSIDE ASSISTANCE IN CASE OF ACCIDENT:Report all accidents to your Agent/Company
CONTINUED MOBILITY as soon as possible. Obtain the following information:
MOTOR CLUB
Company Code: 02929 1. Name and address of each driver, passenger, and witness
NOT VALID MORE THAN ONE YEAR FROM EFFECTIVE DATE 2. Name of Insurance Company and policy number for each involved.
AGENT:
CONTINUED MOBILITY MOTOR CLUB PLEASE CALL (469) 501-5146
Agent Phone Number:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - -- -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- -- -
BODILY INJURY
954-587-2299 / 954-656-6811
PERSONAL INJURY PROTECTION / 561-868-2400 / 305-755-4675
x PROPERTY DAMAGE LIABILITY
LIABILITY
TOWING AND
CONTINUOUS MOBILITY
as soon as possible. Obtain the following information:
MOTOR CLUB
AGENT:
CONTINUED MOBILITY MOTOR CLUB PLEASE CALL (469) 501-5146
Agent Phone Number:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - -- -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- -- -
954-587-2299 / 954-656-6811
BODILY INJURY
PERSONAL INJURY PROTECTION / 561-868-2400 / 305-755-4675
x PROPERTY DAMAGE LIABILITY LIABILITY
TOWING AND
CONTINUED MOBILITY as soon as possible. Obtain the following information:
MOTOR CLUB
AGENT: CONTINUED MOBILITY MOTOR CLUB PLEASE CALL (469) 501-5146

Agent Phone Number:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - -- -

Pearl Holding Group - P020063945601

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OCEAN HARBOR CASUALTY INS. CO.

PAGE 1 OF 2 IF AMENDED,THIS DECLARATION PAGE

POLICY NUMBER NEW BUSINESS PRODUCER CODE

CHRISTIAN M SEDA VALDES UNIVISTA INSURANCE

NEW BUSINESS 06/10/2022 0.000 0.00

OHC 002A1 (02/22) Insured Copy Lienholder Information on Reverse Side

DRIVERS Conviction Points

THIS IS NOT A BILL. YOUR BILL WILL BE SENT SEPARATELY.

Policy Number: P020063945601 Check here if different address/info.

D. **Your CMMCbenefit does not include towing and/or roadside assistance**.

E. Claim your benefits – (469) 501-5146.

F. Exclusions: This contract does not cover the following:

H. This coverage is an additional benefit. No deductible applies to this coverage.

OHC Service Plan 2A (02/22)

CHRISTIAN M SEDA VALDES Company : OCEAN HARBOR CASUALTY

WE AGREE TO PAY YOU THE SUM OF FIVE THOUSAND

1) WE TURN OVER THAT INFORMATION TO ANY

*ADDITIONALLY, CONTACT US IF ANYONE SHOULD CALL

Our Privacy Policy

Personal Information We may Collect and Share

OCEAN HARBOR CASUALTY INSURANCE COMPANY

third parties with your consent or at your direction.

- Service or maintain your policy or process a transaction that you request;

- Your insurance agent, broker, or agency;

How to Opt Out From Information Sharing

How to Review and Correct Your Personal Information

---------------------------------------------------------------------------------------------------- CUT HERE ----------------------------------------------------------------------------------------------------

____ Please do not share information about me with third parties.

Name CHRISTIAN SEDA VALDES Return to

Phone (904)581-1964 attn: Privacy Coordinator

PERSONAL AUTO POLICY OUTLINE

OHC 004 (10/16) 1 of 2 FLORIDA

II. RENEWAL AND CANCELLATION PROVISIONS

III. PREMIUM CREDITS AND SURCHARGES

OHC 004 (10/16) 2 of 2 FLORIDA

AGENT: CONTINUED MOBILITY MOTOR CLUB PLEASE CALL (469) 501-5146

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D. Your CMMCbenefit does not include towing and/or roadside assistance.