TRAVELERS AUTO DECLARATIONS - A. KWAK

Policy Summary Automobile Policy 1. Named Insured

Your Agency’s Name and Address

ANNA KWAK 15935 W KENDALL ST GOODYEAR, AZ 85338-9426

BRENNAN INS AGENCY LLC PO BOX 459 LITCHFIELD PARK, AZ 85340-0459

Your Auto Policy Number Your Account Number

994197986 203 1

For Policy Service For Claim Service For Roadside Assistance

1-623-535-8587 1-800-252-4633 1-800-252-4633

2. Premium Your Total Premium for the Policy Period is $621. The policy period is from July 13, 2015 to July 13, 2016 12:01 A.M. STANDARD TIME at your address shown in Item 1.

3. Your Vehicles

Identification Numbers

1. 2007 TOYOT HIGHLANDER

JTEEP21AX70212950

4. Coverages, Limits of Liability and Premiums Insurance is provided only where a premium entry is shown for the coverage. The premium entry “Incl” or “Pkg” means the premium charge is included in the premium for another coverage or a package. VEHICLE 1 07 TOYOT HIGHLANDER

A. Bodily Injury $100,000 each person $300,000 each accident

$233

B. Property Damage $100,000 each accident

$62

C. Medical Payments $5,000 each person

$28

D. Uninsured Motorists Bodily Injury $100,000 each person $300,000 each accident

$60

D1. Underinsured Motorists Bodily Injury $100,000 each person $300,000 each accident

$29

E. Collision Actual Cash Value less $500 deductible

PL-50014 (03-12) 472/0CPN59

$104

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4. Coverages, Limits of Liability and Premiums (continued) Insurance is provided only where a premium entry is shown for the coverage. The premium entry “Incl” or “Pkg” means the premium charge is included in the premium for another coverage or a package. VEHICLE 1 07 TOYOT HIGHLANDER

F. Comprehensive Actual Cash Value less $500 deductible Glass Deductible See Endorsement E1OCW00 (03-12) $0 deductible

$66

Incl

Extended Transportation Expenses See Endorsement E1MCW00 (03-12) $30 per day/$900 maximum

$16

Personal Property Coverage See Endorsement E1VCW00 (03-12) $500 limit

Pkg

Roadside Assistance Coverage See Endorsement E1RCW01 (06-13) Up to 100 miles per disablement

Pkg

Trip Interruption Coverage See Endorsement E1SCW00 (03-12)

Pkg

Package Premiums^ Premier Roadside Assistance Subtotal for your vehicle(s):

$23 $621

Total Premium for this Policy:

$621

This is not a bill. You will be billed separately for this transaction. ^ The Premier Roadside Assistance Package consists of Roadside Assistance Coverage, Trip Interruption Coverage, and Personal Property Coverage endorsements.

5. Information Used to Rate Your Policy Discounts Safe Driver Discount 5 Years Accident and Violation Free Multi-Policy Discount Paid in Full Discount

PL-50014 (03-12) 472/0CPN59

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Named Insured Policy Period

ANNA KWAK July 13, 2015 to July 13, 2016

Policy Number 994197986 203 1 Issued On Date June 17, 2015

5. Information Used to Rate Your Policy (continued) Discounts Good Payer Discount Continuous Insurance Discount Early Quote Discount

Your Total Savings Reflected in Your Total Premium: Drivers 1. ANNA

Date of Birth 02-16-1956

Vehicles 1. 07 TOYOT HIGHLANDER

Use of Vehicle Pleasure

Gender Female

$463 Marital Status Single

License Status Out of State License

Location of Vehicle GOODYEAR, AZ

If any of the information above is incorrect or has changed, please notify your Travelers representative immediately.

6. Other Information Your Insurer TRAVELERS PROPERTY CASUALTY INSURANCE COMPANY ONE TOWER SQUARE, HARTFORD, CT 06183 Policy Coverage Sections and Endorsements That Form a Part of This Policy: G01AZ01 (07-14)

General Provisions Section

L01AZ00 (03-12)

Liability Coverage Section

M01AZ00 (03-12)

Medical Payments Coverage Section

U01AZ00 (03-12)

Uninsured Motorists Coverage Section

D01AZ00 (03-12)

Underinsured Motorists Coverage Section

P01CW00 (03-12)

Damage To Your Auto Coverage Section

S01AZ01 (05-15)

Signature Page

E1MCW00 (03-12)

Extended Transportation Expenses

E1OCW00 (03-12)

Glass Deductible

E1RCW01 (06-13)

Roadside Assistance Coverage

E1SCW00 (03-12)

Trip Interruption Coverage

E1VCW00 (03-12)

Personal Property Coverage

E2OCW00 (11-14)

Shared Deductible

Online Policy Summary as of June 17, 2015

PL-50014 (03-12) 472/0CPN59

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