**** REPRINTED FROM THE ARCHIVE.
THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS ****
TATE CARDINAL LLC
4200 PAGE AVE STE B August 14, 2022
MICHIGAN CENTER MI 49254-1056
Policy Number: K3601863
24-Hour Claims: 1-866-472-3326
Policy Service: 1-866-472-3326
Online Account Services: [Link]
THIS IS NOT A BILL.
JASON ELLIS IDENTIFICATION CARDS ENCLOSED
COURTNEY M FOSTER
3325 COLUMBUS CT
ANN ARBOR MI 48103-2778
Thank you for allowing us to continue serving your insurance needs.
To ensure you are receiving the best coverage and value available, the following changes have
been made to your 12-month automobile policy, including those requested by you or your agent or
broker.
2019 CHEVROLET EQUINOX LT
- Vehicle is added.
Your discounts or surcharges have changed. Please read the enclosed policy declarations
page carefully.
This change is effective August 12, 2022. Please place this letter with your insurance policy.
Information on coverages and limits can be found on the revised Declarations page, enclosed.
The additional premium for this change is $1,174.03. The billing for this amount will be explained
on your next billing statement.
If you have any questions or wish to make any changes to your policy, you can do so by calling
us at 1-866-472-3326.
We appreciate the opportunity to serve you. Thank you.
AMERICAN ECONOMY INSURANCE COMPANY
OC-429/EP 10/13
**** REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS ****
POLICY NUMBER: K3601863
AUTOMOBILE POLICY DECLARATIONS
NAMED INSURED: POLICY CHANGE
JASON ELLIS CHANGED EFFECTIVE: AUG. 12 2022
COURTNEY M FOSTER POLICY PERIOD FROM: AUG. 6 2022
3325 COLUMBUS CT
ANN ARBOR MI 48103-2778 TO: AUG. 6 2023
Coverage begins at the later of (1) 12:01 A.M. or
(2) the time that the application for insurance is
AGENT: submitted and the policy is bound. No coverage
TATE CARDINAL LLC is provided prior to the policy being bound.
4200 PAGE AVE STE B Coverage will expire at 12:01 A.M. standard time.
MICHIGAN CENTER MI 49254-1056
AGENT TELEPHONE:
1-866-472-3326
RATED DRIVERS JASON ELLIS, COURTNEY M FOSTER
2019 CHEVROLET EQUINOX LT 4 DOOR ID# 3GNAXKEV1KS523093
2019 CHEVROLET EQUINOX LT 4 DOOR ID# 3GNAXKE25KL244501
Insurance is afforded only for the coverages for which limits of liability or
premium charges are indicated.
COVERAGES 2019 CHEV LIMITS PREMIUMS 2019 CHEV LIMITS PREMIUMS
COMBINED SINGLE LIMIT:
BODILY INJURY & $510,000 $ 118.70 $510,000 $ 135.30
PROPERTY DAMAGE Each Occurrence Each Occurrence
LIABILITY
LIMITED PROPERTY DAMAGE 31.60 36.80
PROPERTY PROTECTION INSURANCE 5.90 6.80
PERSONAL INJURY Medical Expenses 636.80 Medical Expenses 728.90
PROTECTION Unlimited per person Unlimited per person
$300 Deductible
UNINSURED/UNDERINSURED MOTORISTS:
BODILY INJURY $510,000 69.80 $510,000 80.50
LIABILITY Each Accident Each Accident
COMPREHENSIVE Actual Cash Value 208.20 Actual Cash Value 239.80
Less $500 Deductible Less $500 Deductible
Full Safety Glass Full Safety Glass
COLLISION Actual Cash Value 433.50 Actual Cash Value 499.90
Less $500 Deductible Less $500 Deductible
Standard Standard
ADDITIONAL COVERAGES:
LOSS OF USE $35 Per Day/$1050 Max 30.50 $35 Per Day/$1050 Max 35.40
THEFT PREVENTN 1.00 1.00
MCCA STATE CHRG 86.00 86.00
MCCA DEFICIT .00 .00
STATUTORY 34.00 34.00
ASSESSMENT
RECOUPMENT FEE
ROADSIDE ASSIST 9.30 10.80
---------- ----------
TOTAL $ 1,665.30 TOTAL $ 1,895.20
-CONTINUED-
SA-1697/EP 1/22 Page 1 of 2 DATE PREPARED: AUG. 14 2022
**** REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS ****
POLICY NUMBER: K3601863
AUTOMOBILE POLICY DECLARATIONS
(CONTINUED)
TOTAL EACH VEHICLE: 2019 CHEV $ 1,665.30
2019 CHEV 1,895.20
PREMIUM SUMMARY PREMIUM
VEHICLE COVERAGES $ 3,560.50
DISCOUNTS & SAFECO SAFETY REWARDS You saved $1,423.50 Included
----------
TOTAL 12 MONTH PREMIUM FOR ALL VEHICLES ................................. $ 3,560.50
You may pay your premium in full or in installments. There is no installment fee
for the following billing plans: Full Pay. Installment fees for all other billing
plans are listed below. If more than one policy is billed on the installment bill,
only the highest fee is charged. The fee is:
$2.00 per installment for recurring automatic deduction (EFT)
$5.00 per installment for recurring credit card or debit card
$5.00 per installment for all other payment methods
YOU HAVE QUALIFIED FOR THE FOLLOWING AVERAGE PERSONAL INJURY PROTECTION PREMIUM
(PIP) SAVING(S) BASED ON YOUR AUTOMOBILE PIP SELECTIONS:
.40% for the selected PIP Deductible
YOU SAVED $1,423.50 BY QUALIFYING FOR THE FOLLOWING DISCOUNTS:
Account
Theft Prevention Device
Low Mileage
Accident Free
Violation Free
Coverage
Multi-Car
The insurance credit score used to determine your IBS discount is: 698
Policy underwritten by AMERICAN ECONOMY INSURANCE COMPANY
(a stock insurance company).
Administrative office: 175 Berkeley St., Boston, MA 02116
Mailing Address: PO Box 704000, Salt Lake City, UT 84170-4000
SA-1698/EP 6/20 Page 2 of 2
