Form_SCTNID_CTGRY.

WI06196489_DECPAGE

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SSB INS SRVCS

PO BOX 439029-2018
SAN YSIDRO, CA 92143

Policy Number: 915644307

Underwritten by:
Artisan and Truckers Casualty Co
JESUS F HERNANDEZ VIDALEZ August 4, 2020
871 S MAIN ST
Policy Period: Jun 30, 2020 - Dec 30, 2020
LOT 171
FOND DU LAC, WI 54935 Page 1 of 2

1-888-672-6999
SSB INS SRVCS
Contact your agent for personalized service.

progressiveagent.com
Auto Insurance Online Service

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

This is a copy of your 1-800-274-4499

To report a claim.
Declarations Page
Your coverage began on June 30, 2020 at 12:01 a.m. This policy expires on December 30, 2020 at 12:01 a.m.
This coverage summary replaces your prior one. 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 WI (12/14). The contract is modified by forms Z357 (01/07), 4884 (10/08) and 7982 WI (06/16).

Drivers and ………………………………………………………………………………………………………………………………………………………..

resident relatives Additional information
Jesus F Hernandez Vidalez Named insured
………………………………………………………………………………………………………………………………………………………..
Alma J Morales Lucio
………………………………………………………………………………………………………………………………………………………..
YOLANDA HERNANDEZ V

Outline of coverage
2013 TOYOTA CAMRY 4 DOOR SEDAN
VIN: 4T1BF1FK0DU638054
Garaging ZIP Code: 54935
Primary use of the vehicle: Pleasure
Length of vehicle ownership when policy started or vehicle added: At least 1 month but less than 1 year
Information regarding your vehicle history (prior damage, theft or title issues) has impacted how we determine your premium.
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $194
Bodily Injury Liability $25,000 each person/$50,000 each accident
Property Damage Liability $10,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist $25,000 each person/$50,000 each accident
………………………………………………………………………………………………………………………………………………………..
20
Underinsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Medical Payments Rejected --
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $1,000 74
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $1,000 160
………………………………………………………………………………………………………………………………………………………..
Total premium for 2013 TOYOTA $448

Form 6489 WI (06/19)

4
Continued
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Policy Number: 915644307

Jesus F Hernandez Vidalez
Page 2 of 2
2008 TOYOTA CAMRY 4 DOOR SEDAN
VIN: 4T1BE46K48U752794
Garaging ZIP Code: 54935
Primary use of the vehicle: Pleasure
Length of vehicle ownership when policy started or vehicle added: At least 1 month but less than 1 year
Information regarding your vehicle history (prior damage, theft or title issues) has impacted how we determine your premium.
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $224
Bodily Injury Liability $25,000 each person/$50,000 each accident
Property Damage Liability $10,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist $25,000 each person/$50,000 each accident
………………………………………………………………………………………………………………………………………………………..
18
Underinsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Medical Payments Rejected --
………………………………………………………………………………………………………………………………………………………..
Total premium for 2008 TOYOTA $242
2001 CHEVROLET EXPRESS G1500 CARGO VAN
VIN: 1GCFG15M111117329
Garaging ZIP Code: 54935
Primary use of the vehicle: Business
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $143
Bodily Injury Liability $25,000 each person/$50,000 each accident
Property Damage Liability $10,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist $25,000 each person/$50,000 each accident 9
………………………………………………………………………………………………………………………………………………………..
Underinsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Medical Payments Rejected --
………………………………………………………………………………………………………………………………………………………..
Total premium for 2001 CHEVROLET ( business use ) $152
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium $842.00

Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
915644307 Electronic Funds Transfer (EFT), Mobile Home Owner, Multi-Car and Continuous
Insurance: Platinum

Lienholder and additional interest information

Vehicle Lienholder Additional interest
………………………………………………………………………………………………………………………………………………………..
2013 TOYOTA CAMRY LANDMARK CREDIT UN LANDMARK CREDIT UN
4T1BF1FK0DU638054 SIOUX CITY, IA 51102 SIOUX CITY, IA 51102

Form 6489 WI (06/19)