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GEICO GOVERNMENT EMPLOYEES INSURANCE COMPANY

Washington DC
VERIFICATION OF COVERAGE
(SEE BELOW UNDER CAUTIONARY NOTE)

MAILING ADDRESS Policy Number: 4585411210


MADELYNN ROSE OMANS Effective Date: 03-15-19
2105 SUMMERLYN PARK DR Expiration Date: 09-15-19
KERNERSVILLE NC 27284-9970 Registered State: NORTH CAROLINA

To whom it may concern:


This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the
effective and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle
meets or exceeds the financial responsibility requirement for your state.
This verification of coverage does not amend, extend or alter the coverage afforded by this policy.

Vehicle Year: 2016


Make: DODGE
Model: DART SE
VIN: 1C3CDFAA2GD661483

COVERAGES LIMITS DEDUCTIBLES


A Liability Coverage
Bodily Injury Liability
Each Person/Each Occurrence $30,000/$60,000
Property Damage Liability
Each Occurrence $50,000
Uninsured Motorists Bodily Injury
Each Person/Each Occurrence $30,000/$60,000
Property Damage
Each Occurrence $25,000
D Damage To Your Auto
Other Than Collision Loss ACV Minus $500
Collision Loss ACV Minus $500
Towing & Labor Costs
Extended Transportation Expenses
Coverage $30 Per Day / $900 Max

X Lienholder Additional Insured Interested Party

LAKE MICHIGAN CREDIT UNION


12409 STRAFFORD RD
RAVENNA, MI 49451

Additional Information:
Issued 03/26/2019

U-33 10-07
GEICO GOVERNMENT EMPLOYEES INSURANCE COMPANY

Washington DC
VERIFICATION OF COVERAGE
(SEE BELOW UNDER CAUTIONARY NOTE)

If you have any additional questions, please call 1-800-841-3000.


CAUTIONARY NOTE: THE CURRENT COVERAGES, LIMITS, AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES, LIMITS AND DEDUCTIBLES IN EFFECT AT
OTHER TIMES DURING THE POLICY PERIOD. THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES, LIMITS, AND DEDUCTIBLES AS OF THE ISSUED
DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER "ADDITIONAL INFORMATION" OR IF AN ISSUED DATE IS NOT SHOWN, THE DATE OF THIS FACSIMILE.

U-33 10-07

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