Form_SCTNID_CTGRY.

TN06226489_DECPAGE

976311693 E IC68277 INS DECPAGE E POLWHITEFONT 37PSK54ZFHGKEXOHCSA4MJNIRF0002 RPUID TRACWHITEFONT BDF_AA

PROGRESSIVE
P.O. BOX 31260
TAMPA, FL 33631

Policy Number: 976311693

Underwritten by:
Mountain Laurel Assurance Company
March 19, 2024
MEGAN MOYERS
Policy Period: Jan 8, 2024 - Jul 8, 2024
409 JAY ST
FAYETTEVILLE, TN 37334 Page 1 of 2

progressive.com
Online Service
Make payments, check billing activity, update
policy information or check status of a claim.

Auto Insurance 1-800-776-4737

Coverage Summary
For customer service and claims service,
24 hours a day, 7 days a week.

This is your Declarations Page

Your policy information has changed
Your coverage began on January 8, 2024 at the later of 12:01 a.m. or the effective time shown on your application. This policy period
ends on July 8, 2024 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 contract is form 9611D TN (12/15). The contract is modified by forms 4884 (10/08), A264 (02/22) and A331
(11/21).

Policy changes effective March 19, 2024

………………………………………………………………………………………………………………………………………………………..
Changes requested on: Mar 19, 2024 01:46 p.m.
………………………………………………………………………………………………………………………………………………………..
Requested by: Megan Moyers
………………………………………………………………………………………………………………………………………………………..
Premium change: -$23.79
………………………………………………………………………………………………………………………………………………………..
Changes: An Automatic Card Payments (ACP) discount has been added to your policy.

The changes take effect as of the date and time requested shown above.
Drivers and household residents
Megan Moyers
Additional information: Named insured
Outline of coverage
2012 NISSAN ALTIMA 4 DOOR SEDAN
VIN: 1N4AL2AP5CC192771
Garaging ZIP Code: 37334
Primary use of the vehicle: Commute
Annual miles: 10,000 - 11,999
Length of vehicle ownership when policy started or vehicle added: At least 6 months but less than 1 year
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $558
Bodily Injury Liability $25,000 each person/$50,000 each accident
Property Damage Liability $25,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Bodily Injury Rejected --
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Property Damage Rejected --
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium $558.00

Form 6489 TN (06/22)

4
Continued
976311693 E IC68277 INS DECPAGE E POLWHITEFONT 37PSK54ZFHGKEXOHCSA4MJNIRF0002 RPUID TRACWHITEFONT BDF_AA

Policy Number: 976311693

Megan Moyers
Page 2 of 2

Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
976311693 Automatic Card Payments (ACP), Online Signature - First Policy Period Only,
Online Quote and Paperless

Customer Service office information

You may contact Customer Service at 1-800-776-4737 or by mail at P.O. Box 31260, Tampa, FL 33631.

Form 6489 TN (06/22)