Form_SCTNID_CTGRY.
PA08196489_DECPAGE
944777316 Q IC64918 INS DECPAGE E POLWHITEFONT UBQ4YGW6O7TOUYKG24FY5O36XE0002 RPUID TRACWHITEFONT
PROGRESSIVE
P.O. BOX 31260
TAMPA, FL 33631
Policy Number: 944777316
Underwritten by:
Progressive Advanced Insurance Co
HANSEL GABRIEL POP MENDEZ November 26, 2021
2333 S 7TH ST
Policy Period: Dec 12, 2021 - Jun 12, 2022
FL 1
PHILADELPHIA, PA 19148 Page 1 of 4
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 revised Renewal
Declarations Page
Your policy information has changed
The coverages, limits and policy period shown apply only if you pay for this policy to renew.
Your coverage begins on December 12, 2021 at 12:01 a.m. This policy expires on June 12, 2022 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, unless
the policy contract or endorsements indicate otherwise. The policy contract is form 9611D PA (02/16) . The contract is modified by forms
Z357 (01/07) and A230 (11/16).
COLLISION COVERAGE FOR RENTAL VEHICLES
IF THIS POLICY PROVIDES COLLISION COVERAGE, IT WILL APPLY TO VEHICLES YOU RENT, BUT NOT TO
VEHICLES RENTED FOR 6 MONTHS OR MORE.
FRAUD NOTICE
Any person who knowingly and with intent to defraud any insurance company or other person files an application for
insurance or statement of claim containing any materially false information or conceals for the purpose of misleading,
information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such
person to criminal and civil penalties.
Policy changes effective December 12, 2021
………………………………………………………………………………………………………………………………………………………..
Changes requested on: Nov 16, 2021
………………………………………………………………………………………………………………………………………………………..
Requested by: Hansel gabriel Pop mendez
………………………………………………………………………………………………………………………………………………………..
Premium change: -$48.00
………………………………………………………………………………………………………………………………………………………..
Changes: Coverage has been changed on the policy.
Underwriting Company
Progressive Advanced Insurance Co
P.O. Box 31260
Tampa , FL 33631
1-800-776-4737
Form 6489 PA (08/19)
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Hansel gabriel Pop mendez
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Drivers and ………………………………………………………………………………………………………………………………………………………..
resident relatives Additional information
Hansel gabriel Pop mendez First Named insured
Outline of coverage
2021 TOYOTA RAV4 4 DOOR WAGON
VIN: 2T3P1RFV7MW217694
Garaging ZIP Code: 19148
Primary use of the vehicle: Commute
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $219
Bodily Injury Liability $15,000 each person/$30,000 each accident
Property Damage Liability $5,000 each accident
………………………………………………………………………………………………………………………………………………………..
First Party Benefits 47
Medical Expenses $5,000 each person
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist - Nonstacked $15,000 each person/$30,000 each accident 17
………………………………………………………………………………………………………………………………………………………..
Underinsured Motorist - Nonstacked $15,000 each person/$30,000 each accident 23
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $2,000 80
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $2,000 231
………………………………………………………………………………………………………………………………………………………..
Total premium for 2021 TOYOTA $617
2006 SCION TC 2 DOOR HATCHBACK
VIN: JTKDE167060093522
Garaging ZIP Code: 19148
Primary use of the vehicle: Commute
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Information regarding your vehicle history (prior damage, theft or title issues) has impacted how we determine your premium.
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $356
Bodily Injury Liability $15,000 each person/$30,000 each accident
Property Damage Liability $5,000 each accident
………………………………………………………………………………………………………………………………………………………..
First Party Benefits 99
Medical Expenses $5,000 each person
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist - Nonstacked $15,000 each person/$30,000 each accident
………………………………………………………………………………………………………………………………………………………..
23
Underinsured Motorist - Nonstacked $15,000 each person/$30,000
………………………………………………………………………………………………………………………………………………………..
each accident 32
Comprehensive Actual Cash Value
………………………………………………………………………………………………………………………………………………………..
$2,000 60
Collision Actual Cash Value
………………………………………………………………………………………………………………………………………………………..
$2,000 153
Total premium for 2006 SCION $723
Form 6489 PA (08/19)
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2005 SUZUKI XL7 4 DOOR WAGON
VIN: JS3TY92V054107702
Garaging ZIP Code: 19148
Primary use of the vehicle: Pleasure/Personal
Length of vehicle ownership when policy started or vehicle added: At least 1 month but less than 1 year
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $285
Bodily Injury Liability $15,000 each person/$30,000 each accident
Property Damage Liability $5,000 each accident
………………………………………………………………………………………………………………………………………………………..
First Party Benefits 107
Medical Expenses $5,000 each person
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist - Nonstacked $15,000 each person/$30,000 each accident
………………………………………………………………………………………………………………………………………………………..
25
Underinsured Motorist - Nonstacked $15,000 each person/$30,000
………………………………………………………………………………………………………………………………………………………..
each accident 34
Comprehensive Actual Cash Value
………………………………………………………………………………………………………………………………………………………..
$2,000 51
Collision Actual Cash Value
………………………………………………………………………………………………………………………………………………………..
$2,000 83
Total premium for 2005 SUZUKI $585
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium $1,925.00
Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
944777316 Multi-Policy, Electronic Funds Transfer (EFT), Online Quote, Multi-Car,
Continuous Insurance: Gold and Paperless
Vehicle
………………………………………………………………………………………………………………………………………………………..
2021 TOYOTA Driver and Passenger-side Airbag, Passive Anti-theft Device and Smart
RAV4 Technology Discount
2006 SCION Driver and Passenger-side Airbag and Passive Anti-theft Device
TC
2005 SUZUKI Driver and Passenger-side Airbag
XL7
Smart Technology Discount ℠ is a service mark of Progressive Casualty Ins. Co.
Lienholder information
Vehicle Lienholder
………………………………………………………………………………………………………………………………………………………..
2021 TOYOTA RAV4 Del Auto Group
2T3P1RFV7MW217694 Thorndale, PA 19372
Tort Option
This policy provides limited tort insurance.
Notice of Available Premium Discounts
You may be eligible for discounts mandated by Act 6 of 1990:
• on first party benefits coverage if your car is equipped with a passive restraint system
• on comprehensive coverage if your car is equipped with a passive anti-theft device
• if all rated drivers are 55 or older and have successfully completed a motor vehicle driver improvement course
approved by PennDOT.
If you have any questions about your eligibility, please call Customer Service.
Form 6489 PA (08/19)
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Company officers
President Secretary
Form 6489 PA (08/19)
