Form_SCTNID_CTGRY.
MA10166489_COVGSELC
14394579 Q GX14588 INS COVGSELC E POLWHITEFONT X3YZKCOLZQO7U4KJBNDRBRAXLD0002 RPUID TRACWHITEFONT
ANGELA WESTEN INS
635 ROGERS ST UNIT 9
LOWELL, MA 01852
Policy Number: 14394579
Underwritten by:
Progressive Casualty Insurance Co
FRANK FERNANDES May 31, 2019
ANDREZA D FERNANDES
Policy Period: Jun 28, 2019 - Jun 28, 2020
114 ENELL ST
LOWELL, MA 01850 Page 1 of 4
1-978-735-4094
ANGELA WESTEN INS
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 your Renewal
Coverage Selections Page
The coverages, limits and policy period shown apply only if you pay for this policy to renew.
Your coverage begins on June 28, 2019 at 12:01 a.m. This policy expires on June 28, 2020 at 12:01 a.m.
This page and any attached endorsements form a part of your policy and 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 9609A MA (11/16). The contract is modified by forms A057 MA (05/14), Z538 MA (05/14), Z624 MA
(05/14), Z625 MA (11/07), Z628 MA (11/07), 9869 MA (05/14) and A205 MA (11/16).
Drivers and ………………………………………………………………………………………………………………………………………………………..
household residents Additional information
Frank Fernandes Named insured
………………………………………………………………………………………………………………………………………………………..
ANDREZA D FERNANDES Named insured
Form 6489 MA (10/16)
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14394579 Q GX14588 INS COVGSELC E POLWHITEFONT X3YZKCOLZQO7U4KJBNDRBRAXLD0002 RPUID TRACWHITEFONT
Policy Number: 14394579
Frank Fernandes
ANDREZA D FERNANDES
Page 2 of 4
Outline of coverage
This policy provides only the coverages for which a premium charge is shown.
Auto 1
2012 HONDA CR-V 4 DOOR WAGON
VIN: 5J6RM4H51CL066587
Principal garaging address: 01850
Primary use of the vehicle: Pleasure, Rideshare
This vehicle has Rideshare Use coverage.
Coverages Parts 1-12
Compulsory insurance Limits
……………………………………………………………………………………………………………………………………………………….. Deductible Premium
Bodily Injury to Others (Part 1) $20,000 each person/$40,000 each accident
………………………………………………………………………………………………………………………………………………………..
$334
Personal Injury Protection (Part 2) $8,000 each person $0 100
………………………………………………………………………………………………………………………………………………………..
Bodily Injury Caused by An Uninsured Auto (Part 3) $25,000 each person/$50,000 each accident 19
(Compulsory Limits $20,000/$40,000)
………………………………………………………………………………………………………………………………………………………..
Damage to Someone Else's Property (Part 4) $100,000 each accident 403
(Compulsory Limit $5,000)
Optional insurance Limits
………………………………………………………………………………………………………………………………………………………..
Deductible Premium
Optional Bodily Injury to Others (Part 5) $50,000 each person/$100,000 each accident 64
………………………………………………………………………………………………………………………………………………………..
Collision (Part 7) Actual Cash Value $500 w/waiver 739
………………………………………………………………………………………………………………………………………………………..
Comprehensive (Part 9) Actual Cash Value $500 173
Comprehensive Window Glass $100 glass
………………………………………………………………………………………………………………………………………………………..
Bodily Injury Caused by An Underinsured Auto $25,000 each person/$50,000 each accident 10
(Part 12)
………………………………………………………………………………………………………………………………………………………..
Total premium for Auto 1 $1,842
Auto 2
2003 ACURA RSX 2 DOOR HATCHBACK
VIN: JH4DC54843C000512
Principal garaging address: 01850
Primary use of the vehicle: Commute
Coverages Parts 1-12
Compulsory insurance Limits
………………………………………………………………………………………………………………………………………………………..
Deductible Premium
Bodily Injury to Others (Part 1) $20,000
………………………………………………………………………………………………………………………………………………………..
each person/$40,000 each accident $369
Personal Injury Protection (Part 2) $8,000 each person $0 145
………………………………………………………………………………………………………………………………………………………..
Bodily Injury Caused by An Uninsured Auto (Part 3) $25,000 each person/$50,000 each accident 24
(Compulsory Limits $20,000/$40,000)
………………………………………………………………………………………………………………………………………………………..
Damage to Someone Else's Property (Part 4) $100,000 each accident 291
(Compulsory Limit $5,000)
Optional insurance Limits
………………………………………………………………………………………………………………………………………………………..
Deductible Premium
Optional Bodily Injury to Others (Part 5) $50,000 each person/$100,000 each accident 75
………………………………………………………………………………………………………………………………………………………..
Bodily Injury Caused by An Underinsured Auto $25,000 each person/$50,000 each accident 10
(Part 12)
………………………………………………………………………………………………………………………………………………………..
Total premium for Auto 2 $914
………………………………………………………………………………………………………………………………………………………..
Total 12 month policy premium $2,756.00
Part 5 - Optional Bodily Injury To Others
The limits shown for this Part are the total limits you have under Compulsory Bodily Injury to Others (Part 1) and this Part.
This means that the Compulsory limits are included within the limits shown for this Part and are not in addition to them.
Form 6489 MA (10/16)
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14394579 Q GX14588 INS COVGSELC E POLWHITEFONT X3YZKCOLZQO7U4KJBNDRBRAXLD0002 RPUID TRACWHITEFONT
Policy Number: 14394579
Frank Fernandes
ANDREZA D FERNANDES
Page 3 of 4
Part 12 - Bodily Injury Caused By An Underinsured Auto
The limits shown for this Part are subject to adjustment. We will only pay for any unpaid damages up to the difference
between the total amount collected from the automobile bodily injury liability insurance covering the owner and operator
of the underinsured auto and the limits shown for this Part.
Premium discounts
Several discounts are available and your premium has been reduced if one or more discounts are indicated below. Contact
customer service for further details.
Policy
………………………………………………………………………………………………………………………………………………………..
14394579 Electronic Funds Transfer (EFT), Residence Insurance, Multi-Car, Continuous
Insurance: Platinum and Paperless
Lienholder information
Vehicle Lienholder
………………………………………………………………………………………………………………………………………………………..
2012 HONDA CR-V Dig. Fed. Cr. Union
5J6RM4H51CL066587 Lehigh Valley, PA 18002
Driver information
Name Date of birth
………………………………………………………………………………………………………………………………………………………..
Frank Fernandes Jun 2, 1984
License status Years licensed Operator status
Valid 19 Rated
Name Date of birth
………………………………………………………………………………………………………………………………………………………..
ANDREZA D FERNANDES Apr 1, 1989
License status Years licensed Operator status
Valid 14 Rated
Check carefully that all operators of your auto(s) are shown. Your failure to list a household member or any individual who
customarily operates your auto may have very serious consequences.
NOTICE: If you or someone else on your behalf has knowingly given us false, deceptive, misleading or incomplete
information and if such false, deceptive, misleading or incomplete information increases our risk of loss, we may refuse to
pay claims under any or all of the Optional Insurance Parts and we may cancel your policy. Such information includes the
description and the place of garaging of the vehicle(s) to be insured, the names of all household members and customary
operators required to be listed and the answers given above for all listed operators. We may also limit our payments
under Part 3 and Part 4. Check to make certain that you have correctly listed all operators and the completeness of their
previous driving records. We may verify the accuracy of the previous driving records of all listed operators.
We will not pay for a collision or limited collision loss for an accident which occurs while your auto is being operated by a
household member who is not listed as an operator on your policy. Payment is withheld when the household member, if
listed, would require the payment of additional premium on your policy because the household member would be
classified as an inexperienced operator or would require payment of additional premium on your policy under our rates.
Form 6489 MA (10/16)
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14394579 Q GX14588 INS COVGSELC E POLWHITEFONT X3YZKCOLZQO7U4KJBNDRBRAXLD0002 RPUID TRACWHITEFONT
Policy Number: 14394579
Frank Fernandes
ANDREZA D FERNANDES
Page 4 of 4
Countersigned by
Authorized Signature
Authorized Signature
Form 6489 MA (10/16)
