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INSURIFY INSURANCE AGENCY, INC
10 CANAL PARK, 5TH FLOOR December 31, 2022
CAMBRIDGE MA 02141
Policy Number: X6293845
24-Hour Claims: 1-800-578-6701
Policy Service: 1-800-578-6701
Online Account Services: www.safeco.com
THIS IS NOT A BILL.
RICHARD KING IDENTIFICATION CARDS ENCLOSED
3359 HEIGHTS DR
RENO NV 89503-3826 Countersigned by:
Authorized Representative
for INSURIFY INSURANCE AGENCY, INC
Thank you for allowing Safeco to continue serving your auto insurance needs. We appreciate
your business and the trust that you have placed in us.
Please place the enclosed insurance identification cards in the vehicle listed on the card.
Your new 12-month policy period will begin on March 1, 2023. Your policy will renew automatically
if you continue to pay the premium.
The renewal premium is $1,480.20.
This is not a bill. Your bill will be sent separately about 25 days before it is due. It will provide
more information about amounts you may pay and your payment due date. For more information
about fees, please see the enclosed policy declarations page and the back of your billing
statement.
If you have any questions or wish to make any changes to your policy, you can do so by calling
us at 1-800-578-6701.
Thank you for entrusting us with your insurance needs.
SAFECO INSURANCE COMPANY OF ILLINOIS
OC-429/EP 10/13
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Information about your Policy
Policy Number: X6293845
RICHARD KING
3359 HEIGHTS DR
RENO NV 89503-3826
Like many insurance companies, Safeco Insurance considers many factors, including information based on your
credit history, claims and auto characteristics to determine your premium. You have the option to request that we
re-evaluate your auto insurance rate with up-to-date factors using the same factors prior to your next renewal
effective date. Policy re-evaluation is limited to one request per calendar year and it may result in a quoted
premium either higher or lower than your current premium. Any changes will be applied upon re-evaluation.
To submit a request, return this form to:
Safeco Insurance
Attn: UW Verification & Policy Support
P.O. Box 515097
Los Angeles, CA 90051-5097
or
Fax it to (877) 344-5107.
By returning this form, you request Safeco Insurance to re-evaluate your policy based on your current credit
information.
CN-7403/EP 11/15
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COVERAGE OPTION FORM
Nevada law requires us to inform you of the options available in selecting Medical Payments Coverage and
Uninsured Motorists Coverage. Please review the limits shown on your enclosed Declarations page. If you
wish to make changes in either coverage, please complete this form and return it with your renewal premium.
MEDICAL PAYMENTS COVERAGE will pay for reasonable expenses incurred for necessary medical services
and supplies as a result of bodily injury from an automobile accident either as an occupant of the insured vehicle
or as a pedestrian struck by a motor vehicle. If you want to change your limits, or wish to reject the coverage
entirely, please make your selection below.
MEDICAL PAYMENTS COVERAGE $1,000 $5,000
LIMITS AVAILABLE: $2,000 $10,000
$3,000 $25,000
TO REJECT THIS COVERAGE, PLEASE CHECK THE BOX BELOW:
NO, I/We do not wish to purchase any Medical Payments Coverage.
UNINSURED MOTORISTS COVERAGE provides coverage for bodily injury resulting from an accident with a hit-
and-run automobile, an automobile with no insurance or an automobile with liability coverage less than the full
amount you are legally entitled to recover (underinsured motorists coverage).
Uninsured Motorists Coverage is required on all automobile policies unless rejected by you. NEVADA
LAW REQUIRES THAT UNINSURED MOTORISTS COVERAGE MUST BE OFFERED AT LIMITS
EQUAL TO THE BODILY INJURY LIMITS SOLD TO YOU. If you want to lower your limits, or wish to
reject the coverage entirely, please make your selection below.
SPLIT LIMITS
UNINSURED MOTORISTS $25,000/$50,000 $100,000/$300,000
LIMITS AVAILABLE: $50,000/$100,000 $250,000/$500,000
$100,000/$100,000
$300,000/$300,000
$500,000/$500,000
COMBINED SINGLE LIMITS
$100,000 $500,000
$300,000
TO REJECT THIS COVERAGE, PLEASE CHECK THE BOX BELOW.
NO, I/We do not wish to purchase Uninsured Motorists Coverage.
Sign: Sign:
Insured Named on Policy Insured Named on Policy Policy No. Date
YOUR AGENT WILL BE ABLE TO ANSWER ANY QUESTIONS REGARDING THESE COVERAGES AND
THEIR COSTS.
SA-2559/NVEP 4/21
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NOTICE OF INFORMATION PRACTICES
Safeco appreciates the trust you place in us when you purchase insurance from one of our companies.
We are committed to protecting your nonpublic personal information (“personal information” or
“information”) and we value you as a customer.
To learn more about how we collect and use information about you, please read the following notice.
OUR SOURCES OF INFORMATION ABOUT YOU
Most of the information we obtain comes directly from you and your independent insurance producer.
Your application gives us information we need to review your request, such as your name, address and
Social Security Number.
We may also ask for information from other outside sources, including:
• Your transactions with our affiliates or other insurance companies (such as your payment
history or claims history); and/or,
• The information we receive from a consumer reporting agency or insurance support
organization (such as your credit history, driving record, claims history or verification of the
value and condition of your property).
Insurance support organizations from which we obtain information may keep such information and
disclose it to others as permitted by law.
If we obtain medical information about you, it is generally received in connection with the administration or
management of your insurance policy or claim or for the detection and prevention of fraud. We will not
share your medical information with our affiliates or non-affiliates for marketing purposes.
It is our policy to treat information we receive about you in the same confidential way we treat information
that you have provided to us on your application. The same confidentiality applies to information about
our former customers.
OUR USE OF INFORMATION ABOUT YOU
We only disclose personal information about you as permitted by law. Generally, this includes sharing it
with third parties to administer your transactions with us, service your insurance policy or claim, detect
and prevent fraud, or with your authorization. We require these parties to use your personal data only for
the reasons we gave it to them. These third parties may include:
• Insurance support organizations, consumer reporting agencies or other insurance companies
(including for the detection and prevention of fraud);
• Independent insurance producers authorized to sell Safeco insurance products;
• Independent contractors (such as automobile repair facilities, towing companies, property
inspectors and independent claims representatives);
• Auditors, attorneys, courts and government agencies;
• Other companies which may reinsure your policy or with which you have other coverage;
• Group policyholders in connection with reporting claims data or an audit; and/or,
• Other companies and insurance support organizations for actuarial or research studies.
We may also disclose your personal information to other financial institutions with which we have joint
marketing agreements for products offered by Safeco and in response to judicial orders such as
subpoenas.
We may also share information about our transactions (such as payment history) and experiences (such
as claims made) with you within our Safeco family of companies.
We do not sell your personal information to others and we do not provide your information to third parties
who are doing business on our behalf for their own marketing purposes.
CN-1/EP 11/11 Page 1 of 2
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PROTECTING YOUR INFORMATION FROM UNAUTHORIZED ACCESS
We maintain physical, electronic and administrative safeguards to protect your information from unauthorized
access. Our employees are authorized to access customer information only for legitimate business purposes.
INDEPENDENT SAFECO INSURANCE AGENTS
The independent insurance producers authorized to sell Safeco products are not Safeco employees and are
not subject to Safeco’ s privacy policy. Because they have a unique business relationship with you, they may
have additional personal information about you that Safeco does not have. They may use this information
differently than Safeco. Contact your Safeco producer to learn more about their privacy practices.
HOW YOU CAN REVIEW YOUR INFORMATION
You can request a copy of the information about you in our files to review it for accuracy. You must make
your request in writing. Within 30 business days (or as required by law) of receiving your request, we will
send you the information. We will advise you of any person or group to whom we have given the information
during the last two years. We will also give you the name and address of any reporting organization from
which we received information about you.
There are certain types of information, such as information collected when we evaluate a claim or when
the possibility of a lawsuit exists, that we are not required to provide you. We obtain medical information
about you only in connection with claims and lawsuits. If the law allows you to review such information in
our files, we will include it with the other information we send to you.
IF YOU DISAGREE WITH OUR RECORDS
If you believe information in our files is wrong, you can notify us in writing. We will review your file within
30 business days of receiving your notice. If we agree with you, we will amend our records and notify you
about the change. This change will become part of the file. It will be included in any future disclosures to
others and will be sent to:
• Anyone you designate who may have received the information during the previous two years.
• Any person or organization who may have received the information from us during the previous
seven years.
• Insurance support organizations that provided the information that was amended or changed
pursuant to your request.
If we disagree with you, we will explain why. You can provide us with a written statement explaining why
you believe the information is wrong. This statement will become part of the file and will be included in
any future disclosures of the disputed subject matter. Your statement will also be sent to the persons
listed above.
SAFECO’S WEB SITE
If you have Internet access and want to learn more about our web site specific privacy and security practices,
click on the Privacy Policy link on www.safeco.com.
This Privacy Statement applies to the following members of the Safeco family of companies:
American Economy Insurance Company
American States Insurance Company
American States Insurance Company of Texas
American States Preferred Insurance Company
First National Insurance Company of America
General Insurance Company of America
Insurance Company of Illinois
Safeco Insurance Company of America
Safeco Insurance Company of Illinois
Safeco Insurance Company of Indiana
Safeco Insurance Company of Oregon
Safeco National Insurance Company
Safeco Surplus Lines Insurance Company
(For mailing address, please contact your agent of the nearest local Safeco office.)
2011 Safeco Insurance Company of America, Member of Liberty Mutual Group. All Rights Reserved.
CN-1/EP 11/11 Page 2 of 2
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POLICYHOLDER RIGHTS
Nevada Insurance Department Regulation PC-21 requires that we advise you of your right to request
the reason for any increase in premium over your last policy period.
Your agent is the best source to obtain this information and for answering any other questions you
might have regarding your automobile insurance. If, however, you have a need to contact us directly,
please feel free to write.
SA-949/NVEP 4/85
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POLICY NUMBER: X6293845
AUTOMOBILE POLICY DECLARATIONS
NAMED INSURED: RENEWAL
RICHARD KING
3359 HEIGHTS DR POLICY PERIOD FROM: MAR. 1 2023
RENO NV 89503-3826
TO: MAR. 1 2024
at 12:01 A.M. standard time at
the address of the insured as
AGENT: stated herein.
INSURIFY INSURANCE AGENCY, INC AGENT TELEPHONE:
10 CANAL PARK, 5TH FLOOR 1-800-578-6701
CAMBRIDGE MA 02141
EXCLUDED DRIVERS LACEY A MEINKE
RATED DRIVERS RICHARD KING, JESSE MEINKE, JAYCOB J MEINKE, SERENITY RIDER
2003 DODGE DURANGO SLT PLUS 4 DOOR ID# 1D4HS58NX3F602709
Insurance is afforded only for the coverages for which limits of liability or
premium charges are indicated.
COVERAGES 2003 DODG LIMITS PREMIUMS
LIABILITY:
BODILY INJURY $25,000 $ 691.30
Each Person
$50,000
Each Occurrence
PROPERTY DAMAGE $20,000 693.30
Each Occurrence
MEDICAL PAYMENTS $1,000 26.30
UNINSURED MOTORISTS:
BODILY INJURY $25,000 56.00
Each Person
$50,000
Each Accident
ADDITIONAL COVERAGES:
ROADSIDE ASSISTANCE PACKAGE 13.30
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TOTAL $ 1,480.20
PREMIUM SUMMARY PREMIUM
VEHICLE COVERAGES $ 1,480.20
DISCOUNTS & SAFECO SAFETY REWARDS You saved $707.00 Included
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TOTAL 12 MONTH PREMIUM .................................................. $ 1,480.20
You may pay your premium in full or in installments. There is no installment fee
for the following billing plans: Full Pay. Installment fees for all other billing
plans are listed below. If more than one policy is billed on the installment bill,
only the highest fee is charged. The fee is:
$2.00 per installment for recurring automatic deduction (EFT)
$5.00 per installment for recurring credit card or debit card
$6.00 per installment for all other payment methods
This policy includes a named driver exclusion surcharge for the excluded driver(s)
listed above.
YOU SAVED $707.00 BY QUALIFYING FOR THE FOLLOWING DISCOUNTS:
Advance Quoting
-CONTINUED-
SA-1697/EP 6/20 Page 1 of 2 DATE PREPARED: DEC. 31 2022
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POLICY NUMBER: X6293845
AUTOMOBILE POLICY DECLARATIONS
(CONTINUED)
Low Mileage
Accident Free
Violation Free
Billing Plan
Both Side Air Bag
Policy underwritten by SAFECO INSURANCE COMPANY OF ILLINOIS
(a stock insurance company).
Administrative office: 175 Berkeley St., Boston, MA 02116
Mailing Address: PO Box 704000, Salt Lake City, UT 84170-4000
SA-1698/EP 6/20 Page 2 of 2
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HOW YOUR AUTO RATES ARE DETERMINED
Your automobile rates are determined by many factors including incidents on your driving record. In accordance
with Nevada law we want to describe how your rates are determined with respect to driving record incidents.
How Driving History Could Impact Your Premium
One of the main factors determining the amount you pay for insurance is your driving record. The more serious
the incident, the higher the premium you pay. Tickets and accidents that occurred in the 34 months preceding the
application or the renewal date of the policy are considered for purposes of calculating premium.
Types of Violations and Accidents That Could Impact Premium
• Minor incidental violations committed in the course of operating a motor vehicle such as failure to use
a signal or failure to obey a flashing yellow light.
• Minor moving violations, such as minor traffic violations including failure to stop, improper turns,
wrong way, and inattentive driving.
• Speed violations include two categories - those where the ticket is for a speed less than 20 mph over
the speed limit and those where the ticket is for a speed more than 20mph over the speed limit.
• Major violations, such as reckless driving, passing a school bus, racing, fleeing the scene of an
accident, and vehicle theft.
• At-fault accidents.
• Driving-under-the-influence violations (DUIs).
The table below outlines the estimated impact of each type of violation or incident. Actual impacts may vary based
on your individual circumstances.
Type of Violation/Incident Estimated
Percentage Impact
on Premium
Minor Incidental Violation 25.3%
Minor Moving Violation 28.1%
Speed less than 20mph 25.3%
Speed greater than 20mph 32.1%
Major Violations 37.1%
At-Fault Accidents 32.1%
Driving Under the Influence 37.1%
Premium impacts diminish over time starting at 24 months from the date of the incident, and are then
automatically dropped at the first renewal after 34 months.
There are other factors that influence the amount you pay for insurance, including the amount and type of
coverage you select. If you have any questions about how your insurance rates are determined, please contact
your Safeco agent or broker, whose number is listed on your billing statement.
One choice you have already made will save you money over time — you have chosen Safeco, a company
dedicated to insuring responsible people who drive carefully. We are also constantly striving to reduce our own
expenses and assisting in the prevention of fraud. This keeps our costs down, so we can pass these savings on
to you.
Thank you for entrusting us with your insurance needs. We appreciate having you as a customer.
SA-1569/NVEP 9/22
