Form_SCTNID_CTGRY.

FL05216489_DECPAGE

<docindex><index>DECPAGE</index></docindex>

ACG SOUTH INS AGENCY

PO BOX 31087
TAMPA, FL 33631

Policy Number: 962869311

Underwritten by:
Progressive American Insurance Co
February 4, 2023
LEONARDO GUTIERREZ
Policy Period: Oct 26, 2022 - Apr 26, 2023
6485 METAL DR
FORT PIERCE, FL 34945 Page 1 of 2

1-800-891-4222
ACG SOUTH INS AGENCY
Contact your agent for personalized service.

agent.progressive.com
Auto Insurance Online Service

Coverage Summary
Make payments, check billing activity, update
policy information or check status of a claim.

This is a copy of your 1-800-274-4499

To report a claim.
Declarations Page
Your coverage began on October 26, 2022 at the later of 12:01 a.m. or the effective time shown on your application. This policy
period ends on April 26, 2023 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 9611A FL (07/17) . The contract is modified by forms A264 (10/18), A261 FL (08/21) and A340
(01/22).

Drivers and household residents

Leonardo Gutierrez
Additional information: Named insured
Outline of coverage
2015 MERCEDES-BENZ C300 4 DOOR SEDAN
VIN: 55SWF4JB9FU071500
Garaging ZIP Code: 34945
Primary use of the vehicle: Pleasure/Personal
Annual miles: 10,000 - 11,999
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others
Bodily Injury Liability $10,000 each person/$20,000 each accident $197
Property Damage Liability $10,000 each accident
………………………………………………………………………………………………………………………………………………………..
226
Personal Injury Protection $10,000 $1,000/person 285
Deductible applies to Named Insured and Spouse
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $1,000 126
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $1,000 571
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium $1,405.00

Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
962869311 Electronic Funds Transfer (EFT), Continuous Insurance: Silver and Paperless

Form 6489 FL (05/21)

4
Continued
<docindex><index>DECPAGE</index></docindex>

Policy Number: 962869311

Leonardo Gutierrez
Page 2 of 2
Vehicle
………………………………………………………………………………………………………………………………………………………..
2015 MERCEDES-BENZ Anti-Lock Brakes, Driver and Passenger-side Airbag, Passive Anti-theft Device,
C300 Smart Technology Discount and Snapshot Participation

Smart Technology Discount ℠ is a service mark of Progressive Casualty Ins. Co.

Lienholder information
Vehicle Lienholder
………………………………………………………………………………………………………………………………………………………..
2015 MERCEDES-BENZ C300 Lobel
55SWF4JB9FU071500 Fort Lauderdale, FL 33309

Policyholder inquiries
You may call your agent at 1-800-891-4222 to present inquiries or obtain information about coverage, and to obtain
assistance with any complaints.

Agent signature

Company officers

Secretary

Form 6489 FL (05/21)