Form_SCTNID_CTGRY.

TN06226489_DECPAGE

976311693 E IC68277 INS DECPAGE E POLWHITEFONT QSO62TCFG46GETSHOVO3FPAIZD0001 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 09:38 a.m.
………………………………………………………………………………………………………………………………………………………..
Requested by: Megan Moyers
………………………………………………………………………………………………………………………………………………………..
Premium change: -$1.83
………………………………………………………………………………………………………………………………………………………..
Changes: A Paperless 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 $597
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 $597.00

Form 6489 TN (06/22)

4
Continued
976311693 E IC68277 INS DECPAGE E POLWHITEFONT QSO62TCFG46GETSHOVO3FPAIZD0001 RPUID TRACWHITEFONT BDF_AA

Policy Number: 976311693

Megan Moyers
Page 2 of 2

Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
976311693 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)