Renewal auto policy declarations
Platinum Gold Standard Value Plan
Your policy effective date is March 7, 2024
Page 1 of 3
Information as of March 7, 2024
Total Premium for the Policy Period
Please review your insured vehicles and verify their VINs are correct. Summary
Vehicles covered Identification Number (VIN) Premium Named Insured(s)
2011 Subaru Outback 4S4BRCGC0B3332268 $1,028.26 Dorianna Bencomo
Mailing address
1400 Herringotn Rd,
Lawrenceville, GA
30044
Additional coverages 88.43
Policy number
If you pay in installments* $1,116.69
821 957 403
If you pay in full (includes FullPay® Discount) $968.43
Your policy provided by
* Your bill will be sent separately. Before making a payment, please refer to your Allstate Property and Casualty
latest bill, which includes payment options and installment fee information. If you do Insurance Company
not pay in full, you will be charged an installment fee(s). If you do not pay your bill by
Policy period
the due date shown on your billing statement, you may be charged a late fee.
Beginning March 7, 2024 through
Sep 7, 2024 at 12:01 a.m.
standard time Your Allstate agency is
Mh Insurance Agency
1098 Herrington Rd
Lawrenceville GA 30044-7581
(770) 686-3408
MARTHA@MARTHAINSURANCE.COM
Some or all of the information on your
Policy Declarations is used in the rating
of your policy or it could affect your
eligibility for certain coverages. Please
notify us immediately if you believe that
any information on your Policy
Declarations is incorrect. We will make
corrections once you have notified us,
and any resulting rate adjustments, will
be made only for the current policy
period or for future policy periods.
Please also notify us immediately if you
believe any coverages are not listed or
are inaccurately listed.
GA010RBD
Renewal auto policy declarations Page 2 of 3
Policy number: 821 957 403
Policy effective date: March 7, 2024
Listed drivers on your policy*
Dorianna Bencomo - Married female driver, age 29, Safe Driving Club
*Are there licensed drivers not listed above who either reside in your household (even if
temporarily away from home) or are guests staying in your home for an extended period? If
so, please contact us so your policy information and coverage is up to date. There are
circumstances under which a loss may not be covered by this policy because the auto was
being operated by someone residing at your house who is not listed on the policy. Additional
detail about how we treat undisclosed drivers can be found in your policy.
Excluded drivers from your policy
None
GA010RBD
AUTR45GA2022062902325901A-000140-005-0-00-00
220628A003022
065 010 010
Renewal auto policy declarations
Policy number: 821 957 395
Page 3 of 3
Policy effective date: March 7, 2024
Coverage detail for 2011 Subaru Outback†
Coverage Limits Deductible Premium
Automobile Liability Insurance Not applicable $721.18
• Bodily Injury $100,000 each person
$300,000 each occurrence
• Property Damage $1,000,000 each occurrence
Auto Collision Insurance Actual cash value $500 $189.91
(Safe Driving Deductible Reward - deductible reduction amount available is $200)
Auto Comprehensive Insurance Actual cash value $500 $30.51
Collision for Custom Equipment Not purchased*
Comprehensive for Custom Not purchased*
Equipment
Roadside Coverage $100 each disablement Not applicable $6.50
Transportation Expense up to $30 per day for a maximum of 30 Not applicable $22.37
days
Uninsured Motorists Insurance
• Property Damage $25,000 each accident $250 $20.18
Auto Replacement Protection Not purchased*
Automobile Medical Payments $1,000 each person Not applicable $37.61
Portable Electronics and Media Not purchased*
Sound System Not purchased*
Total premium for 2011 Subaru Outback $1,028.26
* This coverage can provide you with valuable protection. To help you stay
current with your insurance needs, contact your Allstate agent to discuss
coverage options and other products and services that can help protect
you.
†
Allstate Ride For Hire Endorsement applies to this vehicle.
VIN 4S4BRCGC0B3332268
Rating information
• The rating information for this vehicle is: for pleasure
• This vehicle is driven between 11,001 and 12,000
miles per year.
GA010RBD
