CSAA Insurance Exchange

P.O.Box 22221
Automobile Policy Declarations
Oakland, CA 94623-2221 Please keep with your policy. See Important Notice on reverse.
For questions or changes call: 800.922.8228
Page 1 of 1
1. Name and Address of Insured
Declarations Process

POLICY INFORMATION
Type Amended Declarations Date 04-15-2022

KATHLEEN MCMILLAN Policy

CAAS102003692
Insured
1998
Number Since
1829 WAVERLY PL
From
ROHNERT PARK, CA 94928-4090 12:01 A.M. Standard Time at the address of the
Named Insured, but not prior to the time applied
Your 04-07-2022 for or, if this is a replacement declarations, not
Policy prior to the time coverage change was requested.
Period
To
12:01 A.M. Standard Time at the address of the
04-07-2023 Named Insured.

Alternate Address Occupation Alternate Number Telephone Number

Office/Admin (707) 486-8485

Item Make Model Yr Body Type Vehicle Identification No. Name ADB?*
Drivers
1 TOYOTA 2008 HATCHBACK 4 DOOR JTDKB20U383395304 Kathleen Y
VEHICLES

DRIVERS
do not
necessarily
2 SUBARU 2019 SUV 4S4WMAPD8K3452899 correspond
DANIEL Y
to principally
operated
vehicles.

Liability Limits Item 1 Item 2

Coverage
Each Person Each Occurrence Deductible Premium Deductible Premium Deductible Premium Deductible Premium

Bodily Injury 100,000 300,000 $162 $137

Medical Payments 10,000 $47 $41

Uninsured Motorists 100,000 300,000 $45 $40

Property Damage 100,000 $197 $237

Comprehensive Actual Cash Value Less Deductible 100 $55 100 $138
COVERAGES/PREMIUMS

Full Comprehensive Safety Glass Endorsement

($0 deductible) NO COV NO COV
Collision Actual Cash Value Less Deductible No Coverage 500 $496
Enhanced Transportation Expense
No Coverage $28
$25 per day/$750 aggregate
All Risks Actual Cash Value Less Deductible No Coverage No Coverage

Vehicle Loan/Lease Protection Endorsement No Coverage No Coverage

New Car Added Protection Endorsement No Coverage No Coverage

Original Equipment Manufacturer Parts (OEM) Endorsement No Coverage No Coverage

Ride-sharing Coverage Endorsement No Coverage No Coverage

TOTAL PREMIUM PER VEHICLE Ø $506 $1,117

Premium
* Automobile Death Benefits $15,000 per deceased insured person $6
Premium Summary
This is not a bill.
CA Surcharge: $0

Total Additional Premium: $0.00

Total Premium shown is for the Member AdvantageTM Program.
EXCLUSIONS
There is no coverage provided by this Policy while the following individual(s) operate a motor vehicle:
None
Schedule of Changes
Maintain Discount(s)
CHANGES

55 1500 12 15
(Continued on back)
 Item Rated Driver Driv Safety Record Yrs Driv Exp Est Ann Mi Driven Veh Garage Zip Vehicle Usage Marital
1 DANIEL SNOW 0 Pt 25 6541 Mi 94928 Commute M
DISCOUNTS/MESSAGES

See final page

2 Kathleen Mcmillan 0 Pt 25 7000 Mi 94928 Pleasure M for explanation
of codes.

Discounts:
Mature Driver: None. Multi Car: Item(s) 1, 2.
Good Driver: Item(s) 1, 2. New Driver:None.
Multi Policy Home: Item(s) 1, 2. Good Student: None.

REDWOOD CREDIT UNION You may qualify for other products

LOSS PAYEE(S)

Item
2 PO BOX 6104 and discounts. For more info call
SANTA ROSA CA 95406 your Insurance Agent
Elizabeth Lisa White
(707) 781-6706

IMPORTANT NOTICE: THIS IS A PART OF YOUR DECLARATIONS

The insurance afforded is only with respect to such of the preceding coverages as are indicated by specific premium charge or charges.
The limit of the Exchange's liability under each such coverage shall be as stated herein, subject to all the terms of the policy. The purpose
for which the automobile is to be used is pleasure or business, subject to the exclusions in the policy, including the exclusion for
wholesale and retail delivery.
RENEWAL CERTIFICATE - Extends this policy for the period shown under Policy Period upon payment of the premium.
AMENDED DECLARATIONS - In consideration of the premium adjustment indicated herein this policy is hereby amended only with
respect to such changes as are indicated in the schedule of changes. The limit of the Exchange's liability under such amended coverage
shall be as stated herein.
LOSS PAYEE(S) - Any loss under Physical Damage coverages is payable as interest may appear to the named insured and the Loss Payee in
accordance with the loss payable agreement.
For your protection, California law requires that you be made aware of the following: Any person who knowingly presents false or
fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may
be subject to fines and confinement in state prison.
RATING INFORMATION DISCLOSURE EXPLANATION
(From Discounts/Messages Section on Previous Page)
ITEM (ITEM NUMBER): Item number is the number assigned to the vehicle shown on the Declarations.

RATED DRIVER: The driver assigned to a vehicle whose attributes (e.g., years driving experience, driving safety record and marital status)
are used to develop the premium.

DRIV SAFETY RECORD (DRIVING SAFETY RECORD): The total number of points assessed the driver for “principally at fault chargeable
accidents” with or without injury and/or vehicle code violation convictions (tickets). A “principally at fault chargeable accident” occurs
when the driver of a vehicle is at least 51% at fault for an accident and the total monetary damages (whether paid or not) in the
accident exceed:
• $750 or the accident resulted in death for losses occurring prior to 12/11/11
• $1,000 or the accident resulted in death for losses occurring 12/11/2011 or after
Additional information on the number and types of incidents can be provided on request. Carriers use different point count systems for
rating purposes. The number of points shown on your declarations would not necessarily match the number of points assigned by
another carrier.
YRS DRIV EXP (YEARS DRIVING EXPERIENCE): The number of years a driver has been licensed to drive a motor vehicle anywhere in the
world. However, a driver must have at least 18 months current driving experience in the United States, U.S. Territories, or Canada,
before foreign country driving experience can be counted.
EST ANN MI DRIVEN (ESTIMATED ANNUAL MILES DRIVEN): The estimated number of total miles a vehicle will be driven in the coming
year
VEH GARAGE ZIP (VEHICLE GARAGED ZIP CODE): The ZIP code of the location where the vehicle is garaged.

VEHICLE USAGE: Vehicles are assigned to one of five usage designations: Business Use, Work Commute, Farm Use, Farm Business Use
or Pleasure.
MARITAL (MARITAL STATUS): “M” stands for Married, and “S” stands for Single.
DISCOUNTS: A reduced rate applies for each Discount listed.

55 1500 12 15