POLICY
RENEWAL PO LICY DECLA
DECLARATIONS
RATIONS
PERMANENT
PERMA NENT GENER
GENERAL
AL AS
ASSURAN
SURANCECE CCORPO
ORPORATIO
RATION
N
BOX
PO BO X 305
305054
054
NASHVILLE,
NASHV ILLE, TN 337230
7230-5054
-5054
PGA-998888
RHISON H WILLIAMS THE GENERAL AUTO INS SVCS, INC
340 E BRIGHTON AVE P. O. BOX 305054
SYRACUSE NY 13210-4142 NASHVILLE TN 37230-5054
Date: 04/17/2023 Endorsement Effective: 05/22/2023
Policy: NY5851542 24-Hour Claims: 1-800-280-1466
Policy Period: 05/22/2023 12:01AM* to 11/22/2023 12:01AM Customer Service: 1-800-280-1466
Agent: THE GENERAL AUTO INS SVCS, INC Agent Telephone: (800)280-1466
Pinnacle Program
RHISON H WILLIAMS **/**/1979 M S 000 N Active
2016 GMC SIERRA 1500 CRE *************0102 2954600NZ0NM 000 $1142.00
2017 LINC CONTINENTAL SEL *************5311 2954950NW0NX 001 $1357.00
Total Full Term Premium $ 2499.00
Motor Veh Law Enfmt $ 10.00
Total Premium Due $ 2509.00
FRONT
PA098-0416-NY 1
Policy: NY5851542 POLICY
RENEWAL PO LICY DECLA
DECLARATIONS
RATIONS
TIER: 2731322725 AND
COVERAGES AN D PREMIUMS
VEHICLE
VEHIC LE 1 VEHICLE
VEHIC LE 2 VEHICLE
VEHIC LE 3 VEHICLE
VEHIC LE 4
COVERAGES
COVER AGES LIMITS
LIMIT S PREMIUM
PREMI UM PREMIUM
PREMI UM PREMIUM
PREMI UM PREMIUM
PREMI UM
Bodilyy Inj
Bodil Injury
ury Liab
Liability
ility
Per P Person
erson/Acc
/Accident
ident 25,000/50,
25,00 0/50,000
000 $119.00
$119. 00 $115.00
$115. 00
Property
Prope rty D
Damag
amagee Lia
Liabilit
bilityy
Per AAccide
ccident
nt 25,0000
25,00 $181.00
$181. 00 $175.00
$175. 00
Supplement
Suppl emental
al Sp
Spouse
ouse Liabi
Liability
lity Coverag
No Co veragee Coverag
No Co veragee
Personal
Perso nal IInjury
njury Prote
Protection
ction (PIP) 50,0000
50,00 $108.00
$108. 00 $117.00
$117. 00
Deductible
Deduc tible Ded
$0 De d Ded
$0 De d
Additional
Addit ional PIP Coverag
No Co veragee Coverag
No Co veragee
Basic
Opt B asic Econo
Economic
mic L
Loss
oss Coverag
No Co veragee Coverag
No Co veragee
Aggregate
Total Aggre gate PIP 50,0000
50,00 Included
Inclu ded Included
Inclu ded
Benefits
Death Benef its 2,000 Included
Inclu ded Included
Inclu ded
Incomee Los
Incom Losss per Mont
Monthh 2,000 Included
Inclu ded Included
Inclu ded
Necessary
Other Neces sary Expen
Expenses/
ses/Day
Day 25 Included
Inclu ded Included
Inclu ded
Uninsured
Unins ured Motor
Motorist
ist
Per PPerson
erson/Acc
/Accident
ident 25,000/50,
25,00 0/50,000
000 $13.000
$13.0 $11.000
$11.0
Supplement
Suppl ementary
ary U
UM/UIM
M/UIM (SUM)
(SUM)**
** Coverag
No Co veragee Coverag
No Co veragee
Medical
Medic al P
Paymen
ayments
ts Coverag
No Co veragee Coverag
No Co veragee
Comprehens
Compr ehensive
ive $286.00
$286. 00 $267.00
$267. 00
Deductible
Deduc tible $500 Ded $500 Ded
Collision
Colli sion $372.00
$372. 00 $609.00
$609. 00
Deductible
Deduc tible $500 Ded $500 Ded
Towingg an
Towin andd Lab
Labor
or
Per DDisabl
isablement
ement $35 $5.00 $5.00
Rentall Rei
Renta Reimburs
mbursemen
ementt
Per D Day/30
ay/30 Day Max $30 $58.000
$58.0 $58.000
$58.0
Custom
Custo m Eq
Equipme
uipment
nt Coverag
No Co veragee Coverag
No Co veragee
UM = Uninsured Motorist
UIM = Underinsured Motorist
Policy Email: rhi*******@**ail.com
Pay Plan Description: J5/DBJ5 16.6D 4P TER - 13210 RBC - S25 PGM - C33
Endorsements Made Part of this Policy at Time of Issuance:
PA 039-0416-NY PA001-0416-NY PA117-0519-NY PA123-1010-NY PA124-1110-NY
Lienholder / Additional Interests:
2 NAVY FEDERAL CREDIT UNION PO BOX 25109 LEHIGH VALLEY, PA 180025109
PA098-0416-NY 2
Policy: NY5851542
DISCOUNTS/SURCHARGES
DISCOUNTS/SU RCHARGES DE
DETAIL
TAIL
Discount/S
Disco unt/Surch
urcharge
arge Percentag
Perce ntagee Dollarr Am
Dolla Amount
ount
Multi-Carr
Multi-Ca .00 $.00
Prevention
Acc Prev ention C
Course
ourse D
Drvr
rvr 1 7.80 $116.00
Window V Vin
in Etch Veh 1 1.29 $16.00
Anti-Theft
Anti-The ft Activ
Activee Alarm Veh 1 1.29 $16.00
Daytime Running Lamp Ve Vehh1 2.10 $26.00
Anti-Lock
Anti-Loc k Brake Veh 1 3.38 $42.00
Anti-Theft
Anti-The ft Passi
Passive
ve Alarm Veh 2 .94 $14.00
ACCIDENT/VIOLATION
ACCIDENT/VIO LATION DETA
DETAIL
IL
Accident/V
Accid ent/Violat
iolation
ion Date Percentag
Perce ntagee Dollarr Am
Dolla Amount
ount
AF Paid < $2000 10/24/2021
10/24/20 21 47.45 $1,186.00
$1,186. 00
FRONT
PA098-0416-NY 3
NY5851542
Policy: NY58 51542
