Freeway Insurance Services - National City-E Plaza

7711 Center Avenue Ste 200

Huntington Beach, CA 92647

Aspire General Insurance Services‐ CA Lic#: 0I10876

UNDERWRITTEN BY ASPIRE GENERAL INSURANCE COMPANY

Printed on 7/1/2025

PAYMENT RECEIPT

Policy Number GPSV-00689759-00

Job Alonzo Amount Paid $26.51
1481 W 7th St Apt 98 Payment Method Producer Trust
Upland, CA 91786-7054
Confirmation Number 20741993
Date/Time of Payment 7/01/2025 11:40 AM

*The amount shown on this receipt may differ from the

amount on your bank statement if a third-party payment

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processing fee applies: a $6.00 fee for credit/debit card
payments or a $2.00 fee for EFT transactions.

Aspire General Insurance Company

PO Box 2426
Rancho Cucamonga, CA 91729-2426 To make an immediate payment:
Online:
Go to https://insured.agicins.com
Customer Service Click on Quick Pay
(916) 503-6313
customerservice@agicins.com Pay by Phone:
www.agicins.com Call (916) 503-6313

Important Information

If your payment is returned or declined by your bank due to non-sufficient funds, stop payment or is otherwise invalid, your policy may be subject to
cancellation and a return item fee. Payments will be used to satisfy any balance due on previous policy terms.

Payments received on or after the cancellation date will be subject to a reinstatement fee, if the policy is eligible for reinstatement. If the payment is
accepted, the lapse date will be as of 12:01 A.M. DATE AFTER POSTMARKED. If reinstatement payment is made by check, draft, or other method of
payment and that payment is returned for any reason, your coverage will be null and void and your insurance coverage will cease as of the cancellation date
on your Notice of Cancellation. Payments made on or after the cancellation date will subject your policy to cancellation and if the policy has Triple
Deductible, the Triple Deductible provision will apply for the first 60 days after the effective date of any reinstatement with lapse or renewal with lapse.

Renewal payments received on or after the expiration date will be subject to a reinstatement fee, if the policy is eligible for reinstatement. If the payment
is accepted, the lapse date will be as of 12:01 A.M. DATE AFTER POSTMARKED. If renewal payment is made by check, draft, or other method of payment
and that payment is returned for any reason, your coverage will be null, and void and your insurance coverage will cease as of the policy expiration date.
Payments made on or after the expiration date will subject your policy to cancellation and if the policy has Triple Deductible, the Triple Deductible provision
will apply for the first 60 days after the effective date of any reinstatement with lapse or renewal with lapse.

.........................................................................................................................................................................................................

Thank you for choosing the path to Savings with Aspire.

GBL-064 (05/2025) S, 1, N, N, N, A GPSV-00689759-00

 APPLICATION FOR INSURANCE
SAVINGS PROGRAM
Aspire General Insurance Services‐ CA Lic#: 0I10876
UNDERWRITTEN BY ASPIRE GENERAL INSURANCE COMPANY

Policy Information Policy Term & Policy Premium

Policy Number: GPSV-00689759-00 Effective Date: 07/01/2025 11:40 AM
Named Insured: Job Alonzo Expiration Date: 07/01/2026 12:01 AM
1481 W 7th St Apt 98 Transmit Date: 07/01/2025 11:41 AM
Upland, CA 91786-7054

Garaging 1481 W 7th St Apt 98

Address: Upland, CA 91786 Policy Premium Subtotal $101.00
Fully Earned Policy Fee $35.00
Home: (909) 830-3291 Mobile: (909) 830-3291 CA Fraud Fee $0.00
Work: Email: Other Fees $15.00
job362869@gmail.com CT Auto Club Membership* $0.00
Policy Premium & Fee Total: $151.00
Broker: Freeway Insurance Services - National City-E Plaza
7711 Center Avenue Ste 200
Huntington Beach,CA 92647
(800) 300-0227

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Additional fees when applicable: Cancellation Fee $50,
Reinstatement $10, SR22 Filing $15, SR22 Reinstatement $25, Non-
Sufficient Funds $25, Endorsement $5, EFT/RCCP Installment $10,
Non-EFT Installment $14, Return Mail $5, Fraud Fee $1.76 per vehicle
per year, Policy Fee $35

*If applicable, CT Auto Club Membership is your separate roadside

membership club and not part of your Aspire Insurance policy

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Driver Information
Yrs Intl/
Date of Sex/ Relation to DL#/ DL
Name Driving Other
Birth Marital Status Insured STATE Status
Exp Yrs
Job Alonzo XX/XX/1986 Male / Single Applicant XXXXX0845 / CA Suspended 22 0
Occupation: Work Address:
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Vehicle Information: All vehicles on this policy must be garaged in the same residential location
# Year/Make/Model VIN# Usage Garaging Address

1 1 None (non-owner policy) N/A Non-Owner 1481 W 7th St Apt 98 Upland

California 91786
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Lienholder/Additional Interest
Vehicle: Lienholder/Additional Interest:
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Coverages and Limits of Liability
V1 - 1 None (non-owner policy) Limit/Deductible Premium
Bodily Injury $30,000 / $60,000 $47.00
Property Damage $15,000 $54.00
----------- ----------- -----------
Vehicle Subtotal $101.00
Vehicle Totals $101.00
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Underwriting Information Notes Y N Not
required
1 Are any vehicles used in your business or occupation? If yes please indicate the X
job/occupation duties below.
(Coverage is void during business or artisan use unless such use is indicated and
acceptable by Aspire General Insurance Company.) If Named Non Owners policy select Not
Required.
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Occupation Information Notes Y N

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Page 1 of 5
GPSV-002 (05/2025) D, 1, N, N, N, A GPSV-00689759-00
UNDERWRITING CERTIFICATION
Statement Under Penalty of Perjury:
I certify under penalty of perjury that the foregoing is true and correct:

1. The Insured Vehicle(s) will not be driven by employees.

2. The Insured Vehicle(s) will not be used to transport children/patients being cared for.
3. The Insured Vehicle(s) will not be used to transport flammable liquids, chemicals or explosive materials.
4. The Insured Vehicle(s) will not be used in Racing, Delivery (pizza, newspaper), Taxi service (Uber, Lyft, Zipcar), or Emergency Vehicle.
5. I understand and agree that coverage is void during business or artisan use unless such use is indicated and acceptable by Aspire General
Insurance Company.
6. All residents of your household 14 years and older, including roommates and all regular drivers of the vehicles, and all names currently
showing on the registration of any listed vehicle are either added to the policy or excluded from coverage.
7. All drivers such as children away from home or in college, who may operate your vehicle on a regular or infrequent basis are listed on this
application.
8. I understand that if any operator(s) job, occupation duties or occupancy changes, I agree to provide in writing the updated information.

I certify that all information provided above is true and correct, and that failure to provide correct information may result in denial or
cancellation of coverage.

XSignature of Applicant Date 07/01/2025

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ASPIRE GENERAL INSURANCE COMPANY ELECTRONIC DOCUMENT DISCLOSURE AGREEMENT
By accepting The Aspire General Insurance Company Electronic Document Disclosure Agreement, you consent and agree that we may provide
certain disclosures and notices to you in electronic form, in lieu of paper form. You retain the right to withdraw your consent for electronic
delivery. You may withdraw your consent at any time by giving us at least ten (10) days prior notice. Contact us by phone or by mail. Once
you have withdrawn your consent, we will then discontinue the online document service for the account and paper documents and notices will
be resumed. The cancellation of Online E-Documents in no way affects the validity or legal effect of all Online E-Document and disclosures
which have been previously delivered electronically under the Online E-Document Service.

Provided Email: job362869@gmail.com

XSignature of Applicant Date 07/01/2025

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ASPIRE GENERAL INSURANCE COMPANY COMMUNICATION AND TEXT MESSAGE AGREEMENT
I AGREE that representatives of Aspire General Insurance can call or text message me at the number provided on the application document
GPSV-002 even if I am on a federal or state do not call registry for any purpose, including marketing. There is no separate charge for this
service; however, your carrier’s message and data rates may apply. I agree that the calls and text messages may be generated using an
automatic telephone dialing system and may contain pre-recorded messages. I understand that consenting to receive calls or texts is not
required as a condition of purchasing any goods, services, or property.

By consenting, I agree that if I change the mobile phone number for which I am consenting to receive text messages, I will notify Aspire
General Insurance immediately of any such change in number. To stop receiving text messages, reply via text to 53987 with “STOP”. I
understand that following such a request to unsubscribe, I will receive a final message from Aspire General Insurance confirming that I
have been inactivated in our system. If you have any questions or need help, please contact customer service at (916) 503-6313 or
email us at customerservice@agicins.com

XSignature of Applicant Date 07/01/2025

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COMMERCIAL, BUSINESS, AND PROFESSIONAL USE EXCLUSION
I represent that the vehicle(s) listed on the policy to be insured by Aspire General Insurance Company is (are) NOT commercially, or in a
business or professional endeavor. I fully understand and agree that the insurance to be extended on the policy applied for shall not benefit
either the insured(s) or a third party claimant when the vehicles(s) for which coverage is requested is (are) used commercially, or in a
business or professional endeavor. I further understand and agree that there will be NO INSURANCE COVERAGE IN FORCE from Aspire
General Insurance Company on the policy hereby applied for if I, or any person using the vehicle(s) for which coverage is requested, am (is)
involved in an accident while using the vehicle(s) in the course of any commercial, business or professional endeavor.
07/01/2025
XSignature of Applicant Date

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NOTICE OF INSURANCE INFORMATION PRACTICES (GBL-005)
If you have any questions concerning this policy or its coverages, please contact your broker. Your broker has a copy of your policy and will
be able to provide assistance to you.
-IN THE EVENT YOUR BROKER IS NOT ABLE TO ADDRESS YOUR CONCERNS IN A SATISFACTORY MANNER, YOU DO HAVE THE OPTION OF
CONTACTING THE CALIFORNIA DEPARTMENT OF INSURANCE TO ASSIST YOU.
California Department of Insurance

Page 2 of 5
GPSV-002 (05/2025) D, 1, N, N, N, A GPSV-00689759-00
 Consumer Services Division
300 South Spring Street, South Tower
Los Angeles, CA 90013
(800) 927-4357 (HELP)
Your Privacy and its Protection
In order to protect your privacy, we want you to be aware of the following information:
1. Personal information may be collected from persons other than you or individuals proposed for coverage.
2. If an investigative consumer report is ordered in connection with your insurance transaction, you will be given an opportunity to be
interviewed in connection with it. You also have the right to obtain a copy of the report. You may also personally review the report
by contacting the reporting insurance support organization.
3. I agree and understand that the Company will use electronic means to contact me for a variety of reasons, including, but not limited
to, when my policy cancels due to non-payment of premium or other lapse or expiration of the policy. I hereby authorize the
Company to contact me via any provided email address, home phone, cell phone, or other communication systems and authorize the
Company to email, SMS (I understand that carrier charges may apply), make automated dialer telephone calls to my cell phone or
land line, instant message me or otherwise contact me electronically.
4. You have the right of access and correction with respect to all personal information collected which is contained in our files.
5. Personal information and other privileged information collected by us or our brokers may be, in certain circumstances, disclosed to
certain parties without your authorization, as permitted or required by law.
6. In the normal course of business, we may utilize third-party service providers, including personnel located outside of the United
States, who assist in providing services related to your policy. These individuals may have access to personal information as
necessary to perform their duties, and we require them to adhere to strict confidentiality and data protection standards in
accordance with applicable laws.

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Aspire General Insurance Services is concerned about the protection of your privacy. A more detailed description of our information practices
and your right to privacy is available at your written request.

XSignature of Applicant Date

07/01/2025
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ANNUAL MILEAGE SELF-CERTIFICATION FORM
Below is the estimate of the annual miles per vehicle that will be driven in 12 months following the inception of my Policy. I understand that
the Company will verify my commute mileage based on my garaging and work addresses provided on the application. This estimate will be
used to calculate my overall estimate of mileage. I may elect to change the estimate below and I understand that proof of mileage may be
required.

Vehicle Year/Make/Model Annual Miles Odometer

1 None (non-owner policy) 2500

POLICY ACCIDENTS/VIOLATIONS
The Following Accidents/Violations Will Be Charged. I confirm that I have no undisclosed driving activity
Driver Name Date Description Points Source
Job Alonzo 4/16/2021 CHARGEABLE ACCIDENT-NO INJURY (3P-10020) 0 ISO APlus
Job Alonzo 6/18/2021 NON CHARGEABLE ACCIDENT (3P-60020) 0 ISO APlus
Job Alonzo 9/18/2021 NON CHARGEABLE ACCIDENT (3P-60020) 0 ISO APlus

XSignature of Applicant Date 07/01/2025

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APPLICANT’S CERTIFICATION
I agree all answers to all questions in this Application are true and correct. I understand, recognize, and agree said answers are given and
made for the purpose of inducing the Company to issue the policy for which I have applied. I further agree that ALL residents of my
household age 14 years or over, registered owners, as well as ALL operators who regularly operate my vehicles and do not reside in my
household, are shown above. I agree that my principal residence and place of vehicle garaging is correctly shown above and is in the state for
which I am applying for insurance at least 10 months each year. I understand the Company may rescind this policy if said answers on this
Application are false or misleading, and materially affect the risk the Company assumes by issuing the policy. In addition, I understand that I
have a continuing duty to notify the Company of any changes of: (1) address; (2) location of vehicles; (3) members of my household of
eligible driving age or permit age; (4) operators of any vehicles listed on the policy; or (5) use of any vehicles listed on the policy. I must
notify the company if I acquire a new or replacement vehicle within 3 days and understand there is no coverage for a new or replacement
vehicle after 3 days unless I specifically endorse the car to the policy and pay the premium for coverage. I understand the Company may
rescind this policy if I do not comply with my continuing duty of advising the Company of any change as noted above.
I understand and agree that in connection with my request for a premium quotation and Application for insurance: (1) the Company may
obtain consumer reports which may include a driver history report, or personal or privileged information from third parties; (2) such
information may be disclosed to affiliated or unaffiliated third parties without my prior permission but only as permitted or required by law;
(3) upon my written request, the Company will inform me if a consumer report was requested and the name and address of the consumer
reporting agency that furnished the report; (4) I may also request access to and correction of information the Company has collected on me;

Page 3 of 5
GPSV-002 (05/2025) D, 1, N, N, N, A GPSV-00689759-00
(5) the Company may request and use subsequent consumer reports in updating and renewing any insurance afforded in connection with this
Application; (6) the Company will furnish a more detailed explanation of its information practices upon my request; and (7) refusal to
authorize the Company to obtain a consumer report may give the Company the right to decline insurance to me.
I hereby authorize the Company to obtain consumer reports on me. I agree the named members of my household and all other operators
listed under this policy have authorized me to consent on their behalf to all coverages provided herein and to authorize the Company to
obtain consumer reports on them for the rating and/or underwriting of the insurance for which I am applying and for any renewal thereof. I
agree to pay any additional premium owed if the amount of premium shown is inaccurate for any reason.
I understand that coverage for Damage to a Vehicle only applies when my vehicle is driven by a person listed on the Declarations Page. There
will not be coverage under Damage to a Vehicle if the person driving your vehicle is not listed on the Declarations Page. I made an informed
decision and have selected the policy coverage level shown on the Application.
I understand the policy may be rescinded and no coverage provided if my premium down payment or full payment is paid by check, credit
card, or debit card and the bank returns said check unpaid or fails to honor the credit charge or debit charge in full. I understand there may
be a processing fee imposed on any returned checks.
I understand processing fees may be included with my down payment and installment payments, and additional fees may be charged for late
payments. I understand my payments are first applied to the fees owed and then to the premium.

FRAUD WARNING - Pursuant to California Insurance Code Section 1871.2:

For your protection California law requires the following to appear on this form. 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.

WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an

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insurance policy containing any false, incomplete or misleading information is guilty of a felony.
An insurer which refuses to provide coverage to an applicant who is a Good Driver must provide applicant with a written statement of the
reasons it denied coverage. In general, under California law, a Good Driver is a person who has not had more than one violation point or
more than one at-fault accident resulting in only Property Damage (in excess of $1000) in the last three years, or been convicted of driving
under the influence in the last 10 years.

XSignature of Applicant Date 07/01/2025

I ACKNOWLEDGE, AGREE, AND UNDERSTAND THAT ONLY MINIMUM STATUTORY LIMITS IN THE STATE OF CALIFORNIA OF
$30,000 PER PERSON UP TO A MAXIMUM OF $60,000 PER ACCIDENT AND $15,000 IN PROPERTY DAMAGE WILL BE PROVIDED
FOR BODILY INJURY AND/OR PROPERTY DAMAGE resulting from losses due to the operation or use of a motor vehicle by persons other
than a named insured, a relative or a person listed as a driver on the declarations page with the express or implied permission of a named
insured or relative.

XSignature of Applicant Date 07/01/2025

I ACKNOWLEDGE, AGREE, AND UNDERSTAND THAT ASPIRE GENERAL INSURANCE COMPANY MAY HAVE OTHER PROGRAMS
AVAILABLE AT A LOWER RATE THAT I MAY QUALIFY FOR. I have had all programs, the liability coverages, and limits available for the
purchase, fully explained to me and have selected the limits shown on the Application. I have had the different policy coverage levels
available to me fully explained. I understand that I may contact my broker for a quote or a comparison of the programs.

XSignature of Applicant Date 07/01/2025

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BROKER'S STATEMENT: PLEASE READ CAREFULLY

I, the Broker, accept full responsibility for collecting, completing and obtaining necessary signatures on the application and all of the
supporting documents which will form a part of this application for insurance. I accept full responsibility for the storage of the signed
California Auto Insurance Application and all supporting documentation. These documents will be maintained by the Broker and available
for the periodic review by Aspire General Insurance Services.

For vehicles with physical damage coverages, I have identified all pre-existing damage on the Vehicle Inspection and I understand that I
am required to obtain and keep photos in my files. I understand that I will be required to provide copies, upon request of the damaged
areas.

For vehicles with physical damage coverages or vehicles with business/artisan use I understand that I am required to obtain and keep
photos in my files. I understand that I will be required to provide copies, upon request. (New vehicles written within 72 hours of purchase
only require a Window Sticker or Bill of Sale.)

I, the Broker will disclose to the applicant that any incomplete information gathered during the application process such as an incomplete
VIN and/or an undelivered MVR request, will be reviewed by underwriting and any discovered information may result in a premium
change, cancelation and/or declination of coverage.

Page 4 of 5
GPSV-002 (05/2025) D, 1, N, N, N, A GPSV-00689759-00
 I have confirmed that all married drivers on this policy are currently married and to be rated as married a spouse must be rated or
excluded. I will provide signed marriage certification and proof of marriage if applicable.

I understand International licenses must have never been licensed in the US. I have listed any violations/accidents, and collected signed
International Driver Certification and supporting documentation (document number is listed on this application), if applicable.

I understand all vehicles listed on this policy must be garaged in the same location, and the garaging address is listed on this application.

I have asked the applicant(s) all questions on this Application and these are the applicant(s) responses. To the best of my knowledge, all
of the information on this Application is true, correct and complete.

BROKER'S NAME: (Please Print) Freeway Insurance Services National City-E Plaza
BROKER'S SIGNATURE: Date/Time:
07/01/2025

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Page 5 of 5
GPSV-002 (05/2025) D, 1, N, N, N, A GPSV-00689759-00
GPSV-015 (02/2017)

NAMED NON-OWNED VEHICLE COVERAGE ENDORSEMENT

If you elect Named Non-Owned Vehicle Coverage, you agree with us that this policy is amended as
follows:

GENERAL DEFINITIONS

The general policy definitions of “covered vehicle” (Number 4) and “non-owned vehicle” (Number 8)
are deleted and replaced by the following:

“Covered vehicle” and “non-owned vehicle” mean any vehicle that:

1. is used with express permission of the owner of the vehicle; and is not owned by:
a. you;
b. any person listed as a driver on the Declarations Page;

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c. an insured person’s employer;
d. a relative;
e. your non-resident spouse;
f. a person residing with you; or
g. a corporation or partnership in which the combined ownership interest of you and your relatives
exceeds twenty percent; and
2. has never been owned by or registered to you, or any other person listed as a driver on the
Declarations Page; and
3. is not furnished or available for regular use by you, a resident, or a relative.

The general policy definition Number 19 of “you” and “your” is deleted and replaced by the following:

“You” and “your” mean the person(s) shown as the named insured on the Declarations Page.

PART I – LIABILITY TO OTHERS

ADDITIONAL DEFINITION

When used in Part I, the definition of “insured person” and “insured persons” is deleted and replaced
by the following:

“Insured person” and “insured persons” mean:

1. the person(s) shown as the named insured on the Declarations Page.

OTHER INSURANCE

The insurance provided under this Part I is excess over any other collectible auto liability insurance or bond.

PART II – UNINSURED/UNDERINSURED MOTORIST

COVERAGE

If you pay a premium for Uninsured/Underinsured Motorist Coverage, and it is shown on the Declarations
Page, the Other Insurance provision under this Part III is deleted and replaced by the following:

GPSV-015 (02/2017) S, 1, N, N, N, A GPSV-00689759-00

OTHER INSURANCE

If there is other applicable uninsured or underinsured motorist coverage, any insurance we provide shall
be excess over any other collectible uninsured or underinsured motorist coverage.

We will not pay for any damages which would duplicate any payment made for damages under other
insurance.

If you are injured while not occupying a motor vehicle, the coverage provided under this policy shall be
excess to any uninsured or underinsured motorist coverage provided by a policy under which that insured
person is a named insured.

PART III – DAMAGE TO A VEHICLE

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No coverage applies under Part III – Damage to a Vehicle.

07/01/2025
Signature of Applicant Date

GPSV-015 (02/2017) S, 1, N, N, N, A GPSV-00689759-00

 P.O. Box 2426
Rancho Cucamonga, CA 91729-2426
(916) 503-6313  NAIC# 15290
www.AGICINS.com

Insured Name: Job Alonzo Policy Number: GPSV-00689759-00

DELETION OF UNINSURED/UNDERINSURED MOTORIST BODILY INJURY COVERAGE

The California Insurance Code requires an insurer to provide uninsured motorists coverage in each bodily injury liability insurance
policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the
insurer and the applicant to delete the coverage completely or to delete the coverage when a motor vehicle is operated by a natural
person or persons designated by name. Uninsured Motorists coverage insures the insured, his or her heirs, or legal representatives for
all sums within the limits established by law, which the person or persons are legally entitled to recover as damages for bodily injury,
including any resulting sickness, disease, or death, to the insured from the owner or operator of an uninsured motor vehicle not owned

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or operated by the insured or a resident of the same household. An uninsured motor vehicle includes an underinsured motor vehicle
as defined in subdivision (p) of Section 11580.2 of the Insurance Code.

This rejection shall be binding upon every insured to whom the policy applies while the policy is in force and shall continue to be so
binding with respect to any continuation or renewal of the policy, or with respect to any other policy which extends, changes,
supersedes, or replaces the policy issued to the named insured by the same insurer or with respect to reinstatement of the policy
within thirty (30) days of any lapse thereof.

07/01/2025
Signature of Named Insured Date

GPSV-003 (02/2017) S, 1, N, N, N, A GPSV-00689759-00

 P.O. Box 2426
Rancho Cucamonga, Ca 91729-2426
P (916) 503-6313

Aspire General Insurance Services‐ CA DOI Lic#: 0I10876

UNDERWRITTEN BY ASPIRE GENERAL INSURANCE COMPANY

AUTOMATIC MONTHLY PAYMENT AUTHORIZATION (EFT)

I authorize Aspire General Insurance Services to initiate scheduled deductions from the bank account identified below for payment of premium on the insurance
policy issued to me and any renewals thereof.

I authorize the financial institution identified by the routing number below to accept the post entries to the account.

I represent that I am the owner and/or an authorized signer of the account.

I understand that this authorization allows Aspire General Insurance Services to adjust the scheduled deductions to reflect any premium changes to my policy.
Aspire agrees that it shall notify me in writing at least ten days prior to making any deduction if there is a premium change or seven days if there is a due date
change. Please note that although payment will typically be processed on the Withdrawal Schedule dates, please allow several days for processing of the
withdrawals from your account. Additionally, that Aspire General Insurance Services may electronically withdrawal or create a draft against your account.

I understand that Aspire General Insurance Services will not send me a bill before scheduled deductions are made and that it is my responsibility to ensure
sufficient funds are in the account at the time of each scheduled deduction. The charges will appear on my bank statement as Aspire.

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I also understand that my policy may cancel or expire if there are insufficient funds in the account, which could cancel this agreement and remove my policy from
automatic payment processing. In addition to any fees charged by my bank, Aspire will charge a return item fee of up to $25.00 if my payment is dishonored or
returned for any reason. Additionally, you will be removed from the Automatic Monthly Payment Authorization program.

This authorization is to remain in full force and effect until Aspire General Insurance Services receives a written request from me to cancel my electronic payment
withdrawal or until Aspire General Insurance Services elects to cancel this agreement.

PLEASE NOTE THAT IF YOUR DUE DATE FALLS ON A WEEKEND OR HOLIDAY, WE WILL MAKE THE PAYMENT ON THE NEXT BUSINESS DAY
FOLLOWING THE HOLIDAY/WEEKEND.

Please allow up to 7 days for changes or termination of electronic payment withdrawal to ensure changes are made prior to the withdrawal of your installment.

If you have any questions or concerns about this transaction, you can email customerservice@agicins.com or call Customer Service at (916) 503-6313.

All of the information requested below is required and very important for the accurate processing of your automatic monthly withdrawal payment plan. If any of the
information is missing or inaccurate, please be aware that this may delay the processing.

Please note that your monthly withdrawn payments are subject to change depending if any changes that cause an increase or decrease to your written premium
are made to the existing policy during the term.

Named Insured Job Alonzo

Account Holder Job Alonzo Policy # GPSV-00689759-00
Routing Number: Cell: (909) 830-3291
Account Number: 0140 Home: (909) 830-3291
Account Type: Checking Work:

Signature of Applicant Date

07/01/2025
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PLEASE ATTACH VOIDED CHECK HERE, CHECK REQUIRED

GBL-059 (082020) S, 1, N, N, N, A GPSV-00689759-00

Freeway Insurance Services - National City-E Plaza
7711 Center Avenue Ste 200
Huntington Beach, California 92647

Aspire General Insurance Services‐ CA Lic#: 0I10876

UNDERWRITTEN BY ASPIRE GENERAL INSURANCE COMPANY

Printed on:
Policy Number: GPSV-00689759-00
Job Alonzo
1481 W 7th St Apt 98
Upland, California 91786-7054

AUTOMATIC PAYMENTS NOTICE - THIS IS FOR YOUR RECORDS

You have agreed and are currently set up on Automatic Payments from your bank or credit card. Your Minimum Amount Due will be automatically
withdrawn from your bank account on the Due Dates listed below. The charges will appear on your bank statement as “Aspire.”

If your payment is returned or declined for any reason, it will not be considered received for all purposes and the payment will be ignored with the
respect to all time frames, accordingly, return item fees will apply. Additionally, your policy may be subject to cancellation.

Please note that due to payment processing time, your transaction may not post to your account immediately. If your scheduled due date falls on a
weekend or holiday, your payment will be posted on the next business day.

Job Alonzo eSign: 7/1/2025 11:46 AM PDT, IP: 2600:1012:b154:40ba:0:46:c346:b301

You will not be receiving any further billing notices. Please keep this notice for your records.

As you have elected to have Electronic Funds Transfers withdrawn from your bank or Recurring Credit Card Payments, your policy now qualifies for
a reduced installment fee.

To make an immediate payment:

Pay by Phone
Call (916) 503-6313
Available for Credit Cards and Check Payments

SCHEDULE OF PAYMENT WITHDRAWALS

*Dates subject to change **Includes Installment Fee
Installment No Due Date* Minimum Amount Due**

1 7/31/2025 $21.28

2 8/31/2025 $21.28

3 9/30/2025 $21.28

4 10/31/2025 $21.28

5 11/30/2025 $21.28

6 12/31/2025 $21.28

7 1/31/2026 $21.28

8 2/28/2026 $21.28

9 3/31/2026 $21.28

10 4/30/2026 $21.28

11 5/31/2026 $21.69

..................................................................................................................................................................................................................................................................
Your policy is currently set up on Automatic Payments from your bank.

• Your Minimum Amount Due will be automatically withdrawn from your bank account on the withdrawal date.
• If you have any questions please contact Customer Service at (916) 503-6313.
• To make a change to your Automatic Payments, seven (7) days notice prior to your Due Date is required.
GBL-020 (09/2014) S, 1, N, N, N, A GPSV-00689759-00
 1
CALIFORNIA EVIDENCE OF LIABILITY INSURANCE CALIFORNIA EVIDENCE OF LIABILITY INSURANCE

This policy complies with Sections 16056 or 16500.5 of the California Vehicle Code. This policy complies with Sections 16056 or 16500.5 of the California Vehicle Code.

Involved in an Accident? Call (916) 306-1831 Involved in an Accident? Call (916) 306-1831

Named Insured: Job Alonzo Policy #: GPSV-00689759-00 Named Insured: Job Alonzo Policy #: GPSV-00689759-00

Effective Date: 7/01/2025 11:40 AM - Expiration Date: 7/01/2026 12:01 AM Effective Date: 7/01/2025 11:40 AM - Expiration Date: 7/01/2026 12:01 AM
Insurance Company: Aspire General Insurance Company Insurance Company: Aspire General Insurance Company
PO Box 2426 PO Box 2426
Rancho Cucamonga, CA 91729-2426 Rancho Cucamonga, CA 91729-2426
NAIC Code: 15290 NAIC Code: 15290
Year/Make/Model Vehicle Identification Number Year/Make/Model Vehicle Identification Number
1 None (non-owner policy) N/A 1 None (non-owner policy) N/A
Customer Service Assistance: (916) 503-6313 Customer Service Assistance: (916) 503-6313

Job Alonzo eSign: 7/1/2025 11:46 AM PDT, IP: 2600:1012:b154:40ba:0:46:c346:b301

GPSV-030 (102024) S, 1, N, N, N, A GPSV-00689759-00

 CALIFORNIA INSURANCE PROOF CERTIFICATE
Department of Motor Vehicles
P.O. Box 942884
Sacramento CA, 94284-0884

The Company named below which is authorized to do business in the State of California, certifies that it has issued to or for the benefit of:

NAME DRIVER LICENSE NO. DATE OF BIRTH

Job Alonzo d8990845 12/8/1986
ADDRESS CITY STATE ZIP
1481 W 7th St Apt 98 Upland California 91786-7054

POLICY NUMBER EFFECTIVE DATE

GPSV-00689759-00 7/01/2025 11:40 AM
ASSIGNED RISK PLAN NO.

CHECK ONE BOX ONLY:

SR-1P (P) An automobile liability policy as defined in California Vehicle Code Section 16054.

Job Alonzo eSign: 7/1/2025 11:46 AM PDT, IP: 2600:1012:b154:40ba:0:46:c346:b301

(M) Any other vehicle as defined in California Vehicle Code Section 16431, which meets requirements of Section 16056 for
vehicles with less than four wheels.
SR-22 (S) A Motor vehicle liability policy as defined in California Vehicle Code Section 16450 (BROAD COVERAGE)

(U) Owner's policy covering all motor vehicles registered to the Insured. (Section 16451).

X (T) Operator's policy covering the use by the Insured of any motor vehicle not registered to the Insured. (Section 16452)
Cancellation or termination of this policy shall be in accordance with Vehicle Code Section 16433.
NAME OF INSURANCE COMPANY DEPT. OF INSURANCE ID NO.
ASPIRE GENERAL INSURANCE SERVICES 2490-1
ADDRESS OF INSURANCE COMPANY
PO Box 2426
CITY STATE ZIP
Rancho Cucamonga CA 91729-2426
AUTHORIZED REPRESENTATIVE DATE
7/1/2025

SR-22/SR-1P (REV. 4/91)

GP-034 (04/2014) S, 1, N, N, N, A GPSV-00689759-00