Form_SCTNID_CTGRY.
IL08226489_DECPAGE
990202236 N IC64918 INS DECPAGE E POLWHITEFONT 3FPQRWYZASELEFKMTILTJF47HE0002 RPUID TRACWHITEFONT BDF_AA
PROGRESSIVE
P.O. BOX 31260
TAMPA, FL 33631
Policy Number: 990202236
Underwritten by:
Progressive Universal Insurance Co
KAREN ANDERSON December 4, 2024
204 EAST SEMINARY ST.
GREENCASTLE, IN 46135 Policy Period: Dec 4, 2024 - Jun 4, 2025
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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.
P.O. Box 31260
This is your Declarations Page Tampa, FL 33631
Your coverage began on December 4, 2024 at the later of 12:01 a.m. or the effective time shown on your application. This policy
period ends on June 4, 2025 at 12:01 a.m.
Your insurance policy and any policy endorsements contain a full explanation of your coverage. The policy contract is form 9611D IN
(05/15). The contract is modified by forms 4884 (10/08), 6255 (07/11), A229 IN (06/17), A331 (11/21) and A264 (02/22).
Progressive Universal Insurance Co is a stock company (NYSE: PGR).
PO Box 6949 Cleveland, OH 44101
Drivers and household residents
Karen Anderson
Additional information: Named insured
Outline of general policy coverages Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $534
Bodily Injury Liability $25,000 each person/$50,000 each accident
Property Damage Liability $20,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured/Underinsured Motorist Bodily Injury $25,000 each person/$50,000 each accident
………………………………………………………………………………………………………………………………………………………..
23
Total premium for general policy coverage $557.00
When selected at state minimum limits, Uninsured/Underinsured Motorist Bodily Injury coverage provides a benefit only when the
legally liable owner or operator does not have insurance, has insurance in an amount less than the minimum amounts required by the
financial responsibility laws of the state, or is a hit-and-run motorist (an uninsured motorist).
Form 6489 IN (08/22)
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Continued
990202236 N IC64918 INS DECPAGE E POLWHITEFONT 3FPQRWYZASELEFKMTILTJF47HE0002 RPUID TRACWHITEFONT BDF_AA
Policy Number: 990202236
Karen Anderson
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Outline of vehicle coverage
General policy coverages apply to all listed vehicles unless indicated otherwise.
2021 FORD ECOSPORT 4 DOOR WAGON
VIN: MAJ6S3KL8MC427949
Garaging ZIP Code: 46135
Primary use of the vehicle: Commute
Annual miles: 8,000 - 9,999
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Information regarding your vehicle history (prior damage, theft or title issues) has impacted how we determine your premium.
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value
………………………………………………………………………………………………………………………………………………………..
$2,000 $137
Collision Actual Cash Value $2,000 355
………………………………………………………………………………………………………………………………………………………..
Roadside Assistance 16
with Trip Interruption $500 each occurrence
………………………………………………………………………………………………………………………………………………………..
Total vehicle coverage premium for 2021 FORD $508
………………………………………………………………………………………………………………………………………………………..
Subtotal policy premium $1,065.00
………………………………………………………………………………………………………………………………………………………..
Theft Prevention and Insurance Verification fee 0.50
………………………………………………………………………………………………………………………………………………………..
Law Enforcement Training fee 2.00
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium and fees $1,067.50
Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
990202236 Automatic Card Payments (ACP), Online Signature - First Policy Period Only,
Online Quote and Paperless
Vehicle
………………………………………………………………………………………………………………………………………………………..
2021 FORD Anti-theft Device
ECOSPORT
Lienholder information
Vehicle Lienholder
………………………………………………………………………………………………………………………………………………………..
2021 FORD ECOSPORT CONSUMER PORTFOLIO
MAJ6S3KL8MC427949 IRVINE, CA 92619
A11Y LEH End Locator
Form 6489 IN (08/22)
