Form_SCTNID_CTGRY.

MI03106489_DECPAGE

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PROGRESSIVE
P.O. BOX 31260
TAMPA, FL 33631

Policy Number: 31623995-0

Underwritten by:
Progressive Marathon Insurance Co
December 26, 2011
DANIELLE S HINE
Policy Period: Dec 15, 2011 - Jun 15, 2012
1830 KENT RD
ORTONVILLE, MI 48462 Page 1 of 2

progressive.com
Online Service
Make payments, check billing activity, update
policy information or check status of a claim.

Auto Insurance 1-800-776-4737

For customer service and claims service,
Coverage Summary 24 hours a day, 7 days a week.

This is your Declarations Page

Your policy information has changed
Your coverage began on December 15, 2011 at the later of 12:01 a.m. or the effective time shown on your application. This policy
period ends on June 15, 2012 at 12:01 a.m.
This coverage summary replaces your prior one. Your insurance policy and any policy endorsements contain a full explanation of your
coverage. The policy contract is form 9610D MI (05/06). The contract is modified by forms Z445 MI (07/10) and 4884 MI (03/07).

Policy changes effective December 25, 2011

………………………………………………………………………………………………………………………………………………………..
Changes requested on: Dec 25, 2011
………………………………………………………………………………………………………………………………………………………..
Premium change: -$39.00
………………………………………………………………………………………………………………………………………………………..
Changes: An Electronic Funds Transfer (EFT) discount has been added to your policy.

Drivers and ………………………………………………………………………………………………………………………………………………………..

household residents Additional information
DANIELLE S HINE Named insured

Outline of coverage
2000 Mitsubishi Eclipse
VIN 4A3AC54L7YE132228
Primary use of the vehicle: Commute
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $219
Bodily Injury Liability $20,000 each person/$40,000 each accident
Property Damage Liability $10,000 each accident
………………………………………………………………………………………………………………………………………………………..
Personal Protection Insurance (PIP) $500 282
Excess Medical/Excess Workloss
………………………………………………………………………………………………………………………………………………………..
Uninsured/Underinsured Motorist $20,000 each person/$40,000 each accident
………………………………………………………………………………………………………………………………………………………..
8
Property Protection Insurance $1,000,000 $0 37
………………………………………………………………………………………………………………………………………………………..
Subtotal policy premium $546.00
………………………………………………………………………………………………………………………………………………………..
MCCA assessment recoupment 72.50
………………………………………………………………………………………………………………………………………………………..
Statutory assessment recoupment 8.50
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium and fees $627.00

Form 6489 MI (03/10)

4
Continued
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Policy Number: 31623995-0

DANIELLE S HINE
Page 2 of 2

Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
31623995-0 Paperless, Online Quote, Online Signature - First Policy Period Only, Continuous
Insurance: Platinum, Electronic Funds Transfer (EFT) and F1 credit
Vehicle
………………………………………………………………………………………………………………………………………………………..
2000 Mitsubishi Airbag
Eclipse

Form 6489 MI (03/10)