Tel: 1-800-841-3000 Declarations Page
This is a description of your coverage.
Please retain for your records.
GEICO General Insurance Company
One GEICO Center Policy Number: 4251-58-36-80
Macon, GA 31295-0001
Coverage Period:
07-17-25 through 01-17-26
Your coverage begins and ends at 12:01am local time at the
address of the named insured.
Endorsement Effective: 07-17-25
Date Issued: June 25, 2025
DAVID A SZYMANSKI AND EVELYN M
DIAZ SZYMANSKI
540 VINE ST
MELBOURNE FL 32904-5627
Email Address: davidpraise7@gmail.com
Named Insured Additional Drivers
David Alan Szymanski David Felipe Navarro
Evelyn Maritza Diaz Szymanski
Vehicles VIN Vehicle Location Finance Company/
Lienholder
1 2018 Nissan Rogue JN8AT2MT1JW463280 MELBOURNE FL 32904-5627
2 2021 Kia Forte 3KPF34AD5ME387233 MELBOURNE FL 32904-5627
3 2020 Nissan Versa 3N1CN8FV6LL805768 MELBOURNE FL 32904-5627 SPACE COAST CU
Coverages* Limits and/or Deductibles Vehicle 1 Vehicle 2 Vehicle 3
Bodily Injury Liability
Each Person/Each Occurrence $100,000/$300,000 $323.70 $383.90 $406.20
Property Damage Liability $25,000 $98.40 $110.20 $106.40
Personal Injury Protection Non-Ded/Insd&Rel $94.30 $104.50 $129.40
Uninsured Motorist/Stacked
Each Person/Each Occurrence Insured Rejects - - -
Comprehensive (Excluding Collision) $500 Ded - - $88.50
Collision $500 Ded $152.60 $205.70 $184.30
Emergency Road Service ERS COLL $7.50 - -
Six Month Premium Per Vehicle $676.50 $804.30 $914.80
Total Six Month Premium $2,395.60
*Coverage applies where a premium or $0.00 is shown for a vehicle.
T-4
Continued on Back
DEC_PAGE (06-16) (Page 1 of 2) Endorsement Page 9 of 10
If you elect to pay your premium in installments, you may be subject to an additional fee for each installment. The fee amount
will be shown on your billing statements and is subject to change.
Discounts
The total value of your discounts is $1,251.00
Seatbelt (All Vehicles) ...................................................................................................................................$53.50
Passive Restraint/Air Bag (All Vehicles) .......................................................................................................$202.10
Multi-Car (All Vehicles) ................................................................................................................................$136.80
5 Year Good Driving (All Vehicles) ..............................................................................................................$735.50
Anti-Lock Brake (All Vehicles) ......................................................................................................................$114.00
Anti-Theft Device (Veh 3) ................................................................................................................................$9.10
Contract Type: A30FL, FAMILY AUTO INSURANCE POLICY
Contract Amendments: ALL VEHICLES - A30FL(09-24) PTFL(03-24) SIGPGCW(07-20)
Unit Endorsements: UE316F(02-15) (VEH 3)
Countersigned by Authorized Representative
Important Policy Information
- If you have any questions about this policy, about the insurance services we offer, or if you need assistance resolving
a complaint please contact GEICO at 1-800-841-3000. We can assist you with your personal insurance needs.
- Congratulations! You have earned the free Accident Forgiveness benefit. That means we will waive the surcharge
associated with the first at-fault accident caused by an eligible driver on your policy.
- Please review the front and/or back of this page for your coverage and discount information.
- Special 50+ rating applies.
- We have a new rating program available. If you're interested in learning more, inquire at 1-866-422-0360.
- This adjustment is effective 2025-06-25.
- Any person who knowingly and with intent to injure, defraud or deceive any insurer, files a statement of claim or an
application containing any false, incomplete or misleading information is guilty of a felony in the third degree. GEICO
asks that you support us in the battle against insurance fraud by reporting any suspicious activities to GEICO at (800)
824-5404 x3313 or the National Insurance Crime Bureau (NICB) (800) TEL-NICB or www.nicb.org. Your call is free.
Your call can be anonymous. You could be eligible for a reward.
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