665 N Lawrence Ave

Payment Receipt Yuba City CA 95991

New Business Phone : 530-671-8580
Transaction #41270346 License # 6002326
Office : 372 Yuba City-N
New Business #28042772
Lawrence

Kyle Woodland Customer #20479843

1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

Fees
Added Date Type Description Amount
4/9/2024 Automobile Insurance Down Payment to Carrier $83.61
4/9/2024 Documentation Fees Documentation and Imaging Fee $40.00
4/9/2024 Broker Fee Broker Fee $100.39
4/9/2024 Tire Hazard DRIVEN $65.00
4/9/2024 Split Payment Fee Split Payment Fee $15.00

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

Total Fees: $304.00

Received Payments

Received Date Type Description Credit Card # / Check # / Other Amount

4/9/2024 None- $204.00
NoCoverageUntilPaid
Total Amount Received : $204.00
Due Payments

Added Date Type Description Credit Card # / Check # / Other Due Date Amount
4/9/2024 Hold Credit Card Card# *0490 4/23/2024 $100.00
Total Amount Due : $100.00

TOTAL PAYMENT : $304.00

By way of this receipt, I acknowledge that I have may conducted this insurance transaction with an affiliated company. Any
sharing of my information by and amongst these affiliates is solely for the purpose of completing the insurance transaction.
Affiliated companies are listed here: https://www.freeway.com/affiliate-disclosure/

Customer Service: (800) 998-3417

Insurance Company: Infinity Auto Insurance

Note: For Credit Card and Electronic Check Payments (AHC) charges will appear on your statement as COST-U-LESS INSURANCE

** If the Received Payments Type above indicates "None - No Coverage Until Paid", then no payment has been received and
this document is not evidence of coverage or receipt of payment. **

Customer Signature: Agent Signature:

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

BIG SAVINGS!
Find out more about our additional products:
• Auto • Motorcycle • Home • Small Commercial Auto • Hospital Indemnity
• Renter’s • Identity Theft • Telemedicine
Ask your agent or call: 888-253-0674

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

DEFERRED DOWN PAYMENT AGREEMENT

As a courtesy to the undersigned Insured,Freeway Insurance Services America, LLC DBA Cost U Less Insurance Center (California). (“Freeway”) agrees to defer a
portion of the down payment representing remuneration (e.g BROKER FEES and RELATED FEES) due Freeway in accordance with this Deferred Down Payment
Agreement (“Agreement”):

I (We), Kyle Woodland, the undersigned Insured, presently residing at 1608 Cherry Hills Cir South Lake Tahoe, CA 96150, for value received, hereby promise to
pay to Freeway the sum specified below, without interest, by no later than the due date specified below.
In the event that payment of the full amount of this Deferred Down Payment is not received by the aforementioned due date, the entire amount of the unpaid
Deferred Down Payment then remaining unpaid shall immediately become due and shall bear a service fee of ten percent (10%) per annum until paid in full,
along with a late charge of twenty dollars ($20.00). In the event of non-payment of the Deferred Down Payment, Freeway may refer the matter to a collections
firm who is authorized by me to obtain my credit report and to report my credit status to the credit bureau(s).

NOTE: PAYMENT OF THE DEFERRED DOWN PAYMENT WILL NOT BE APPLIED TO YOUR INSURANCE POLICY, SO PLEASE CONTINUE TO PAY YOUR PREMIUMS AS
BILLED

CREDIT CARD AUTHORIZATION

I Kyle Woodland and/or name of cardholder below hereby authorize Freeway to charge my credit card (information found below) on the date or after due date

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

specified below and for the payment amount specified below, which is the balance of the automobile insurance down payment for Kyle Woodland. This
authorization is to remain in force until the Deferred Down Payment is paid in full.
Credit Card #: *0490 Due Date: 4/23/2024 Payment Amount: $100.00
Name of Cardholder: Kyle Woodland
Billing Address: 1608 Cherry Hills Cir
South Lake Tahoe, CA 96150-4932

3rd PARTY CREDIT CARD AUTHORIZATION

(If the Cardholder is other than the Applicant, use the following authorization)

I Kyle Woodland and/or name of cardholder below hereby authorize Freeway to charge my credit card (information found below) on the date or after due date
specified below and for the payment amount specified below, which is the balance of the automobile insurance down payment for Kyle Woodland. This
authorization is to remain in force until the Deferred Down Payment is paid in full.

DEFERRED PAYMENT GUARANTEE

By signing this Agreement, I understand and acknowledge that I am legally bound to make the payment described above to Freeway (including its successors and
assigns). If I should fail to make the Deferred Down Payment:

1. I may be sent to a Collection Agency, without further notice of calls, for the total amount of this Deferred Down Payment and applicable service fees
and late charges;
2. I may be sued and be liable for the total amount of this Deferred Down Payment and applicable service fees, late charges, attorney’s fees, and costs.

04/09/2024
__________________ Kyle Woodland
Insured’s Signature Date Insured’s Name (please print)

__________________ __________________
Home Phone Number Work Phone Number

Warning: The California Penal Code outlines certain criminal activities involving the fraudulent use of Access Cards, including debit and credit cards. Sections 484(d)-484(j) of the
California Penal Code provide in part (i) that any person who, with the intent to defraud, for the purpose of obtaining money, goods, services or anything of value with an Access Card
that has been altered, forged, expired or revoked (e.g., canceled, reported lost or stolen, or closed account), or without the consent of the cardholder is guilty of theft, and (ii) that any
person who, with the intent to defraud, designs, makes, alters a counterfeit Access Card or signs the name of another person to an Access Card, sales slip or sales transaction is guilty
of a forgery. Suspected violations of these provisions of the California Penal Code will be reported to the authorities for appropriate legal action and may be prosecuted to the full
extent of the law.

Note: For Credit Card and Electronic Check Payments (AHC) charges will appear on your statement as FREEWAY INSURANCE CA

Freeway Insurance Services America, LLC DBA Cost U Less Insurance Center (California)
7711 Center Ave. #200 • Huntington Beach, CA 92647 • TEL (800) 300-0227 • FAX (714) 252-2606• Lic. No. 6002326

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

Freeway Insurance Services America, LLC DBA Cost U Less Insurance Center
(California)
(License No. 6002326)
PROMISE TO PROVIDE AGREEMENT
I am seeking to obtain insurance coverage effective 4/9/2024, but I do not have the following information with me, which is
necessary in order to complete my transaction:
Due Date

▪ Valid vehicle registration for 5/1/2024

Vehicles
Vehicle 1: 1991 MITSUBISHI MIGHTY MAX

▪ Valid California driver's license for 5/1/2024

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

Drivers
Driver 1: Kyle Woodland

I will provide the indicated information on the date stated above.

In the event that the information is not provided by the above date, I understand that some or all of my coverage may be subject to
a premium increase, cancellation, or rejection, with no coverage in effect. I also understand that if this occurs, I may lose all or
part of my down payment and fully-earned Broker Fee, and I may incur other financial loss.

AGREED TO BY : DATE: 4/9/2024

NAMED INSURED'S SIGNATURE ONLY

NAMED INSURED: Kyle Woodland

DRIVERS LICENSE: F1570434
HOME PHONE: (530) 721-2321
AGENT: Joanna Gonzalez
OFFICE: 372 Yuba City-N Lawrence

AUTHORIZED BY:________________________________ 04/09/2024

DATE: _____________________

MAIL Information to: FAX Information to:

Freeway Insurance Services America, LLC DBA Cost U Less Insurance Center (California)
Freeway Insurance Services America, LLC DBA Cost U Less Insurance Center (California)

7711 Center Ave. #200 processing@freewayinsurance.com

Huntington Beach, CA 92647 FAX: (714) 252-2606
ATTN: Customer Service Dept. ATTN: Customer Service Dept

CUSTOMER SERVICE TELEPHONE NUMBER (800) 998-3417

7711 Center Ave. #200• Huntington Beach, CA 92647 • TEL (800) 998-3417 • FAX (714) 252-2606

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

BROKER FEE DISCLOSURE FORM

This disclosure was prepared by the California Insurance Commissioner.

Please READ IT CAREFULLY!

I. Do not sign any broker fee agreement unless all of its blank lines and spaces have been filled-in
and you have read the entire document and the agreement carefully.

II. Your insurance broker represents you, the consumer, and is entitled to charge a broker fee if
he/she chooses. This fee is not set by law, and may be negotiable between you and the broker.

III. It is illegal for an insurance broker to charge you a fee for placing coverage solely with the
California Automobile Assigned Risk Plan or the California Fair Plan. Fees may be charged for placement

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

of other coverages.

IV. Broker fees are often non-refundable even if you cancel your coverage. Refer to your broker fee
agreement to see if your broker fee is non-refundable. However, you may be entitled to a full refund of
a broker fee if your broker acted incompetently or dishonestly. Unresolved disputes over non-refunded
broker fees can be forwarded to the Department of Insurance for review.

V. You are entitled to obtain and keep a completed copy of this disclosure and any broker fee
agreement you sign.

VI. Your broker may receive a commission from insurance company (ies) for placing your insurance.
This commission may be paid to your broker by the insurance company (ies) in addition to any broker
fee you pay.

VII. If you will be paying your premium in installments to a finance company, by law you must receive
a copy of a premium finance disclosure and agreement. Be sure to obtain and read those documents
before signing a premium finance agreement. Also, ask the broker if the insurer offers its own
installment payment plan. Insurer installment plans are often cheaper than premium financing through
a separate premium finance company.

VIII. If your broker is placing automobile coverage, your broker must provide you with a copy of the
current Department of Insurance pamphlet “Automobile Insurance.” If your broker is placing
residential coverage, your broker must provide you with a copy of the current Department of
Insurance pamphlet “Residential Insurance.” By signing this disclosure, you acknowledge receipt of
the appropriate pamphlet(s).

Client Initials:

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

Freeway Insurance Services America, LLC DBA Cost U Less Insurance Center (California)
(License No. 6002326)

BROKER FEE AGREEMENT

APPOINTMENT OF INSURANCE BROKER and AGREEMENT TO PAY BROKER FEE

As of 4/9/2024, the undersigned (Client) appoints Freeway Insurance Services America, LLC DBA Cost U Less Insurance Center (California) (Broker and us) as
his/her insurance broker of record. This Agreement shall continue in full force until terminated by either party. Broker agrees to represent Client honestly and
competently in obtaining and servicing the desired insurance coverages, as may be available. Client agrees to act in good faith with Broker. For each non-Assigned
Risk policy, Client agrees to pay a broker fee for Broker's services, as specified below. This broker fee is in addition to any commissions paid, if at all, to Broker by
an insurance company.

Included in the estimated cost is a Broker Fee of $100.39 for Automobile policy or for Renter's policy.. Client agrees to this fee and fully understands that the
broker fee is / is not refundable, including if the insurance is cancelled or rejected. Broker and Client agree to the following additional fees, if applicable: (1)
Processing the request for reinstatement of a cancelled policy - $100.00 fee, (2) Processing Endorsements - $100.00 fee, (3) Accepting and processing of monthly
premium payments - $10.00 fee, (4) A non-refundable Document Imaging/Storage Fee of Client’s documentation - $40.00, (5) A non-refundable fee to process

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

and handle “split” down payments - $15.00, and (6) A non-refundable $20.00 Convenience Fee to electronically conduct a new business application. Client
authorizes Broker to maintain premium payments in interest-bearing trust accounts, and to receive any interest income therefrom, until paid to the insurance
company.
CANCELLATION AND OTHER MISCELLANEOUS PROVISIONS
Cancellation. Client agrees that all cancellation request(s) or changes to the policy, of any kind, must be in writing to be processed by Broker. In the event that
any changes to the policy result in additional fees or premium, Client acknowledges that he/she is responsible for same. In the event that Broker provides Client
an insurance Identification Card, Client acknowledges and understands that insurance coverage is not provided until the application is underwritten and accepted
by the insurance company. According to the State of California, the Identification Card cannot be used as proof of insurance until the insurance company has
accepted and issued coverage as evidenced by a declarations page and/or policy. Client further agrees and understands that the choice of coverage(s) and limits
of liability is that of the Client and not of the Broker, and as such, Broker is not responsible for the adequacy of coverage(s) and/or limits of liability. Finally, Broker
and Client agree that venue for any and all small claims actions between the parties shall exclusively reside in the Santa Ana Court, Orange County, California.

Effective Date. Client understands and acknowledges that the effective date of the policy(ies) may differ from the date stipulated in this Agreement and can be
obtained from the insurance company application. Client agrees to the conditions set forth above and acknowledges receipt of a copy of this Agreement. Client
understands that upon signing this document, the broker fee will be fully earned by Broker and will not be refunded even if the policy is cancelled.

Communications Consent and Telephone Monitoring. By providing the number of a land line, cell phone or other wireless device, Client expressly consents and
authorizes us and any of our Affiliates, agents, service providers or assignees to: (i) call you using an automatic telephone dialing system or otherwise; (ii) leave
a voice, prerecorded, or artificial voice message for Client; and/or (iii) send Client a text or other electronic message for any purpose related to the servicing or
collection of the Policy or for other transactional or informational purposes related to the Policy (each a “Communication”). Client agrees that we and any of our
affiliates, agents, service providers or assignees may call or text Client at any telephone number associated with Client’s Policy, including cellular telephone
numbers, which Client provides to us, now or in the future. Client also agrees that we and any of our Affiliates, agents, service providers or assignees may include
Client’s personal information in a Communication. We will not charge Client for a Communication, but Client’s service provider may. In addition, Client
understands and agrees we and any of our Affiliates, agents, service providers or assignees may communicate with Client in any lawful manner that does not
require prior consent. Client agrees that we may monitor and record any telephone calls to assure the quality of our service or for other reasons. Client also
agrees that no additional notice or approval is needed for any call monitoring or recording.

Consent to Receive Telemarketing Calls and Text Messages. By signing this Agreement, Client authorizes us and any of our Affiliates, agents, service providers
or assignees to deliver telemarketing calls and text messages to the following telephone number(s) (530) 721-2321, and (530) 721-2321 or to any additional or
alternate phone number that the Client may provide, in connection with their application or otherwise, using an automatic telephone dialing system and/or a
prerecorded or artificial voice message. These telemarketing calls and text messages include communications required to complete the purchase and ensure the
effectiveness of Client’s desired insurance coverages. Client understands that this authorization is not required as a condition of purchasing any property, goods
or services. If Client would not like to receive telemarketing calls and text messages using an automatic telephone dialing system and/or a prerecorded or
artificial voice message, please do not sign this Agreement and ask to receive a copy of the Broker Fee Agreement without this provision.

“Affiliated Companies” or “Affiliates.” Please see the enclosed Privacy or Affiliation Disclosure or our website for a list of our Affiliates.

4/9/2024
Insured's Signature Date

Insured Name: _______________________________________________________________________________________________

(Please Print) Last Name First Name Middle I.
4/9/2024
BROKER’S Signature Date

For general customer service questions, please call (800) 998-3417

For unresolved issues and complaints only, please call 800-960-0036 or email us at customercare@confie.com.
For questions/problems concerning broker fees or insurance, you may contact the Dept. of Insurance at (800) 927-HELP.
7711 Center Avenue, Suite 200, Huntington Beach, CA 92647 • TEL (800) 998-3417 • FAX (714) 252-2606

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

LIVERY (UBER – LYFT – RIDE SERVICE)

AND FOR-HIRE (DELIVERY/Pick-Up) DISCLOSURE

I, Kyle Woodland hereby acknowledge that neither myself nor anyone who is intended to be a covered driver (or permissive user)
under this policy uses the vehicle(s) disclosed on the application (or any other vehicle added at a later date) for any:

a) For-Hire ride or driving service, including but not limited to UBER, RIDE, LYFT, TAXI, LIMOUSINE, or similar Shuttle or
Ride-For-Hire or Ride Share service.

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

b) Delivering or picking up property, goods, or products, INCLUDING BUT NOT LIMITED TO pizza, documents, newspapers,
food, flowers, equipment, supplies, or consumer products;

Failure to accurately attest to the foregoing may lead to your policy being cancelled or coverage/claims being denied.
Customer must also inform the insurance carrier or Freeway immediately upon engaging in the above services.

Signed and acknowledged this 4/9/2024

Customer Signature

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

Freeway Insurance Services America, LLC DBA Cost U Less Insurance Center
(California)

Replacement Policy Disclosure

By signing below, I acknowledge that I have read all the terms, coverages, effective date and pricing
for the insurance policy I am purchasing.

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

If the effective date of this policy, which can be found on the policy contract, is in the future,
I acknowledge that I have no coverage until that date.

If I am buying a replacement policy for a policy that is active or re-instatable, or because I am making
changes (endorsements) to the policy, I acknowledge that I have reviewed the coverage(s), pricing and
fees with my producer. If the pricing is higher, I have voluntarily selected a new carrier after discussing
options with the producer.

Insured Signature

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

IMPORTANT PRIVACY CHOICES

FOR CALIFORNIA CONSUMERS

You have the right to restrict the sharing of personal and financial information with our affiliates (companies
we own or control) and with outside companies with which we do business.

• Please read the enclosed information carefully before you make your choices
• You may exercise your rights at any time
• Please keep these documents for your records

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

To exercise your privacy rights, you may use the enclosed forms or you may visit us at
http://privacychoices.confie.com.

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

Consent to Receive Text Messages

Customer Name: Kyle Woodland

Phone Number(s): (530) 721-2321

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

I agree to the Freeway Insurance Services America, LLC DBA Cost U Less Insurance Center (California) Privacy
Policy and Terms of Use , and I give consent to share my information with Freeway Insurance Services America,
LLC DBA Cost U Less Insurance Center (California)’s Affiliates, External Marketing Partners, and their
successors and assigns. For all of these, I also give my express written consent to be contacted at the mobile phone
number provided above for marketing purposes by call, text, or automated telephone dialing system, including with
an artificial or prerecorded voice, which may leave a message. Message and data rate may apply. Message
frequency varies. Text HELP for help and STOP to cancel at any time. I understand that I am providing this consent
even if my telephone number is currently listed on a federal, state, internal, or corporate Do-Not-Call list. I
understand that I do not have to agree to receive these types of calls or text messages as a condition of purchasing
any goods or services.

Signature

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

Confie U.S. Consumer Privacy Notice

WHAT DOES CONFIE HOLDING II CO.

(“CONFIE”) DO WITH YOUR PERSONAL
INFORMATION?
Why? Financial companies choose how they share your personal information. Federal law gives
consumers the right to limit some but not all sharing. Federal law also requires us to tell you how
we collect, share, and protect your personal information. Please read this notice carefully to
understand what we do.

What? The types of personal information we collect and share depend on the product or service you
have with us. This information can include:
• Social Security number and Income

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• Payment History and Transaction History
• Credit History and Insurance Claim History

How? All financial companies need to share customers’ personal information to run their everyday
business. In the section below, we list the reasons financial companies can share their customers’
personal information; the reasons Confie chooses to share; and whether you can limit this
sharing.

Reasons we can share your personal information Can you limit this sharing?
Does Confie share?

For our everyday business purposes—

such as to process your transactions, maintain
your account(s), respond to court orders and Yes No
legal investigations, or report to credit bureaus

For our marketing purposes—

to offer our products and services to you Yes No

For joint marketing with other financial companies

Yes No
For our affiliates’ everyday business purposes—
information about your transactions and experiences Yes No

For our affiliates’ everyday business purposes—

information about your creditworthiness Yes Yes

For our affiliates to market to you

Yes Yes
For non-affiliates to market to you
Yes Yes

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

To limit ▪ Call 877-214-0149 – our menu will prompt you through your choice(s)
our sharing ▪ Visit us online: https://www.freeway.com/privacy-policy/
▪ Mail the form below
Please note:
If you are a new customer, we can begin sharing your information 30 days from the date we sent
this notice. When you are no longer our customer, we continue to share your information as
described in this notice.
However, you can contact us at any time to limit our sharing.

Questions? Call 877-214-0149 or go to https://www.freeway.com/privacy-policy/

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

Mail-in Form
If you have a joint Mark any/all you want to limit:
policy, your Do not share information about my creditworthiness with your affiliates for their everyday
choice(s) will apply business purposes.
to everyone on your Do not allow your affiliates to use my personal information to market to me.
account unless you Do not share my personal information with nonaffiliates to market their products and
mark below. services to me.
[_] Apply my
choice(s) only
to me. Name Mail to:
Address Freeway Insurance Services
ATTN: Customer Service
Escalations Team
City, State, Zip

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4630 Border Village Rd.,
Policy # STE 2018
San Ysidro, CA 92173

Who we are
Who is providing this notice? The companies listed at https://www.freeway.com/affiliate-disclosure/

What we do

How does Confie protect my personal To protect your personal information from unauthorized access
information? and use, we use security measures that comply with federal law.
These measures include computer safeguards and secured files
and buildings.
Access to information in our possession is limited to those employees
who need it to perform services, process transactions, or marketing.
How does Confie collect my personal We collect your personal information, for example, when you
information? • Make an inquiry about an insurance product or service
• Apply for insurance or pay insurance premiums
• File an insurance claim or provide account information
We also collect your personal information from others, such as credit
bureaus, affiliates, or other companies.

Why can’t I limit all sharing? Federal law gives you the right to limit only
• sharing for affiliates’ everyday business purposes—
information about your creditworthiness
• affiliates from using your information to market to you
• sharing for non-affiliates to market to you
State laws and individual companies may give you additional rights to
limit sharing. See below for more on your rights under state law.

What happens when I limit sharing Your choices will apply to everyone on your account – unless you tell us
for an account I hold jointly with otherwise.
someone else?

Definitions

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

Affiliates Companies related by common ownership or control. They can be

financial and nonfinancial companies.
• Our affiliates are listed at https://www.freeway.com/affiliate-
disclosure/
Non-affiliates Companies not related by common ownership or control. They can be
financial and nonfinancial companies.
• Nonaffiliates we share with can include companies such as
insurance companies, insurance agencies, mortgage brokers,
bankers, securities broker-dealers, airlines, direct marketing
companies, and others.
Joint marketing A formal agreement between nonaffiliated financial companies that
together market financial products or services to you.
• Our joint marketing partners may include insurance companies,
insurance agencies, and others.

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Other important information

You may have other privacy protections under applicable state laws. To the extent these state laws apply, we will
comply with them when we share information about you.

MONTANA RESIDENTS. If you are a resident of Montana, we will not disclose your financial information to non-affiliated
companies for their marketing purposes unless the company has an insurance license, you authorize us to do so, or as
permitted by law.

RESIDENTS OF NEW MEXICO, NORTH DAKOTA, AND VERMONT. If you are a resident of New Mexico, North
Dakota, or Vermont, we will not disclose your financial information to non-affiliated companies unless you expressly
authorize us to do so. This does not prohibit us from disclosing your Financial Information to third parties that perform
business services for us or that assist us in servicing your policy or fulfilling a request made by you, or as otherwise
permitted by law.

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South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

Important Privacy Choices for Consumers

You have the right to control whether we share some of your personal information. Please read the
following information carefully before you make your choices below.

Your Rights

You have the following rights to restrict the sharing of personal and financial information with our affiliates
(companies we own or control) and outside companies that we do business with. Nothing in this form prohibits the
sharing of information necessary for us to follow the law, as permitted by law, or to give you the best service on
your accounts with us. This includes sending you information about some other products or services.

Your Choices

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

Restrict Information Sharing With Companies We Own or Control (Affiliates): Unless you say “No,” we
may share personal and financial information about you with our affiliated companies.

(__) NO, please do not share personal and financial information with your affiliated companies.

Restrict Information Sharing with Other Companies We Do Business With To Provide Financial Products
And Services: Unless you say “no,” we may share personal and financial information about you with outside
companies we contract with to provide financial products and services to you.

(__) NO, please do not share personal and financial information with outside companies you contract with to provide
financial products and services.

Time Sensitive Reply

You may make your privacy choice(s) at any time. Your choice(s) marked here will remain unless you state
otherwise. However, if we do not hear from you we may share some of your information with affiliated companies
and other companies with whom we have contracts to provide products and services.

Name: ______________________________________

Account or Policy Number(s): ____________________

Signature: ___________________________________

To exercise your choices do one of the following:

(1) Fill out, sign and send back this form to us using the envelope provided (you may want to make a copy for your
records);
(2) Call this toll-free number (877) 214-0149;
(3) Fill out, sign, and fax this form to us at (844) 236-4345 toll free; or
(4) Visit our website at https://privacychoices.confie.com/,

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

CONSENT TO DISCLOSE INFORMATION

By signing this form, I understand that I am consenting to the disclosure of my personal information to
third-parties that are not affiliated with Confie Holding II Co. and its affiliates (collectively, “Confie”),
which are listed at https://www.freeway.com/affiliate-disclosure/. I understand that my consent will
remain in effect until I revoke or modify it. I understand that I may revoke or modify this consent at
any time by contacting Confie at the address, website, or telephone number below.

PRINT NAME: Kyle Woodland

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

ADDRESS: 1608 Cherry Hills CirSouth Lake Tahoe, CA 96150

DATE: 4/9/2024

SIGNATURE: ________________________

Confie will maintain a copy of this form and will provide a copy upon request. You may want to make
a copy for your records. You may revoke your consent at any time by contacting Confie at the address
below, by visiting our website at https://privacychoices.confie.com/, or by telephone at 877-214-0149
toll-free.

Freeway Insurance Services

ATTN: Customer Service Escalations Team
4630 Border Village Rd., STE 2018
San Ysidro, CA 92173

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

Freeway Insurance Services America, LLC DBA Cost U Less Insurance Center (California)
License #6002326
IMPORTANT CHOICES REGARDING YOUR MOTOR VEHICLE REPORT

In order for Freeway Insurance Services America, LLC DBA Cost U Less Insurance Center (California) (“Cost-U-Less”) to provide
me with a quote from the insurance carrier(s), a certified Department of Motor Vehicle (“DMV”) printout of my Motor Vehicle
Report (“MVR”) reflecting my driving record and a printout of the Motor Vehicle Report (“MVR”) of any other drivers listed on my
insurance policy (“Additional Drivers”) is required. By signing below, I agree that Cost-U-Less can obtain my MVR and the MVR
of Additional Drivers. The MVR printout(s) may be provided by me as long as the following criteria are met: (a) the MVR is an
official certified copy from the DMV, and (b) the MVR is not older than 30 days from today’s date.

I understand I have the option to provide Cost-U-Less with an official certified MVR printout or Cost-U-Less can obtain this
information on my behalf and on behalf of any Additional Drivers. I understand there is a Document Storage/Imaging charge of
$25.00. By signing below, I also understand that Cost-U-Less may only use the MVR obtained on my behalf and on behalf of the
Additional Drivers for (a) underwriting purposes, or (b) for delivery to the insurance carrier(s), and is prohibited by DMV
regulations from giving me (or any Additional Drivers) a copy. I may obtain my own certified copy at any time by contacting the
DMV. Please note that an MVR obtained directly (printed) from the DMV website is NOT AN OFFICIAL CERTIFIED MVR.

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

Regardless of whether Cost-U-Less is able to obtain the MVR, I understand that I must disclose all violations and accidents
concerning my driving record and the Additional Drivers’ to the best of my knowledge on the insurance application. I further
understand that should the insurance carrier(s) that I am applying for coverage with discover any additional violations or accidents
concerning my driving record (or for any Additional Drivers), my policy may be subject to an increase in premium or cancellation.

I have received and read the above notice, and I understand and agree to its provisions.

Client’s Signature: Date: 4/9/2024

SR-FILING ELIGIBILITY STATEMENT

(Sign only if applicable)

I understand that according to my MVR, I may not be eligible to obtain a valid license with the DMV. I have requested an SR-
Filing to be issued with my insurance policy and understand all fees are fully earned and non-refundable, even if I am not eligible
to obtain a valid license on the effective date of the policy.

I have received and read the above notice and I understand and agree to its provisions.

Client’s Signature: Date: 4/9/2024

PAYMENT DISCLOSURE

Insurance premiums must be paid when due. To keep my policy in force, I must pay the Insurance Carrier the monthly
premium when due. If I do not send my monthly payment to the Insurance Carrier when due, I will lose my insurance coverage.
If my coverage is cancelled, a new down payment is required in order to replace the coverage. Furthermore, the down
payment I paid today does not include my next monthly payment.

Finally, I understand that, even if I do not receive a bill, it is still my responsibility to pay the premiums when due. If I do not
receive a bill, I must notify my broker or insurance carrier immediately. I can reach your Customer Service Department
by calling (800) 998-3417.

I have received and read the above notice, and I understand and agree to its provisions.

Client’s Signature: Date: 4/9/2024

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

(Initial Next To Each Product Accepted) Additional Products CA

Initials____ Hospital Indemnity

Hospital Indemnity coverage offers protection to the member or their family (when
a gamily plan is purchased) should they become hospitalized due to an accident
while riding or driving in any 4-wheel private passenger vehicle. It includes AD&D
Benefit for $5,000.

Initials____ Identity Theft

Identity Theft Protection plan monitors your credit report and personal information
and alerts you of suspicious activity. Our ID theft plan also assists with the costs
of restoring and repairing a consumer’s identity and credit history.

Initials____ Telemedicine

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

A US doctor will diagnose you over the phone for common conditions and if needed
provide a prescription. Service is available to use 24 hours/7 days a week. A $25
co-pay applies for each call.

Initials____ Repair Assist Bundle -

The membership includes the following:
· Repair Tech Assistance - Provides access to ASE certified mechanic to receive
phone guidance for performing your own basic automotive repairs.
· Repair Advocate Assistance - Repair Specialists will speak directly with
service/repair facilities to validate costs and scope of repairs. The Repair Advocate
Specialists are certified mechanics who can help ensure that the vehicle being
properly diagnosed for necessary repairs, the repair facility’s estimated repair cost
is on par with the average cost in the area and the vehicle is at the best-possible
facility for the nature of the repair.
· Auto Repair Discount - The Reimbursement Amount will be limited to twenty
percent (20%) of the repair payment up to the five hundred dollars ($500.00) per
Occurrence limit.

Initials____ Tire Hazard

Unlimited Tire Hazard protection provides for reimbursement up to $65.00 per tire
for the repair of a flat tire damaged by a Road Hazard, or any item causing tire
damage, other than normal wear and tear. If tires incur damage from a road
hazard, it will pay you, per occurrence, a maximum of $65.00 for each tire. If not
repairable, no benefit will be provided. Road Hazard is defined as debris on the
road surface (rock, nail, glass, wood, or tree limb/branch) or road surface
conditions (potholes, cracks or breaks). You must call their customer care team
PRIOR to any repair work being performed.

Initials____ Paintless Dent Repair

Unlimited Paintless Dent Repair (PDR) is a process, developed by automobile
manufacturing production teams, that uses specialized hand tools to gently push
the dented metal back to its original form. This permanently removes door dings
and minor dents without harming a vehicle’s factory finish. Repairable areas are
defined as and limited to exterior vertical body panels repairable within the limits
of Paintless Dent Repair (PDR) inspected and approved by an authorized PDR
technician. If the damage to the vehicle is not repairable by PDR methods, no
benefit is provided. Damage caused by any vehicle in motion is excluded from
coverage. Such damage may be directed to the owner's comprehensive insurance
policy. You must call our Customer Care PRIOR to any repair work being

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

performed.

Initials____ Vehicle Maintenance Bundle -

The membership includes the following:
· Oil change – Oil change up to 5 quarts (maximum of one (1) oil change
during the membership period) up to $40.00 for each service; however, if full
synthetic oil or synthetic blends are used, or for diesel and V8 vehicles, You will
receive up to $55.00 for the oil change.
· Battery Replacement – Receive a $100.00 credit towards replacement of a
failed battery (maximum one (1) per membership period). Not valid if replacement
of battery is in conjunction with or due to another repair.
· Unlimited Tire Hazard - reimburse up to $65 per tire (per occurrence). As
described above.

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

· Unlimited Paintless Dent Repair – removes minor dings and dents (as
described above).

4/9/2024
Customer Signature Date

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Kyle Woodland Customer #20479843
1608 Cherry Hills Cir Received By: Joanna Gonzalez
South Lake Tahoe CA 96150-4932 Print Date/Time : 4/9/2024 6:29 PM PDT

Date: 4/9/2024

Household Member Disclosure

A driver should be listed on your automobile policy if they:

1. Live in the same household, have an active drivers license, and do not have an automobile policy of
their own.
2. Use a vehicle on your policy on a regular or occasional basis regardless of whether they live in the
same household or not.

I, Kyle Woodland , do hereby represent that I have listed all drivers/operators of the insured motor
vehicle(s) on the Carrier Application, and all residents of my household (over the age of 14 and regardless

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

of whether they drive the vehicle) on the Carrier Application or Named Driver Exclusion document.

I agree to notify my insurance company of any new drivers and/or residents of my household (including
those who have since turned the age of 14) should changes occur during the term.

Address Verification Disclosure

The garaging location is commonly referred to as the location where the vehicle sleeps at night. If the vehicle
stays at more than one location during the year, the garaging location can be determined by how long the
vehicle stays at each location. Wherever the vehicle stays for the majority of the year, should be the
garaging location.
I certify that the mailing and garaging addresses indicated on this application are true and accurate.

Furthermore, I agree to notify the Company of any changes of: (1) Resident Address, (2) Garaging Address
of Vehicles insured.

NOTICE: FAILURE TO ACCURATELY DISCLOSE AND UPDATE GARAGING ADDRESS, DRIVERS AND
HOUSEHOLD MEMBERS MAY LEAD TO RESCISSION OF YOUR POLICY AND DENIAL OF ANY CLAIMS.

Applicant’s Signature:

Print Applicant’s Name: Kyle Woodland

Page 20
 Universal Deal Checklist (AppOne)
Binding/Carrier Paperwork
 All carrier guidelines met.
 All required documents uploaded (driver’s license, registrations, proof of prior insurance, marriage, ITC, etc.).
 Where does the application need to be signed and/or initialed?
 File scanned within 2 hours.
 All paperwork scanned correctly. (If not, open a ticket and follow up with IT.)
 Carrier application properly bound with a policy number.
 Correct effective date on the application.
 Submitted amount—premium and applicable fees—uploaded correctly.
 Address, driver’s license, coverages, and vehicle(s) match in the carrier application, AppOne, and the Insurance
101-GCD Form.
 EFT agreement completed correctly. (Signature needed from bank account holder, not always same as policy
holder.)
 Added New Business Correction Form and proof of confirmation (if applicable).

Kyle Woodland eSign: 4/9/2024 6:38 PM PDT, IP: 2600:1010:b17b:150a:a9dc:fa6d:8a19:5c63

 Uploaded or scanned ITC quote sheet (if required by state).
 Customer signature on any carrier endorsement for ride sharing (if applicable).
 Customer signature and proof of fax to carrier on any needed carrier driver exclusion documents (to prevent
cancellation).
 Uploaded exclusion form confirmation in operating system.
 Copies of the insured’s driver’s license and registration.
 Noted in system whether our customer is an in-store or phone sale.
FWY Paperwork
 All required FWY Forms are scanned and signed correctly. Includes:
 Privacy Notice, Household Member Disclosure, and Livery Ride Sharing Disclosure
 All other applicable forms (My Plan Coverage Checklist, Fee Disclosure Statement, Customer Receipt, SR-22
Disclosure Notice, Cancellation Request for policies being rewritten, Vehicle Inspection Form for Comp and
Collision, Quote Sheet, Driver Exclusion)
 Store customers only: All information on the Customer Profile correct, matching client information.
 Use scan cover sheet to confirm required documentation.
 ESign customers only: Check EchoSign document history confirmation.
CK/CC Barcode
 Funds collected at point of sale to cover submission amount (payment method and amount bridged correctly to
AppOne).
 Customer signature on Deferred Down Payment Agreement (hold credit card or promissory note, if applicable)
Photos
 Photos uploaded to AppOne (if required by carrier)
 Photos do not show existing damage, special equipment, or any other modifications.
 Uploaded signed Vehicle Inspection.
Proof of Ownership (VR)
 Uploaded proof of ownership (if required).
 Registered owners are excluded or rated per carrier guidelines (Vehicle, VIN, make, year, and model).
Additional Products
 Added NSD contract signed by the customer and seller.
 Customer info and amount collected match with payment receipt.
 NSD Membership number matches in operating system.

Producer Signature ____________________________________ Manager Signature _______________________________

Revision: 3/11/2021