Form_SCTNID_CTGRY.
TX11226489_DECPAGE
<docindex><index>DECPAGE</index></docindex> BDF_AA
PROGRESSIVE
P.O. BOX 31260
TAMPA, FL 33631
Policy Number: 864438196
Underwritten by:
Progressive County Mutual Ins Co
October 15, 2025
DAISHOWN VALREY
Policy Period: Oct 15, 2025 - Apr 15, 2026
5811 CAMELIA EVERGREEN LN
RICHMOND, TX 77407 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
Coverage Summary
For customer service and claims service,
24 hours a day, 7 days a week.
This is a copy of your
Declarations Page
Your coverage began on October 15, 2025 at the later of 12:01 a.m. or the effective time shown on your application. This policy
period ends on April 15, 2026 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 limits shown for a vehicle may not be combined with the limits for the same coverage on another vehicle. The
policy contract is form 9611D TX (08/15). The contract is modified by forms 4884 (10/08), Z357 (06/06), A331 (11/21), A395 TX
(12/23) and A340 (01/22).
Motor Vehicle Crime Prevention Authority Fee
Your payment includes a fee per vehicle each year. This fee helps fund:
• auto burglary, theft, and fraud prevention;
• criminal justice efforts;
• trauma care and emergency medical services for victims of accidents due to traffic offenses; and
• the detection and prevention of catalytic converter thefts.
By law, we send this fee to the Motor Vehicle Crime Prevention Authority (MVCPA).
Drivers and household residents
Daishown Valrey
Additional information: Named insured
Form 6489 TX (11/22)
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Policy Number: 864438196
Daishown Valrey
Page 2 of 2
Outline of coverage
2019 AUDI Q8 4 DOOR WAGON
VIN: WA1FVAF12KD0M5917
Garaging ZIP Code: 77407
Primary use of the vehicle: Commute
Annual miles: 20,000 - 21,999
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
We were unable to validate or locate prior history for the VIN you provided, which has impacted how we determine your premium.
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability to Others $1,162
Bodily Injury Liability $30,007 each person/$60,007 each accident
Property Damage Liability $25,007 each accident
………………………………………………………………………………………………………………………………………………………..
Personal Injury Protection Rejected --
………………………………………………………………………………………………………………………………………………………..
Uninsured/Underinsured Motorist Bodily Injury Rejected --
………………………………………………………………………………………………………………………………………………………..
Uninsured/Underinsured Motorist Property Damage Rejected --
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $999 321
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $999 1,002
………………………………………………………………………………………………………………………………………………………..
Subtotal policy premium $2,485.00
………………………………………………………………………………………………………………………………………………………..
Motor Vehicle Crime Prevention Authority Fee 2.50
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium and fees $2,487.50
Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
864438196 Online Signature - First Policy Period Only, Electronic Funds Transfer (EFT),
Online Quote and Paperless
Lienholder information
Vehicle Lienholder
………………………………………………………………………………………………………………………………………………………..
2019 AUDI Q8 American Heritage Credit Union
WA1FVAF12KD0M5917 Philadelphia, PA 19115
A11Y LEH End Locator
Form 6489 TX (11/22)
