Auto Insurance Identification Card(s)

PAIDCARD**#Insured#LEAH NICHOLSON

State law requires that you be able to provide proof of insurance. You can use the attached card(s) to show that you are in compliance with state law. STATE OF OKLAHOMA

AUTOMOBILE LIABILITY INSURANCE – SECURITY VERIFICATION FORM An authorized Oklahoma insurer has issued an Owner's Liability Insurance Policy pursuant to the Compulsory Insurance Law of Oklahoma.

POLICY NUMBER: OKAP0000027046 EFFECTIVE DATE: 03/24/2017 EXPIRATION DATE: 09/24/2017 American Mercury Insurance Company NAIC# 16810

8240 N. MoPac Expwy, Ste 110, Austin, TX 78759

NAMED INSURED:

LEAH NICHOLSON

ADDITIONAL DRIVER(S):

YEAR MAKE MODEL VIN

2005 TOYOTA MATRIX 2T1KR30E25C463895

TO REPORT A CLAIM, 24 HOURS A DAY, 7 DAYS A WEEK

PLEASE CALL 800-***-****

This card must be carried in the insured motor vehicle for production upon demand. Any alteration will void this card. Any binder or policy issued thereon is void if any check, money order, or credit card tendered in payment is not honored when first presented. Examine policy exclusions carefully. This form does not constitute any part of your insurance policy. See “Warning” on reverse side. STATE OF OKLAHOMA

AUTOMOBILE LIABILITY INSURANCE – SECURITY VERIFICATION FORM An authorized Oklahoma insurer has issued an Owner's Liability Insurance Policy pursuant to the Compulsory Insurance Law of Oklahoma.

POLICY NUMBER: OKAP0000027046 EFFECTIVE DATE: 03/24/2017 EXPIRATION DATE: 09/24/2017 American Mercury Insurance Company NAIC# 16810

8240 N. MoPac Expwy, Ste 110, Austin, TX 78759

NAMED INSURED:

LEAH NICHOLSON

ADDITIONAL DRIVER(S):

YEAR MAKE MODEL VIN

2005 TOYOTA MATRIX 2T1KR30E25C463895

TO REPORT A CLAIM, 24 HOURS A DAY, 7 DAYS A WEEK

PLEASE CALL 800-***-****

This card must be carried in the insured motor vehicle for production upon demand. Any alteration will void this card. Any binder or policy issued thereon is void if any check, money order, or credit card tendered in payment is not honored when first presented. Examine policy exclusions carefully. This form does not constitute any part of your insurance policy. See “Warning” on reverse side. Auto Insurance Identification Card(s)

THE COVERAGE PROVIDED BY THIS POLICY MEETS THE

MINIMUM LIABILITY LIMITS PRESCRIBED BY LAW

WARNING:

Oklahoma state law requires a current copy of the Security Verification Form must be surrendered to the motor license agent or other registering agency upon application or renewal for a motor vehicle license plate. (The foregoing does not apply with respect to an Operator's Liability Insurance Policy.)

The other copy of the Security Verification Form is to be carried in the motor vehicle at all times, and produced by any driver of the vehicle upon request for inspection by any peace officer or representative of the Department of Public Safety. In case of an accident, the Security Verification Form shall be shown upon request of any person affected by the accident. Note: If the named insured has been issued an Operator's Liability Insurance Policy, this Security Verification Form applies in lieu of an Owner's Security Verification Form.

IF YOU HAVE AN ACCIDENT EXCLUDED DRIVER(S):

x Notify the police immediately. SHELBY HODGE

x Write down names, addresses, telephone numbers, driver license numbers and license plate numbers of all persons involved and of witnesses.

x Please note any damage to other vehicles.

x Do not admit fault. Do not discuss the accident with anyone except your agent, Mercury or the police.

x Please take photos if possible.

x Immediately report all claims to Mercury at 800-***-****. AGENT: AIS Auto Ins Spec Agy-OK

AGENT’S ADDRESS: P O BOX 6507, ARTESIA, CA 90702

AGENT’S PHONE NUMBER: 800-***-****

ID-OK 09/2013

THE COVERAGE PROVIDED BY THIS POLICY MEETS THE

MINIMUM LIABILITY LIMITS PRESCRIBED BY LAW

WARNING:

Oklahoma state law requires a current copy of the Security Verification Form must be surrendered to the motor license agent or other registering agency upon application or renewal for a motor vehicle license plate. (The foregoing does not apply with respect to an Operator's Liability Insurance Policy.)

The other copy of the Security Verification Form is to be carried in the motor vehicle at all times, and produced by any driver of the vehicle upon request for inspection by any peace officer or representative of the Department of Public Safety. In case of an accident, the Security Verification Form shall be shown upon request of any person affected by the accident. Note: If the named insured has been issued an Operator's Liability Insurance Policy, this Security Verification Form applies in lieu of an Owner's Security Verification Form.

IF YOU HAVE AN ACCIDENT EXCLUDED DRIVER(S):

x Notify the police immediately. SHELBY HODGE

x Write down names, addresses, telephone numbers, driver license numbers and license plate numbers of all persons involved and of witnesses.

x Please note any damage to other vehicles.

x Do not admit fault. Do not discuss the accident with anyone except your agent, Mercury or the police.

x Please take photos if possible.

x Immediately report all claims to Mercury at 800-***-****. AGENT: AIS Auto Ins Spec Agy-OK

AGENT’S ADDRESS: P O BOX 6507, ARTESIA, CA 90702

AGENT’S PHONE NUMBER: 800-***-****

ID-OK 09/2013

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