Automobile Policy Declarations

Please keep with your policy. See Important Notice on reverse.

For questions or changes call: 800-***-****

Page 1 of 1

Declarations

Type Amended Declarations

Process

Date 10-31-2022

Policy

Number CAAS216970057

Insured

Since 2022

From

10-31-2022

12:01 A.M. Standard Time at the address of the

Named Insured, but not prior to the time applied

for or, if this is a replacement declarations, not prior to the time coverage change was requested.

POLICY INFORMATION

Your

Policy

Period

To

03-10-2023

12:01 A.M. Standard Time at the address of the

Named Insured.

1. Name and Address of Insured

MAY M VITUG

928 RACCOON VALLEY DR

MANTECA, CA 95336-8282

CSAA Insurance Exchange

P.O.Box 22221

Oakland, CA 94623-2221

55 1500 12 15

(Continued on back)

Alternate Address

Occupation

Other

Alternate Number

Telephone Number

Item

Make

Model Yr

Body Type

Vehicle Identification No.

Name

ADB?*

1 TOYOTA 2005 SEDAN 4 DOOR 4T1BA30K55U064605 MAY Y ERIC N

VEHICLES

DRIVERS

Drivers

do not

necessarily

correspond

to principally

operated

vehicles.

Liability Limits Item 1

Coverage

Each Person Each Occurrence Deductible Premium Deductible Premium Deductible Premium Deductible Premium Bodily Injury 50,000 100,000 $228

Medical Payments No Coverage No Coverage

Uninsured Motorists 50,000 100,000 $87

Uninsured Motorist

Property Damage

3,500 INCL

Property Damage 50,000 $232

Comprehensive Actual Cash Value Less Deductible

Full Comprehensive Safety Glass Endorsement

($0 deductible)

No Coverage

NO COV

Collision Actual Cash Value Less Deductible

Collision Deductible Waiver

No Coverage

NO COV

Enhanced Transportation Expense

$0 per day/$0 aggregate

No Coverage

All Risks Actual Cash Value Less Deductible No Coverage Vehicle Loan/Lease Protection Endorsement No Coverage New Car Added Protection Endorsement No Coverage

Original Equipment Manufacturer Parts (OEM) Endorsement No Coverage Ride-sharing Coverage Endorsement No Coverage

COVERAGES/PREMIUMS

TOTAL PREMIUM PER VEHICLE $547

* Automobile Death Benefits $15,000 per deceased insured person Premium

$3

Premium Summary

This is not a bill.

CA Surcharge: $0

Total Additional Premium: $0.00

Total Premium shown is for the Member Advantage

TM

Program.

EXCLUSIONS

There is no coverage provided by this Policy while the following individual(s) operate a motor vehicle: None

CHANGES

Schedule of Changes

Other Premium Bearing : Express: Driver Assignment 55 1500 12 15

Item Rated Driver Driv Safety Record Yrs Driv Exp Est Ann Mi Driven Veh Garage Zip Vehicle Usage Marital 1 MAY VITUG 0 Pt 29 11000 Mi 95336 Commute S

See final page

for explanation

of codes.

DISCOUNTS/MESSAGES

Discounts:

Mature Driver: None.

Good Driver: Item(s) 1.

Multi Policy : None.

Multi Car: None.

New Driver: None.

Good Student: None.

You may qualify for other products

and discounts. For more info call

your Insurance Agent

LOSS PAYEE(S)

Stephanie Villagomez

209-***-****

IMPORTANT NOTICE: THIS IS A PART OF YOUR DECLARATIONS The insurance afforded is only with respect to such of the preceding coverages as are indicated by specific premium charge or charges. The limit of the Exchange's liability under each such coverage shall be as stated herein, subject to all the terms of the policy. The purpose for which the automobile is to be used is pleasure or business, subject to the exclusions in the policy, including the exclusion for wholesale and retail delivery.

RENEWAL CERTIFICATE - Extends this policy for the period shown under Policy Period upon payment of the premium. AMENDED DECLARATIONS - In consideration of the premium adjustment indicated herein this policy is hereby amended only with respect to such changes as are indicated in the schedule of changes. The limit of the Exchange's liability under such amended coverage shall be as stated herein.

LOSS PAYEE(S) - Any loss under Physical Damage coverages is payable as interest may appear to the named insured and the Loss Payee in accordance with the loss payable agreement.

For your protection, California law requires that you be made aware of the following: Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. RATING INFORMATION DISCLOSURE EXPLANATION

(From Discounts/Messages Section on Previous Page) ITEM (ITEM NUMBER): Item number is the number assigned to the vehicle shown on the Declarations. RATED DRIVER: The driver assigned to a vehicle whose attributes (e.g., years driving experience, driving safety record and marital status) are used to develop the premium.

DRIV SAFETY RECORD (DRIVING SAFETY RECORD): The total number of points assessed the driver for "principally at fault chargeable accidents" with or without injury and/or vehicle code violation convictions (tickets). A "principally at fault chargeable accident" occurs when the driver of a vehicle is at least 51% at fault for an accident and the total monetary damages (whether paid or not) in the accident exceed:

● $750 or the accident resulted in death for losses occurring prior to 12/11/11

● $1,000 or the accident resulted in death for losses occurring 12/11/2011 or after Additional information on the number and types of incidents can be provided on request. Carriers use different point count systems for rating purposes. The number of points shown on your declarations would not necessarily match the number of points assigned by another carrier.

YRS DRIV EXP (YEARS DRIVING EXPERIENCE): The number of years a driver has been licensed to drive a motor vehicle anywhere in the world. However, a driver must have at least 18 months current driving experience in the United States, U.S. Territories, or Canada, before foreign country driving experience can be counted. EST ANN MI DRIVEN (ESTIMATED ANNUAL MILES DRIVEN): The estimated number of total miles a vehicle will be driven in the coming year VEH GARAGE ZIP (VEHICLE GARAGED ZIP CODE): The ZIP code of the location where the vehicle is garaged. VEHICLE USAGE: Vehicles are assigned to one of five usage designations: Business Use, Work Commute, Farm Use, Farm Business Use or Pleasure.

MARITAL (MARITAL STATUS): "M" stands for Married, and "S" stands for Single. DISCOUNTS: A reduced rate applies for each Discount listed.

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