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Motor Vehicle Bodily Injury

Location:

Bakersfield, CA

Posted:

July 04, 2023

Contact this candidate

Resume:

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Membership eligibility, dues, fees, beneﬁts and services are subject to change without notice. Membership is not valid unless paid in full. If you have a vehicle disablement before you join, that disablement will not be covered after you join as one of your four allowable service calls per membership year. If you would like such service, you may request service for an additional

$75 non-refundable service fee. Every membership year, you and all other AAA members of your family are each allowed up to four (4) free calls for Roadside Assistance. After that, a service charge applies. &YUFOEFE 3PBETJEF "TTJTUBODF TFSWJDFT GPS 1MVT¥ 1SFNJFS¥ PS PQUJPOBM 37 BOE .PUPSDZDMF TFSWJDFT BSF FGGFDUJWF TFWFO DBMFOEBS EBZT BGUFS QSPDFTTJOH BOE SFDFJQU PG UIF GVMM QBZNFOU EVF You will receive an ofﬁcial membership card by mail at your next renewal. Select membership beneﬁts and services including 3oadside "ssistance are provided by independent service providers. Certain restrictions and limitations apply. See Member Guide for details, terms and conditions. 1Available for iPhone® and smartphones for AndroidTM. Message, data and roaming rates may apply. Mobile text messages are intended for subscribers over the age of 18 and are delivered via USA short code 99000. For help, text HELP to 99000. Terms and Conditions and Privacy Notice at AAA.com/textterms. The number of messages received will depend on the frequency of your use of the Auto Club App Program. You may stop mobile subscriptions at any time by messaging STOP to short code 99000. If you text STOP, we will send a single conﬁrmation text. Copyright © 2021 Automobile Club of Southern California. All Rights Reserved. Non-transferable Download Your Digital Card

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Download digital membership card at AAA.com/mobile Roadside Assistance is provided by independent service providers. All Club services are subject to change without notice. By acceptance of card, member agrees to be bound by Club’s bylaws. PRESENT THIS CARD AT TIME OF SERVICE AAA.com

HERE IS YOUR PAPER MEMBERSHIP CARD!

Roadside & Battery Service

(In CA)

1-800-***-****

AAA.com/GetHelp

CARD EXPIRATION DATE

CLUB CODE

Year

Member

ANGELO DILANO FERNANDEZ

620 004-******** 0 4

03/29/23

Interinsurance Exchange of the Automobile Club

Insurance provided to qualified Auto Club members by the Interinsurance Exchange of the Automobile Club. 8984 7/21

Acknowledgement of Auto and Renters Policies

I understand that I am completing an application for a Renters policy. Signature Date

I understand that I am completing an application for an Auto policy. Signature Date

Electronically Signed 2023-02-28 01:43:20 UTC - 174.208.167.113 Angelo Nintex AssureSign® Dilano Fernandez 241fcdde-e5b8-485a-84e2-afb7001c0445 2023-02-27 17:43:34 (UTC-08:00) Electronically Signed 2023-02-28 01:43:22 UTC - 174.208.167.113 Angelo Nintex AssureSign® Dilano Fernandez ea2fbf60-bad4-45b1-b7af-afb7001c0456 2023-02-27 17:43:34 (UTC-08:00) Interinsurance Exchange of the Automobile Club

31195 1/19 Insurance provided to qualified Auto Club members by the Interinsurance Exchange of the Automobile Club. Pg. of 1 Automobile Insurance Coverages and Limits

NAMED INSURED MEMBERSHIP NUMBER POLICY NUMBER

A. APPLICATION INFORMATION:

APPLICANT’S NAME AND MAILING ADDRESS: APPLICANT’S RESIDENCE ADDRESS, IF DIFFERENT: B. DRIVER INFORMATION: In addition to yourself, list all permit and licensed drivers in your household, including relatives, roommates, residence employees, etc. Next, list all drivers who have regular access to your vehicles who DO NOT live with you, such as relatives, students away at school, friends and household help.

Drivers’ Names (Last, First) Excluded Date of Birth Year First

Licensed

Relationship to

Applicant

Household

Resident

C. VEHICLE INFORMATION: All vehicles to be insured. Veh.

No. Year Make/Model

Annual

Miles

Odometer

Reading Verified Mileage Salvage

Deductibles Car Rental Expense

Comp. Collision (Limit Per Day)

1 2009 BMW X5 4D 4WD.XDRIVE 15,000 234,000 AAA OnBoard Yes $1,000 $1,000 $45 a day D. VEHICLE EQUIPMENT (if applicable): Coverage may not be provided for any special equipment unless equipment is listed below. Vehicle No. Equipment Description Total Value

E. REQUESTED COVERAGES, LIMITS AND PREMIUMS: Coverage is not afforded unless a premium is shown. Coverages Limits Vehicle 1 Vehicle 2 Vehicle 3 Bodily Injury

(each person)

(each occurrence)

Property Damage (each occurrence)

Medical Payments (each person)

Excess Medical Payments (each person)

Uninsured and Underinsured Motorist Bodily Injury (each person)

(each accident)

Uninsured Collision

Uninsured Deductible Waiver

Comprehensive (Comp.) (See Deductibles Above)

Collision (See Deductibles Above)

Car Rental Expense (See Above)

ANNUAL VEHICLE PREMIUM:

LIMIT OF LIABILITY (IF APPLICABLE) / TRAILERS, MOTORHOMES, CLASSIC VEHICLES: Vehicle No. Year Make/Model Purchase Price (Cost New) Limit of Liability F. YOUR ANNUAL PREMIUM INCLUDES THE FOLLOWING DISCOUNTS: Please review these carefully, as you are warranting that you are entitled to the following discounts.

Good Driver Good Student Student Away Multi - Vehicle Multi - Policy Mature Driver Driving Course Loyalty Grp-Deg.

Professional

Verified

Mileage

12-MONTH POLICY PREMIUM TOTAL:

a.m. p.m.

Applicant’s Signature Date Time

a.m. p.m.

Co-Applicant’s Signature Date Time

Bakersfield CA 93312

10001 laurie ave

CAA189098256

30,000

Other

Policy Holder

15,000

12501

Vehicle 1

Fernandez, Angelo dilano

1,059

Morales, Yolly

Morales, Gustavo

Yes

5,000

30,000

1,968

Yes

1,000

fernandez, angelo dilano

262

15,000 270

No No

Yes

2003

Yes

50,000

250

Yes

2019 No

167

Verified

06-18-1968

1,968

10-21-1963

02-11-1985

No No

fernandez, angelo dilano 35826111

SUBA/WRX 4D 4WD, 30245

Included

Electronically Signed 2023-02-28 01:43:24 UTC - 174.208.167.113 Angelo Nintex AssureSign® Dilano Fernandez 156b487d-6748-4ab5-b88a-afb7001c0464 2023-02-27 17:43:34 (UTC-08:00) INTERINSURANCE EXCHANGE of the Automobile Club

EXCLUSION OF DESIGNATED PERSON ENDORSEMENT

Effective 12:01 A.M. Pacific Standard Time Forming a part of Policy No. issued by the INTERINSURANCE EXCHANGE OF THE AUTOMOBILE CLUB. Named Insured: Designated Person(s):

We will issue or continue this policy because you and we have agreed that coverage afforded by Part I (Liability), Part II

(Expenses for Medical Services), Part III (Physical Damage) and Part IV (Uninsured Motorist) of this policy for the use of or damage to any automobile insured shall not apply nor accrue to the benefit of you, any other person insured or any third party claimant while said automobile is being operated by a designated person. Under Part I (Liability), our obligation to defend shall not apply nor accrue to the benefit of you, any other person insured or any third party while any automobile is being operated by a designated person. We will defend you when all of the following apply to such designated person:

1. The designated person is a resident of the same household in which you reside. 2. As a result of operating your insured automobile, the designated person is jointly sued with you. 3. The designated person is an insured under a separate automobile liability policy issued to the designated person as a named insured, which does not provide a defense to you. This agreement will be in force as long as your policy remains in force and shall apply to any continuation, renewal or replacement of your policy by you or to reinstatement of your policy within 30 days of any lapse thereof. When uninsured motorist coverage—bodily injury (Coverage F) is deleted with respect to one or more natural persons designated by name when operating a motor vehicle, California law requires the agreement to be in the following form:

“The California Insurance Code requires an insurer to provide uninsured motorist coverage in each bodily injury liability insurance policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the insurer and the applicant to delete the coverage completely or to delete the coverage when a motor vehicle is operated by a natural person or persons designated by name. Uninsured motorists coverage insures the insured, his or her heirs, or legal representatives for all sums within the limits established by law, which the person or persons are legally entitled to recover as damages for bodily injury, including any resulting sickness, disease, or death, to the insured from the owner or operator of an uninsured motor vehicle not owned or operated by the insured or a resident of the same household. An uninsured motor vehicle includes an underinsured motor vehicle as defined in subdivision (p) of Section 11580.2 of the Insurance Code*.”

*Subdivision (p) of Section 11580.2 of the Insurance Code defines an underinsured motor vehicle as one that is insured under a motor vehicle liability policy, or automobile liability insurance policy, self-insured, or for which a cash deposit or bond has been posted to satisfy a financial responsibility law, but insured for an amount that is less than the uninsured motorist limits carried on the motor vehicle of the injured person. All provisions of your policy not affected by this endorsement remain unchanged. By accepting this endorsement you declare that you have read the endorsement and understand it, that it represents a voluntary agreement between you and us, and that you agree to be bound by the limitations it imposes. Accepted Signature of Insured Date Hour

Print Name Here

ACSC Management Services, Inc.

ATTORNEY-IN-FACT

WARNING: READ THIS ENDORSEMENT CAREFULLY!

By signing this endorsement, no coverage will be provided by this policy while any vehicle is being operated by any Designated Person listed below. Please read the following information in its entirety and make sure you understand the exclusion of coverage before signing. 2184

Ed. 4-17

Morales, Yolly Morales, Gustavo

fernandez, angelo dilano

CAA189098256

02/28/2023

Electronically Signed 2023-02-28 01:43:25 UTC - 174.208.167.113 Angelo Nintex AssureSign® Dilano Fernandez 10991cb9-b8e0-49e6-9cb5-afb7001c046e 2023-02-27 17:43:34 (UTC-08:00) Angelo Dilano Fernandez

Interinsurance Exchange of the Automobile Club

30551 1/ Insurance provided to qualified Auto Club members by the Interinsurance Exchange of the Automobile Club. Pg. of 2 Automobile Insurance Application

1. ADDITIONAL APPLICANT INFORMATION: Do You Own Any Vehicles That You Do Not Want To Insure With Us Now YES NO 2. NON-DRIVER HOUSEHOLD RESIDENT INFORMATION: List ALL residents of your household who are NOT drivers. For each, give their reason for not driving. (For example, “child,” “never learned,” “license suspended,” “disabled,” etc.) Name All Other Residents (Last Name, First Name M.I.) Gender Date of Birth Relationship To Applicant Reason For Not Driving 3. POLICY PERIOD: (Pacific Standard Time) 12-MONTH POLICY PREMIUM TOTAL: $ FROM: Month Day Year 12:01 A.M. TO: Month Day Year 12:01 A.M. If the “FROM” date above has not been filled in, when do you want your policy to become effective? Month Day Year IMPORTANT INFORMATION AND BINDER OF INSURANCE:

)RU \RXU SURWHFWLRQ &DOLIRUQLD ODZ UHTXLUHV WKH IROORZLQJ WR DSSHDU RQ WKLV IRUP $Q\ SHUVRQ ZKR NQRZLQJO\ SUHVHQWV IDOVH RU IUDXGXOHQW LQIRUPDWLRQ WR REWDLQ RU DPHQG LQVXUDQFH FRYHUDJH RU WR PDNH D FODLP IRU WKH SD\PHQW RI D ORVV LV JXLOW\ RI D FULPH DQG PD\ EH VXEMHFW WR ILQHV DQG FRQILQHPHQW LQ VWDWH SULVRQ

,W LV \RXU UHVSRQVLELOLW\ WR FKRRVH WKH OHYHO RI LQVXUDQFH SURWHFWLRQ WKDW EHVW VXLWV \RXU QHHGV E\ VHOHFWLQJ DQG PDLQWDLQLQJ FRYHUDJHV DQG OLPLWV WKDW ZLOO DGHTXDWHO\ SURWHFW \RX DQG \RXU SURSHUW\ LQ WKH HYHQW RI D ORVV

:KLOH ZH UHYLHZ \RXU DSSOLFDWLRQ IRU LQVXUDQFH FRYHUDJH LV ERXQG HIIHFWLYH DW 0 3DFLILF 6WDQGDUG 7LPH RQ WKH GDWH UHTXHVWHG DERYH %87 127 ($5/,(5 7+$1 WKH IROORZLQJ GDWH

- IF YOU PAID YOUR PREMIUM DEPOSIT BY CREDIT CARD OR ELECTRONIC FUNDS TRANSFER, OR IN PERSON BY CASH OR CHECK: Coverage is bound no earlier than the day after the date you paid your premium deposit.

- IF YOU PAID YOUR PREMIUM DEPOSIT BY CHECK VIA MAIL: Coverage is bound no earlier than the day after the postmark date on the envelope in which your premium deposit and signed application are mailed to us. If you do not enclose your premium deposit with the signed application, coverage does not become effective until after your application is approved by us and your payment is received. This binder will expire 60 days after its effective date or may be cancelled by the named insured at any time during this 60 day period. Approval of the application and issuance of a policy to you will void the binder. We may cancel this binder by mailing to the named insured at the address shown on the application at least 10 days’ advance written notice of cancellation. Unless a policy is issued, a premium charge will be made for coverage provided under this binder. This binder provides the coverages and limits shown in this application and its enclosures, on the terms described in the applicable policy form and endorsements. This binder does not provide cumulative insurance with any existing policy. Comprehensive and Collision coverages may be severely restricted, suspended or revoked unless vehicles requiring inspection for physical damage coverage are inspected by an authorized inspector no later than seven days after the policy effective date. Notice of Short Rate Cancellation: Any cancellation of your entire automobile policy requested by you during the first policy period, including cancellation for nonpayment of premium, will be calculated on a short rate basis. This means the amount due us for the time your policy was actually in effect will be more than a proportionate share of the annual premium. The additional amount will not exceed 11% of the annual premium. I have read, agree and subscribe to the subscriber’s agreement of the Interinsurance Exchange of the Automobile Club and to all other statements, notices, terms, conditions and agreements appearing on all pages of this application, including all attachments and other documents provided with this application. I declare that all statements I have made are true and that I have fully disclosed all required information. I understand that my insurance policy will be issued in reliance on the information I provided, including information about my household, its vehicles and their drivers, and that such information will be used to determine my eligibility for insurance and premium. I also understand that inaccurate or incomplete information may jeopardize my coverage or change my premium. To the extent my authorization is required under applicable law, for a period of one year from the date I sign, I authorize the Automobile Club of So. California and the Interinsurance Exchange of the Automobile Club and their employees and agents (Authorized Parties) to verify the accuracy of the information I have provided using other available sources and to access personal and confidential information concerning me and other drivers. I hereby waive Cal. Veh. Code § 1808.21 to allow the Authorized Parties to access confidential information (including residence address) concerning me and other drivers in Department of Motor Vehicles records. I request issuance of a policy with the coverages and limits described in the accompanying Automobile Insurance Coverages and Limits form. a.m. p.m.

Applicant’s Signature Date Time

a.m. p.m.

Co-Applicant’s Signature Date Time

a.m. p.m.

Representative’s Signature Date Time

NAMED INSURED MEMBERSHIP NUMBER POLICY NUMBER

February

fernandez, angelo dilano

February

Dependent Child

CAA189098256

01-25-2011

03-17-2010

2023 28

1,968

Fernandez Alyssa Macie

Fernandez Angelo jr

004-********

2024

Electronically Signed 2023-02-28 01:43:28 UTC - 174.208.167.113 Angelo Nintex AssureSign® Dilano Fernandez e2a98c91-1c82-491a-b62a-afb7001c047c 2023-02-27 17:43:34 (UTC-08:00) Interinsurance Exchange of the Automobile Club

30551 1/ Insurance provided to qualified Auto Club members by the Interinsurance Exchange of the Automobile Club. Pg. of 2 Automobile Insurance Application

:KLOH ZH UHYLHZ \RXU DSSOLFDWLRQ IRU LQVXUDQFH FRYHUDJH LV ERXQG HIIHFWLYH DW 0 3DFLILF 6WDQGDUG 7LPH RQ WKH GDWH UHTXHVWHG DERYH %87 127 ($5/,(5 7+$1 WKH IROORZLQJ GDWH

- IF YOU PAID YOUR PREMIUM DEPOSIT BY CREDIT CARD OR ELECTRONIC FUNDS TRANSFER, OR IN PERSON BY CASH OR CHECK: Coverage is bound no earlier than the day after the date you paid your premium deposit.

Applicant’s Signature Date Time

a.m. p.m.

Co-Applicant’s Signature Date Time

a.m. p.m.

Representative’s Signature Date Time

NAMED INSURED MEMBERSHIP NUMBER POLICY NUMBER

February

fernandez, angelo dilano

February

Dependent Child

CAA189098256

11-25-2015

2023 28

1,968

Fernandez Maliah J

004-********

2024

Electronically Signed 2023-02-28 01:43:28 UTC - 174.208.167.113 Angelo Nintex AssureSign® Dilano Fernandez 3fbe9bb9-e5b7-47e0-bccc-afb7001c048f 2023-02-27 17:43:34 (UTC-08:00) 8165 12/20

--- FOLD HERE --- --- FOLD HERE --- --- FOLD HERE --- Call our AAA Claims Hotline at

1-800-***-****

--- FOLD HERE ---

PROOF OF INSURANCE

Interinsurance Exchange of the Automobile Club

NAIC #: 15598

VEHICLES ON POLICY

YEAR MAKE VEH I.D. #

Named Insured

Effective Date:

Policy Number:

Expiration Date:

DRIVERS ON POLICY

This policy provides at least the minimum amounts of liability insurance required by the CA VEH CODE SECTION 16056 for the specified vehicles and named insureds. Coverage subject to policy terms and limits. IF YOU HAVE AN ACCIDENT CALL OUR 24/7 AAA CLAIMS HOTLINE 1-800-***-**** After an accident, exchange information with the other party and follow these 5 easy steps:

Step 1: Pull vehicle over to a safe place. Get the names, addresses, and phone numbers of all persons involved in the accident, e.g., pedestrians, witnesses, other passengers, etc. Step 2: Take photos of or write down the other person’s driver’s license information and other vehicle’s license plate number, including state of registration.

Step 3: Take photos of or write down the other person’s insurance card information.

Interinsurance Exchange of the Automobile Club

NAIC #: 15598

VEHICLES ON POLICY

YEAR MAKE VEH I.D. #

Named Insured

Effective Date:

Policy Number:

Expiration Date:

DRIVERS ON POLICY

Step 3: Take photos of or write down the other person’s insurance card information.

Step 4: Take photos of the vehicles involved, damages and surrounding area of the accident, if it is safe to do so. Step 5: Call our AAA Claims Hotline at 800-***-**** to report the loss. If necessary, we will arrange to have your vehicle towed. Our provider’s tow trucks always display the AAA emblem. Do not admit responsibility for or discuss the circumstances of the accident with anyone other than the police or an authorized Auto Club claims representative. Do not disclose your policy limits to anyone. For questions or changes to your policy, call 1-877-***-****, Monday through Friday from 7 a.m. to 9 p.m. or Saturday from 8 a.m. to 5 p.m. Place a Proof of Insurance card in each vehicle insured under your policy. In addition, we suggest that each listed driver carry a card. Under California law, drivers and owners of a motor vehicle must be able to show proof of financial responsibility at all times. These cards become invalid and should be destroyed on the expiration or termination date of the policy. 2019

2019

fernandez, angelo dilano

CAA189098256

SUBA

02/28/2023

02/28/2024

JF1VA1A66K9827971

Fernandez, Angelo dilano

AAA

P.O. Box 25499

Santa Ana, CA 92799-5499

OR Fax: 714-***-****

8684 02/14

EXPIRE

DATE

Please detach at line.

AUTHORIZATION AGREEMENT FOR INSURANCE DEBIT CARD PAYMENTS AAA Auto Pay Plan

To use AAA Auto Pay for your membership, enter your Club Code and Membership Number as it appears on your membership card in the boxes below.

Please enter the number of each insurance policy you want billed through AAA Auto Pay.

Unless the last 4 digits of your debit card (previously provided to us) have already been filled in, please enter your complete 16-digit account number and card expiration date below.

Club Code First 8 Digits of Membership Number Letter Prefix (up to 3) MEMBER # - POLICY #

Letter Prefix (up to 3) Letter Prefix (up to 3)

POLICY # POLICY # l

I hereby authorize the Interinsurance Exchange of the Automobile Club (“Exchange”) and Automobile Club of Southern California (“AAA”) to charge my DEBIT CARD ACCOUNT indicated below for (i) all amounts that become due by me to the Exchange, including, without limitation, insurance premiums on the above policies and any renewals thereof, finance charges, installment, return payment, late payment and other fees, and (ii) all membership dues that become due by me to AAA. All charges to my Debit account are governed by the Terms and Conditions that accompanied this Agreement. Visa®

MasterCard®

Discover®

CARD # /

This authorization is to remain in full force and effect until terminated by the Exchange or AAA or until the Exchange or AAA has received notification from me of its termination in such time and in such manner as to afford the Exchange or AAA, as applicable, a reasonable opportunity to act on it. NAME OF ACCOUNT HOLDER DATE SIGNATURE OF ACCOUNT HOLDER AAA Employee # (if applicable) Branch/Sec # Membership # Member Name Important: We must have a signature to complete this transaction. Please do not return by e-mail. Please keep a copy of this form for your records.

AAA Auto Pay Plan for Debit Card

Terms and Conditions for Insurance and Membership

The Authorization Agreement at the bottom of this page is valid only for insurance policies written by the issuer of the insurance policies identified below (“Insurer”) and for your membership with the AAA club that issued the membership identified below in the Authorization Agreement (“AAA”).* Insurance only: Automatic charges to your debit card for insurance policies will begin with the first AAA Auto Pay Plan payment billed after the Authorization Agreement is received and processed (Please allow 15 days for processing). Until then, your insurance payment is still due on the date shown on your most recent billing statement and should be returned to us in the white envelope provided. Once AAA Auto Pay is active, your periodic billing statements will indicate the amount and timing of the next payment prior to your card being charged for that payment. We gave you notice of the amount of all applicable fees at the time

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