Customer Service Motor Vehicle

USSH-*** (******) S, *, N, N, N, A

STATE OF MICHIGAN CERTIFICATE OF NO-FAULT INSURANCE

Involved in an Accident? Call 855-***-****

Customer Service Assistance: 855-***-****

Policy #:

- Expiration Date:

USA Underwriters Insurance Company

PO Box 2426

Rancho Cucamonga, CA 91729-2426

NAIC Code: 30457

Name Insured:

Effective Date:

Insurance Company:

Year/Make/Model Vehiicle Identification Number

STATE OF MICHIGAN CERTIFICATE OF NO-FAULT INSURANCE Involved in an Accident? Call 855-***-****

Customer Service Assistance: 855-***-****

Policy #:

- Expiration Date:

USA Underwriters Insurance Company

PO Box 2426

Rancho Cucamonga, CA 91729-2426

NAIC Code: 30457

Name Insured:

Effective Date:

Insurance Company:

Year/Make/Model Vehicle Identification Number

PENALTY FOR OPERATION WITHOUT INSURANCE

Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle registered in this state must have insurance or other approved security for the payment of fault benefits on the vehicle at all times. An owner or operator who drives or permits a vehicle to be driven upon a public highway without the proper insurance or other security is guilty of a misdemeanor.

An owner or registrant convicted of such a misdemeanor shall be fined not less than

$200.00 nor more than $500.00, imprisoned for not more than 1 year, or both. THISFORMMUSTBEPRESENTEDASEVIDENCEOFINSURANCEWITH

YOURAPPLICATIONFORLICENSEPLATES,EITHERBYMAILORATANY SECRETARYOFSTATELICENSEPLATEBRANCHOFFICE.APERSONWHO ISSUESORWHOSUPPLIESFALSEINFORMATIONTOTHESECRETARYOF STATEORUSESANINVALIDCERTIFICATEOFINSURANCEISGUILTYOFA MISDEMEANORPUNISHABLEBYIMPRISONMENTFORNOTMORETHAN1 YEAR,ORAFINEOFNOTMORETHAN$1,000.00,ORBOTH.

WARNING-WHENANAMEDEXCLUDEDPERSONOPERATESAVEHICLE

ALLLIABILITYCOVERAGEISVOID-NOONEISINSURED.OWNERSOFTHE VEHICLEANDOTHERSLEGALLYRESPONSIBLEFORTHEACTSOFTHE

NAMEDEXCLUDEDPERSONREMAINFULLYPERSONALLYLIABLE.A

NAMEDEXCLUDEDPERSONISNOTENTITLEDTOBEPAIDPERSONAL

PROTECTIONINSURANCEBENEFITS.

PENALTY FOR OPERATION WITHOUT INSURANCE

Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle registered in this state must have insurance or other approved security for the payment of fault benefits on the vehicle at all times. An owner or operator who drives or permits a vehicle to be driven upon a public highway without the proper insurance or other security is guilty of a misdemeanor.

An owner or registrant convicted of such a misdemeanor shall be fined not less than

$200.00 nor more than $500.00, imprisoned for not more than 1 year, or both. THISFORMMUSTBEPRESENTEDASEVIDENCEOFINSURANCEWITH

YOURAPPLICATIONFORLICENSEPLATES,EITHERBYMAILORATANY SECRETARYOFSTATELICENSEPLATEBRANCHOFFICE.APERSONWHO ISSUESORWHOSUPPLIESFALSEINFORMATIONTOTHESECRETARYOF STATEORUSESANINVALIDCERTIFICATEOFINSURANCEISGUILTYOFA MISDEMEANORPUNISHABLEBYIMPRISONMENTFORNOTMORETHAN1 YEAR,ORAFINEOFNOTMORETHAN$1,000.00,ORBOTH.

WARNING-WHENANAMEDEXCLUDEDPERSONOPERATESAVEHICLE

ALLLIABILITYCOVERAGEISVOID-NOONEISINSURED.OWNERSOFTHE VEHICLEANDOTHERSLEGALLYRESPONSIBLEFORTHEACTSOFTHE

NAMEDEXCLUDEDPERSONREMAINFULLYPERSONALLYLIABLE.A

NAMEDEXCLUDEDPERSONISNOTENTITLEDTOBEPAIDPERSONAL

PROTECTIONINSURANCEBENEFITS.

EXCLUDED DRIVERS: EXCLUDED DRIVERS:

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