Form_SCTNID_CTGRY.

MI03106489_DECPAGE

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This is your
PROGRESSIVE
P.O. BOX 31260
TAMPA, FL 33631
Declarations Page

Policy Number: 31623995-0

NADALEEN GUERRIER
Underwritten by:
1830 KENT RD
Progressive Marathon Insurance Co
ORTONVILLE, MI 48462
December 26, 2011
Policy Period: Dec 15, 2011 - Jun 15,
2012
Page 1 of 2
progressive.com

Auto Insurance
Online Service
Make payments, check billing activity,
update policy information or check
Coverage Summary status of a claim.

1-800-776-4737
For customer service and claims
service, 24 hours a day, 7 days a
week.

Your policy information has changed

Your coverage began on February 15, 2023 at the later of 12:01 a.m. or the effective time shown on your application.
This policy period ends on August 15, 2023 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 contract is form 9610D MI (05/06). The contract is modified by forms Z445
MI (07/10) and 4884 MI (03/07).

Policy changes effective February 16, 2023

………………………………………………………………………………………………………………………………………………………..
Changes requested on: Feb 16, 2023
………………………………………………………………………………………………………………………………………………………..
Premium change: -$39.00
………………………………………………………………………………………………………………………………………………………..
Changes: An Electronic Funds Transfer (EFT) discount has been added to your policy.

Drivers and household residents………………………………………………………………………………………………………………………………………………………..Additional

information
DANIELLE S HINE Named insured

Outline of coverage
2012 KIA FORTE
VIN KNAFU5A24C5597721
Primary use of the vehicle: Commute
……………………………………………………………………………………………………………………………………………………….. Limits Deductible
Premium
Liability To Others $219
Bodily Injury Liability $20,000 each person/$40,000 each accident
 ……………………………………………………………………………………………………………………………………………………….. Property Damage Liability
$10,000 each accident
Personal Protection Insurance (PIP) $500 282
Excess Medical/Excess Workloss
………………………………………………………………………………………………………………………………………………………..

Uninsured/Underinsured Motorist………………………………………………………………………………………………………………………………………………………..$20,000
each person/$40,000 each accident 8 Property Protection Insurance $1,000,000 $0 37
……………………………………………………………………………………………………………………………………………………….. Subtotal policy premium
$546.00
……………………………………………………………………………………………………………………………………………………….. MCCA assessment recoupment 72.50
……………………………………………………………………………………………………………………………………………………….. Statutory assessment recoupment
8.50
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium and fees $627.00

Form 6489 MI (03/10) Continued 4

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Policy Number: 31623995-0

DANIELLE S

HINE Page2 of 2 Premium discounts

Policy
………………………………………………………………………………………………………………………………………………………..
31623995-0 Paperless, Online Quote, Online Signature - First Policy Period Only, Continuous
Insurance: Platinum, Electronic Funds Transfer (EFT) and F1 credit
Vehicle
………………………………………………………………………………………………………………………………………………………..
2000 Mitsubishi Airbag
Eclipse
Form 6489 MI (03/10)