ABC Insurance Company

POLICY DECLARATIONS

Named Insured/Residence Address	Producer	Policy Number
John or Jane Smith 899 Hanover Avenue Sunnyvale, CA 94086	Your Insurance Agent 123 Ocean View Blvd. Pacific Grove, CA 93950	123456-7890123
Mailing Address	Garage Address	Policy Term
899 Hanover Avenue Sunnyvale, CA 94086	899 Hanover Avenue Sunnyvale, CA 94086	1/1/2013 to 1/1/2014 12:01 am Standard Time

Description of Vehicle(s)
#	Year, Make, Model and Body Type	V.I.N.	Value	Plan	Driver(s)
1 2 3	1985 Porsche 911 Carrera Cabriolet 2008 Mercedes-Benz E350 Sport 1996 Wells Cargo 24' trailer	WP0EB0917FS123456 WDBUF56018B123456 1WC200L2BT1234567	$30,000 $35,000 $5,000	Pleasure Commute Transport	1,2 1,2,4 1,2

Premiums and Coverages (coverage is provided only where a premium is indicated)
Coverage	Limits	#1	#2	#3
Bodily Injury Liability Property Damage Liability Uninsured/Underinsured Motorists Medical Payments Collision Deductible Other Than Collision Deductible Roadside Assistance	$100,000 (ea. person) $300,000 (ea. accident) $100,000 (ea. accident) $100,000 (ea. person) $300,000 (ea. accident) $10,000 (ea. accident) $500 $500 Included	$100.00 10.00 50.00 10.00 210.00 200.00 10.00	Included Included Included Included $355.00 350.00 10.00	$120.00 100.00

Loss Payee(s)

1    N/A
2    Mercedes-Benz Financial Services, P.O. Box 17496 Baltimore MD 21297-1495. Loan# 12345678
3    N/A

Driver(s)
1 John Smith 2 Jane Smith	3 John Smith, Jr. - EXCLUDED 4 Sally Smith

Misc Notes
Rated with NO violation or accident incidents. Rated as garaged and driven primarily in the State of CALIFORNIA. Valuation Basis for Vehicle #1: Agreed Value.	20% Good Driver Discount INCLUDED.

Policy Forms and Endorsements

PC01230611
PP00010105
PP01691107

PP04870805
CV90110209
PP13011299

PCIDCA0611

Signed By:

(Authorized Representative)

Date:

1/1/2013

PC01230611

This document is part of the article How to Read Your Policy Declarations - Part 1 of an instructional series on How to Read Your Car Insurance Policy