Personal Auto Policy Declarations
AAA Insurance
underwritten by CSAA General Insurance Company
PO Box 24511 Oakland, CA 94623-9865
For claims call 888.222.0086
Notice of Amended Policy
For customer service call 888.222.0094 Effective December 20, 2024
This Declarations Page Replaces Any Previous Declarations Page
Please Read and Attach to Your Policy
POLICY NUMBER: DCSS231791605
PROGRAM: AAA Select
AAA Insured Since 2024
Sales Rep Name & Address 500016864
Named Insured(s) & Mailing Address
ACA Club Insurance Agency, Inc./House Agent
1 River Pl
Wilmington, DE 19801
WEXSIMAR PEREZ (800) 492-5901
4600 CONNECTICUT AVE NW POLICY PERIOD
APT 332 FROM: TO: TIME:
WASHINGTON, DC 20008-5721 02/15/24 02/15/25 12:01 A.M.
DESCRIPTION OF VEHICLE (S) YOU WILL BE BILLED SEPARATELY FOR ANY BALANCE DUE.
VEHICLE YEAR MAKE MODEL VEHICLE IDENTIFICATION ZIP CODE
1 2003 TOYO COROLLA SEDAN 4 DOOR 2T1BR38E63C144582 20008
2 2009 TOYO COROLLA SEDAN 4 DOOR 2T1BU40E79C175543 20008
3 2009 TOYO COROLLA SEDAN 4 DOOR 2T1BU40E09C119704 20008
Insurance is provided only with respect to the following coverages for which a specific limit of liability is shown. Subject to all conditions of this policy.
COVERAGES LIMIT OF LIABILITY VEHICLE INFORMATION
1 DED 2 DED 3 DED
Bodily Injury $50,000 / person 396.00 580.00 580.00
$100,000 / accident
Property Damage $50,000 / accident 418.00 520.00 520.00
Uninsured Motorist Bodily Injury $50,000 / person 86.00 112.00 112.00
$100,000 / accident
Uninsured Motorists Property Damage $50,000 / accident 3.00 No Ded. 5.00 No Ded. 5.00 No Ded.
Underinsured Motorist Bodily Injury $50,000 / person 12.00 16.00 16.00
$100,000 / accident
Underinsured Motorists Property Damage $50,000 / accident
Personal Injury Protection
Medical Expense Benefits Excluded
Work Loss Benefits Excluded
Funeral Expense Benefits Excluded
Automobile Death Benefits (See driver info) $15,000/person 14.00
FULL TERM PREMIUM $931 $1,235 $1,235
FULL TERM PREMIUM TOTAL: $4,348.00
TOTAL CHARGES: $2,013.00
CHANGES MADE TO: DRIVER INFORMATION
FORMS AND ENDORSEMENTS
FORMS AND ENDORSEMENTS MADE PART OF THIS POLICY:
AAADXX 01 12 AA01DC 02 14 AA11DC AAAEDC 01 20
EXCLUSIONS
There is no coverage provided by this Policy while the following individual(s) operate a motor vehicle:
NONE
AA02DCA 01 20 SEE BACK OF THIS FORM FOR ADDITIONAL INFORMATION
Issued: 12/19/2024 08:55 AM MST
Lienholder information: L=Lienholder A=Additional Insured/Interest C=Certificate Holder
NONE
Driver # Name Birthdate Marital Status Gender Auto Death Benefits
1 WEXSIMAR PEREZ **/**/1997 Single Female Yes
2 WENDY DIAZ **/**/1994 Single Female No
3 CARLOS JOSE PARRA DIAZ **/**/2001 Single Male No
4 Sheila Ramirez Marcano **/**/1987 Single Female No
DISCOUNT INFORMATION
Policy: Loyalty Discount; Multi-Vehicle Discount
Driver:
Vehicle:
Driver # Date Violation Driver # Date Violation
2 01/04/2021 AAF
The following endorsement applies when a lienholder is shown on the declarations page:
Loss Payable Endorsement
AALPXX 01 12
Loss or damage under this policy shall be paid, as interest may appear, to you and the loss payee shown in the Declarations or in this
endorsement. This insurance with respect to the interest of the loss payee, shall not become invalid because of your fraudulent acts or omissions
unless the loss results from your conversion, secretion or embezzlement of "your covered auto". However, we reserve the right to cancel the
policy as permitted by policy terms and the cancellation shall terminate this agreement as to the loss payee's interest. We will give the same
advance notice of cancellation to the loss payee as we give to the named insured shown in the Declarations.
When we pay the loss payee we shall, to the extent of payment, be subrogated to the loss payee's rights of recovery.
Copyright, Insurance Services Office, Inc., 1986
AA02DCA 01 20
Personal Auto Policy Declarations
AAA Insurance
underwritten by CSAA General Insurance Company
PO Box 24511 Oakland, CA 94623-9865
For claims call 888.222.0086
Notice of Amended Policy
For customer service call 888.222.0094 Effective December 20, 2024
This Declarations Page Replaces Any Previous Declarations Page
Please Read and Attach to Your Policy
POLICY NUMBER: DCSS231791605
PROGRAM: AAA Select
AAA Insured Since 2024
Sales Rep Name & Address 500016864
Named Insured(s) & Mailing Address
ACA Club Insurance Agency, Inc./House Agent
1 River Pl
Wilmington, DE 19801
WEXSIMAR PEREZ (800) 492-5901
4600 CONNECTICUT AVE NW POLICY PERIOD
APT 332 FROM: TO: TIME:
WASHINGTON, DC 20008-5721 02/15/24 02/15/25 12:01 A.M.
DESCRIPTION OF VEHICLE (S) YOU WILL BE BILLED SEPARATELY FOR ANY BALANCE DUE.
VEHICLE YEAR MAKE MODEL VEHICLE IDENTIFICATION ZIP CODE
4 2007 TOYO YARIS HATCHBACK 2 DOO JTDJT923X75078645 20008
Insurance is provided only with respect to the following coverages for which a specific limit of liability is shown. Subject to all conditions of this policy.
COVERAGES LIMIT OF LIABILITY VEHICLE INFORMATION
4 DED
Bodily Injury $50,000 / person 445.00
$100,000 / accident
Property Damage $50,000 / accident 399.00
Uninsured Motorist Bodily Injury $50,000 / person 85.00
$100,000 / accident
Uninsured Motorists Property Damage $50,000 / accident 4.00 No Ded.
Underinsured Motorist Bodily Injury $50,000 / person 12.00
$100,000 / accident
Underinsured Motorists Property Damage $50,000 / accident
Personal Injury Protection
Medical Expense Benefits Excluded
Work Loss Benefits Excluded
Funeral Expense Benefits Excluded
FULL TERM PREMIUM $947
CHANGES MADE TO: DRIVER INFORMATION
FORMS AND ENDORSEMENTS
FORMS AND ENDORSEMENTS MADE PART OF THIS POLICY:
AAADXX 01 12 AA01DC 02 14 AA11DC AAAEDC 01 20
EXCLUSIONS
There is no coverage provided by this Policy while the following individual(s) operate a motor vehicle:
NONE
AA02DCA 01 20 SEE BACK OF THIS FORM FOR ADDITIONAL INFORMATION
Issued: 12/19/2024 08:55 AM MST
Lienholder information: L=Lienholder A=Additional Insured/Interest C=Certificate Holder
NONE
Driver # Name Birthdate Marital Status Gender Auto Death Benefits
1 WEXSIMAR PEREZ **/**/1997 Single Female Yes
2 WENDY DIAZ **/**/1994 Single Female No
3 CARLOS JOSE PARRA DIAZ **/**/2001 Single Male No
4 Sheila Ramirez Marcano **/**/1987 Single Female No
DISCOUNT INFORMATION
Policy: Loyalty Discount; Multi-Vehicle Discount
Driver:
Vehicle:
Driver # Date Violation Driver # Date Violation
2 01/04/2021 AAF
The following endorsement applies when a lienholder is shown on the declarations page:
Loss Payable Endorsement
AALPXX 01 12
Loss or damage under this policy shall be paid, as interest may appear, to you and the loss payee shown in the Declarations or in this
endorsement. This insurance with respect to the interest of the loss payee, shall not become invalid because of your fraudulent acts or omissions
unless the loss results from your conversion, secretion or embezzlement of "your covered auto". However, we reserve the right to cancel the
policy as permitted by policy terms and the cancellation shall terminate this agreement as to the loss payee's interest. We will give the same
advance notice of cancellation to the loss payee as we give to the named insured shown in the Declarations.
When we pay the loss payee we shall, to the extent of payment, be subrogated to the loss payee's rights of recovery.
Copyright, Insurance Services Office, Inc., 1986
AA02DCA 01 20
