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MAIL MCH-M-I
LTMDI
SEPTEMBER 15, 2021
AUTOMOBILE POLICY PACKET

JAMES COOK
620 W BELT LINE RD
RICHARDSON TX 75080-6113

GIC 01459 59 03 7103 7

POLICY PERIOD: EFFECTIVE SEP 15 2021 TO JAN 17 2022
IMPORTANT MESSAGES
Refer to your Declarations Page and endorsements to verify that coverages, limits, deductibles and other
policy details are correct and meet your insurance needs. Required information forms are also enclosed
for your review.
Check your vehicle for a safety recall today! Visit www.usaa.com/autorecall
to learn more.
TEXTING & DRIVING ... It Can Wait! Join USAA in the movement against
distracted driving by going to http://itcanwait.usaa.com to watch powerful
videos and take the pledge to not text and drive!

This is not a bill. Any premium charge or change for this policy will be reflected on your
next regular monthly statement. Your current billing statement should still be paid by
the due date indicated.
To receive this document and others electronically, or manage your Auto Policy online,
go to usaa.com.
For U.S. calls: Policy Service (800) 531-8111. Claims (800) 531-8222.
ACS1 49708-0406
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USAA GENERAL INDEMNITY COMPANY AMENDMENT TO
(A Stock Insurance Company) State 06 Veh POLICY NUMBER
9800 Fredericksburg Road - San Antonio, Texas 78288 TX 846 Terr 01459 59 03G 7103 7
TEXAS PERSONAL AUTO POLICY POLICY PERIOD: (12:01 A.M. standard time)
AMENDED DECLARATIONS EFFECTIVE SEP 15 2021 TO JAN 17 2022
(ATTACH TO PREVIOUS POLICY) OPERATORS
Named Insured and Address 01 JAMES COOK

JAMES COOK
620 W BELT LINE RD
RICHARDSON TX 75080-6113
Description of Vehicle(s) VEH USE* WORK/SCHOOL
Miles Days
VEH YEAR TRADE NAME MODEL BODY TYPE ANNUAL IDENTIFICATION NUMBER One Per
MILEAGE SYM Way Week
06 08 LEXUS RX 350 4D 4D 9000 2T2GK31UX8C052793 P

The Vehicle(s) described herein is principally garaged at the above address unless otherwise stated. * W/C=Work/School; B=Business; F=Farm;P=Pleasure
VEH 06 SAN ANTONIO TX 78259-1829
This policy provides ONLY those coverages where a premium i s shown below. The limits shown
m a y b e reduced b y policy provisions and m a y not b e combined regardless o f the number of
vehicles for which a premium is listed unless specifically authorized elsewhere in this policy.
VEH VEH VEH VEH
COVERAGES LIMITS OF LIABILITY 06 6-MONTH
D=DED PREMIUM D = D E D PREMIUM D = D E D PREMIUM D=DED PREMIUM
("ACV" MEANS ACTUAL CASH VALUE) AMOUNT $ AMOUNT $ AMOUNT $ AMOUNT $
PART A - LIABILITY
BODILY INJURY EA PER $ 30,000
EA ACC $ 60,000 245.28
PROPERTY DAMAGE EA ACC $ 25,000 220.64
PART B2-PERSONAL INJURY PROTECTION
(OPTIONAL) EA PERSON $ 2,500 44.72
PART C - UM/UIM
BODILY INJURY EA PER $ 30,000
EA ACC $ 60,000 37.78
PROPERTY DAMAGE EA ACC $ 25,000D 250 51.06
PART D - PHYSICAL DAMAGE COVERAGE
COMPREHENSIVE LOSS ACV LESS D 200 226.12
COLLISION LOSS ACV LESS D 200 412.98
TOWING AND LABOR 9.75

___________________________________________________________________________________
VEHICLE TOTAL PREMIUM 1248.33

-------------------------------ADJUSTMENT REASON--------------------------------
POLICY ADJUSTMENT

TOTAL PREMIUM - SEE FOLLOWING PAGE(S)

ENDORSEMENTS: ADDED 09-15-21 - NONE

REMAIN IN EFFECT(REFER TO PREVIOUS POLICY)- A200TX(01) A402TX(01) RSGPTX(01)
5100TX(03)
M2 1
V V V V
E
H06 RSM4300000 E
H
E
H
E
H

In WITNESS WHEREOF, we have caused this policy to be signed by our President and Secretary at San Antonio, Texas,
on date this SEPTEMBER 15, 2021

8500 G 05-12
91919-05-12
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USAA GENERAL INDEMNITY COMPANY
(A Stock Insurance Company) State Veh POLICY NUMBER
9800 Fredericksburg Road - San Antonio, Texas 78288 TX Terr 01459 59 03G 7103 7
TEXAS PERSONAL AUTO POLICY POLICY PERIOD: (12:01 A.M. standard time)
AMENDED DECLARATIONS EFFECTIVE SEP 15 2021 TO JAN 17 2022
(ATTACH TO PREVIOUS POLICY)
Named Insured and Address

JAMES COOK
620 W BELT LINE RD
RICHARDSON TX 75080-6113
Description of Vehicle(s) VEH USE* WORK/SCHOOL
Miles Days
ANNUAL One Per
VEH YEAR TRADE NAME MODEL BODY TYPE MILEAGE IDENTIFICATION NUMBER SYM Way Week

The Vehicle(s) described herein is principally garaged at the above address unless otherwise stated. * W/C=Work/School; B=Business; F=Farm;P=Pleasure

This policy provides ONLY those coverages where a premium i s shown below. The limits shown
m a y b e reduced b y policy provisions and m a y not b e combined regardless o f the number of
vehicles for which a premium is listed unless specifically authorized elsewhere in this policy.
VEH VEH VEH VEH
COVERAGES LIMITS OF LIABILITY
("ACV" MEANS ACTUAL CASH VALUE) D=DED PREMIUM D = D E D PREMIUM D = D E D PREMIUM D=DED PREMIUM
AMOUNT $ AMOUNT $ AMOUNT $ AMOUNT $

REVISED 6 MONTH PREMIUM...$ 1248.33 6 MONTH INCREASE...$ 119.12

PREMIUM DUE AT INCEPTION. THIS IS NOT A BILL, STATEMENT TO FOLLOW.

MVCPA FEE 2.00

NOTICE: AN ASSESSMENT OF $ 0.04 IS PAYABLE IN ADDITION TO THE PREMIUM DUE

UNDER THIS POLICY. THIS ASSESSMENT WAS CREATED BY THE TEXAS LEGISLATURE
TO FUND THE RURAL VOLUNTEER FIRE DEPARTMENT ASSESSMENT PROGRAM.

THE FOLLOWING COVERAGE(S) DEFINED IN THIS POLICY ARE NOT PROVIDED FOR:
VEH 06 - RENTAL REIMBURSEMENT

V V V V
E E E E
H H H H

In WITNESS WHEREOF, we have caused this policy to be signed by our President and Secretary at San Antonio, Texas,
on this date SEPTEMBER 15, 2021

8500 G 0 5 - 1 2
91919- 05-12
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GIC 01459 59 03 7103

SUPPLEMENTAL INFORMATION
EFFECTIVE SEP 15 2021 TO JAN 17 2022

The following approximate premium discounts or credits have already been applied to reduce your policy
premium costs.
NOTE: Age or senior citizen status, if allowed by your state/location, was taken into consideration when
your rates were set and your premiums have already been adjusted.
VEHICLE 06
ANNUAL MILEAGE DISCOUNT -$ 11.94
AUTOMATIC PAYMENT PLAN DISCOUNT -$ 36.55
DAYTIME RUNNING LIGHTS DISCOUNT -$ 12.12
PASSIVE RESTRAINT DISCOUNT -$ 7.47
PREMIER DRIVER LEVEL DISCOUNT -$ 333.23

SUPDECCW Rev. 7-95 SEPTEMBER 15, 2021