Form_SCTNID_CTGRY.
CA0223CDQUOTE_QUOTE
Q 02NWR INS QUOTE POLWHITEFONT 2GTAT546BSD4U2CIIHXRC63VPD0001 RPUID TRACWHITEFONT BDF_AA
LEE CAMPOS INSURANCE
211 UTICA AVE # C
HUNTINGTON BEACH, CA 92648
Underwritten by:
Drive Insurance Co
March 5, 2025
STACY DELAVEGA Page 1 of 3
TIMOTHY WITTER
17581 BURKWOOD CIR
YORBA LINDA, CA 92886
Customer: Stacy DeLaVega
Agent License Number:
home:
work:
Auto Insurance Quote
Thank you for contacting me about your auto insurance needs.
Quote for a 6 month policy period
………………………………………………………………………………………………………………………………………………………..
Total policy premium $2,548.76
If you select a paid in full bill plan, you will not be charged an installment fee.
Payment plans
Our standard fee for most installment payment plans is $6.00. The EFT payment plan automatically withdraws your
payments from your checking account and offers a reduced fee of $1.00 per installment.
Automatic Payments by Electronic Funds Transfer (EFT) assures that your payment is on time. Each payment
(excluding the initial payment) includes an installment fee of $1.00.
Payment plan Total premium Initial payment Payments
………………………………………………………………………………………………………………………………………………………..
6 Payments $2,548.76 $511.16 5 payments of $408.52
Make payments by mail or at DriveInsurance.com. Each payment (excluding the initial payment) includes an
installment fee of $6.00.
Payment plan Total premium Initial payment Payments
………………………………………………………………………………………………………………………………………………………..
6 Payments $2,548.76 $511.16 5 payments of $413.52
To purchase insurance
Please review the information on your quote for accuracy; incomplete and inaccurate information could affect your rate.
These rates are subject to verification of information. If you have any questions or would like to purchase a Drive
Insurance policy, please call me at 1-714-612-1027. Your coverage will begin once your initial payment has been
received. Thanks again for the opportunity to work with you.
Important notice
An insurer which refuses to provide coverage to an applicant who is a "Good Driver" must provide the applicant with a
written statement of the reasons it denied coverage. In general, under California law a Good Driver is a person who has
not had more than one violation point or more than one at-fault accident resulting in only property damage in the last
three years.
For your protection California law requires the following to appear on this form. Any person who knowingly presents false
or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a
crime and may be subject to fines and confinement in state prison.
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Page 2 of 3
Drivers and household residents
The applicant, spouse and all household residents 15 years of age or older, all regular operators of the vehicles described
in this application, and all children who live away from home who drive these vehicles, even occasionally, are listed
below.
Stacy DeLaVega
Date of birth: Dec 27, 1976 Marital status: Married
Relationship: Insured Driver status: Rated
DAISY M DELAVEGA
Date of birth: Feb 25, 1997 Marital status: Single
Relationship: Child Driver status: Rated
DIEGO C DELAVEGA
Date of birth: May 4, 2001 Marital status: Single
Relationship: Child Driver status: Rated
Timothy witter
Date of birth: Apr 30, 1975 Marital status: Married
Relationship: Spouse Driver status: Rated
Outline of coverage
Your insurance policy and any policy endorsements contain a full explanation of your coverage. The policy limits shown for
a vehicle may not be combined with the limits for the same coverage on another vehicle.
2017 SUBARU FORESTER 4 DOOR WAGON
VIN: JF2SJABC7HH431212
Garaging ZIP Code: 92886
Primary use of the vehicle: Pleasure
Annual miles: 12545
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $846
Bodily Injury Liability $30,000 each person/$60,000 each accident
Property Damage Liability $15,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured/Underinsured Motorist $30,000 each person/$60,000 each accident 82
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $500 160
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $500 862
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Collision Deductible Waiver $500 waived 4
………………………………………………………………………………………………………………………………………………………..
Rental Reimbursement up to $50 each day/maximum 30 days 87
………………………………………………………………………………………………………………………………………………………..
Roadside Assistance 3
………………………………………………………………………………………………………………………………………………………..
Loan/Lease Payoff 25% Of The Actual Cash Value 6
………………………………………………………………………………………………………………………………………………………..
Total premium for 2017 SUBARU $2,050
2009 ACURA MDX 4 DOOR WAGON
VIN: 2HNYD28619H528371
Garaging ZIP Code: 92886
Primary use of the vehicle: Pleasure
Annual miles: 10498
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $430
Bodily Injury Liability $30,000 each person/$60,000 each accident
Property Damage Liability $15,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured/Underinsured Motorist $30,000 each person/$60,000 each accident 58
………………………………………………………………………………………………………………………………………………………..
Roadside Assistance 9
………………………………………………………………………………………………………………………………………………………..
Total premium for 2009 ACURA $497
Drive Insurance Co 4
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Page 3 of 3
………………………………………………………………………………………………………………………………………………………..
Subtotal policy premium $2,547.00
………………………………………………………………………………………………………………………………………………………..
Anti-Fraud fee 1.76
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium $2,548.76
Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
Multi-Car
Driver
………………………………………………………………………………………………………………………………………………………..
DAISY M DELAVEGA 5 Year Accident Free Discount, Good Driver and 3 Year Clean Discount
DIEGO C DELAVEGA 5 Year Accident Free Discount, Good Driver and 3 Year Clean Discount
Timothy witter 5 Year Accident Free Discount, Good Driver and 3 Year Clean Discount
Form CDQUOTE CA (02/23)
Drive Insurance Co
