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Declaration Page

This document outlines a Texas Personal Auto Policy for the insured, Jesus Cornejo, covering three vehicles with specified liability limits and premiums. Coverage includes bodily injury, property damage, personal injury protection, and uninsured/underinsured motorist provisions. The policy is effective from December 25, 2020, to June 25, 2021, with a total premium of $531.00.

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juliachavez458
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16 views

Declaration Page

This document outlines a Texas Personal Auto Policy for the insured, Jesus Cornejo, covering three vehicles with specified liability limits and premiums. Coverage includes bodily injury, property damage, personal injury protection, and uninsured/underinsured motorist provisions. The policy is effective from December 25, 2020, to June 25, 2021, with a total premium of $531.00.

Uploaded by

juliachavez458
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Texas Personal Auto Policy 'HFODUDWLRQV

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EAB1683446 12/24/2020 12/25/2020 THROUGH 06/25/2021 12:01 AM
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JESUS CORNEJO Freeway Insurance Services America, LLC
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1117 NOVELLA 5303 Antoine Dr
ADKINS, TX 78101 Houston, TX 77092

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515A, AIC.CrimeIntent.008, AIC.Storage.004

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JESUS CORNEJO, VIRGILIO CORNEJO

The Automobiles described in this policy are principally garaged at the above address unless otherwise stated.
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2004 TOYOTA SEQUOIA SR5 SEQUOIA SR5 5TDZT34A44S213703 PW 3
2003 TOYOTA CAMRY LE/CAMRY SE/CAMRY XLE CAMRY LE/CAMRY SE/CAMRY
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2016 TOYOTA COROLLA L/LE/S/SE COROLLA L/LE/S/SE 5YFBURHE9GP385723 ML 3

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Coverage is provided where a Limit of liability and a premium is shown for the coverage.
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Auto 1 Auto 2 Auto 3 Auto 4
Liability - Bodily Injury 30000 Each Person 60000 Each Accident 73.00 73.00 97.00
Liability - Property Damage Each Person 25000 Each Accident 63.00 58.00 77.00
Personal Injury Protection Each Person
Uninsured/Underinsured Motorist - Bodily Injury Each Person Each Accident
$250 Deductible Applicable to
Un insured/Underinsured Motorist - Property Damage Each Accident
Property Damage Liability
Medical
Coverage for damages to your automobile Auto 1 Auto 2 Auto 3 Auto 4
Collision Actual cash value unless otherwise stated

Collision Less Deductible

Auto 1 Auto 2 Auto 3 Auto 4


Other than Collision Actual cash value unless otherwise stated

Other than Collision Less Deductible

Rental 3HU'D\ 0D[LPXP


Towing
127,&(<RXUSD\PHQWLQFOXGHVDBBBBBIHH7KLVIHHJRHVWR
6.00 7otal Premiums 136.00 131.00 174.00
help fund: (1) auto burglary, theft, and fraud prevention, (2) criminal justice efforts, and (3) trauma MVCPA)HH 6.00
care and emergency medical services for victims of accidents due to traffic offenses. By law, we 65)HH 0.00
send this fee to the Motor Vehicle Crime Prevention Authority (MVCPA). 3ROLF\)HH
 84.00
727$/ 531.00

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Pursuant to the Texas Insurance Code §1812.003, you may access a copy of the above policy forms and endorsements by logging into our
website at www.empowerins.com. For a paper copy of your policy form and endorsements at no charge, please call (877)437-5010.

Countersigned at: Fort Worth, Texas on _____________________ by: ___________________________________________________________________


Date Authorized Representative

INSURED COPY

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