Quote Number

QAZ0561791

Effective Date
06/01/2012

Mercury Casualty Company

This proposal is for your information only and is subject to the company's review and approval.
This is not an insurance policy or binder.

Prepared For:

Prepared By:

John Lakoseljac
6236 N 16th St
PHOENIX, AZ 85016

TERRAVITA INSURANCE LLC

2111 E BROADWAY STE 3
TEMPE, AZ 85282
Phone: 4803482000

Name

Points

Age

Gender

John Lakoseljac

64

Male

2012 HONDA CIVIC LX

Bodily Injury Liability

$100,000 Each Person, $300,000 Each Accident

$316.00

Property Damage Liability

$100,000 Each Accident

$190.00

Medical Payment

$1000 Per Person

$59.00

Uninsured Motorist Bodily

Injury

$100,000 Each Person, $300,000 Each Accident

$109.00

Underinsured Motorist Bodily

Injury

$100,000 Each Person, $300,000 Each Accident

$53.00

Comprehensive

$500 w/Full Glass

$144.00

Full Glass

Yes

INCL

Loan/Lease GAP

No

$0.00

Collision

$500

$393.00

Rental Reimbursement

$30 per day for 45 days

$47.00

Roadside Assistance

INCL

Non-Factory Equipment
Repair and Replacement Cost

$0.00
No

Auto Theft

$1.00
Total Vehicle Premium

Total Premium
Discounts Applied
Paid in Full
Advance Quote
3 Year Accident & Violation Free
5 Year Accident Free
Occupation
Mature Driver

$0.00

$1,312.00

$1,312.00

Quote Number
QAZ0561791

Effective Date
06/01/2012

Installments
Automatic Payment
Fee: $3.00 per installment (not included)
Due Date:
Amount
06/01/2012
$144.30
07/01/2012
$118.06
08/01/2012
$118.06
09/01/2012
$118.06
10/01/2012
$118.07
11/01/2012
$118.06
12/01/2012
$118.07
01/01/2013
$118.06
02/01/2013
$118.07
03/01/2013
$118.06
04/01/2013
$118.07
05/01/2013
$118.06
$154.00 discount
Total Amount:
$1,443.00

Monthly Pay
Fee: $5.00 per installment (not included)
Due Date:
Amount
06/01/2012
$239.55
07/01/2012
$123.40
08/01/2012
$123.41
09/01/2012
$123.40
10/01/2012
$123.41
11/01/2012
$123.40
12/01/2012
$123.41
01/01/2013
$123.40
02/01/2013
$123.41
03/01/2013
$123.40
04/01/2013
$123.41
05/01/2013
$123.40
Total Amount:
$1,597.00

Paid In Full
Fee: $0.00 per installment (not included)
Due Date:
Amount
06/01/2012
$1,312.00
$285.00 discount
Total Amount:
$1,312.00

4 Pay
Fee: $5.00 per installment (not included)
Due Date:
Amount
06/01/2012
$399.25
08/01/2012
$399.25
10/01/2012
$399.25
12/01/2012
$399.25
Total Amount:
$1,597.00