Form_SCTNID_CTGRY.

IA05196489_DECPAGE

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SSB INS SRVCS

6350 LAUREL CYN BLVD
NORTH HOLLYWOOD, CA 91606

Policy Number: 910299699

Underwritten by:
Progressive Northern Insurance Co
ELIZABETH M SALAZAR CAMPOS August 12, 2021
503 W 8TH ST
Policy Period: May 28, 2021 - Nov 28, 2021
TRAILER D
STORM LAKE, IA 50588 Page 1 of 3

1-888-672-6999
SSB INS SRVCS
Contact your agent for personalized service.

progressiveagent.com
Auto Insurance Online Service

Coverage Summary
Make payments, check billing activity, update
policy information or check status of a claim.

This is a copy of your 1-800-274-4499

To report a claim.
Declarations Page
Your coverage began on May 28, 2021 at 12:01 a.m. This policy expires on November 28, 2021 at 12:01 a.m.
This coverage summary replaces your prior one. 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. The
policy contract is form 9611A IA (07/16). The contract is modified by forms 4884 (10/08), Z195 (07/05) and A264 (10/18).
Progressive Northern Insurance Co is a stock company (NYSE: PGR).

Drivers and household residents

Elizabeth M Salazar Campos
Additional information: Named insured
William Talamante JR
Andrea M Salazar
Additional information: excluded driver

Outline of coverage
2010 TOYOTA TUNDRA CREW PICKUP
VIN: 5TFUW5F19AX120532
Garaging ZIP Code: 50588
Primary use of the vehicle: Commute
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $412
Bodily Injury Liability $20,000 each person/$40,000 each accident
Property Damage Liability $15,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Underinsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Total premium for 2010 TOYOTA $412

Form 6489 IA (05/19)

4
Continued
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Policy Number: 910299699

Elizabeth M Salazar Campos
Page 2 of 3
2008 GMC SIERRA C1500/K1500 CREW PICKUP
VIN: 3GTEK13388G300100
Garaging ZIP Code: 50588
Primary use of the vehicle: Pleasure/Personal
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $288
Bodily Injury Liability $20,000 each person/$40,000 each accident
Property Damage Liability $15,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Underinsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Total premium for 2008 GMC $288
2017 GMC CANYON CREW PICKUP
VIN: 1GTG6CEN3H1273443
Garaging ZIP Code: 50588
Primary use of the vehicle: Commute
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $247
Bodily Injury Liability $20,000 each person/$40,000 each accident
Property Damage Liability $15,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Underinsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Total premium for 2017 GMC $247
2015 JEEP WRANGLER SAHARA 4 DOOR WAGON
VIN: 1C4BJWEGXFL727832
Garaging ZIP Code: 50588
Primary use of the vehicle: Commute
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Information regarding your vehicle history (prior damage, theft or title issues) has impacted how we determine your premium.
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $423
Bodily Injury Liability $20,000 each person/$40,000 each accident
Property Damage Liability $15,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Underinsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $1,000 148
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $1,000 236
………………………………………………………………………………………………………………………………………………………..
Total premium for 2015 JEEP $807
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium $1,754.00

Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
910299699 Electronic Funds Transfer (EFT), Multi-Car, Continuous Insurance: Diamond and
Paperless

Form 6489 IA (05/19)

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Policy Number: 910299699

Elizabeth M Salazar Campos
Page 3 of 3

Lienholder information
Vehicle Lienholder
………………………………………………………………………………………………………………………………………………………..
2015 JEEP WRANGLER SAHARA 414 Green State Credit Union
1C4BJWEGXFL727832 North Liberty, IA 52317

Company officers

President Secretary

Form 6489 IA (05/19)