Policy Number: SIGOTX -112643798

Luis Rojas
Ronmel Diaz
Page 1 of 6

Sigo Insurance Services, LLC Policy Number: SIGOTX -112643798

101 Grovers Mill Road, Suite 200 Underwritten by:
Lawrenceville, NJ 08648 Old American County Mutual Fire Insurance
Company
Luis Rojas Policy period: 10/28/2023 - 04/28/2024
Ronmel Diaz Sigo Insurance Services LLC
8413 ARIEL ST, HOUSTON, TX 77074 www.sigoinsurance.com
HOUSTON TX 77074 Online Service
Make payments, check billing activity, update

Auto Insurance
policy information or check status of a claim.

Coverage
1-877-476-7446
To report a claim

Summary
1-877-476-7446
For customer service and claims service.

This is your Declarations Page You may obtain a copy of your policy at
www.sigoinsurance.com. Please call 1-877-
476-7446 to obtain a paper copy at no
additional cost.

Your coverage begins on 10/28/2023 at 2:14 PM CT.

This policy period ends on 04/28/2024 at 12:00 AM CT.

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 OACM.PAP. The contract is modified by forms
OACM.TempVeh.022, OACM.Storage.004, OACM.OutOfState.016a, OACM.CrimeIntent.008,
OACM.Punitive.018 (rev 2013 01), OACM.DelFee.005, OACM.ContLiab.006, and
OACM.AutoTerm.007.

SIGO.DEC 11/21
 Policy Number: SIGOTX -112643798
Luis Rojas
Ronmel Diaz
Page 2 of 6

Drivers
Name Luis Rojas DOB 1995-06-03
Gender Male Marital status Married
Relationship Primary named Driver Status Included
insured Education level Unknown
Occupation Unknown Telematics No

Name Sabrina Alvarado DOB 1995-05-30

Gender Female Marital status Married
Relationship Spouse Driver Status Excluded
Education level Unknown Occupation Unknown
Telematics No

Name Ronmel Diaz DOB 1997-02-06

Gender Male Marital status Married
Relationship Non relative Driver Status Included
Education level Unknown Occupation Unknown
Telematics No

SIGO.DEC 11/21
 Policy Number: SIGOTX -112643798
Luis Rojas
Ronmel Diaz
Page 3 of 6

Outline of coverage
2006 HONDA CIVIC EX
VIN: 2HGFG12876H538733
Garaging ZIP Code: 77074
Primary use of the vehicle: Commuting
Limits Deductible Premium

Bodily Injury 30,000/60,000 $239.85

Property Damage 25,000 $210.27

Medical Payments Rejected

Personal Injury Protection Rejected

Uninsured/Underinsured Motorist-Bodily
Rejected
Injury

Uninsured/Underinsured Motorist-Property
Rejected
Damage

Collision Rejected

Other Than Collision Rejected

Rental Reimbursement Rejected

Total premium for 2006 HONDA CIVIC EX $450.12

SIGO.DEC 11/21
 Policy Number: SIGOTX -112643798
Luis Rojas
Ronmel Diaz
Page 4 of 6

2013 HONDA ACCORD EX-L

VIN: 1HGCT1B8XDA017595
Garaging ZIP Code: 77074
Primary use of the vehicle: Commuting
Limits Deductible Premium

Bodily Injury 30,000/60,000 $262.67

Property Damage 25,000 $217.44

Medical Payments Rejected

Personal Injury Protection Rejected

Uninsured/Underinsured Motorist-Bodily
Rejected
Injury

Uninsured/Underinsured Motorist-Property
Rejected
Damage

Collision Rejected

Other Than Collision Rejected

Rental Reimbursement Rejected

Total premium for 2013 HONDA ACCORD EX-L $480.11

Subtotal policy premium $930.23

Policy fees $65.25

Total 183 day policy premium and fees $995.48

SIGO.DEC 11/21
 Policy Number: SIGOTX -112643798
Luis Rojas
Ronmel Diaz
Page 5 of 6

Premium discounts
Policy Description

SIGOTX -
Multi-Car
112643798

SIGOTX -
Proof of prior
112643798

SIGOTX -
Homeowner
112643798

Driver Description

Luis Rojas 3-Year Safe Driving

Sabrina Alvarado 3-Year Safe Driving

Ronmel Diaz 3-Year Safe Driving

Luis Rojas 5-Year Accident Free

Sabrina Alvarado 5-Year Accident Free

Ronmel Diaz 5-Year Accident Free

Vehicle Description

2006 HONDA CIVIC

Liability Only Discount
EX

2013 HONDA
Liability Only Discount
ACCORD EX-L

SIGO.DEC 11/21
 Policy Number: SIGOTX -112643798
Luis Rojas
Ronmel Diaz
Page 6 of 6

Additional policy information

Policy Description

No additional information

Driver Description

Luis Rojas Foreign/Domestic ID

Sabrina Alvarado Out of state license

Ronmel Diaz Foreign/Domestic ID

Vehicle Description

No additional information

Lienholder and additional interest

information
Vehicle Lienholder/Additional interest

No Lienholders or Additional interest

SIGO.DEC 11/21
 The following endorsements apply only if indicated on the Declarations page.

515A. EXCLUSION OF NAMED DRIVER AND

PARTIAL REJECTION OF COVERAGES
WARNING
READ THIS ENDORSEMENT CAREFULLY!
This acknowledgement and rejection is applicable to all renewals issued by us or any affiliated insurer.
However, we must provide a notice with each renewal as follows: “This policy contains a named driver exclusion.”

You agree that none of the insurance coverages afforded by this policy shall apply while

ANY LISTED EXCLUDED DRIVER

(The Excluded Driver)
is operating your covered auto or any other motor vehicle. You further agree that this endorsement will also serve as a rejection of
Uninsured/Underinsured Motorists Coverage and Personal Injury Protection Coverage while your covered auto of any other motor vehicle is oper-
ated by the excluded driver.

515A. Exclusion of Named Driver and Partial Rejection of Coverages

PRIVACY NOTICE
We value our business relationship in serving you for your important insurance needs. We recognize your confidentiality expectations and are
committed to protecting your right to privacy of any non-public personal information collected before, during, and after you have ended your
business relationship with us. Because we value our business relationship with you, we do not sell customer information or share it with outside
organizations for any marketing purposes. It is our policy to:

• Collect only information that is necessary or relevant to our business.

• Make a reasonable effort to ensure that information that we act upon is accurate, relevant, and complete.
• Use only legitimate means to collect information.
• Make personal information available externally only to respond to legitimate business needs, to regulatory or other government
authorities, or as otherwise permitted by law.
• Limit employee access to those who need to and are trained in the proper handling of personal information.

We are providing you with the following summary of the kinds of information that we may collect; what is done with information after it is
collected; and how you can find out about such information.

What kind of information do we collect about you and from whom?

We receive the majority of information directly from you. The policy application form that you complete, as well as any additional information you
provide, generally provides the information that we need to know. On occasion, you may be contacted by one of our representatives by mail,
telephone, and other electronic means to secure additional information. Depending on the nature of the transaction, additional information may
be secured from outside sources, such as motor vehicle records, loss information reports, credit reports, court records, or other public records.
Third parties, such as other insurance companies or investigative consumer reporting agencies may also provide information. An investigative
consumer report may gather information through telephone or personal interviews with your neighbors, friends, associates, acquaintances, or
others who may have knowledge concerning those items of information.

If we order any kind of consumer report, we will notify you and, under applicable State laws and the Federal Fair Credit Reporting Act. Upon
written request, we will give you or tell you how to obtain a copy of the report. The agency preparing a consumer report for us may keep the
information collected about you as permitted by law.

What do we do with the information collected about you?

Information that has been collected about you and retained will be contained in our policy records. The information is reviewed to evaluate your
request for insurance coverage; in determining your premium rates; issuing and servicing insurance policies; and servicing insurance claims. We
may also use information about you for insurance marketing purposes, or to assist with your overall insurance coverage.

If coverage is declined or the charge for coverage is increased because of information contained in a consumer report we obtained, we will tell
you as required by applicable State law and the Federal Fair Credit Reporting Act. We will also give you the name and address of the consumer
reporting agency issuing the report.

To whom do we disclose information about you?

• Your agent or broker.
• Parties whom perform a business, professional, or insurance function for us.
• Independent claims adjusters, appraisers, investigators, and attorneys who require the information to investigate, defend, or settle a
claim you are involved in.
• Businesses that assist us with data processing or marketing.
• Businesses that conduct scientific research, including actuarial or underwriting studies.
• Other insurance companies, agents or consumer reporting agencies as reasonably necessary in connection with any application, policy,
or claim you are involved in.
• Insurance support organizations that are established to collect information for the purpose of detecting and/or preventing insurance
crimes or fraud.
• Medical care institutions or medical professionals to verify coverage or conduct an audit of services.
• Insurance regulatory agencies in connection with the regulation of our business.
• Authorized persons as ordered by a subpoena, warrant or other court order, or as required by law.
• Certificate holders or policyholders for the purpose of providing information regarding the status of an insurance transaction.
• Lienholders, lessors or other persons or organizations shown in our records as having a legal interest or beneficial interest in your policy.

We do not provide information about you, such as your name and address, to parties that may wish to provide you with information about their
non-insurance products or services.

Should you cease to be a policyholder of ours, or after your claim is settled, we will archive your information for a period of six (6) years, unless
law or regulation requires an additional archival period. At any time, you have the right to remove yourself from our databases by contacting us
in writing.

1 SIGO.PRIV 01/21
How can you find out about the information contained in our records?
You have the right to know what kind of information we retain about you in our files and records, to have reasonable access to it, and to receive
a copy of the information. Write to us if you have questions about information you would care to receive. Provide your complete name, address,
and policy number for which you applied.

Within thirty (30) business days of receipt of your request, you will be informed in writing of the nature and substance of locatable and retrievable
recorded personal information about you contained in our files. In addition, you will be provided the name and address of any consumer-reporting
agency that prepared a report about you so that you can contact them to request a copy.

Following the review of your personal information contained in our file, you may write to us if you believe that any information should be corrected,
amended or deleted. Include a narrative, summarizing what you think is incorrect and why. Within thirty (30) business days, the files will either be
corrected, or you will be provided with the reasons in writing explaining why the file was not changed. If we do not make the changes, you will
have the right to insert in our file a concise statement containing what you believe to be the correct, relevant, or fair information and explaining
why you believe the information in your file is improper. We will notify persons or organizations designated by you to whom we have previously
disclosed the information of the change or your statement. Subsequent disclosures to any other persons or organizations will include a copy of
your statement.

How do we protect the confidentiality of information about you?

We maintain appropriate security standards and procedures to prevent unauthorized access to your information in whatever medium it is stored.
We limit employee access to personally identifiable information to those with a business reason for knowing such information. We believe in
educating our employees so that they will understand the importance of confidentiality of personal information, and in taking appropriate measures
to enforce employee privacy responsibilities.

2 SIGO.PRIV 01/21