SWAN INSUR*NCE YolrrFrot*thn, . ,- .1,.. r,, , j.,r:: ....1 J...j.,..;.

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AGENCY CORP. e#Fficrttf :
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Date: APRTL 29,2024

Attentioni clo srR SAYAN|

Assured: MOSES JARVIS RUSSELI.CATAN

Subjectr MOTOR CAR INSURANCE PREMIUM qUOTATION
Unit: 2022 FORD EVEREST 4X2 AIT SUv
Plate No.: C5: C3U415

WITH ACTS OF NATURE WITHOUTACTS OF NATURE

Coverage PREMIUM Coverage PREMIUM
200,000.00 C?PL M9.r2 200,000.00 CTPL M9,L2
1.320.000.00 oD/r 17.160.00 1,320,000.00 oD/T 17,160.00
2s0,000.00 EXBI 510.00 250,000.00 EXBI 510.00
2s0.000.00 PD 1,320.00 2s0,000.00 PD 1.320.00
APA (5PAX/5oK APA {5PAX/50K
250,000.00 EACH} 500.00 250,000.00 IACH} 500.00
1.320.000.00 AON 6,600.00

TOTAL PRTMIUM 26,5?9.L2 TOTAL PREMIUM 19,939.12

EVAT 3,184.69 EVAT 2.392.6
LGT 32.11 LGT 24.13
D.stmp 3,317.50 D.Stmp 2,492.5A
Other Charse 97.20 Others 97.20
TOTAL 33,t7O,62 rOTAL 24,945.54

rOTAL 33,L70.62 rOTAL 2a.qns.6a

Period: ONE YEAR {365 DAYS}

Deductible: 3,000.00
InSuIEr: WESTERNGUARANTYCORPORATION
Thank you & Eest regards.

Eva Jane B. Dugos

Marketing Assistant