COLORADO

INSURANCE IDENTIFICATION CARD

Valid in U.S. and Canada
This Card Must Be Shown To Any Law Enforcement Officer Upon Request
BRISTOL WEST INSURANCE COMPANY NAIC #19658
PO BOX 31029 INDEPENDENCE, OH 44131-0029 Underwritten By: Bristol West Insurance Company
POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE
G01 1622777 00 05/02/2024 11/02/2024 Examine policy exclusions carefully. This form does not constitute any part
of your insurance policy.
INSURED Not Valid More than One Year from Effective Date
TAI NGUYEN
470 S IRVING ST
DENVER CO 80219

PRODUCER PHONE: 833-445-3779

0596778
JERRY INSURANCE AGENCY LLC
430 SHERMAN AVE STE 305
PALO ALTO CA 94306-1854
In the event of a loss, you can submit your loss information
YEAR MAKE/MODEL. 24/7 at www.BristolWest.com or call us Toll-Free during business hours at
2010 HONDA ACCORD EX 1-800-274-7865
SEE IMPORTANT MESSAGE
VEHICLE IDENTIFICATION NO ON REVERSE SIDE For policy information or billing go to www.BristolWest.com
1HGCP2F81AA005271
COID00001 (03/04)

COLORADO
INSURANCE IDENTIFICATION CARD
Valid in U.S. and Canada
This Card Must Be Shown To Any Law Enforcement Officer Upon Request
BRISTOL WEST INSURANCE COMPANY NAIC #19658
PO BOX 31029 INDEPENDENCE, OH 44131-0029 Underwritten By: Bristol West Insurance Company
POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE
G01 1622777 00 05/02/2024 11/02/2024 Examine policy exclusions carefully. This form does not constitute any part
of your insurance policy.
INSURED Not Valid More than One Year from Effective Date
TAI NGUYEN
470 S IRVING ST
DENVER CO 80219

PRODUCER PHONE: 833-445-3779

JERRY INSURANCE AGENCY LLC
0596778
430 SHERMAN AVE STE 305
PALO ALTO CA 94306-1854

YEAR MAKE/MODEL In the event of a loss, you can submit your loss information
2010 HONDA ACCORD EX 24/7 at www.BristolWest.com or call us Toll-Free during business hours at
VEHICLE IDENTIFICATION NO 1-800-274-7865
SEE IMPORTANT MESSAGE
1HGCP2F81AA005271 ON REVERSE SIDE
COID00001 (03/04) For policy information or billing go to www.BristolWest.com
 ~ BRISTOL WEST'
. , I N SU RA N CE GROUP

PERSONAL AUTO DECLARATION

Underwritten by: Bristol West Insurance Compa nv
PO BOX 31029 POLICY NUMBER Policy Period
INDEPENDEN CE, OH 441 31-0029 From To
1-888-888-0080
Inquire or pay you r bill online using www.bristolwest.com
G01 2007663 00 07/22/2022 later of 12:01 a.m. or time 01/22/2023 12:01a.m. '
application is executed

•unless cancelled sooner for valid reasons.

Named Insured: 0590111
JOLYN K FURLEY SERENITY GROUP INC
4112 W 105TH WAY PO BOX 2205
WESTMINSTER CO 80031-1902 SPOKANE WA 99210-2205
Telephone: 877-215-4610

POLICY PREMIUM TOTAL $545.00

(includes $25.00 ro r Policy Fee)
Transaction Description
POLICY DECLARATION
Drivers
Drivers on Policy Rated SR22 Birth Mar Sex
JOLYN K FURLE Y Rated No 1974 s F
Forms and Endorsements
CO BNO -001 (03/08) 40154 (08/ 13) 49205 (01 / 12) 40227 (09/ 16) CO BNO-002 (09/ 15) CO-PCE-01 (07/ 17)

Vehicle 1 PREMIUM $520.00

Year/ Make/ Model: Broad Form Vehicle Use: Pl easure
Vehicle Identification#: N/A
Discounts: Preferred Driver Discount, Go Paperless
Garaging Location: Same
Loss Payee: N/A
Additional Interest: N/A
Mandatory Per Person Per Accident Deductible Premium
Coverage Limit Limit
BODILY INJURY LI ABILITY y 25,000 50,000 206.00
PROPERTY DAMAG E LIABILITY y 15,000 314.00
MEDI CAL PAY MENTS y Rejected
UNINSURED/UNDE RINSURED MOTORI ST BODILY N Rejected
INJURY

APVDEC (04/14) Issued Date: 07/22/2022 INSURED Authorized Signature

Page 1 of 6
Colorado Personal Auto Policy Endorsement - Broad Form Named Operator Medical Payments Endorsement

Please be aware of the following changes to your policy, specifically the Broad Form Named Operator Endorsement (CO BNO-001
03/08)

The definition of Insured Person as defined in the Broad Form Named Operator Endorsement referenced above, under PART B -
MEDICAL PAYME NTS COVERAGE , is deleted and replaced with the fol lowi ng:

As used in this Part, insured means: You while occupying, or when struck by, a car or trailer. Insured also includes any
passenger occupying a car operated by you .

This endorsement is a part of the policy. It changes the policy so please read it carefully. All other terms , conditions , limits
and provisions of this policy remain unchanged.

CO-BNO-002 (09/15)
Additional Fee Information

In addition to the "Fees" identified in the "Policy Premium Total" section above, the fol lowing additional fees also apply:

In consideration of our agreement to allow you to pay in installments, the following service fee(s) wi ll apply:
For the Monthly Recurring Electronic Funds Transfer (EFT) billing option, a service fee of $7.00 per installment is
applied.
For all Non-EFT payment plans, a service charge of $12.00 per installment is applied.

In addition, the following fees also apply:

LATE FEE: $10.00 (applied per policy term and each renewal policy for any payment that is not postmarked by the
scheduled due date)
NSF/ RETURNED PAYMENT CHARGE : $25.00 (applied per each check , electronic transaction or other remittance
which is not honored by your financial institution for any reason including but not limited to insufficient funds or a
closed account)
REINSTATEMENT/LAPSE FEE : $20.00 (applied per policy when the Company reinstates the policy for any reason)
UNINSURED/UNDERINSURED MOTORI ST BODILY INJURY REJECTION/SELECTI ON FEE : $ 10.00 (applied per
policy when you reject Uninsured/Underinsured Motorist Bodily Injury Coverage or you select an
Uninsured/Underinsured Motorist Bodily Injury Limit lower than the Bodily Injury Limit)
EXCLUDED DRIVER FEE : $10.00 (applied per policy when there is an Excluded Driver listed on the policy.)

LOSS PAYEE/ADD ITION AL INTEREST FEE: $3.00 (applied per policy when there is a Loss Payee or Additional
Interest listed on the policy.)
PAPER DOCUMENTS FEE : $25.00 (applied per policy when paper documents are sent instead of receiving
electronic documents through our Go Paperless feature)
One or more of the fees or charges described above may be deemed a part of premium under applicable state law.

A PVDEC (04/14)

Page 3 of 6
Colorado Personal Auto Policy Endorsement

Please be aware of the following changes to your policy:

The following definitions are added to your policy:

Commercial Ridesharing Program means an arrangement or activity through which persons or property are transported
for compensation , regardless of the amount or form of compensation charged or paid and includes the time:

1. Commencing when a driver of a car is available to accept transportation requests for passengers or property for
compensation;

2. Between the driver accepting a transportation request and the passengers or property entering into or bein g loaded upon
the auto used for this request;

3. Passengers or property are in or upon the auto used for this request ; and

4. Between the passengers or property exiting or unloadi ng from the car and the driver is no longer available to accept
transportation req uests;

Personal vehicle sharing means the use of private passenger cars, utility cars, or utili ty trailers by any person other than
their owner, in connection with a personal vehicle sharing program .

Personal vehicle sharing program means a legal entity engaged in the business of faci litating the sharing of private
passenger cars, utility cars, or utili ty trai lers for noncomm ercial use by individuals within the state.

The definition of non-owned auto (definition K) is removed in its entirety and replaced with the following definition:

K. Non-owned auto means any private passenger auto, pickup, van or trailer not owned by or furnished or available for
the regular use of you or any family member while in the custody of, or being operated by, you or any family
member. Non-owned auto includes a rental vehicle only if the following conditions are met:
1. The rental vehicle is not owned by or furn ished or available for the regular use of you or any family member;
2. The rental vehicle is operated within the United States, its territories or possessions, and Canada;
3. The rental vehicle is a private passenger automobile and not a motor home, camper, travel trailer, LI-Haul type
moving truck , or customized van;
4. The rental vehicle is owned by a person engaged in business of renting or leasing vehicles rented or leased
without a driver to persons other than the owner and is registered in the name of such owner; and
5. The rental vehicle is rented under a rental agreement with a term no longer than thirty consecutive days.
Non-owned auto does not in clude a vehicle that is not in the lawful possession of the person operating it.

Th e following paragraph is added to the definition of insured under PART A - LIABI LITY COVERAG E:

Insured does not mean:

Any person whil e operating, occupying or usi ng any auto that is available for hire or whi le usi ng any auto that is part of a
Personal Vehicle Sharing Program , Commercial Ridesharing Program or similar arrangement.

The following Exclusion is added to PART A - LI AB ILITY COVERAGE:

We do not insure bodily injury or property damage for any accident that occu rs whil e your covered auto or any auto is
being used in a Personal Vehicle Sharing Program, a Commercial Ridesharing Program or a similar arrangement.

Th e OTHER INSURANCE provision under PART A - LI ABILITY COVERAGE is removed in its entirety and replaced with the
following:

If there is any other appl icable liability insurance or bond, any liability insurance we provide will be excess over that other
appl icable liability insurance or bond. If more than one liability insurance policy or bond appl ies on an excess basis, we will
pay only our share of the damages. Our share is the proportion that our lim it of liability bears to the total of all applicable
limits.

If any applicable insurance other than this policy is issued to you by us or any member company of the Farmers Insurance
Group of Companies, the total amount payable among all such policies shall not exceed the limits provided by the single
policy with the highest limits of liability.

Th e following paragraph is added to the definition of insured under PART B • MEDI CAL PAYM ENTS COVERAGE:

Insured does not mean:

Any person whil e operating any auto that is available for hire or whi le using any auto that is part of a Personal Vehicle
Sharing Program , Commercial Ridesharing Program or similar arrangement.
Provision B under PART B - MEDICAL PAYMENTS COVERAGE - LIMIT OF LIABILTY has been removed in its entirety and replaced
wi th th e following:

B. No one will be entitled to receive duplicate payments for the same elements of loss under Part B of this policy and Part A
of this policy.

The following exclusion is added to PART B - MEDICAL PAYMENTS COVERAGE:

We do not provide Medical Payments Coverage for any insured person for bodily injury for any accident that occurs while
your covered auto or any auto is being used in a Personal Vehicle Sharing Program , a Commercial Ridesharing
Program or a similar arrangement.

The following paragraph is added to the definition of insured under PART C - UNINSURED/ UNDERINSURED MOTORISTS
COVERAG E:

Insured does not mean:

Any person whi le operating any auto that is available for hire or while using any auto that is part of a Personal Vehicle
Sharing Program , Commercial Ridesharing Program or similar arrangement.

Provision C under PART C - UNINSURED/ UNDERIN SURED MOTORISTS COVERAG E - LI MIT(S) OF LIAB ILITY has been removed
in its entirety and replaced with the following:

C. No one will be entitled to receive duplicate payments for the same elements of loss under Uninsured Motorists Bodily
Injury Coverage and Part A of this policy.

The following exclusion is added to PART C - UNINSURED/UNDERINSURED MOTORISTS COVERAGE:

We do not provide coverage under Part C for any insured person for bodily injury or property damage for any accident
that occu rs whi le your covered auto or any auto is being used in a Personal Vehicle Sharing Program , a Commercial
Ridesharing Program or a simi lar arrangement.

The OTHER INSURANCE provision under PART C - UNINSURED/ UNDERINSURED MOTORISTS COVERAGE is removed in its
entirety and replaced with the following:

The Uninsured/ Underinsured Motorist Coverage provided by this policy is excess over any other collectible uninsured
motorist insurance coverage provided by any other policy which applies to the same accident.

The following exclusion is added to PART D - DAMAGE TO YO UR AUTO:

We do not provide coverage under Part D while your covered auto or any non-owned auto is being used in a Personal
Vehicle Sharing Program , a Commercial Ridesharing Program or a sim ilar arrangement.

Exclusion T under PART D - COVERAG E FOR DAMAGE TO YOUR AUTO has been removed in its entirety and replaced with the
following:

T. Collision under this policy if any vehicle is being operated by any person not listed on the application , Declarations or
policy, who has either never been licensed or who has had their license revoked , regardless of where that person resides.

The following is added to the LI MI T OF LI ABILITY under PART D - DAMAGE TO YOUR AUTO:

If your covered auto is disabled due to loss insured under this policy, we will pay reasonable costs to transport it from the
place of loss. We will pay reasonable and necessary storage charges for protection of your covered auto, but you must
allow us to move your covered auto to a storage location of our choice at our expense, consistent with appli cable law. If
you do not allow us to move your covered auto, then we wi ll pay only the lower storage costs that would have resulted if
we had moved your covered auto.

The following condition is added to the GENERAL PROVISIONS of your policy:

You must disclose to us your participation, as either a driver or vehicle owner, in any Personal Vehicle Sharing Program ,
Commercial Ridesharing Program , or other simi lar arrangement. Failu re to do so may result in the rescission ,
cancellation or nonrenewal of your policy.

This endorsement is a part of the policy. It changes the policy so please read it carefully. All other terms , conditions , limits
and provisions of this policy remain unchanged.

CO-PCE-01 (07/17)
Colorado Personal Auto Policy Endorsement - Liability Household Member Exclusion

Please be aware of the following change to your policy:

Excl usion 11 under PART A• LIABILITY COVER AG E has been removed in its entirety and replaced with the following:

11. For bodily injury or property damage sustained by a person who is a member of the same household as the insured
against whom the claim is made.

This endorsement is a part of the policy. It changes the policy so please read it carefully. All other terms , conditions , limits
and provisions of this policy remain unchanged.

40227 (09/16)
Colorado Personal Auto Policy Endorsement - Civil Union Partner Endorsement

Please be aware of the following changes to your policy:

DEFINITIONS

The definition of you and your is deleted and replaced with the following :

A. Throughout this policy, you and your refer to:

1. The named insured on your Declarations Page; and
2. A named insured's spouse or civi l union partner recognized by Colorado law. A spouse or civi l union partner
must be a resident of the named insured's household during the policy period.

The definition of Family member is deleted and replaced with the following:

H. Family Member means a person related to you by blood , marriage, civil union, or adoption. A family member must
be a resident of your household. This includes a ward or foster child. A Family member includes your unmarried
dependent chi ldren living temporarily away from home.

The definition of Non-owned auto is deleted and replaced with the following :

K. Non-owned auto means any auto that is not owned by you , a family member, or the named insured 's non-resident
spouse or civil union partner, and not furnished or avai lable for the regular use of you or any family member, while in
the custody of or being operated by you or any family member. Non-owned auto includes a rental vehicle, only if:
1. The vehicle is not owned by or furnished or available for the regular use of you or any family member;
2. The vehicle is operated within the United States, its territories or possessions and Canada ;
3. The vehicle is a private passenger automobile and not a motor home, camper, travel trailer, or customized van;
4. The vehicle is owned by a person engaged in the business of renting or leasing; and
5. The vehicle is rented under a rental agreement. The term must be no longer than 30 consecutive days.

EXCLUSIONS THAT APPLY TO PART D- COVERAGE FOR DAMAGE TO YOUR AUTO

Subsection K(1 ) is deleted and replaced with the following :

1. Sustains the loss as the result of family violence by:

a. You ;
b. A family member;
c. A former spouse or civil union partner; or
d. Any person who resides in or has resided in your household.

GENERAL PROVISIONS

TRANSFER OF YOUR INTEREST IN THIS POLICY

Subsection A(1) is deleted and replaced with the following :

1. The surviving spouse or civil union partner if a resident of your household at the time of death. Coverage
applies to the spouse or civil union partner as if shown as a named insured on your Declarations page ; and

All other terms , conditions, limits and provisions of this policy remain unchanged.

40154 (08/ 13)

 Colorado private passenger automobile insurance

SUMMARY DISCLOSURE FORM

Thi s summary disclosure form is a basic guide to the major coverages and exclusions in you r policy. It is a general description. It is not
a policy of any kind . All coverage is subject to the terms, conditions , and exclusions of your policy and all applicable endorsements.

PLEASE READ YOUR POLICY FOR COMPLETE DETAILS. THIS SUMMARY DISCLOSURE FORM SHALL NOT BE CONSTRUED
TO REPLACE ANY PROVISION OF THE POLICY ITSELF.

Complete details include, but are not limited to, information on the method we use to calculate your unearned premium (e.g. , pro rata or
short rate) , if you should cancel your pol icy before the next renewal. This summary disclosu re form also provides some of the factors
considered for cancellation , nonrenewal and increase-in-premium . These factors are general in nature. They do not represent the only
reasons a policy may be cancelled or changed. Please contact us or your agent for further information .

Unless you have purchased the appropriate endorsement, you r policy excludes coverage for livery conveyance. If you are a driver for a
transportation network company please verify you have purchased appropriate coverage.

I. REQUIRED COVERAGE - Liability

Colorado law requi res you to have liability coverage on your automobile. This coverage pays bodily injury to another person and
property damage to another's property that are the result of an accident in which you are found to be at fault.

Coverage is not provided for any automobi le owned by you or a resident relative that is not insured for liability under your
policy. There is no coverage for intentional acts.

Please read you r policy for other conditions and exclusions.

II. OTHER COVERAGES

A. Uninsured and Underinsured Motorist Coverage

Uninsured and underinsured motorist coverage wi ll be included in you r policy unless you reject it in writing .

Uninsured Motorist coverage pays for your bodi ly injury damages that are the result of a not at fault accident with an uninsured
or hit and run driver.

Underinsured Motorist coverage pays for your bodily injury damages that are the result of a not at fault accident with an
underinsured driver. A motorist is considered underinsured if his or her liability coverage is not enough to pay the full amount
you are legally allowed to recover as damages.

Please read your policy for other conditions and exclusions.

B. Physical Damage Coverage - Collision and Comprehensive

You must be offered collision coverage.

Collision coverage pays for damage to your own automobile when it collides with another automobi le or object. It also pays if
you r automobi le overturns.

Comprehensive coverage pays for damage to your automobile from causes such as fire , theft , vandal ism , hail , and falling
objects.

Collision and comprehensive coverage may be written with a deductible. A deductible is that part of a loss you wi ll pay. We will
pay th e balance of covered repairs subject to your policy provisions. A lender may require you purchase both collision and
comprehensive coverage.

Coverage does not apply to losses that occu r while your automobile is rented or leased to others. There is no coverage for
wear, tear, freezing, mechanical failu re or breakdown, or road damage to tires.

Please read you r policy for other conditions and exclusions.

CO SD001 (04/18)
 C. Medical Payments Coverage

Medical payments coverage of $5,000 will be included in you r policy unless you reject it. You may reject the coverage in
writing or in th e same method in which you applied for the policy.

Medical payments coverage is not required to be offered on motorcycles , low-power scooters, off-road vehicles or other
miscell aneous vehicles.

Medical payments coverage pays for you and your passengers reasonable health ca re expenses incurred for bodily injury
caused by an automobi le accident.

If you are in an automobile accident, your medical payments coverage will pay before your health insurance coverage.

Medical payments coverage wi ll apply toward health coverage coinsurance or deductible amounts.

We must prioritize the payment of your benefits in a manner consistent with Colorado insurance law.

Injuries to you that are the result of an at-fault accident wi ll not be paid, un der an automobile insurance policy, unless
medical payments coverage is purchased.

Pl ease read your policy for other conditions and exclusions.

D. Uninsured Motorist Physical Damage

This coverage pays for damages to your automobile caused by an at-fault owner of an uninsured automobile.

This is an optional coverage you can request if you do not have collision coverage on you r automobile.

This coverage will not apply if the automobiles do not make physical contact.

This coverage only pays actual cash value of you r automobile or cost of repair or replacement, whichever is less.

Pl ease read your policy for other conditions and exclusions.

Ill. CANCELLATION , NONRENEWAL AND INCREASE IN PREMIUM

A. Cancellation

During the first 59 days we may cancel you r policy for any reason not prohibited by law. After you r pol icy has
been in effect for more than 59 days, we may cancel you r policy for any of the following reasons:

1. Nonpayment of policy prem ium ; or

2. Knowingly making a false statement on your application for automobi le insurance; or

3. A driver's license suspension or revocation; or

4. Knowing and willfully making a false material statement on a claim under the pol icy.

B. Nonrenewal

We may choose to non -renew your policy. Some examples of reasons for nonrenewal include, but are not limited to:

1. An unacceptable number of traffic convictions;

2. An unacceptable number of at-fault accidents; or

3. Conviction of a major violation such as drunk driving or reckless driving.

CO SD001 (04/18)
 C. Increase in Premium

We may increase your premiums. Some examples for increased premium include, but are not limited to:

1. Change of garage location of the automobile;

2. Change of automobile(s) insured;

3. Addition of a driver;

4. Change in use of your automobile;

5. A general rate increase. Thi s results from the loss experience of a large group of policyholders rather than from a
single policyholder. A general rate increase applies to everyone in the group, not just those who had a loss.

The above li st of reasons is not all inclusive. There may be other changes that result in an increased premium.

We may add a surcharge or remove a discount because of an at-fault accident or traffic conviction. Under this
circumstance you will receive a notice of your statutory right to file a complaint with the Colorado Division of Insurance.

CO S0001 (04/18)
How the Determination of Fault in an Automobile Accident affects the Applicability of Coverage.

A. Regarding Bodily Injury and Property Damage Liability coverage, we pay damages for which any insured person is
legally liable because of bodi ly injury to any person and property damage arising out of the ownership, maintenance or
use of a private passenger car, a utility car, or a utility trailer. A determination that an insured person is at fault does not
affect coverage.

B. Regarding Medical Expense coverage, we pay reasonable and customary expense for necessary medical services
furnished within two years from the date of the accident, because of bodily injury sustained by an insured person. A
determination that an insured person is at fault does not affect coverage.

C. Regarding Uninsured Motorists• Bl coverage, we pay all sums which an insured person is legally entitled to recover
as damages from the owner or operator of an uninsured motor vehicle because of bodily injury sustained by the insured
person. The bodily injury must be caused by accident and arise out of the ownership, maintenance or use of the
uninsured motor vehicle. A determination that an insured person is at fault does not affect coverage, but may affect the
amount of benefit to which the insured person is entitled.

Regarding Uninsured Motorists• PD, we will pay damages for property damage to your insured car or your insured
motorcycle, which an insured person is legally entitled to recover from the owner or operator of an uninsured motor
vehicle. A determination that an insured person is at fault does not affect coverage, but may affect the amount of benefit
to which the insured person is entitled.

D. Regarding Damage to your Auto - Collision Loss, we will pay for loss to your insured car caused by collision less any
applicable deductibles. A determination that an insured person is at fault does not affect coverage.

Regarding Damage to your Auto - Other than Collision Loss, we will pay for loss to your insured car caused by an
accidental means except collision , less any applicable deductibles. A determination that an insured person is at fault
does not affect coverage.

Regarding Towing and Labor, we will pay for reasonable and necessary towing and labor costs incurred because of
disablement of your insured car. A determination that an insured person is at fault does not affect coverage

W hen shopping for auto insurance, compare coverage, premium and service. Should you have any questions about this
notice, or any other products, please do not hesitate to contact your agent or producer.
 ~ BRISTOL WEST'
. , I N SU RA N CE GROUP

Underwritten by: Bristol West Insurance Company

Go Paperless Customer Summary

Please complete the following steps:

1. Open the authentication e-mail sent to you by Bristol West Auto and click on the authentication link.

2. Log in and register on www. BristolWest.com using you r policy number - G01 2007663 00.

3. Click and accept the Terms and Conditions for Go Paperless.

E-mail address: jolynfurley@gmail.com

Please ensure that your e-mail account has sufficient space for new e-mails and that your e-mail server and
spam -blocking software do not block our e-mails.

If you do not authenticate, you will receive paper documents and the Paper Documents fee will apply.

If you have additional questions, please review the Go Paperless Frequency Asked Questions (FAQ) document
wh ich can be found by logging into your account at www. BristolWest.com.

With Go Paperless, you can :

• Access any of your policy documents 24/7 at www. BristolWest.com
Print your insurance ID cards when you need them.
Save electronic copies of you r policy documents to your computer.

GP-001 (03/13)
 COLORADO
INSURANCE IDENTIFICATION CARD
Valid in U.S. and Canada ~ BRISTOL WEST
This Card Must Be Shown To Any Law Enforcement Officer Upon Request . . , I N SU RANCE GROUP
BRISTOL WEST INSURANCE COMPANY NAIC #19658
PO BOX 3 1029 INDEPENDENCE , OH 44131-0029 Underwritten By: Bristol West Insurance Company
POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE
G01 2007663 00 07/22/2022 01/22/2023 Examine policy exclusions carefully. T his form does not constitu te any part
of your insurance policy.
INSURED Not Valid More than One Year rrom Effective Date
JOLYN K FURLEY
411 2W 105TH WAY
WESTMI NSTER CO 80031-1902

PRODUCER 0590111 PHONE: 877-215-4610

SEREN ITY GROUP INC
PO BOX2205
SPOKANE WA 99210-2205
In the event of a loss , you can submit your loss information
YEAR MAKE/MODEL 24ll at www.BristolWest.com or call us T oll-Free during business hours at
N/A Broad Form 1-800-274-7865
VEHICLE IDENTIFICATION NO SEE IMPORTANT MESSAGE
Broad Form ON REVERSE SIDE For policy information or billing go to www.BristolWest.com
COID00001 (03104)
Owner/Operator Policy

COLORADO
INSURANCE IDENTIFICATION CARD
Valid in U.S. and Canada
.......
- •◄ BRISTOL WEST
Thi s Card Must Be Shown To Any Law Enforcement Officer Upon Request . . , I N SU RANCE GROUP
BRISTOL WEST INSURANCE COMPA NY NAIC # 19658
PO BOX 31029 INDEPENDENCE, OH 44131-0029 Underwritten By: Bristol West Insurance Company
POLIC Y NUMBER EFFECTIVE DATE EXPIRATION DATE
G01 2007663 00 07/22/2022 01/22/2023 Examine policy exclusions caref ully. This form does not constitute any part
of your insurance policy.
INSURED Not Valid M:!re than One Year lrom Effective Date
JOLYN K FURLEY
4112 W 105TH WAY
WEST MINSTER CO 80031-1902

PRODUCER 05901 11 PHONE : 877-215-4610

SEREN ITY GROUP INC
PO BOX2205
SPOKAN E WA 99210-2205

YEAR MAKE/MODEL In the event of a loss, you can submit your loss information
N/A Broad Form 24ll at www.BristolWest.com or call us Toll-Free during business hours at
1-800-274-7865
VEHICLE IDENTIFICATION NO SEE IMPORTANT MESSAGE
Broad Form ON REVERSE SIDE
For policy information or billing go to www.BristolWest.com
COID00001 (03104)
Owner/Operator Policy

Guck
 ~ BRISTOL WEST
" I N SURANCE GROUP

Underwritten by: Bristol West Insurance Company

Notice of Underwriting Decision & Information Practices

Dear BRISTOL W EST IN SURANC E COM PANY Customer ,
In addition to the information provided to us by you when you applied for insu rance, we have collected consumer reports in
connection with your insurance transaction with us, which may include driver history, credit reports, credit scores, or personal or
privi leged information obtained from the following consumer reporting agencies:
Driver History Report:
LexisNexis Risk Solutions
C. L.U .E . National Service Center
P.O. Box 105108
Atlanta, GA 30348-5108
1-800-456-6004
A·PLUS Consumer Inqui ry Center
P. O. Box 5404, Suite 300
Mt. Laurel , NJ 08054-5404
Telephone: 1-800-709-8842
Fax: 1-201-469-4140
Credit Report:
Equifax Information Services
P.O. Box 740241
Atlanta , GA 30374
1-800-685-1111
www.eauifax.com/ fcra

In certain circu m stances, the information contained in consumer reports , and other personal or privileged information subsequently
collected by us, may be legally disclosed to third parties without your consent.
We have used this information to underwrite and/or rate your insurance, and any rate increase or other adverse underwriting
decision may be attributable, in part , to our use of this information. W ith respect to you r driving history, please see the Accident
and Violation Disclosure page if one is included with these policy documents. No consumer-reporting agency m ade any decision to
take any adverse action against you regarding your insurance transaction with us. Therefore, no consumer-reporting agency will be
able to provide you with the specific reason why any action was taken.
Your credit score was one of the factors used to determ ine your insurance rate. If you receive this notice as a new policyholder , it is
to inform you that your credit score, as reported by the consumer-reporting agency, was less than the score required to receive our
lowest avai lable rate. If you receive this notice upon renewal of you r policy, it means that either a new or previous credit score was
used, in part , to determine your current rate, which was less than the score required to receive our lowest available rate. At the time
you r credit score was reported to us, your score was most impacted by the following items.
043-Number of Months Since Oldest Credit Card was Opened = 58-87: Best Possible is 223+
120-Age of Newest Trade Opened With in 58 Months= 4-9: Best Possible is 37+
062-Utilization of all Open Accounts= 27%-40%: Best Possible is 1%- 13%
129-Utilization of Open Credit Card Accounts= 53%-69%: Best Possible is 1%-8%
At your request, we will (1) provide you m ore detai led information regarding ou r collection , use, and disclosure of personal
information, and you r rights to access and correct such information ; and (2) identify any third parties to whom we may have
disclosed this information. You may contact us by calling us at 1-888-888-0080. Upon your request , we will provide you a more
detail ed notice regarding our information practices.
You have the right to: (1) obtain information regarding the nature and substance of recorded personal information about you ; (2)
access this information; (3) dispute the accu racy of completeness and request the correction of this information ; and (4) file a
statement setting forth what you think is the correct information, and why you disagree with any refusal to correct the information.
Also , for 60 days after you receive this notice, you may obtain a free copy of any consumer report resulting in any adverse action.
T o exercise any of these rights , simply call us or the appropriate consumer reporting agency identified above. W e will also, at your
request, once per policy term , re-order your credit report and adjust our underwriting at renewal to refl ect any change in credit
score.

Rev . 1 212007
IP-00001 (12/07)
Privacy Policy
This notice describes our privacy policies and procedures in safeguarding information about customers and
former customers that obtain financial products or services for personal, family or household purposes. Please
note that if state law is more protective of an individual's privacy than federal privacy law, we will
protect information in accordance with state law while also meeting federal requirements.

Information We Collect
We may collect the following categories of information for the purposes identified below. Please note that the
examples are not an exhaustive list and may fall into multiple categories. Categories and specific pieces of
information collected may vary depending on the nature of your relationship with us.

~ategory Purpose of Use What may be included !Some examples

n this category

nternal Authenticate your identity; Knowledge and Belief , Passwords, PIN , mother's
create , maintain and secure Authenticating , maiden name , individual
vour account with us; Preference nterests
maintain your preferences.

Historical Complete a transaction or Personal history Past claims, prior insurance

provide a service for which arriers , prior addresses,
he personal information was medical history, criminal history
ollected ; conduct analytics
and modeling .

Financial Process your billing ; make
payments; complete a
ransaction or provide a
service for which the
personal information was
ollected.
Account, Ownership , K;redit card number, bank
Transactional, Credit account, records of real or
Personal property, credit,
ncome , loan records , taxes

~xternal dentify information to verify Identifying, Ethnicity, Name, username, government

you ; complete a transaction
or provide a service for which
he personal information was
collected ; deliver product
offerings that may be
elevant to you ; conduct
analytics.
Gender, Demographic, ssued identification, social
Medical and Health, ~ecurity number, gender,
Physical Characteristics J:>rowsing behavior, age range ,
ncome bracket, physical and
mental health, medical records

$ocial Establish your Professional , Criminal , I.Job titles, work history, school
ommunication preferences; Public Life, Family, ~ttended , convictions, charges ,
complete a transaction or Social Network, marital and family status, email ,
provide a service for which Communication elephone recordings
he personal information was
ollected ; process your
policy, account or claim.

Ifracking Contact you ; provide Computer or Mobile P Address, geolocation , email

elevant information; provide Device, Contact, ~ddress, physical address,
a location-based product or ocation elephone number, country
service requested by you ;
conduct analytics.

PRVN99 (01 /20) Page 1 of 5

We collect certain information ("nonpublic personal information") about you and the members of your household
("you") from the following sources:
• Information you provide on applications or other forms, such as your social security number, assets, income ,
and property information;
• Information about your transactions with us, our affiliates or others, such as your policy coverage, premiums,
and payment history;
• Information from your visits to the websites we operate , use of our mobile sites and applications , use of our
social media sites , and interaction with our online advertisements;
• Information we receive from consumer reporting agencies or insurance support organizations, such as motor
vehicle records, credit report information and insurance claims history; and
• If you obtain a life , long-term care or disability product, information we receive from you , medical
professionals who have provided care to you and insurance support organizations, regarding your health.
How We Protect Your Information
Our customers are our most valued assets. Protecting your privacy is important to us. We restrict access to
personal information to those individuals, such as our employees and agents , who provide you with our
products and services. We require individuals with access to your information to protect it and keep it
confidential. We maintain physical, electronic, and procedural safeguards that comply with applicable regulatory
standards to guard your nonpublic personal information . We do not disclose any nonpublic personal information
about you except as described in this notice or as otherwise required or permitted by applicable law.
Information We Disclose
We may disclose the nonpublic personal information we collect about you , as described above , to our affiliates ,
to companies that perform marketing services on our behalf or to other financial institutions with which we have
joint marketing agreements, and to other third parties , all as permitted by law and for our everyday business
purposes, such as to process your transactions and maintain your accounts and insurance policies. Many
employers, benefit plans or plan sponsors restrict the information that can be shared about their employees or
members by companies that provide them with products or services. If you have a relationship with Farmers or
one of its affiliates as a result of products or services provided through an employer, benefit plan or plan
sponsor, we will follow the privacy restrictions of that organization.
We are permitted to disclose personal health information:
(1) to process your transaction with us, for instance, to determine eligibility for coverage, to process claims or to
prevent fraud ;
(2) with your written authorization , and
(3) otherwise as permitted by law.
When you are no longer our customer, we continue to share your information as described in this notice.

PRVN99 (01 /20) Page 2 of 5

Sharing Information with Affiliates

The Farmers Insurance Group® of Companies includes affiliates that offer a variety of financial products and
services in addition to insurance. Sharing information enables our affiliates to offer you a more complete
range of products and services.
We may disclose nonpublic personal information, as described above in Information We Collect, as
permitted by law to our affiliates, which include:
• Financial service providers such as insurance companies and reciprocals, investment companies,
underwriters and brokers/dealers.
• Non-financial service providers , such as data processors, billing companies and vendors that provide
marketing services for us.
We are permitted by law to share with our affiliates information about our transactions and experiences with
you. In addition, we may share with our affiliates consumer report information, such as information from credit
reports and certain application information, received from you and from third parties, such as consumer
reporting agencies and insurance support organizations.

IMPORTANT PRIVACY CHOICES

You have choices about the sharing of some information with certain parties. These choices may differ based
on the particular affiliate(s) with which you do business.
For 21st Century customers: We are offering you an Opt-Out opportunity which is provided on the Opt-Out
Form provided with your policy documents. If you prefer that we not share your consumer report information
with Farmers you may opt-out of such disclosures that is, you may direct us not to make those disclosu re s
--other than as otherwise permitted by law. You may do so by following the procedure explained in the
Opt-Out Form. You may opt-out only by returning the Opt-Out Form. We will implement your request within a
reasonable time. If it is you r decision not to opt-out and to allow sharing of your information with the Farmers
affiliates, you do not need respond in any way.

For Bristol West customers: If you prefer that we not share consumer report information with our affiliates,
except as otherwise permitted by law, you may use the Opt-out form below. Please verify that your Bristol
West policy number is listed. If not, please add the policy numbers on the form and mail to the return address
printed on the form. We will implement your request within a reasonable time after we recei ve it. Any
policyholder may opt-out on behalf of other joint policyholders. An opt-out by any joint policyholder will be
deemed to be an opt-out by all policyholders of the policy. If it is you r decision not to opt-out and to allow
sharing of your information with our affiliates, you do not need to request an Opt-Out or respond to us in any
way.

For Farmers customers: If you prefer that we not share consumer report information with our affiliates, except
as otherwise permitted by law, you may request an Opt-Out Form by calling toll free , 1-800-327-6377 ,
(please have all of your policy numbers available when requesting Opt-Out Forms). A form will be mailed to
your attention. Please verify that all of your Farmers policy numbers are listed. If not, please add the policy
numbers on the form and mail to the return address printed on the form. Any policyholder may opt out on
behalf of other joint policyholders. An opt-out by any joint policyholder will be deemed to be an opt-out by all
policyholders of the policy issued by the affiliates listed on the Farmers Privacy Notice. We will implement
your request within a reasonable time after we recei ve the form.
If you decide not to opt-out or if you have previously submitted a request to opt-out on each of your
policies, no further action is required.

PRVN99 (01 /20) Page 3 of 5

Additionally, under the California Consumer Privacy Act ("CCPA"), California residents have the right to
opt out of the sale of personal information to certain third parties. Although we do not currently share
personal information in a manner that would be considered a sale under CCPA, you may still submit a request
to opt out by calling us at 1-855-327-6548 or submitting a request through our CCPA Web Form at
https://www.farmers.com/california-consumer-privacy/ .

Modifications to our Privacy Policy

We reserve the right to change our privacy practices in the future , which may include sharing nonpublic
personal information about you with other nonaffiliated third parties. Before we make any changes, we will
provide you with a revised privacy notice and give you the opportunity to opt-out of, or, if applicable, to opt-in to
that type of information sharing.

Website and Mobile Privacy Policy

Our Enterprise Privacy Statement includes our website and mobile privacy policies which provides additional
information about website and mobile application use. Please review those notices if you transmit personal
information to us over the Internet through our websites and/or mobile applications.

Recipients of this Notice

While any policyholder may request a copy of this notice, we are providing this notice to the named policyholder
residing at the mailing address to which we send your policy information. If there is more than one policyholder
on a policy, only the named policyholder will receive this notice. You may receive more than one copy of this
notice if you have more than one policy with us. You also may receive notices from affiliates, other than those
listed below.

More Information about these Laws?

This notice is required by applicable federal and state law. For more information, please contact us.

Signed
Farmers Insurance Exchange, Fire Insurance Exchange, Truck Insurance Exchange , Mid-Century Insurance
Company, Farmers Insurance Company, Inc. (A Kansas Corp.), Farmers Insurance Company of Arizona ,
Farmers Insurance Company of Idaho, Farmers Insurance Company of Oregon , Farmers Insurance Company
of Washington, Farmers Insurance of Columbus, Inc. , Farmers Insurance Hawaii, Inc., Farmers New Century
Insurance Company, Farmers Services Insurance Agency, Farmers Specialty Insurance Company, Farmers
Texas County Mutual Insurance Company, Farmers Financial Solutions, LLC (a member of FINRA and SIPC)·,
FFS Holding, LLC , Illinois Farmers Insurance Company, Mid-Century Insurance Company of Texas, Texas
Farmers Insurance Company, Civic Property and Casualty Company, Exact Property and Casualty Company,
and Neighborhood Spirit Property and Casualty Company, American Federation Insurance Company, 21st
Century Advantage Company, 21st Century Assurance Company, 21st Century Auto Insurance Company of
New Jersey, 21st Century Casualty Company, 21st Century Centennial Insurance Company, 21st Century
Indemnity Insurance Company, 21st Century Insurance & Financial Services, Inc. , 21st Century Insurance
Company, 21st Century Insurance Company of Southwest, 21st Century North America Insurance Company,
21st Century Pacific Insurance Company, 21st Century Premier Insurance Company, 21st Century Superior
Insurance Company, Hawaii Insurance Consultants Ltd. , American Pacific Insurance Company, Inc.,

PRVN99 (01/20) Page 4 of 5

Bristol West Casualty Insurance Company, Bristol West Holdings, Inc., Bristol West Insurance
Company, Bristol West Insurance Services of California, Inc. , Bristol West Insurance Services, Inc. of
Florida, Bristol West Preferred Insurance Company, BWIS of Nevada, Inc. ; Coast National Holding
Company, Coast National Insurance Company; Foremost County Mutual Insurance Company,
Foremost Insurance Company Grand Rapids , Michigan, Foremost Lloyds of Texas , Foremost Property
and Casualty Insurance Company, Foremost Signature Insurance Company, and Security National
Insurance Company (Bristol West Specialty Insurance Company in TX).

The above is a list of the affiliates on whose behalf this privacy notice is being provided. It is not a
comprehensive list of all affiliates of the companies comprising the Farmers Insurance Group of
Companies.
*For more background information on Farmers Financial Solutions, LLC ("FFS") or its registered
representatives/Agents , visit FINRA's BrokerCheck at www.finrabrokercheck.com or call the
BrokerCheck toll free hotline at (800) 289-9999. You may obtain information about the Securities
Investor Protection Program (SIPC) including the SIPC brochure by contacting SIPC at (202) 371-8300
or via the internet at www.sipc.org . FFS is registered with the US Securities and Exchange
Commission and the Municipal Securities Rulemaking Board (MSRB). The MSRB website is
accessible at www.msrb .org and includes an Investor Brochure that describes the protections that may
be provided by the MSRB and how to file a complaint with the appropriate regulatory authority.

- - - - - - - - - X -- - - - - - - < . u t h e r e - - - - - - - - X - - - - - - - -

Please do not share consumer report information about me with your affiliates except as
otherwise permitted by law.
Policy Number: G01-2007663-00

Insured:
JOLYN K FURLEY
4112 W 105TH WAY
WESTMINSTER , CO 80031-1902

Mail the opt-out to:

Bristol West Service Operations
C/O Opt Out
PO Box 31029
Independence, Ohio 44131-0029

PRVN99 (01 /20) Page 5 of 5

 ~ BRISTOL WEST
~ I N SU RA N C E GRO U P

Underwritten by:
Bristol West Insurance Company

Transaction Confirmation
Policyholder Copy
Named Insured: JOLYN K FURLEY
Policy Number: G01 2007663 00
Producer: 059011 1 SERENITY GROUP INC

Transaction : New Business

Transaction Date: 07/22/2022
Transaction Time: 1:02 PM EST
Effective Date: 07/22/2022
Effective Time: 1:02 PM EST

Amount Received : $92.74

Payment Type: Debit Card

PRODUCE R NOTE : Do not accept check or cash from the Policyholder. The down payment shown above wi ll be charged against
the policyholder's debit/credit card.

Cut Here

~
-•◄ BRISTOL WEST
~ I N SU RA N C E GRO U P

Underwritten by :
Bristol West Insurance Company

Transaction Confirmation
Producer Copy
Named Insured: JOLYN K FURLEY
Policy Number: G01 2007663 00
Producer: 059011 1 SERENITY GROUP INC

Transaction: New Business

Transaction Date: 07/22/2022
Transaction Time: 1:02 PM EST
Effective Date: 07/22/2022
Effective Time: 1:02 PM EST

Amount Received: $92.74

Payment Type: Debit Card

PRODUCER NOTE: Do not accept check or cash from the Policyholder. The down payment shown above wi ll be charged against
the policyholder's debit/credit card.
 ~ BRISTOL WEST'
"Iii I N SU RANCE GROUP

Underwritten by : Bristol West Insurance Company

PAYMENT SCHEDULE
***Please Keep for Future Reference•••
Named Insured:
JOLYN K FURLE Y SERENITY GROUP INC
41 12W 105TH WAY PO BOX 2205
W ESTMINSTER CO 80031-1902 SPOKANE WA 99210-2205
Producer Telephone: 877-2 15-4610

Policy Number Effective Date Expiration Date Issue Date

G01 2007663 00 07/22/2022 01 /22/2023 07/22/2022
Dear JOLYN K FUR LE Y

The payment plan you selected convenientl y deducts you r monthly payment from your financial institution. Listed below are the due
dates and amounts of you r future payments. Since we do not send out notifications each month, please retain this document for
future reference.

SCHEDULE OF FUTURE AUTOMATIC PAYMENTS

Installment Number Due Date• Amount of Payment .. Method of Payment

Current 07/22/2022 $92.74 Automatic

02 08/22/2022 $99.46 Automatic

03 09/22/2022 $99.46 Automatic

04 10/22/2022 $99.46 Automatic

05 11 /22/2022 $99.46 Automatic

06 12/22/2022 $99.42 Automatic

"Fu nds wi ll be debited from your bank account on or after the payment due date. The debit will appear on your bank statement as
"BRISTOL W EST INS". Please be sure there are sufficient funds in your account.
**Th e payment amount for each installment includes an EFT installment fee of $7.00. The payment amount also includes the
following fees: UM/UI M Rejection/ Selection. If your outstanding policy balance is paid in fu ll prior to the next payment due date, no
EFT installment fees wi ll be charged for the remainder of the policy term .

If you r financial institution does not honor your payment , a $25.00 NSF fee will be charged. If you have any questions, or wish to
discontinue this payment method , please visit our website at www.bristolwest.com or if you prefer, you can contact you r producer at
877·2 15·4610 or Bristol West In surance directly during business hours at 1·888·888·0080. In the event you decide to terminate
this payment method, you mu st advise the Company at least 3 business days prior to the installment due date.
Thank you for your business.

For questions on your policy, please call : 1·888·888·0080

Por favor vea la pr6xima pagina para la informaci6n en Espariol

 ~ BRISTOL WEST'
"Iii I N SU RANCE GROUP

Underwritten by : Bristol West Insurance Company

PLAN DE PAGOS
••• Por Favor Conservese para Futuras Referencias •••
Asegurado:
JOLYN K FURLEY SERENITY GROUP INC
4112 W 105TH WAY PO BOX 2205
WESTM INSTER CO 80031-1902 SPOKANE WA 99210-2205
Telefono: 877-215-461 O
Nllmero de POliza Fecha de lncepci6n Fecha de Expiraci6n Fecha de Envi6
G01 2007663 00 07/2212022 01 /2212023 07/2212022
Estimado (a) JOLYN K FURLEY

Para su conveniencia, con el plan de pago que usted seleccion6 nosotros retiramos los fondos para sus pages mensuales de su
instituci6n financiera . Se enumeran abajo las fechas de vencim iento y las cantidades de sus pages futures . Debido a que nosotros
no enviamos una notificaci6n cada mes, por favor conserve este documento para futuras referencias.

PLAN DE FUTUROS PAGOS AUTOMATICOS

Nllmero del Pago Fecha de Vencimiento• Cantidad del Pago0 Metodo de Pago

Pago Corriente 07/22/2022 $92.74 Automatico

02 08/22/2022 $99.46 Automatico

03 09/22/2022 $99.46 Automatico

04 10/22/2022 $99.46 Automatico

05 11 /22/2022 $99.46 Automatico

06 12122/2022 $99.42 Automatico

"Los fondos se cargaran a su cuenta bancaria en la fecha de vencimiento del pago o despues de dicha fecha. El cargo aparecera
en su estado bancario come "BRISTOL W EST INS". Asegl.Jrese de que haya fondos suficientes en su cuenta.

"" La cantidad del pago de cada plaza incluye una cuota por plazo EFT (transferencia electr6nica de fondos) de $7.00. La cantidad
del pago tambi8n incluye las siguientes cuotas : rechazo/selecci6n de UM/UIM. Si se paga el saldo pendiente de la p6Iiza en su
total idad antes de la fecha de vencimiento del sig uiente pago , nose cobrara n cuotas por plaza EFT durante el resto del periodo de
la p6Iiza.

Si su instituci6n financiera no acepta su pago , se cobrara una cuota NSF (falta de fondos) de $25.00. Si tiene alguna pregunta o
desea suspender este m8todo de page, visite nuestro sitio web en www.bristolwest.com, o si lo prefiere, ll ame a su productor al
877-2 15-4610 o a Bristol W est directamente durante horas h3biles al 1-888-888-0080. En case de que decida suspender este
metodo de pago, debera avisar a la Compafiia un m inima de 3 dias h3biles antes de la fecha de vencim iento del pago del plaza.

Gracias por ser cliente de Bristol W est.

Atentamente,

Bristol West In surance Group

Si tiene preguntas sabre su p6Iiza , llame al: 1-888-888-0080

 ~ BRISTOL WEST'
. , I N SU RA N CE GROUP

Underwritten by:
BRISTOL WEST INSURANCE COMPANY
PO BOX 31029 ACCIDENT AND VIOLATION DISCLOSURE
INDEPENDENCE , O H 44131-0029
Your premium rate is based , in part , on the driving record of the drivers listed on this Policy Number:
policy. The following li sts accidents and/or traffic convictions of these drivers. If you G01 2007663 00
have any questions about you r premium rates, please contact your insurance Named Insured:
producer. Your producer's phone number is: 877-215-4610 JOLYN K FURLEY

JOLYN K FURLEY
Date of Birth: 1974 License State: CO
Li cense Number: 920768066

ACCIDENTN IOLATI ON DATE

Failure to obey device 05/24/2021
Speeding(<= 15 MPH) 04/ 17/2021
Speeding ( <= 15 MPH ) 12/09/2019

As a result of the above driving history, you did not receive our lowest available rate.

POI NTLTR (07/96)