Form_SCTNID_CTGRY.

NY07126489_DECPAGE

928298519 Q IC94549 INS DECPAGE E POLWHITEFONT 2FJL4OBICFB5UCG34HI42MZMNC0001 RPUID TRACWHITEFONT

PROGRESSIVE
P.O. BOX 31260
TAMPA, FL 33631

Policy Number: 928298519

Underwritten by:
Progressive Max Insurance Company
Valued customer since 2019
SANJEEV K JHA
Date of Mailing: September 3, 2019
150-90 87TH RD
JAMAICA, NY 11432 Policy Period: Sep 20, 2019 - Mar 20, 2020
Page 1 of 3

progressive.com
Online Service
Make payments, check billing activity, update

Auto Insurance policy information or check status of a claim.

1-800-776-4737
Coverage Summary For customer service and claims service,
24 hours a day, 7 days a week.
This is your revised Renewal
Declarations Page
Your policy information has changed
The coverages, limits and policy period shown apply only if you pay for this policy to renew.
Your coverage begins on September 20, 2019 at 12:01 a.m. This policy expires on March 20, 2020 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 contract is form 9611D NY (07/17).

Policy changes effective September 20, 2019

………………………………………………………………………………………………………………………………………………………..
Premium change: $35.00
………………………………………………………………………………………………………………………………………………………..
Changes: A Snapshot Driving discount has been removed from the 2008 LEXUS RX 350.

Supplementary Uninsured/Underinsured Motorist: (SUM)

The maximum amount payable under SUM coverage shall be the policy's SUM limits reduced and thus offset by motor
vehicle bodily injury liability insurance policy or bond payments received from, or on behalf of, any negligent party
involved in the accident, as specified in the SUM endorsement.

Drivers and household residents

Age Gender Marital Status
………………………………………………………………………………………………………………………………………………………..
Sanjeev K Jha 45 Male Married
Additional Information: Named insured
………………………………………………………………………………………………………………………………………………………..
Sonalben Acharya 45 Female Married

Form 6489 NY (07/12)

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928298519 Q IC94549 INS DECPAGE E POLWHITEFONT 2FJL4OBICFB5UCG34HI42MZMNC0001 RPUID TRACWHITEFONT

Policy Number: 928298519

Sanjeev K Jha
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Outline of coverage
2008 LEXUS RX 350
VIN 2T2HK31U28C060424
Garaging ZIP Code: 11432
Primary use of the vehicle: Commute
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others
Bodily Injury Liability $25,000 each person/$50,000 each accident $581
Including Supplemental Spousal Liability
Property Damage Liability $10,000 each accident
………………………………………………………………………………………………………………………………………………………..
143
Mandatory Personal Injury Protection $50,000
………………………………………………………………………………………………………………………………………………………..
each person $0 319
Aggregate No-Fault Benefits Available $50,000
Death Benefit $2,000
Maximum Monthly Work Loss $2,000
Other Reasonable & Necessary Expenses (per day) $25
………………………………………………………………………………………………………………………………………………………..
Supplementary Uninsured/Underinsured Motorist $25,000 each person/$50,000 each accident 25
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $1,000 24
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $1,000 156
………………………………………………………………………………………………………………………………………………………..
Subtotal policy premium $1,248.00
………………………………………………………………………………………………………………………………………………………..
Motor vehicle law enforcement fee 5.00
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium and fees $1,253.00

Premium discounts
Vehicle Vin
……………………………………………………………………………………………………………………………………………………….
2008 LEXUS 2T2HK31U28C060424
RX 350
Description Amount Description Amount
……………………………………………………………………………………………………………………………………………………….
Anti-Lock Brakes $6 Anti-Theft $1
Daytime Running Lamps $10 Paperless $67
Continuous Insurance: Silver $11
Please review the Rating Information provided in the Required Information Notice, Form 3072, included with your initial
Auto Insurance Coverage Summary (Declarations Page) or latest renewal declarations page, for a description of discounts
which may be available if you qualify.
Premium surcharges
Vehicle Vin
……………………………………………………………………………………………………………………………………………………….
2008 LEXUS 2T2HK31U28C060424
RX 350
Description Amount
……………………………………………………………………………………………………………………………………………………….
1

Prior Insurance Compliance 1

$177
High Performance $78

Lienholder information
Vehicle Lienholder
………………………………………………………………………………………………………………………………………………………..
2008 LEXUS RX 350 WESTLAKE FIN SVCS
2T2HK31U28C060424 LOS ANGELES, CA 90076

Form 6489 NY (07/12)

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Policy Number: 928298519

Sanjeev K Jha
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New York Motor Vehicle Law Enforcement Fee

The New York Motor Vehicle Law Enforcement Fee is required by law and is used to fund activities relating to the
detection, prosecution, or reduction of auto thefts.

Policy tier
This policy has been assigned to the M8 tier.

Form 6489 NY (07/12) rr 062017, co 07, ac IC-94549