Safety Insurance AUTO. HOME. BUSINESS

Transcription

1 Safety Insurance AUTO. HOME. BUSINESS Personal Selections Page This Selections Page shows the coverages and discounts for your auto insurance policy issued by Safety Insurance Company. This page, the attached endorsements and the Massachusetts Insurance Policy (2008 edition) form your policy. Your Policy #: Your ITEM 2. Policy Effective Dates: (12:01 A.M. Eastern Standard Time) ITEM 1. Policy Issued to: Your Agent: Agent Code ITEM 3. The following auto(s) are covered by this insurance policy: 1: 2: Policy Level s (These discounts apply to your entire policy.) Account Credit Other Carrier Credit I Group I Renewal Credit I E-Customer I Agency Loyalty Credit I I I I Level s and s (These discounts apply to all or a portion of the premium for a specific auto.) Safety Loan Good Away at Hybrid Anti Annual Multi Age 65 Shield Lease/Gap Student School Theft Mileage Car or older MBTA ITEM 4 ThIS policy provides only the coverages for WhICh a prenuum charge IS shown s, Parts Limits - Limits 1. Bodily Injury to Others Per Person, Per Person, Per Accident Per Accident 2. Personal Injury Protection Per Person Per Person -- No Deductible -- No Deductible -- Deductible for You -- Deductible for You -- Deductible for You -- Deductible for You 3. Bodily Injury Caused by an Per Person, Per Person, Uninsured Per Accident Per Accident 4. Damage to Someone Else's Per Accident Per Accident Property 5. Optional Bodily Injury to Per Person, Per Person, Others Per Accident Per Accident 6. Medical Payments Per Person Per Person 7. Collision Deductible Deductible 8. Limited Collision Deductible Deductible 9. Comprehensive Deductible Deductible 10. Substitute Transportation Up to a day to a Up to a day to a maximumof maximum of 11. Towing and Labor Up to for each Up to for each 12. Bodily Injury Caused by an Per Person, Per Person, Underinsured Per Accident Per Accident Merit Rating Plan Adjustment Subtotal Total for this Total for this Policy: I Subtotal Total for this

2 Operator Name P -Principal Date First Licensed O=Occasional E= Excluded Date of License Number Birth and State Driver # Deferred Motorcycle Training Operator (YIN) Attached Endorsements: ITEM 5. Garaging: ITEM 6. Lienholder- Additional Insured Information: Remarks: E-CUSTOMER AND ELECTRONIC BOOK TRANSFER - 7% LOW FREQUENCY DISCOUNT VEHIIOOI Check carefully to ensure that the information listed on your Selections Page is correct. Are all operators listed? Failure to list a household member or any individual who customarily operates your auto may have very serious consequences. Are all your autos listed? Is the garaging correct? Are you receiving all the discounts you are entitled to? Is your mailing address correct? NOTICE: It is important for you to notify us of any changes that have occurred prior to the renewal of this policy and at any time during the policy period. Please review this Selections Page and the Massachusetts Insurance Policy (2008 Edition) carefully to ensure that you understand the coverages and limits contained in this policy. It is a crime to knowingly provide false or fraudulent information for the purpose of defrauding an insurance company. If you or someone else on your behalf has knowingly given us false, deceptive, misleading or incomplete information and if such false, deceptive, misleading or incomplete information increases our risk of loss, we may refuse to pay claims under any or all of the Optional Iusurance (Parts 5 thru 12) and we may cancel your policy. MERIT RATING PLAN The Merit Rating Board may verify the accuracy of the previous driving records of all listed operators. The Merit Rating Plan adjustment shmvn on the Selections Page for each auto is based on the driving records of the operators listed on your policy. Thank you for insuring your auto with Safety Insurance ed. Countersigned by:.

3 Dec_SFTY pdf - Adobe Acrobat Professional Personal Selections Page This Selections Page shows the coverages and discounts for your auto insurance policy issued by Safety Insurance Company. This page, the attached endorsements and the Massachusetts Insurance Policy (2008 edition) form your policy. Your Policy #: ITEM 2. Policy Effective Dates: September 21, September 21, 2010 Your smitty123@aol.com (12:01 A.M. Eastern Standard Time) ITEM 1. Policy Issued to: Your Agent: Agent Code Jane Smith Breslin Insurance Agency 123 Any St 84 Court St Braintree MA Plymouth MA, smitty123@aol.com (508) 74 (508) ITEM 3. The following auto(s) are covered by this insurance policy: 1: 2009 Lexus Fancy 5FTNYF18418B : 2003 Toyota Camry 5FTNYF18418B05564 Policy Level s (These discounts apply to your entire policy.) Group 5% Agency Loyalty 5% Account Credit 10% Agency Loyalty 5% Renewal 6% gency Loyalty 5% Level s and s (These discounts apply to all or a portion of the premium for a specific auto.) Safety Shield Loan Lease/Gap Good Student Away at School Hybrid Anti Theft Annual Mileage Multi Car Age 65 or older Passive Restraint 1: Yes Yes 30% 10% 5% 25% 25% 2: 25% 25% 25% ITEM 4. This policy provides only the coverages for which a premium charge is shown. s, Parts Limits 2- Limits 1. Bodily Injury to Others 20,000 Per Person, 40,000 Per Accident Personal Injury Protection 8,000 Per Person Deductible for You 38 Deductible for You and household members 20,000 Per Person, 40,000 Per Accident 126 8,000 Per Person Deductible for You 38 Deductible for You and household members 3. Bodily Injury Caused by an Uninsured 100,000 Per Person, 100,000 Per Person, Damage to Someone Else s Property 100,000 Per Accident ,000 Per Accident Optional Bodily Injury to Others 100,000 Per Person, 100,000 Per Person, Medical Payments Per Person Per Person 7. Collision 500 Deductible 500 Deductible Limited Collision Deductible Deductible 9. Comprehensive 500 Deductible 500 Deductible Substitute Transportation Up to 30 a day to a Up to 30 a day to a 51 maximum of 900 maximum of Towing and Labor Up to for each Up to 50 for each Bodily Injury Caused by an Underinsured 100,000 Per Person, 100,000 Per Person, Subtotal 973 Subtotal 988 Merit Rating Plan Adjustment 01 (112) 00 (95) Total for this Total for this 861 Total for this Policy: Page 1 of 2

4 CovgSelectionPg_Eff_07_01_2010.pdf Personal Selections Page This Selections Page shows the coverages and discounts for your auto insurance policy issued by Safety Insurance Company. This page, the attached endorsements and the Massachusetts Insurance Policy (2008 edition) form your policy. Your Policy #: ITEM 2. Policy Effective Dates: September 21, September 21, 2010 Your smitty123@aol.com (12:01 A.M. Eastern Standard Time) D Amended 02/01/2010 ITEM 1. Policy Issued to: Your Agent: Agent Code Jane Smith Breslin Insurance Agency 123 Any St 84 Court St Braintree MA Plymouth MA, smitty123@aol.com (508) 74 (508) ITEM 3. The following auto(s) are covered by this insurance policy: 1: 2009 Lexus Fancy 5FTNYF18418B05564 Symbol 11 Class 10 2: 2003 Toyota Camry 5FTNYF18418B05564 Symbol 16 Class 10 Policy Level s (These discounts apply to your entire policy.) Account Credit Other Carrier Credit Group Renewal Credit E-Customer Agency Loyalty Credit NO NO NO NO NO Level s and s (These discounts apply to all or a portion of the premium for a specific auto.) Safety Shield Loan Lease/Gap Good Student Away at School Hybrid Anti Theft Annual Mileage Multi Car Age 65 or older MBTA 1: Yes Yes NO NO NO 30% 10% 5% 25% 10% 2: NO NO NO NO NO 25% NO NO 25% NO ITEM 4. This policy provides only the coverages for which a premium charge is shown. s, Parts Limits 1. Bodily Injury to Others 20,000 Per Person, 40,000 Per Accident Personal Injury Protection 8,000 Per Person Deductible for You 38 Deductible for You 3. Bodily Injury Caused by an 100,000 Per Person, Uninsured Damage to Someone Else s 100,000 Per Accident Property Optional Bodily Injury to 100,000 Per Person, Others Medical Payments Per Person 7. Collision *Includes Waiver of Deductible 500* Deductible Limited Collision Deductible 9. Comprehensive 500 Deductible 10. Substitute Transportation Up to 30 a day to a maximum of Towing and Labor Up to for each 12. Bodily Injury Caused by an Underinsured ,000 Per Person, Limits 20,000 Per Person, 40,000 Per Accident 126 8,000 Per Person Deductible for You 38 Deductible for You 100,000 Per Person, ,000 Per Accident ,000 Per Person, Per Person Deductible 281 Deductible 500 Deductible 86 Up to 30 a day to a maximum of Up to 50 for each ,000 Per Person, 29 Subtotal 973 Subtotal 988 Merit Rating Plan Adjustment 01 (112) 00 (95) Total for this 861 Total for this Total for this Policy:

5 Dec_SFTY pdf - Adobe Acrobat Professional Operator Name Date of Birth License Number and State Date First Licensed Motorcycle Driver Training (Y/N) P=Principal O=Occasional E= Excluded # Deferred Operator Jane Smith 08/01/1960 S MA 01/01/1978 P John Smith 02/15/1960 S MA 01/01/1978 P Attached Endorsements: SAT003 Special Safety Endorsement SSA001 Safety Shield Endorsement MPY0016 Massachusetts Mandatory Endorsement SLL 002 Loan/Lease Gap Endorsement ITEM 5. Garaging: 1: 123 Any Street, Braintree MA : 123 Any Street, Braintree MA ITEM 6. Lienholder- Additional Insured Information: 1: Honda Lease TRS*BX Sacramento CA : Honda Lease TRS*BX Sacramento CA Remarks: Address Change resulting in premium decrease of 72. Check carefully to ensure that the information listed on your Selections Page is correct. Are all operators listed? Failure to list a household member or any individual who customarily operates your auto may have very serious consequences. Are all your autos listed? Is the garaging correct? Are you receiving all the discounts you are entitled to? Is your mailing address correct? NOTICE: It is important for you to notify us of any changes that have occurred prior to the renewal of this policy and at any time during the policy period. Please review this Selections Page and the Massachusetts Insurance Policy (2008 Edition) carefully to ensure that you understand the coverages and limits contained in this policy. It is a crime to knowingly provide false or fraudulent information for the purpose of defrauding an insurance company. If you or someone else on your behalf has knowingly given us false, deceptive, misleading or incomplete information and if such false, deceptive, misleading or incomplete information increases our risk of loss, we may refuse to pay claims under any or all of the Optional Insurance (Parts 5 thru 12) and we may cancel your policy. MERIT RATING PLAN The Merit Rating Board may verify the accuracy of the previous driving records of all listed operators. The Merit Rating Plan adjustment shown on the Selections Page for each auto is based on the driving records of the operators listed on your policy. Thank you for insuring your auto with Safety Insurance ed. Page 2 of 2 Countersigned by:

6 CovgSelectionPg_Eff_07_01_2010.pdf Operator Name Date of Birth License Number and State Date First Licensed Motorcycle Driver Training (Y/N) P=Principal O=Occasional E= Excluded # Deferred Operator Jane Smith 08/01/1960 XXXXX7878 MA 01/01/1978 P John Smith 02/15/1960 XXXXX7878 MA 01/01/1978 P Attached Endorsements: SAT003 Special Safety Endorsement SSA001 Safety Shield Endorsement MPY0016 Massachusetts Mandatory Endorsement SLL 002 Loan/Lease Gap Endorsement ITEM 5. Garaging: 1: Braintree MA : Braintree MA ITEM 6. Lienholder- Additional Insured Information: 1: Honda Lease TRS*BX Sacramento CA : Honda Lease TRS*BX Sacramento CA Remarks: Address Change resulting in premium decrease of 72. Check carefully to ensure that the information listed on your Selections Page is correct. Are all operators listed? Failure to list a household member or any individual who customarily operates your auto may have very serious consequences. Are all your autos listed? Is the garaging correct? Are you receiving all the discounts you are entitled to? Is your mailing address correct? NOTICE: It is important for you to notify us of any changes that have occurred prior to the renewal of this policy and at any time during the policy period. Please review this Selections Page and the Massachusetts Insurance Policy (2008 Edition) carefully to ensure that you understand the coverages and limits contained in this policy. It is a crime to knowingly provide false or fraudulent information for the purpose of defrauding an insurance company. If you or someone else on your behalf has knowingly given us false, deceptive, misleading or incomplete information and if such false, deceptive, misleading or incomplete information increases our risk of loss, we may refuse to pay claims under any or all of the Optional Insurance (Parts 5 thru 12) and we may cancel your policy. MERIT RATING PLAN The Merit Rating Board may verify the accuracy of the previous driving records of all listed operators. The Merit Rating Plan adjustment shown on the Selections Page for each auto is based on the driving records of the operators listed on your policy. Thank you for insuring your auto with Safety Insurance ed. Countersigned by:

7 Personal Selections Page This Selections Page shows the coverages and discounts for your auto insurance policy issued by Safety Insurance Company. This page, the attached endorsements and the Massachusetts Insurance Policy (2008 edition) form your policy. Your Policy #: ITEM 2. Policy Effective Dates: September 21, September 21, 2010 Your smitty123@aol.com (12:01 A.M. Eastern Standard Time) D Amended 02/01/2010 ITEM 1. Policy Issued to: Your Agent: Agent Code Jane Smith Breslin Insurance Agency 123 Any St 84 Court St Braintree MA Plymouth MA, smitty123@aol.com (508) 74 (508) ITEM 3. The following auto(s) are covered by this insurance policy: 1: 2009 Lexus Fancy 5FTNYF18418B05564 Symbol 11 Class 10 2: 2003 Toyota Camry 5FTNYF18418B05564 Symbol 16 Class 10 Policy Level s (These discounts apply to your entire policy.) Account Credit Other Carrier Credit Group Renewal Credit E-Customer Agency Loyalty Credit NO NO NO NO NO Level s and s (These discounts apply to all or a portion of the premium for a specific auto.) Safety Shield Loan Lease/Gap Good Student Away at School Hybrid Anti Theft Annual Mileage Multi Car Age 65 or older MBTA 1: Yes Yes NO NO NO 30% 10% 5% 25% 10% 2: NO NO NO NO NO 25% NO NO 25% NO ITEM 4. This policy provides only the coverages for which a premium charge is shown. s, Parts Limits 1. Bodily Injury to Others 20,000 Per Person, 40,000 Per Accident Personal Injury Protection 8,000 Per Person Deductible for You 38 Deductible for You 3. Bodily Injury Caused by an 100,000 Per Person, Uninsured Damage to Someone Else s 100,000 Per Accident Property Optional Bodily Injury to 100,000 Per Person, Others Medical Payments Per Person 7. Collision *Includes Waiver of Deductible 500* Deductible Limited Collision Deductible 9. Comprehensive 500 Deductible 10. Substitute Transportation Up to 30 a day to a maximum of Towing and Labor Up to for each 12. Bodily Injury Caused by an Underinsured ,000 Per Person, Limits 20,000 Per Person, 40,000 Per Accident 126 8,000 Per Person Deductible for You 38 Deductible for You 100,000 Per Person, ,000 Per Accident ,000 Per Person, Per Person Deductible 281 Deductible 500 Deductible 86 Up to 30 a day to a maximum of Up to 50 for each ,000 Per Person, 29 Subtotal 973 Subtotal 988 Merit Rating Plan Adjustment 01 (112) 00 (95) Total for this 861 Total for this Total for this Policy:

8 Operator Name Date of Birth License Number and State Date First Licensed Motorcycle Driver Training (Y/N) P=Principal O=Occasional E= Excluded # Deferred Operator Jane Smith 08/01/1960 XXXXX7878 MA 01/01/1978 P John Smith 02/15/1960 XXXXX7878 MA 01/01/1978 P Attached Endorsements: SAT003 Special Safety Endorsement SSA001 Safety Shield Endorsement MPY0016 Massachusetts Mandatory Endorsement SLL 002 Loan/Lease Gap Endorsement ITEM 5. Garaging: 1: Braintree MA : Braintree MA ITEM 6. Lienholder- Additional Insured Information: 1: Honda Lease TRS*BX Sacramento CA : Honda Lease TRS*BX Sacramento CA Remarks: Address Change resulting in premium decrease of 72. Check carefully to ensure that the information listed on your Selections Page is correct. Are all operators listed? Failure to list a household member or any individual who customarily operates your auto may have very serious consequences. Are all your autos listed? Is the garaging correct? Are you receiving all the discounts you are entitled to? Is your mailing address correct? NOTICE: It is important for you to notify us of any changes that have occurred prior to the renewal of this policy and at any time during the policy period. Please review this Selections Page and the Massachusetts Insurance Policy (2008 Edition) carefully to ensure that you understand the coverages and limits contained in this policy. It is a crime to knowingly provide false or fraudulent information for the purpose of defrauding an insurance company. If you or someone else on your behalf has knowingly given us false, deceptive, misleading or incomplete information and if such false, deceptive, misleading or incomplete information increases our risk of loss, we may refuse to pay claims under any or all of the Optional Insurance (Parts 5 thru 12) and we may cancel your policy. MERIT RATING PLAN The Merit Rating Board may verify the accuracy of the previous driving records of all listed operators. The Merit Rating Plan adjustment shown on the Selections Page for each auto is based on the driving records of the operators listed on your policy. Thank you for insuring your auto with Safety Insurance ed. Countersigned by: