EFTA01136399.pdf

COVERAGE SELECTIONS PAGE This page and any attached endorsements form a part of your policy Commerce I N S U R A N C E &.1)A MAPP- Hr COMPANY This policy is issued by: The Commerce Insurance Company Webster, MA 01570-0758 vwiew.Commerceinsurance.corn Item 1: This policy is issued to: Massachusetts Personal Automobile Policy Number: DWL496 TncrmA IIACH Agent: 886 et nnimuic rut • GENCY, INC MA 02139-2717 113 CAMBRIDGE ST BURLINGTON MA 01803 Item 2: This policy Is in effect from: APRIL 28, 2015 to APRIL 28, 2016(1201 A M Eastern Standard Time) Item 3: Description of your Auto: DIRECT BILL Auto 1 06 HONDA CR—V SE 4D WAGON Auto SHSRD78986U414640 Item 4: This policy provides only the coverages for which a premium charge is shown: Coverages, Parts 1-12 AUTO 3, AUTO COMPULSORY Annual Adjustedd UMITS Annual Adjusted LIMITS 0educbbl. A/aniline Premium 0cclude,* Prennturn Prernsurn INSURANCE pee None Person $ Person 1 Bodily Injury To Others $ 20000 Per None $ 40000 Aciodom $ 328 s A.den, r $ $ NONE $ 2 Personal Injury Protection $ 8000 Person _.,..... ', $ anon _ r>ois• Ammn end youmel and --AnAnnne e 109 __,... " $. 3 Bodily Injury Caused By An pet Per $ None $ Persc, Uninsured Auto (Compulsory 100000 Pe"'°' None Limits $20.000 / $40.O00) pm Pe, $ 300000 ACC'der S 24 $ Accident $ a Damage To Someone Else's Pf Property (Compulsory Limits $ A""en' e None S ACarCAent None $5.000) 100000 $ 425 $ OPTIONAL INSURANCE Pet Pe, 5 Optional Bodily Injury To Others $ 100000 Pe --°' None $ PerbOn None Pe PN $ 300000 AOC,Ient S 191 $ Accident $ Pee CH 6 Medical Payments $ a $ $ pe,„ None $ 7 Collision Actual Cash Value * $ 1000 $ 458 Actual Cash Value $ $ 8 Limited Collision Actual Cash Value $ 5 Adual Cash Value $ $ 9 Comprehensive Actual Cash Value $ 300 $ 154 Actual Cash Value $ $ Uplo$ 15 aday. Up [QS aday. 10 Substitute Transportation None $ $Maximum None $ r"Vb 25 uptog fee each Up to $ tor each ii Towing and Labor None None e. disablement disablement a Per None Pe, 12 Bodily Injury Caused By An $ 100000 Peron $ Peqw None Underinsured Auto we $ 300000 o de,,, $ 28 $ Aocoent $ MERIT RATING PLAN Premium Adjustment $ 265 I Premium Adjustment $ PREMIUM (per AUTO) AUTO $1742 265 I AUTO TOTAL PREMIUM (POLICY) * INCL WAIVER OF DED 265.00 Age 653 vAir e n:20 al Antl G0OCI Nco sSma hOp a Sit ayrit MOIciCycle Pay Smart Clean Welcome DISCOUNT$ Ai:co:int Oen; Inert Student Traprno Plan Driver In 3 Ban AUTO 1 20% 1% AUTO REFER TO OTHER SIDE FOR ADDITIONAL INFORMATION AMENDED 04/28/15 INSURED PAGE 1 OF 1 CA \',1 EFTA01136399