Form_SCTNID_CTGRY.

FL03156489_DECPAGE

911099847 Q PF29972 INS DECPAGE E POLWHITEFONT XWX3T2TZ7QWZEJGJIOGEO4IOUD0002 RPUID TRACWHITEFONT

FLORIDIAN INS SERV

1703 N MAIN ST #A
KISSIMMEE, FL 34744

Policy Number: 911099847

Underwritten by:
Progressive American Insurance Co
-DQXDU\ 4, 201
REINALDO MARTINEZ Policy Period:
)HE 7, 201
-
$XJ 7, 2018

1301 DORADO DR APT B
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KISSIMMEE, FL 34741
1-407-350-5988
FLORIDIAN INS SERV
Contact your agent for personalized service.

progressiveagent.com
Auto Insurance Online Service

Coverage Summary
Make payments, check billing activity, update
policy information or check status of a claim.

This is your Renewal 1-800-274-4499

To report a claim.
Declarations Page
The coverages, limits and policy period shown apply only if you pay for this policy to renew.
Your coverage begins on )HEUXDU\ 7, 201 at 12:01 a.m. This policy expires on $XJXVW 7, 2018 at 12:01 a.m.
Your insurance policy and any policy endorsements contain a full explanation of your coverage. The policy limits shown for a vehicle
may not be combined with the limits for the same coverage on another vehicle, unless the policy contract or endorsements indicate
otherwise. The policy contract is form 9611A FL (07/13). The contract is modified by form A139 FL (06/14).

Drivers and ………………………………………………………………………………………………………………………………………………………..

resident relatives Additional information
REINALDO MARTINEZ Named insured
………………………………………………………………………………………………………………………………………………………..
YASMIN NIEVES
………………………………………………………………………………………………………………………………………………………..
Gabriel Bello

Outline of coverage

2014 HYUNDAI ACCENT 4 DOOR HATCHBACK

VIN: KMHCT5AE5EU142237
Garaging ZIP Code: 34741
Primary use of the vehicle: Commute
Number of years owned/leased when policy started or vehicle added: 3-4 years
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others
Bodily Injury Liability $10,000 each person/$20,000 each accident $180
Property Damage Liability $10,000 each accident 129
………………………………………………………………………………………………………………………………………………………..
Personal Injury Protection $10,000 $500/person 541
Deductible applies to You and Dependent Relatives
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $500 54
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $500 223
………………………………………………………………………………………………………………………………………………………..
Roadside Assistance 5
………………………………………………………………………………………………………………………………………………………..
Total premium for 2014 HYUNDAI $1,132
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium $2,138.00

Form 6489 FL (03/15)

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911099847 Q PF29972 INS DECPAGE E POLWHITEFONT XWX3T2TZ7QWZEJGJIOGEO4IOUD0002 RPUID TRACWHITEFONT

Policy Number: 911099847

REINALDO MARTINEZ

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Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
911099847 Five-Year Accident Free, Electronic Funds Transfer (EFT), Multi-Car, Continuous
Insurance: Gold, Paperless and Three-Year Safe Driving
Vehicle
………………………………………………………………………………………………………………………………………………………..
2014 FORD Anti-Lock Brakes, Driver and Passenger-side Airbag and Passive Anti-Theft
ESCAPE Device
2014 HYUNDAI Anti-Lock Brakes and Driver and Passenger-side Airbag
ACCENT

Lienholder and additional interest information

Vehicle Lienholder Additional interest
………………………………………………………………………………………………………………………………………………………..
2014 FORD ESCAPE GM FINANCIAL
1FMCU0GXXEUD30907 MINNEAPOLIS, MN 55440

………………………………………………………………………………………………………………………………………………………..
2014 HYUNDAI ACCENT AUTOTRAKK/LYCO AUTO AUTOTRAKK/LYCO AUTO
KMHCT5AE5EU142237 MINNEAPOLIS, MN 55439 MINNEAPOLIS, MN 55439

Policyholder inquiries
You may call your agent at 1-407-350-5988 to present inquiries or obtain information about coverage, and to obtain
assistance with any complaints.

Agent signature

Company officers

Secretary

Form 6489 FL (03/15)