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Total Premium for the policy period The policy period is from January 1, 20X0 at 12:01 A.M. STANDARD TIME to January 1, 20X1 at 12:01

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Total Premium for the policy period The policy period is from January 1, 20X0 at 12:01 A.M. STANDARD TIME to January 1, 20X1 at 12:01 A.M. STANDARD TIME at the residence premises. Your Vehicles Identification Numbers (VIN) Premium 1. BMW X5 WBADE6321W5034024 $1,416 2. FORD F-150 XL 2D 1FTLP62W4XH128703 $1,425 Total Premium for this Policy: $2,841.00 This is not a bill. You will be billed separately. Insurance is provided only where a premium entry is shown for the coverage. The premium entry "Incl" or "Pkg" means the premium charge is included in the premium for another coverage or a package Loss Payee True Blue Bank & Trust 456 Main Street Anywhere, XL 56789 Coverages, Limits of Liability and Premiums VEHICLE 1 VEHICLE 2 BMW X5 FORD F150 Part A Liability Bodily Injury $25,000 each person $50,000 each accident $218 $469 Property Damage $15,000 each accident $205 $260 AL-12345 5M (08-19) Insured Copy Page D-1Named Insured SALLY JONES Policy Number 600789 123 9 Policy Period January 1, 20X0 to January 1, 20X1 Online Part B - Medical Payments $500 each person $10 $18 Part C Uninsured Motorists Bodily Injury $25,000 each person $50,000 each accident $190 $218 Property Damage $15,000 each accident $26 $30 Part D - Coverage for Damage to Your Auto Collision Actual Cash Value less $250 deductible $365 $342 Comprehensive Actual Cash Value less $100 deductible $402 $348 Please review your policy for Special Limits of Liability and Additional Coverages that may apply. Information Used to Rate Your Policy Discounts Safe Driver Discount 5 Years Accident and Violation Free Multi-Policy Discount Multi-Car Discount Paid in Full Discount Good Payer Discount Continuous Insurance Discount Early Quote Discount Drivers Date of Birth Gender Marital Status Driver Type 1. SALLY 12-17-19XX Female Married Licensed 2. CHUCK 06-09-19XX Male Married Licensed 3. CHARLES, JR 06-05-20XX Male Single Licensed Vehicles Use of Vehicle Mileage Location of Vehicle 1. BMW X5 Commute 5,060 ANYWHERE, XL 2. FORD F-150 XL 2D Commute 60, 163 ANYWHERE, XL

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