Form_SCTN ID_CTG RY.

XX0506W ELCOMELTR_COVERLTR

<docindex><index>W ELCOME</ index></ docindex>

Dear SUI TAUTOLO,

Progressive
P.O. Box 94739
Cleveland, OH 44101

Underwritten by:
United Financial Casualty Company
January 12, 2024
Policy Period: Jan 12, 2024 - Jan 12,
SUI TAUTOLO
2025
3590 East G Street
Page 1 of 2
TACOMA, WA 98404

Thank you for giving me the opportunity to quote your Commercial Auto insurance coverage. I appreciate
your business and am confident that you will be pleased with your decision to purchase coverage through
Progressive . We'll get your hard-working vehicles back on the road fast following an accident. Instead of
outsourcing, our commercial claims professionals manage all repairs to help save you time and money
when it really matters - when you need to get back in business. Our commercial auto claims representatives
are ready to assist you 24 hours a day, 7 days a week, every day of the year by calling 1-800-274-4499 . You
also have the ability to make payments, check billing activity, print policy documents, or check the status of
a claim at progressivecommercial.com.
Welcome SUI TAUTOLO!

Thank you for choosing Progressive for your commercial insurance needs. We're excited that you've joined
us, and we look forward to providing the superior service our customers have come to expect from us.

What we have for you

Enclosed is Your Checklist, indicating records we'll need from you in order to complete your purchase. The
rate we're offering you is based on information you provided, and we need certain items to document your
eligibility for the premium we quoted.

Enclosed you will find:

• Your application. Please review and sign where indicated.
• Policy documents that require your signature.

Within 2 weeks you will receive:

• Your policy contract and Commercial Auto Insurance Coverage Summary (Declarations Page).
• Please take a few minutes to review these important documents and call Progressive if you have any
questions about your coverage.
• Permanent ID cards for your wallet.
 4
Continued
<docindex><index>W ELCOME</ index></ docindex>

What to do next
• Send in the information needed to complete your insurance purchase
• Go to progressivecommercial.com and log in to our online service site
• Watch for your new policy information (coming soon)

What we want you to know

You're important to us, and we're here for you and your business 24 hours a day, seven days a week--
whether you need to update your policy, report or check the status of a claim, or simply ask us a question.
So please call us anytime at 1-800-895-2886 or visit us at progressivecommercial.com.

Again, thank you for putting your trust in us for your commercial insurance needs.

Sincerely,

Karen B. Bailo
President, Commercial Lines
Progressive

Receipt of initial payment for the policy

This is receipt of $573.29 for the initial payment on this policy. Payment was made by Insured
Checking Acct (EFT). If you have any questions, please call Progressive at 1-800-876-7206.
Form WELCOMELTR (05/06)
Form_SCTN ID_CTG RY.WA0508C HECKLIST_COVERLTR

<docindex><index>CHECKLST</ index></ docindex>

Policy number: 00280340-0

Policyholder:
SUI TAUTOLO
January 12, 2024
Policy period: Jan 12, 2024 - Jan 12, 2025
Page 1 of 1

This information will complete

your purchase of insurance
Please review the items listed below and return the requested information to Progressive as soon as
possible. Your insurance premium is based on the information you provided on the application. If we do not
receive the items requested, your insurance premium may change.

Your Checklist
Thank you for taking a moment to review the following information. By returning the items requested
below, we can finalize your insurance purchase.
Please know that your insurance premium is based on this information. Without documentation to confirm
your eligibility for certain rates, your premium may change. We appreciate your taking the time to complete
these requests, and we thank you for your business!

Sign and return

………………………………………………………………………………………………………………………………………………………………
Your application
………………………………………………………………………………………………………………………………………………………………
Electronic Funds Transfer (EFT) Authorization
………………………………………………………………………………………………………………………………………………………………

Underinsured Motorist Coverage - election of lower limits

Return to: Progressive

P.O. Box 94739
Cleveland, OH 44101
Fax: 1-800-556-0014
Email: [email protected]
(attach as PDF/Word documents and include policy number in subject line)
Form CHKLST WA (05/08)
Form_SCTN ID_CTG RY.WA0219Z421_APPLICAT

<docindex><index>APPLICAT</ index></ docindex>

Application for Insurance

Please review and sign where
indicated Policy number: 00280340-0
Named Insured: SUI TAUTOLO

January 12, 2024

Page 1 of 4

Policy and premium information for policy number 00280340-0

………………………………………………………………………………………………………………………………………………………..
Insurance company: United Financial Casualty Company
P.O. BOX 94739
Cleveland, OH 44101
………………………………………………………………………………………………………………………………………………………..
Named Insured: SUI TAUTOLO

3590 EAST G Street TACOMA, WA

98404 e-mail address:
[email protected]
Phone Number: 1-253-312-3905
………………………………………………………………………………………………………………………………………………………..
Financial responsibility vendor: EXPERIAN
1-888-397-3742
………………………………………………………………………………………………………………………………………………………..
Policy period: Jan 12, 2024 - Jan 12, 2025
………………………………………………………………………………………………………………………………………………………..
Effective date and time: Jan 12, 2024 at 05:59PM ET
………………………………………………………………………………………………………………………………………………………..
Total policy premium: $3,439.00
………………………………………………………………………………………………………………………………………………………..
Initial payment required: $573.29
………………………………………………………………………………………………………………………………………………………..
Initial payment received: $573.29
………………………………………………………………………………………………………………………………………………………..
Payment plan: 11 Payments

Rated drivers
The insured declares that no persons other than those listed in this application are expected to operate,
even occasionally, the vehicle(s) described in this application.
Date Driver's Original
of Marital license
Additional year
Name birth Age status number State
informationCDL Points
CDL issued
……………………………………………………………………………………………………………………………………………………….. SUI TAUTOLO 07/31/1985 37
Single ********803B WA 0 No

4
Continued
<docindex><index>APPLICAT</ index></ docindex>

Outline of coverage Description………………………………………………………………………………………………………………………………………………………..Limits Deductible

Premium

Liability To Others $2,342

………………………………………………………………………………………………………………………………………………………..Bodily Injury and Property Damage Liability
$1,000,000 combined single limit

Underinsured Motorist Bodily Injury………………………………………………………………………………………………………………………………………………………..$500,000

combined single limit 274
Underinsured Motorist Property Damage $300,000 each accident $100 47
$300 hit & run
………………………………………………………………………………………………………………………………………………………..
Personal Injury Protection………………………………………………………………………………………………………………………………………………………..$10,000 each person
199
Comprehensive 91
……………………………………………………………………………………………………………………………………………………….. See Auto Coverage Schedule
Limit of liability less deductible
Collision 486
See Auto Coverage Schedule Limit of liability less deductible

………………………………………………………………………………………………………………………………………………………..
Total 12 month policy premium $3,439
Auto coverage schedule
1. 2019 KIA OPTIMA Stated Amount: * $15,000 (including Permanently Attached
Equip) VIN: 5XXGT4L39KG275421 Garaging Zip Code: 98404 Territory: 14 Radius:
50 miles Personal use: Y Body type: Car Use class: S

Liability ………………………………………………………………………………………………………………………………………………Liability UIM BI

UIM PD PIP
Premium $2342 $274 $47 $199
Comp Comp Collision Collision

Physical Damage ………………………………………………………………………………………………………………………………………………Deductible Premium

Deductible Premium
Auto Total

Premium
$1,000 $91 $1,000 $486 $3,439
Vehicle questions
………………………………………………………………………………………………………………………………………………………..
1. Is this vehicle used for business, personal or both? Business/Personal
………………………………………………………………………………………………………………………………………………………..
2. What is the average number of jobsites, trips, deliveries or errands per day? 2
………………………………………………………………………………………………………………………………………………………..
3. Is this vehicle used to provide sightseeing tours? No
………………………………………………………………………………………………………………………………………………………..
4. Is this vehicle used to transport seasonal farm workers? No
<docindex><index>APPLICAT</ index></ docindex>

*A vehicle's stated amount should indicate its current retail value, including any special or permanently attached
equipment. In the event of a total loss, the maximum amount payable is the lesser of the Stated Amount or Actual
Cash Value, less deductible. Be sure to check stated amount at every renewal in order to receive the best value from
your Progressive Commercial Auto policy.

Financial responsibility information

Name………………………………………………………………………………………………………………………………………………………..Home address Age
Date of birth

SUI TAUTOLO 3590 EAST G STREET 38 07/31/1985

TACOMA, WA 98404-0000

Business information
Business type ………………………………………………………………………………………………………………………………………………………..Sub business type Other
Passenger Transportation (Not For Hire) Social & Health Services

Applicant ………………………………………………………………………………………………………………………………………………………..Employer ID number

Individual/Sole Proprietor

Does the insured ever transport passengers for hire? No

Does the applicant have a USDOT Number? No
If a USDOT Number is obtained in the future, it must be provided to Progressive.

Additional policy questions

1. Year the current business was established: 2023
2. Does the insured currently have General Liability Insurance or a Business Owners Policy? Neither

Prior insurance questions

………………………………………………………………………………………………………………………………………………………..
Prior insurance: No

Underwriting questions
Does the applicant require any Waivers of Subrogation? No If yes, how many? 0
How many Additional Insureds are required? 0
Are any state or federal filings required? No
Application agreement
Verification of content
The insured declares that the statements contained herein are true to the best of their knowledge and
belief. The insured also agrees to pay any surcharges applicable under the Company rules which are
necessitated by inaccurate statements. The insured declares that no persons other than those listed in this
application are expected to operate, even occasionally, the vehicle(s) described in this application. If a
federal or state endorsement is attached to this policy that subjects the Company to public liability for
negligence in the insured's operation, maintenance or use of motor vehicles, the insured: (1) declares that
all commercially owned or operated vehicles have been disclosed to us and are listed on this Application;
(2) will promptly notify us of any additional commercially owned or operated vehicles put into service in
the future; and (3) understands that failure to promptly inform us of, and list, all current and future
commercially owned or operated vehicles may result in the cancellation or nonrenewal of this policy, or in
a premium increase. The insured understands that this policy may be rescinded and declared void if this
 <docindex><index>APPLICAT</ index></ docindex>

application contains any false information or if any information that would alter the Company's exposure is
omitted or misrepresented, with the intent to deceive.
It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for
the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance
benefits.

Notice of information practices

The insured understands that to calculate an accurate price for their insurance, the Company may obtain
information from third parties, such as consumer reporting agencies that provide driving, claims and credit
histories. The Company may use a credit-based insurance score based on the information contained in the
credit history. The Company or its affiliates may obtain new or updated information to calculate the
renewal premium or service the insurance. The insured may access information about them and correct it
if inaccurate. In some cases, the law permits the Company to disclose the information it collects without
authorization. However, the Company will not share personal information with nonaffiliated companies for
their marketing purposes without consent. Complete details are in the Company's Privacy Policy, which will
be provided with this insurance policy and upon request. The insured has or will obtain from existing and
new drivers employed or contracted by the insured, an acknowledgement that their driving record
information may be disclosed to the insured or their employer, contractor, or agent in connection with the
insurance being applied for hereunder. The insured agrees to submit to loss control inspections as often as
the Company may reasonably require. The insured agrees that refusal to submit to an inspection is
grounds for cancellation of this policy.

The insured affirms that

If the initial payment is made by electronic funds transfer, check, draft, or other remittance, the coverage
afforded under this policy is conditioned on payment to the Company by the financial institution. If the
transfer, check, draft, or other remittance is not honored by the financial institution, the Company shall be
deemed not to have accepted the payment and this policy shall be void.
If the initial payment is made by credit card, the coverage afforded under this policy is conditioned on
payment to the Company by the card issuer. The insured understands that if the Company is unable to
collect my initial payment from the card issuer, the Company shall be deemed not to have accepted the
payment and this policy shall be void. The insured also understands that if a credit card transaction is
authorized for any payment other than the initial payment, this policy will be subject to cancellation for
nonpayment of premium if the Company is unable to collect payment from the card issuer. The Company is
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deemed "unable to collect" in the following instances: (1) when the insured reaches the credit limit on the
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credit card and the card issuer refuses the charge; (2) when the card issuer cancels or revokes the credit
card; or (3) when the card issuer does not pay the Company, for any reason whatsoever, upon the
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If the insured has an outstanding unpaid balance from a prior Progressive commercial lines policy, payment
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of that balance is required. Nonpayment of a prior unpaid balance may result in the denial, cancellation, or
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nonrenewal of this policy.
<docindex><index>APPLICAT</ index></ docindex>

Policy number: 00280340-0

SUI TAUTOLO
Page 5 of 4
Other charges
The insured agrees to pay the installment fees shown on the billing statement that become due during the
policy term and each renewal policy term in accordance with the payment plan they have selected. The
insured understands that the amount of these fees may change upon policy renewal or if they change their
payment plan. Any change in the amount of installment fees will be reflected on the payment schedule.
The insured understands that a returned payment fee of $20.00 will be assessed to the balance due on
the policy if any check offered in payment is not honored by the bank or other financial institution.
Imposition of such charge shall not deem the Company to have accepted the check unconditionally.
The insured agrees to pay a late fee of $10.00 during the policy term and each renewal policy term when
either the minimum amount due is not paid or payment is postmarked more than 2 days after the premium
due date. The amount of this fee may change upon policy renewal.

Applicant signature
I represent that I am the person identified as the named insured or I am the authorized signatory of the
named insured entity. I acknowledge and agree to the statements contained within this application.
I also acknowledge and agree that by typing my name in the designated boxes on the screen below this form
and clicking "click to e-sign", I am electronically signing this application, which will have the same legal effect
as the execution of this document by a written signature and shall be valid evidence of my intent and
agreement to bind the named insured to its terms.

Signature of first named insured or Authorized signatory of the named insured entity Date Title
{{Jan 12, 2024
X_es_:signer:date}} {{Sig_es_:signer:signature}}
{{OTtl_es_:signer:Opttitle}}
………………………………………………………………………………………………………………………………………………….

Form Z421 WA (02/19)

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 Policy number:
9005
Form_SCTN ID_CTG RY.WA11162702_SIG N FORM

<docindex><index>SIGN FORM</ index></ docindex>

00280340-0
SUI TAUTOLO
Page 1 of 1

Underinsured Motorist Coverage - election of lower limits

I have been offered and I have rejected the option to purchase Underinsured Motorist Coverage for bodily
injury in an amount equal to the limits of bodily injury liability coverage. Instead, I elect the lower limits of
Underinsured Motorist Coverage for bodily injury selected below. I understand that Underinsured Motorist
Coverage for bodily injury protects insureds under the policy who sustain bodily injury, including any
resulting death, in an accident in which the owner or operator of a motor vehicle who is legally liable does
not have insurance or does not have enough insurance. Insureds for purposes of this coverage include any
occupant of an insured auto, and when the named insured is a person, the named insured and named
insured's resident relatives.
I understand and agree that this rejection of the higher limits and election of lower limits shall be binding
on all persons insured under the policy, and that this election shall apply to any supplemental or renewal
policy with this company, unless the first named insured, or authorized representative of the first named
insured, revokes this election or selects a different option.
(………………………………………………………………………………………………………………………………………………………..Please check one coverage option
only.) ………………………………………………………………………………………………………………………………………………………..$25,000 each person/$50,000
each accident

………………………………………………………………………………………………………………………………………………………..$50,000 each person/$100,000 each

$100,000 combined single limit
accident ………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………..$100,000 each person/$300,000 each

accident ………………………………………………………………………………………………………………………………………………………..$300,000 combined single limit

………………………………………………………………………………………………………………………………………………………..$250,000 each person/$500,000 each

accident

……………………………………………………………………………………………………………………………………………………….. X $500,000 combined

single limit

………………………………………………………………………………………………………………………………………………………..$750,000 combined single limit

$1,000,000 combined single limit

In order to provide for an informed decision of the potential consequences of rejecting underinsured
motorist coverage; the undersigned acknowledges that by rejecting underinsured motorist coverage there
is exposure to the risk of not being sufficiently insured for injury and/or damages when involved in an
accident with a driver of an underinsured vehicle.

Signature of first Named Insured or Authorized signatory of the Named Insured entity Date Title
{{Jan 12, 2023Dte_es_:signer:date}}
X {{Sig_es_:signer:signature}}
{{OTtl_es_:signer:Opttitle}}
………………………………………………………………………………………………………………………………………………….
49;2
 Policy number:
Form 2702 WA (11/16)

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Form_SCTN ID_CTG RY.XX05066252_SIG N FORM

<docindex><index>EFT</ index></ docindex>

00280340-0
SUI TAUTOLO
Page 1 of 1

Electronic funds transfer (EFT) authorization

I authorize United Financial Casualty Company and its corporate and mutual company affiliates
("Company") to initiate scheduled deductions from the bank account, identified below, for payment of
premium on the insurance policy issued to me by Company, and any renewals thereof, and to initiate
credit entries to the account to correct any erroneous deductions or provide a refund of premium. I
authorize the financial institution identified by the routing number below to accept and post entries to
the account. I represent that I am the owner and/or an authorized signer on the account. I understand
that this authorization allows Company to adjust the scheduled deductions to reflect any premium
changes. Company agrees that it shall notify me at least ten (10) days prior to making any deduction that
will be less than the previous deduction.
I understand that Company will not send me a bill before scheduled deductions are made and that it is my
responsibility to ensure sufficient funds are in the account at the time of each scheduled deduction. I also
understand that my policy may cancel or expire if there are insufficient funds in the account.
I acknowledge that the origination of ACH (Automated Clearing House) transactions to the account must comply
with the provisions of U.S. law.

Bank information
Name on
account: SUI
TAUTOLO
Account number: Routing
number:
This authorization will remain in effect until I notify Company of its termination, either in writing,
electronically or by calling a Company representative, in such time and manner as to afford Company a
reasonable opportunity to act on it.

Signature (must be a person authorized to sign on this account) Date

49;2
 Policy number:

X {{ ……………………………………… Sig_es_:signer:signature}} ……………………………………………………………………………………………………………….. {{Jan 12,

2023Dte_es_:signer:date}}
IMPORTANT NOTICE FOR CREDIT UNION MEMBERS: Many smaller credit unions use a different account
number than the one shown on your check. You may wish to verify your account number through your local
office to assure proper setup for withdrawals.
Form 6252 (05/06)

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Form_SCTN ID_CTG RY.XX0506Z159_PYMTSC DL

<docindex><index>PYMTSCDL</ index></ docindex>

Policy number: 00280340-0

Policyholder:
SUI TAUTOLO
January 12, 2023
Policy period: Jan 12, 2023 - Jan 12, 2024
Page 1 of 1

Electronic Funds Transfer (EFT) payment schedule

Date of Date of Date of
withdrawal Amount withdrawal Amount withdrawal Amount
Feb 12, 2023.......................$291.58 Jun 12, 2023 .......................$291.58 Oct 12,
Mar 12, 2023 ......................$291.58 Jul 12, 2023 ........................$291.58 2023.......................$291.58 Nov
Apr 12, 2023.......................$291.58 Aug 12, 2023......................$291.58 12, 2023 .....................$291.49
May 12, 2023......................$291.58 Sep 12, 2023.......................$291.58
Total Premium: $3,439.00
Payment Option: 11 Payments

An installment fee of $5.00 has been included in each payment. You may avoid paying installment fees by
paying your policy premium in full.
Form Z159 (05/06)
<docindex><index>N OTICE</ index></ docindex>

Policy number: 00280340-0

SUI TAUTOLO
Form_SCTN ID_CTG RY.XX0313A107_N OTICE
Page 1 of 1

Important Notice
Federal, state and local laws may require you to carry higher limits of liability insurance based on your
business or vehicle type. It’s your responsibility to comply with these laws.
Please contact the state department of transportation, your employer, or the city and municipalities where
you operate, to determine if you’re required to carry higher limits.

Form A107 (03/13)

Form_SCTN ID_CTG RY.XX0311A022_I DCAR D

<docindex><index>IDCARD</ index></ docindex>

Keep these cards handy--in your glove compartment or wallet. And contact us anytime you have a question or need to report a
claim.

If you have a claim, we'll get you back on the road as soon as possible. And while you'll always have a choice where to
repair your vehicle, when you use a shop in our preapproved network, we'll guarantee your repair for as long as you own
or lease your vehicle.

Thank you for choosing Progressive.