DECLARATIONS
Endorsement Infinity Insurance Company
DECLARATIONS EFFECTIVE ON: 11/09/2022 PO Box 830189 Birmingham, AL 35283-0189
CURRENT POLICY PERIOD. POLICY IS EFFECTIVE AT THE ADDRESS OF THE POLICY HOLDER AS STATED HEREIN.
POLICY NUMBER:
104589752910001 FROM: 10:31 AM 11/09/2022 TO: 12:01 AM 02/20/2023
STANDARD TIME
HOGAN, JANE L FREEWAY INSURANCE SERVICES INC PRODUCER NUMBER
30035
9802 BLOOMFIELD AVE 7711 CENTER AVE STE 200
APT 41 HUNTINGTN BCH, CA 92647 TELEPHONE NO.
CYPRESS, CA 90630 (714) 252-2500
DESCRIPTION OF OWNED AUTOMOBILE
VEH USE YEAR MAKE, MODEL, BODY VEHICLE IDENTIFICATION DRV PTS RATE ZIP
NUMBER (VIN)
1 Pleasure 2012 NISS ALTIMA ALTIMA 2.5/2.5 S SED 1N4AL2AP0CC246316 1 0 90630
2 Pleasure 2019 KIA FORTE FORTE FE/LX/LXS SEDA 3KPF24AD7KE036629 2 0 90630
INSURANCE IS AFFORDED ONLY FOR THE COVERAGES FOR WHICH LIMITS OF LIABILITY AND PREMIUM CHARGES ARE INDICATED
COVERAGE AND LIMITS OF LIABILITY PER PERSON PER ACCIDENT VEH1 VEH2
Bodily Injury $15,000 each person $30,000 each accident 296.00 397.00
Property Damage $5,000 each accident 287.00 451.00
Uninsured Motorist - BI ****REJECTED**** ****REJECTED**** No Cov No Cov
Collision $500.00 Deductible No Cov 734.00
Collision $1,000.00 Deductible 376.00 No Cov
Comprehensive $500.00 Deductible No Cov 57.00
Comprehensive $1,000.00 Deductible 31.00 No Cov
Total Premium For Each Car 990.00 1639.00
CA Fraud Fee 1.76 1.76
Processing Fee 20.00
THIS POLICY PROVIDES REDUCED LIABILITY LIMITS WHEN AN INSURED AUTO IS BEING OPERATED BY A PERMISSIVE DRIVER AS DEFINED
WITHIN THE POLICY. LIABILITY LIMITS DROP TO THE MINIMUM STATUTORY LIMITS WHICH ARE $15,000 PER PERSON, $30,000 PER
ACCIDENT, AND $5,000 FOR PROPERTY DAMAGE IN CALIFORNIA.
ENDORSEMENTS: 03486R0110; 01412R0215; 03333R0215; 02836R0711; 0123R1004; 104AMDE01; 00067R1017; 10463ARN08
COUNTERSIGNED AT BY
67D04 11/10/2022 5-2 RSVP INSURED COPY
NAME AND ADDRESS OF LOSS PAYEE OR LESSOR
VEH
2 federal partner credit union pobox 7005 Downey CA 90241
OPTIONAL EQUIPMENT VEH CURRENT MARKET VALUE
ITEM VEH DESCRIPTION VALUE 1
2
OPERATORS INSURED UNDER THIS POLICY
# NAME SR22 DATE OF MARITAL SEX DRIVER'S LICENSE YRS DRV
BIRTH STATUS NUMBER EXP
1 Jane Leslie Hogan No xx/xx/xxxx S F xxxxxxx 27
2 Marina Macias No xx/xx/xxxx S F xxxxxxx 11
EXCLUDED OPERATORS
# NAME DATE OF MARITAL SEX DRIVER'S LICENSE
BIRTH STATUS NUMBER
DISCOUNTS AND SURCHARGES
VEH 1 VEH 2
DESCRIPTION DESCRIPTION DESCRIPTION
13000-13999 MLG 15000-15999 MLG
Good Driver 2 Good Driver 2
3Year Renewal 3Year Renewal
ADDITIONAL INSURED UNDER THIS POLICY
VEH NAME AND ADDRESS OF ADDITIONAL INSURED (LESSORS SHOULD REFER TO ENDORSEMENTS)
KEY:
YRS DRV EXP = YEARS OF DRIVING EXPERIENCE
RATE ZIP = RATE ZIP CODE
VEH = VEHICLE
104IDCD01
NAIC# 22268 CALIFORNIA
PROOF OF FINANCIAL RESPONSIBILITY CARD
Infinity Insurance Company
PO Box 830189, Birmingham, AL 35283-0189
YEAR MAKE/MODEL VEHICLE ID NUMBER
2012 NISS/ALTIMA 1N4AL2AP0CC246316
HOGAN, JANE LESLIE
POLICY NUMBER NAME & ADDRESS OF INSURED
9802 BLOOMFIELD AVE 104589752910001 JANE HOGAN
APT 41 9802 BLOOMFIELD AVE
APT 41
CYPRESS, CA 90630 EFFECTIVE DATE
CYPRESS, CA 90630
02/20/2022
DRIVER(S) Jane Leslie Hogan
EXPIRATION DATE Marina Macias
02/20/2023
THIS CARD SHOULD BE KEPT IN THE VEHICLE WITH THE
30035 VEHICLE'S REGISTRATION CARD AT ALL TIMES
NAIC# 22268 CALIFORNIA
PROOF OF FINANCIAL RESPONSIBILITY CARD
Infinity Insurance Company
PO Box 830189, Birmingham, AL 35283-0189
Company YEAR MAKE/MODEL VEHICLE ID NUMBER
Infinity Insurance Company 2019 KIA/FORTE 3KPF24AD7KE036629
Policy Holder
HOGAN, JANE LESLIE POLICY NUMBER NAME & ADDRESS OF INSURED
104589752910001 JANE HOGAN
Policy Number 9802 BLOOMFIELD AVE
104589752910001 EFFECTIVE DATE APT 41
CYPRESS, CA 90630
Effective 02/20/2022
02/20/2022 DRIVER(S) Jane Leslie Hogan
EXPIRATION DATE Marina Macias
02/20/2023
THIS CARD SHOULD BE KEPT IN THE VEHICLE WITH THE
VEHICLE'S REGISTRATION CARD AT ALL TIMES
Company
Infinity Insurance Company
Policy Holder
HOGAN, JANE LESLIE NAIC# CALIFORNIA
Policy Number PROOF OF FINANCIAL RESPONSIBILITY CARD
104589752910001
Effective
YEAR MAKE/MODEL VEHICLE ID NUMBER
02/20/2022
POLICY NUMBER NAME & ADDRESS OF INSURED
EFFECTIVE DATE
Company
Infinity Insurance Company DRIVER(S)
EXPIRATION DATE
Policy Holder
HOGAN, JANE LESLIE
Policy Number
104589752910001
Effective THIS CARD SHOULD BE KEPT IN THE VEHICLE WITH THE
VEHICLE'S REGISTRATION CARD AT ALL TIMES
02/20/2022
CALIFORNIA INSUREDS
THIS CALIFORNIA PROOF OF FINANCIAL RESPONSIBILITY CARD IS
PROVIDED FOR YOUR USE TO ENABLE YOU TO COMPLY WITH SECTION
16028 OF THE CALIFORNIA VEHICLE CODE WHICH BECAME EFFECTIVE
JULY 1, 1985, AND WHICH READS IN PART:
16028(a) Every person who drives a motor vehicle required to be registered in
this state upon a highway shall, when requested by a peace officer, provide
evidence of financial responsibility for the vehicle.
One of the definitions of "evidence of financial responsibility" reads in part: (A)
The name of the insurance company which issued the automobile liability policy,
in effect for the vehicle and the number of the insurance policy.
SHOW THIS CARD TO THE REQUESTING PEACE OFFICER WHEN ASKED
TO PROVIDE EVIDENCE OF FINANCIAL RESPONSIBILITY.
X ______________________________________
IF YOU ARE INVOLVED IN AN ACCIDENT
REPORT YOUR LOSS IMMEDIATELY
PHONE: 800-334-1661
7 DAYS A WEEK / 24 HOURS A DAY
CALIFORNIA INSUREDS
THIS CALIFORNIA PROOF OF FINANCIAL RESPONSIBILITY CARD IS 24-HOUR CLAIMS SERVICE
PROVIDED FOR YOUR USE TO ENABLE YOU TO COMPLY WITH SECTION (800) 334-1661
16028 OF THE CALIFORNIA VEHICLE CODE WHICH BECAME EFFECTIVE
IF YOU HAVE AN ACCIDENT:
JULY 1, 1985, AND WHICH READS IN PART:
1. OBTAIN THE NAMES, ADDRESSES, AND PHONE NUMBERS OF
16028(a) Every person who drives a motor vehicle required to be registered in EVERYONE INVOLVED.
this state upon a highway shall, when requested by a peace officer, provide 2. RECORD THE DATE, TIME, AND PLACE OF THE ACCIDENT.
evidence of financial responsibility for the vehicle. 3. IDENTIFY THE OTHER DRIVER AND HIS/HER INSURANCE
COMPANY.
One of the definitions of "evidence of financial responsibility" reads in part: (A) 4. LIST THE MAKE, MODEL, AND LICENSE PLATE NUMBER OF
The name of the insurance company which issued the automobile liability policy, THE OTHER VEHICLE.
in effect for the vehicle and the number of the insurance policy. 5. PHONE THE POLICE AT ONCE.
6. PHONE US IMMEDIATELY, 24 HOURS A DAY, 7 DAYS A WEEK.
SHOW THIS CARD TO THE REQUESTING PEACE OFFICER WHEN ASKED
TO PROVIDE EVIDENCE OF FINANCIAL RESPONSIBILITY.
MEMBER OF THE NATIONAL INSURANCE CRIME BUREAU
X ______________________________________
IF YOU ARE INVOLVED IN AN ACCIDENT 24-HOUR CLAIMS SERVICE
REPORT YOUR LOSS IMMEDIATELY (800) 334-1661
PHONE: 800-334-1661 IF YOU HAVE AN ACCIDENT:
7 DAYS A WEEK / 24 HOURS A DAY
1. OBTAIN THE NAMES, ADDRESSES, AND PHONE NUMBERS OF
EVERYONE INVOLVED.
2. RECORD THE DATE, TIME, AND PLACE OF THE ACCIDENT.
3. IDENTIFY THE OTHER DRIVER AND HIS/HER INSURANCE
CALIFORNIA INSUREDS COMPANY.
THIS CALIFORNIA PROOF OF FINANCIAL RESPONSIBILITY CARD IS 4. LIST THE MAKE, MODEL, AND LICENSE PLATE NUMBER OF
PROVIDED FOR YOUR USE TO ENABLE YOU TO COMPLY WITH SECTION THE OTHER VEHICLE.
16028 OF THE CALIFORNIA VEHICLE CODE WHICH BECAME EFFECTIVE 5. PHONE THE POLICE AT ONCE.
JULY 1, 1985, AND WHICH READS IN PART: 6. PHONE US IMMEDIATELY, 24 HOURS A DAY, 7 DAYS A WEEK.
16028(a) Every person who drives a motor vehicle required to be registered in MEMBER OF THE NATIONAL INSURANCE CRIME BUREAU
this state upon a highway shall, when requested by a peace officer, provide
evidence of financial responsibility for the vehicle.
24-HOUR CLAIMS SERVICE
One of the definitions of "evidence of financial responsibility" reads in part: (A) (800) 334-1661
The name of the insurance company which issued the automobile liability policy,
in effect for the vehicle and the number of the insurance policy. IF YOU HAVE AN ACCIDENT:
SHOW THIS CARD TO THE REQUESTING PEACE OFFICER WHEN ASKED
1. OBTAIN THE NAMES, ADDRESSES, AND PHONE NUMBERS OF
TO PROVIDE EVIDENCE OF FINANCIAL RESPONSIBILITY. EVERYONE INVOLVED.
2. RECORD THE DATE, TIME, AND PLACE OF THE ACCIDENT.
X ______________________________________ 3. IDENTIFY THE OTHER DRIVER AND HIS/HER INSURANCE
COMPANY.
IF YOU ARE INVOLVED IN AN ACCIDENT 4. LIST THE MAKE, MODEL, AND LICENSE PLATE NUMBER OF
REPORT YOUR LOSS IMMEDIATELY THE OTHER VEHICLE.
5. PHONE THE POLICE AT ONCE.
PHONE: 800-334-1661 6. PHONE US IMMEDIATELY, 24 HOURS A DAY, 7 DAYS A WEEK.
7 DAYS A WEEK / 24 HOURS A DAY
MEMBER OF THE NATIONAL INSURANCE CRIME BUREAU
