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<br />07/12/2005 20:18
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<br />28147'30880
<br />
<br />CHARLIE HINDS
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<br />PAGE
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<br />03
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<br />Policynumber. 03365138-0
<br />CHARlIE HINDS PAINT & IK)D
<br />Pagt2 of]
<br />
<br />
<br />Rated drivers
<br />
<br />.........."....................................................................... .......,.............................."",..,...".............................,..
<br />
<br />~: ~E~'.~.,:'~f~. ... ........ ....,." ,...........,.....,.,........... ....,. "'" ,.....,.,....."..."..,... ,."..,..,',....",...........,., "" ,........ .......' '''1
<br />
<br />...............................................................................................,...........,.........................................,.................
<br />3. GREGORY HINDS
<br />..",................'..,...'...,.,.......................,.'...'..'..,.."....."'............................................,..,........,...........................
<br />4. DONNA EDMONDSON
<br />............................................... ......'............'...........,.,..,.",...,..,........,.............................................................. I
<br />5. JERRY EDMONSON
<br />
<br />__.._~ .0
<br />------ ",
<br />.J-' . \,.
<br />. Outline of coverage (Symbol 7 applies unless otherwise stated in item two) , \
<br />~~. ... .......,.. ..... ............... ..... .......... ,... .......~~........,.............."........,........,.. ....,..... .\.. .'... .~.!.~~~. ........... .~~~~
<br />liability Coverage $10,021
<br />Bodily Injury and Property Damage Liabifity $500,000 combined single limit
<br />ijiii',;suii!diUOdeiiii5u~ifMoto~'St'''''''''''''''''''''''' ...SSOO.,OOO..c~.mbineci s.jngle.ii.U;it............................,......... ....... ..~......430
<br />Unj'risU~(iMoti;ri5i'pro'~rtY'Dama'ge'''''''''''''''''' ....,SO:OOO.e~di.acddent....."........."......,..,.."'..,... '$25'" .. ........ ....... '108
<br />P~;S.o~a.,.inju;yP~t~aion.. ................................... 's25:600'~a~h 'p~~~~'''''''''''''''''''''''''''''''''''''''''''''' ..... ..........,.. '''9i6
<br />S~~d'caij~s'Of'L~~""" ........"....... ......................... .,........"...."...",.,..... ......" ......,..., .....,...., ......... .......,....... "64"
<br />See Sch&dule Of Covered Autos limit of liability I@ss deduaible.
<br />Colii~i~~"'"'' ..................... ................... ............................ '..,."...............'................ ..,........"........... ...... .......1'.' i04
<br />
<br />
<br />.....' ~~.d~~~.~f.~~.~~~.~~~~.."................".. ,..~i~!~.~!. r~~i.Jity le5~............. ~ ",..,., .......".....".................. .....".. ...........
<br />Garage e . 947
<br />See Endo3~ment $50,000 $500
<br />...............,."..........."............................."............................ ...........!....................................,.............................,,,
<br />Storage loU1tion 853
<br />See Schedule of Covered locations $50,000 $500
<br />~~~~~. p',o~.I.~.~~~!~~.... ....... ,..."............ ........................,'...,..,.........................,.. '.".....,.....,......... ......~.~~~~~~
<br />~~!P~.9.~!~.~,T.~.Efr~.~~~~I.9.~.~~.~~9~fTX.f~~.........................,.........................,.....,.....,,,.................. .....................f
<br />~ li;;o;njjj PO;kJ pm;;~;;;uu uu Uu u u u u U U $is;i:q
<br />!
<br />
<br />Item Three - Auto coverage sc~edull
<br />
<br />~
<br />..
<br />
<br />1.
<br />
<br />2005 Ch.vrol.t C3500 SUverada
<br />VIN: 1 GBJC34UX5E296461
<br />
<br />Stated Amount
<br />Garaging Zip Code:
<br />
<br />o
<br />.
<br />o
<br />
<br />$40.000
<br />77503
<br />
<br />Radius: 50
<br />
<br />I
<br />II
<br />
<br />liability
<br />Premium
<br />
<br />~~!'~... .., ..... .~.~I~.~... ... ...~~,~~..... ........ ~!~,..... '......,.,..,....,......,.,... ,. ,.,... ... ,. ,......, '" '..,........ '. ........... ..... ..... ,.. ,.
<br />$5.058 5215 $54 $463
<br />
<br />!'hyslcal Damage
<br />Premium
<br />
<br />f~<<
<br />Deductible
<br />
<br />MIc
<br />~Ium
<br />
<br />Collision
<br />Dtdooibl!
<br />
<br />(oU~on
<br />Pl!mlUm
<br />
<br />A.-o Total
<br />
<br />..................................................................................,.....,..,......................................................................
<br />
<br />S 1,000
<br />
<br />S40S
<br />
<br />$1,000
<br />
<br />S708
<br />
<br />$6,90&
<br />
<br />2.
<br />
<br />199' UD UD2
<br />VIN: JNAMB20H4WGf65225
<br />
<br />Stated Amount:
<br />Garaging Zip Code:
<br />
<br />$20,000
<br />77503
<br />
<br />Radius: SO
<br />
<br />Uablllty
<br />Premium
<br />
<br />~~.~.. ,.....,.. .~.~I~,~,I"..,.. ..~~.~~ .,,'.... ....~!P"..... ,...... ....... ..,..
<br />$4,963 $215 $54 $463
<br />
<br />.........,......,......,."...................................."......,
<br />
<br />Physical Damage
<br />Premium
<br />
<br />fl/Cat ftX:,K Collision Collision
<br />Deductible Prtmium D!duaible Premium AUlO Total
<br />...,............................"................................................ ..............,,,.,...,,...,.,...................................,.."".......
<br />$1.000 $233 S 1,000 $396 $6,324
<br />
<br />Form 6489 TX (05.112)
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<br />ClIlIliaUMf
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