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<br />07/12/2005 20:18 <br /> <br />2814790880 <br /> <br />L;HA~.Lt:. M.l.I'll.l:> <br /> <br /> <br />..~ <br /> <br /> <br />I........=-..':::~ <br /> <br /> <br />Policy number. 03365138-0 <br />CHARUE HINDS PAINT III>D <br />P1lgt 2 of] <br /> <br /> <br />Rated drivers <br />...............11................,..........................................................................................'.".'1."...,.,............................. <br />1. CHARLIE HINDS I <br />2. KAREN.~jIN.DS...... .......................... ,....., ...'....' ......... .................. .........,. ........ ,...,.. "" ................ ................. ........... . <br /> <br />.......................................................................................................,...................................................'..1.11............. <br />3. GREGORY HINDS <br />I..'.....................,..".....................................................................................................,...............1...................... <br />4. DONNA EDMONDSON <br />S. iRRVEDMONSON............ ..... ......... .... ....................,................................................ .............................. .......... .... I <br /> <br />~---_. .. <br />. Outline of coveragl '(SymboI7 applies unless otherwise stated in item two) \ <br /> <br /> <br />~............ ............. ......... ..... ........ ............~~........ .......,............ ............... ............ .\,.:... .~~~. ............~ <br />liability Coverage $ 10,021 <br />Bodily Injury and Property DamagQ liability $500,000 combined single limit <br />UnlnsuiediU;;derinsu;eifMOiOiiSi............... ......... '''S50(I,OOO'a;~bi'ned' siogie'iio;it. ................................ ..... ....... ..:......4.30 <br />u~iriSu;cjMotori5t'Pro'peitY'Dama'ge'''''''''''''''''' ....i5o:ooo.~~di.a(ddeiii................... ......... .......,... 'ils'" ........... ..... ",08 <br />p~~o~~i'in~ry'P~CiiM'"'''''''''''''''''''''''' .......... 'si5:000'~ad.;'pe~~~"'''''''''' .................................. ............... ......926 <br />S~(rcai.iS8S'Ofl~"""""'''''' .....,.......................... ....................................... .......... ......,..... ........... .............. '~'; <br /> <br />See ScMdule Of COile red Autos Umit of liability less deduaible. <br />coili~i~n"'''''''''''''''''''''' .... ............ ............... .......... ................................... .............. '" ................ ...... ..... ........( 104 <br /> <br /> <br />...... ~~.~~~.~.~~~.'Y:~.~~~.................... .... ...~':':'~.~f. ~~~i.'ity le~............ .~. ......... ...... .............. ............. ......... ........... <br />Garage . 947 <br />See Endorsement S50,000 $500 <br />Stomge'location .............. .........................,. .............. .... ....................................................,................... ............. 'is3 <br /> <br />See Schedule of Covered locations $50,000 $500 <br />Subtatal policy pNIIllum 5'5.030 <br />......................................................................................................,1......................................,...................................... <br />~Y!P~9.~!~ .T.~.~f.I:.~.~~~~I.l?~.~~!~!?~~TX.~~...... ....................................,............,............................... ..................~ <br /> <br />~.. ..... ........... ....... ....... ................. ...................... ....................,.................................................... ....... .......... .~.~~ I <br />Total 11 month policy premium $15, '57 <br />! <br /> <br />It 1m Three - Auto cov.rage s~.dull <br /> <br />1. 2005 Ch_vroIet C3500 Sllv~rada <br />VIN: <br /> <br />Stated Amount: $40.000 <br />Garaging Zip Code: 77503 <br /> <br />Radius; 50 <br /> <br />Uability <br />Premium <br /> <br />1lIblIIty UMJUIM &l UM po PIP i <br />.............................................................................,......................................................................................... :I <br />$5,058 $215 S54 $463 ~ <br /> <br />Physical Damage <br />PremIum <br /> <br />ft.lCac ~ Collision (oIfrsion <br />Dedu::1ibIe PremIum Otduaible PI!ll'lIIIm AWl lCICII <br />'S;),oo' .........S408....... .....'$';:000..........,7"08........ ....... .,.. ,,"" ,.. ........ ................. ....... ..... ............ ........$,;90& <br /> <br />2. 1"' UD UD2 <br />VlN: <br /> <br />Stated Amount: $20,000 <br />Garaging Zip Code: 77503 <br /> <br />Radius: SO <br /> <br />Uablllty <br />Premium <br /> <br />l.iiIbility UMAJlM " UM PD PIP <br />$4;963......... 'si 15'" ..... ,.. .'5'54.......... ....$463........................................'........'............................ ..... ............. <br /> <br />Physical Damage <br />Premium <br /> <br />Ft/CaC FtUc Collision Collision <br />Deductible PItIIIium Deduoible Pmnium Alao Teal <br />............................................................................................................................................,......................... <br />$ 1,000 $133 S 1 ,000 $396 56,124 <br /> <br />Form 5489 TX C05~21 <br /> <br />. <br />CanIiIIlIMI <br />