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BLORPA.
<br />~ Erie
<br />Insurance
<br />Group
<br />t00 Ede Mi PL
<br />Er4, PA 18680
<br />AMENDED DECLARATIONS Ol
<br />ATTACH THIS TO YOUR POLICY.
<br />REASON FQR AMENDMENT -
<br />ERIE INSURANCE EXCHANGE
<br />PERSONAL AUTO POLICY
<br />EFFECTIVE lp/24/0$
<br />ELIMINATED COVERAGE ,
<br />JJ1013 HERRING & BICKERS INS 10/24/QS TQ 10/24/09 Q10 2406438 NG
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<br />DIANE C REYNOLDS AS LISTED BELOW
<br />4102 KILDRUMMY DR ,
<br />pURNAM NC 27705-6315'
<br />AGENT - HERRING & HICKER5 IN$ 2344 OPERATIONS.DR., SUITE; 101 •
<br />AGENT PHONE - (919) 479-9900 DURHAM NC 27705 2336
<br />* CQNGRATULATIONS! A PIONEER EXPERIENCE RATING CREDIT HAS ~
<br />~*$*****p****n**~**~****~**********~***********~**********~
<br />ITEM 4. AUTOS COVERED
<br />A'U10 D3 ACUR 3.2TL l~UUA56603A09OQ80 NC T13 GYM RAT~$G CLASS PTS
<br />ITEM 5. INSURANCE IS PRONTO D WHERE A PREMIUM OR INCL IS SHOWN FOR THE
<br />COVERAGE. FOR "UNINSURED AND~OR UNDERINSURED MOTORISTS COVERAGE " IF A PREMIUM
<br />CHARGE IS INDICATED, COVERAGES IS PROVIDED FOR EACH VEHICLE LI5T~D UNDER ITEM 4
<br />FQR WHICH LIABILITY PROTECTION HAS BEEN PURCHASED. COVERAGES ,,.LIMITS AND
<br />ANNUAL PREMIUMS ARE AS FOLLOWS- '
<br />LIABILITY PROTECT~0~1-
<br />BODILY INJURY ~ uuUM/PERSON $3QOM/ACC 259.66
<br />PROPERTY DAMAG gg50 ACC 151.6E
<br />P~HYS I CAL DAMAGE CO~IERA~ES- ~ '
<br />COMPREHENSIVE - 104
<br />COLLISION - 500$DED DED 27],
<br />8
<br />QPEXTEND
<br />DQ
<br />N
<br />E
<br />E
<br />TRA
<br />S
<br />~Xp - $30/DAY 900 LOSS
<br />r ~ / ~,
<br />20
<br />TOTAL ANNUAL PREMIUM FOR EACH AUTO 820,32 '
<br />UNINSURET MOTORISTS COVERAGE-
<br />PROPERTY bAMAGE $$50M/ACC^ 10.0 DED 3
<br />UNINSURED~UNDERINSI7RED MOTO~ISTS COVERAGE-
<br />$O
<br />I
<br />D
<br />LY NJURY $1dOM/PERSON ~300M/ACC 44
<br />TOTAL ANNUAL .POLICY PREMIUM $ 857,32.
<br />PREMIUM REDUCTION DUE 7'0 THIS CHANGE $ 58,OOCR
<br />A~
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<br />~ 02T05~~6TONC~OlOR10%~7S I'TEMS
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<br />A T 1 NG0302 O1/9
<br />.
<br />AUTO~HOME MULTI POLICY DISCOUNT APPLIES
<br />ANTIWLOGK BRAKE DISCOUNT APPLIED AUTO 1
<br />10+~ ANTI-THEFT DISCOUNT APPLIED A^TO 1
<br />30~$ AIRBAG DISCOUNT APPLIED AUTO 1
<br />*******,t*,x~rw~rwwww~r***********~***~*****~r>tc*,r~r~rar,x,~x**~r~r*rr****~r*~:**~**I
<br />'* FIRST ACCIDENT FORGIVENESS APPLIES., THE
<br />* FIRST SURCHILRGE :FOR A
<br />*'
<br />.
<br />FUTURE AT-FAULT ACCIDENT WII~~, ~F~ WAIVED. x
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<br />MISCELLANEOUS INFORMATION
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