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DocuSign Envelope ID:48D95A50-1183-4EB9-9997-46BD3AOD7724 <br /> State Farm <br /> VEHICLE INFORMATION <br /> Review your policy information carefully. If anything is incorrect, or if there are any changes to your vehicle information, please <br /> let us know right away, <br /> Vehicle Identification <br /> Vehicle Description Number(VIN) Who principally drives this vehicle? How is this vehicle normally used? <br /> NONOWNED Not applicable. <br /> Premium Adjustment comprehensive and collision rates. If you carry <br /> Comprehensive and collision rates are based upon State comprehensive and/or collision coverages,these <br /> Farm's loss experience. This loss experience is reviewed adjustments are reflected in the rates shown on this renewal <br /> periodically to determine which makes and models have notice. <br /> earned decreases or increases from State Farm's standard <br /> COVERAGE AND LIMITS See yourpolicyforan explanation of these coverages. <br /> AB Liability Bodily Injury 1,000,00011,000,000 $164,00 <br /> Property Damage 1,000,000 Included <br /> Amount Due $164,00 <br /> Coverage AB is on a per policy basis, you the broader protection without issuing a new policy, <br /> If any coverage you carry is changed to give broader starting on the date we adopt the broader protection, <br /> protection with no additional premium charge, we will give NOTICE OF RIGHT TO PURCHASE HIGHER LIMITS OF <br /> UM/UIM NOTICE: YOU ARE REQUIRED TO PURCHASE <br /> (continued on next page) <br /> Policy Number:156 3777-CO8-33A Page number 2 of 3 <br /> Prepared August 3,2018 <br />