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DocuSign Envelope ID:COB 173FE-65A7-41C5-985D-8D6B23DF80FB <br /> Prepared on March 18,2020 Page 2 of <br /> Nationwide Your Policy Declarations <br /> is on your side <br /> Nationwide Auto Policy <br /> Policy Period: Jan 12,2020-Jul 12,2020 <br /> For coverage definitions and descriptions, Policy Number: 6132P 493603 <br /> visit Nationwide.com <br /> Insured Driver(s) <br /> Driver Date of Marital Driver Driver Assigned <br /> # Name Birth Status Gender Type Vehicle <br /> 01 Pamela M Hines 06/28/70 Single Female Principal 01 <br /> Insured Vehicle(s)and Schedule of Coverages <br /> 2010 Hyundai Sonata G <br /> VIN 5NPET4AC9AH636286 <br /> Coverages Limits of Liability Premium <br /> A Damage To Your Auto $ <br /> Other Than Collision Actual Cash Value Less$ 100 <br /> (Comprehensive) <br /> Collision Actual Cash Value Less$ 250 $ T" I( <br /> B Liability <br /> Property Damage Liability $ 50,000 Each Accident $ hasm <br /> Bodily Injury Liability $ 50,000 Each Person <br /> $ 100,000 Each Accident $ AREW <br /> C Medical Payments $ 1,000 Each Person $ XXW <br /> Increased Limits Endorsement 3083A $ MOM <br /> Transportation $ 50 Per Day <br /> Expenses Coverage $ 1,500 Per Accident <br /> Towing and Labor Plus-Covers Disablement/ $ Ate ( <br /> (Roadside Assistance) $ 100 Lockout <br /> $ 500 Trip Interruption <br /> Endorsement 3450 3446 <br /> Total for this Vehicle $ YAWM <br /> Policy Level Schedule of Coverages <br /> Coverages Limits of Liability Premium <br /> Part D2-Combined <br /> Uninsured and Underinsured <br /> Motorist-Bodily Injury $ 50,000 Each Person $ MSC <br /> $ 100,000 Each Accident <br /> Uninsured-Property Damage $ 50,000 Each Accident $ <br /> Coverage For Damage To Rented Endorsement 3092B $ diC <br /> Vehicles <br /> Total for Policy Coverages $ ��iC <br /> Continued on the next page <br />