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Coverage provided by: <br />Erie Insurance Exchange <br />100 Erie Insurance Place Erie,PA 16530 <br />www.erieinsurance.com <br />Page 1 of 3 <br />Your Auto Policy Declarations (Amended) <br />000001 <br />NC DEC 05/14 W FS 07/02/2022 10:26:07 <br />Amendment Effective 07/01/2022 <br />Policy Number <br />Q01 1512028 <br />Policy Period <br />01/15/2022 to 01/15/2023 <br />NAIC Code <br />26271 <br />Named Insured <br />MARLENE HAMPTON & <br />MICHAEL TODD HAMPTON <br />7726 FALCON REST CIR <br />RALEIGH,NC 27615-2550 <br />Your ERIE Agent (JJ1481) <br />CHAN WRIGHT INSURANCE AGY INC <br />150 PROVIDENCE RD STE 100-A <br />CHAPEL HILL,NC 27514 <br />http://www.chanwrightinsurance.com <br />Agent Phone <br />(919)341-1606 <br />Total Annual Policy Premium:(This is not a bill.Your invoice will follow in a separate mailing.)$1,573.06 <br />Vehicles Covered:Vehicle Rating Information: <br />Vehicle VIN State Use <br />1.2011 FORD ESCAPE 1FMCU0EG9BKB28425 NC Business -Multi <br />2.2004 HOND ACCORD EX 1HGCM66504A023710 NC To work 10 or more miles -Multi <br />3.2007 BUIC LUCERNE CX 1G4HD57287U168589 NC Pleasure -Multi <br />Driver Rating Information: <br />Drivers Included Driving Experience Status Gender Vehicle <br />MARLENE HAMPTON 38 years Married Female 1 <br />MICHAEL TODD HAMPTON 35 years Married Male 2 <br />COLE B BARBERA 2 years Single Male 3 <br />Discounts that apply:Vehicle: <br />Anti-Lock Brake Discount 1,2,3 <br />Anti-Theft Discount/Passive Non-Disabling 1,2,3 <br />Claims/Violation Free Discount 1,2,3 <br />Multi-Policy Discount -Auto/Home 1,2,3 <br />Prior Bodily Injury Limits Discount 1,2,3 <br />Thank you for being a responsible driver.The Claims/Violation Free Discount has been applied to your policy premium. <br />First Accident Forgiveness applies to your policy.The first surcharge for a future at-fault accident will be waived. <br />Surcharges that apply:Driver:Vehicle:Date: <br />Inexperienced Operator Surcharge (IOS)3 <br />Coverages/Limits of Protection/Premiums <br />Insurance is provided where a premium is shown for the coverage.Coverages,limits and annual premiums are as follows: <br />DocuSign Envelope ID: 9E4F9B69-0119-4357-BF61-464E6994AE86