Policy Document
Policy Document
PO Box 137089
Fort Worth, Texas 76136
Description Amount
Payment Received On Endorsement 46.00
VISA/MASTERCARD (Reference #: 29515224)
Changes to Policy
ADDED 2008 NISSAN 350Z 2-DOOR COUPE JN1BZ34D08M702906 COMP/COL: NONE REN: NONE TOW: NONE
This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated
herein.
WARNING
This acknowledgement and rejection is applicable to all renewals issued by XVRUDQ\ affiliated insurer.
However, we must provide a notice with each renewal as follows: “This policy contains a named driver exclusion”
You agree that nonH of the insurance coverage is afforded by this policy shall apply while
JOEL CASSIO, MAYLIN PINEDA VARELA, JOEL CASSIO REYES, MAYLIN PINEDA VARELA, SOPHIA LANDEROS,
MARTHA PEREZ, ESPERANZA MONTES DE OCA, MELISSA MONTESDEOCA, MARTIN MONTES DE OCA ROMAN,
MELISSA MONTESDEOCA, ANDRES MONTES DE OCA, MARTIN MONTES DE OCA ROMAN, ANDRES MONTES DE
OCA
is operating your covered auto or any other motor vehicle. You further agree that this endorsement will also serve as a
rejection of Uninsured/Underinsured Motorists Coverage an Personal Injury Protection Coverage while your covered
auto or any other motor vehicle is operated by the excluded driver.
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JESUS CASSIO SAME Luna Insurance Agency
4504 NEWMAN DR 4475 Hemphill
HALTOM CITY, TX 76117 Fort Worth, TX 76115
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515A, AIC.Storage.004, AIC.ContLiab.006, AIC.AutoTerm.007, AIC.OutOfState.016
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JESUS CASSIO, MA DE LOS ANGELES REYES MONSIVAIS, ANGEL CASSIO REYES, ANDREA CASSIO
The Automobiles described in this policy are principally garaged at the above address unless otherwise stated.
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2008 NISSAN 350Z 350Z JN1BZ34D08M702906 HJ 4
2007 FORD MUSTANG MUSTANG 1ZVFT80N875277436 PM 4
2003 FORD F-150 SUPERCREW F-150 SUPERCREW 1FTRW07L53KB27423 TW 4
2011 CHEVROLET EQUINOX LTZ EQUINOX LTZ 2CNALFEC9B6390300 LT 4
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Coverage is provided where a Limit of liability and a premium is shown for the coverage.
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Auto 1 Auto 2 Auto 3 Auto 4
Liability - Bodily Injury 30000 Each Person 60000 Each Accident 82.00 259.00 154.00 218.00
Liability - Property Damage Each Person 25000 Each Accident 81.00 273.00 191.00 242.00
Personal Injury Protection Each Person
Uninsured/Underinsured Motorist - Bodily Injury Each Person Each Accident
$250 Deductible Applicable to
Un insured/Underinsured Motorist - Property Damage Each Accident
Property Damage Liability
Medical
Coverage for damages to your automobile Auto 1 Auto 2 Auto 3 Auto 4
Collision Actual cash value unless otherwise stated
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Pursuant to the Texas Insurance Code §1812.003, you may access a copy of the above policy forms and endorsements by logging into our
website at www.alinsco.com. For a paper copy of your policy form and endorsements at no charge, please call (877)437-5010.
INSURED COPY
Texas Personal Auto Policy 'HFODUDWLRQV
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JESUS CASSIO SAME Luna Insurance Agency
4504 NEWMAN DR 4475 Hemphill
HALTOM CITY, TX 76117 Fort Worth, TX 76115
(QGRUVHPHQWVWR3ROLF\
515A, AIC.Storage.004, AIC.ContLiab.006, AIC.AutoTerm.007, AIC.OutOfState.016
5HSRUWHG'ULYHUV
JESUS CASSIO, MA DE LOS ANGELES REYES MONSIVAIS, ANGEL CASSIO REYES, ANDREA CASSIO
The Automobiles described in this policy are principally garaged at the above address unless otherwise stated.
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2008 NISSAN 350Z 350Z JN1BZ34D08M702906 HJ 4
2007 FORD MUSTANG MUSTANG 1ZVFT80N875277436 PM 4
2003 FORD F-150 SUPERCREW F-150 SUPERCREW 1FTRW07L53KB27423 TW 4
2011 CHEVROLET EQUINOX LTZ EQUINOX LTZ 2CNALFEC9B6390300 LT 4
/LHQKROGHU,QIRUPDWLRQ
$XWR 1DPH
Coverage is provided where a Limit of liability and a premium is shown for the coverage.
&RYHUDJH /LPLWVRI/LDELOLW\ 3UHPLXPV
Auto 1 Auto 2 Auto 3 Auto 4
Liability - Bodily Injury 30000 Each Person 60000 Each Accident 82.00 259.00 154.00 218.00
Liability - Property Damage Each Person 25000 Each Accident 81.00 273.00 191.00 242.00
Personal Injury Protection Each Person
Uninsured/Underinsured Motorist - Bodily Injury Each Person Each Accident
$250 Deductible Applicable to
Un insured/Underinsured Motorist - Property Damage Each Accident
Property Damage Liability
Medical
Coverage for damages to your automobile Auto 1 Auto 2 Auto 3 Auto 4
Collision Actual cash value unless otherwise stated
:HDJUHHWRPDNHDYDLODEOHWR\RXDQLQVWDOOPHQWSODQH[FHSWZKHQDQLQVWDOOPHQWSODQLVSURKLELWHGE\UXOHRUVWDWXWH
Pursuant to the Texas Insurance Code §1812.003, you may access a copy of the above policy forms and endorsements by logging into our
website at www.alinsco.com. For a paper copy of your policy form and endorsements at no charge, please call (877)437-5010.
AGENT COPY
Texas Liability Insurance Card - Keep This Card
Name & Address of Insured Covered Vehicle - Year, Make & Model
(Nombre y Dirección del Asegurado) (El Año, Marca y Modelo de Cada Vehículo con Cobertua)
JESUS CASSIO 2008 NISSAN 350Z
4504 NEWMAN DR
HALTOM CITY, TX 76117
Vehicle ID Number
(Numero de Identificacion de Vehículo)