Tel: 1-800-841-3000 Declarations Page

This is a description of your coverage.

Please retain for your records.
Government Employees Insurance Company
One GEICO Boulevard Policy Number: 6028-47-81-51
Fredericksburg, VA 22412-0003
Coverage Period:
01-12-22 through 07-12-22
12:01 a.m. local time at the address of the named insured.

Date Issued: December 4, 2021

ELAINE M SUCHOSKI AND JOHN K

SUCHOSKI
5 CIDER MILL DR
SUSSEX NJ 07461

Email Address: ebacon1966@gmail.com

Named Insured Additional Drivers

Elaine M Suchoski Julie A Bacon
John K Suchoski

Vehicles VIN Vehicle Location Finance Company/

Lienholder
1 2018 Cad Xts 2G61M5S38J9128851 SUSSEX NJ 07461 ALLY FINANCIAL

2 2015 Ford Mustang 1FATP8EM8F5383514 SUSSEX NJ 07461

3 2015 Kia Optima 5XXGR4A61FG369665 SUSSEX NJ 07461 ALLY FINANCIAL

4 2014 Ram 1500 1C6RR7GG0ES348134 SUSSEX NJ 07461 ALLY FINANCIAL

5 2000 GMC CL Sir3500 1GDJC34RXYF414025 SUSSEX NJ 07461

Coverages* Limits and/or Deductibles Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4

Bodily Injury Liability

Each Person/Each Occurrence $250,000/$500,000 $79.20 $82.80 $100.20 $100.00
Property Damage Liability $100,000 $55.50 $56.40 $73.50 $90.80
PIP Full PIP Primary Option E
$250,000
$250 Ded $64.80 $66.20 $73.50 $56.80
Uninsured & Underinsured Motorists
Each Person/Each Occurrence $250,000/$500,000 $66.90 $66.90 $66.90 $66.90

Tier B
Continued on Back
DEC_PAGE (03-14) (Page 1 of 4) Renewal Page 15 of 125
Coverages* Limits and/or Deductibles Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4

Underinsured Motorist Property Damage $100,000 $2.10 $2.10 $2.10 $2.10

Comprehensive (Excluding Collision) $500 Ded $72.40 $39.30 $42.80 $29.10
Collision $500 Ded $194.70 $157.10 $146.40 $116.10
Emergency Road Service ERS FULL $4.40 $8.90 $8.90 $10.90
Rental Reimbursement $50 Per Day
$1,500 Max $16.20 $16.20 $16.20 $16.20
Six Month Premium Per Vehicle $556.20 $495.90 $530.50 $488.90
Coverages* Limits and/or Deductibles Vehicle 5

Bodily Injury Liability

Each Person/Each Occurrence $250,000/$500,000 $90.80
Property Damage Liability $100,000 $69.20
PIP Full PIP Primary Option E
$250,000
$250 Ded $92.20
Uninsured & Underinsured Motorists
Each Person/Each Occurrence $250,000/$500,000 $66.90
Underinsured Motorist Property Damage $100,000 $2.10
Comprehensive (Excluding Collision) $500 Ded -
Collision $500 Ded -
Emergency Road Service ERS FULL -
Rental Reimbursement $50 Per Day
$1,500 Max -
Six Month Premium Per Vehicle $321.20

Total Six Month Premium $2,392.70

*Coverage applies where a premium or $0.00 is shown for a vehicle.

If you elect to pay your premium in installments, you may be subject to an additional fee for each installment. The fee
amount will be shown on your billing statements and is subject to change.

Discounts
The total value of your discounts is $937.30
Passive Restraint/Air Bag (Veh 1, 2, 3, 4) ......................................................................................................$79.40
Anti-Theft Device (Veh 1, 2, 3, 4) ..................................................................................................................$29.40
Multi-Car (All Vehicles) ................................................................................................................................$527.00
5 Year Good Driving (All Vehicles) ..............................................................................................................$301.50

Continued on Next Page

DEC_PAGE (03-14) (Page 2 of 4) Renewal Page 16 of 125
Contract Type: FAMILY STANDARD AUTO

Contract Amendments: ALL VEHICLES - UE112A(07-21) A30NJ(02-08) A54NJ(06-17)

Unit Endorsements: UE316A(04-88) (VEH 1,3,4); A115(04-08) (VEH 1,2,3,4); A431NJ(05-11) (VEH 1,2,3,4);
A468NJ(07-04) (VEH 1,2,3,4,5)
Class: A -N -50-64 A (VEH 1); A -N -50-64 A (VEH 2); A -N -50-64 D (VEH 3); A -N -50-64 D (VEH 4);
A -N -50-64 B (VEH 5)

HCI: 157R18

Important Policy Information

- Please review the front and/or back of this page for your coverage and discount information.
- A discount for successfully completing an approved Defensive Driver Course is available in New Jersey.
- You are currently carrying the Limited Tort option on your policy.
- Reminder - Physical damage coverage will not cover loss for custom options on an owned automobile, including
equipment, furnishings or finishings including paint, if the existence of those options has not been previously reported
to us. This reminder does NOT apply in VIRGINIA, however, in Virginia coverage is limited for custom furnishings or
equipment on pick-up trucks and vans but you may purchase coverage for this equipment. Please call us at
1-800-841-3000 or visit us at geico.com if you have any questions.
- Confirmation of coverage has been sent to your lienholder and/or additional insured.
- Claims incurred while an insured vehicle is being used to carry passengers for hire may not be covered by this
contract. Please review the contract for a full list of exclusions and contact us if you plan to use any of your insured
vehicles for this purpose.
- The Multi-Line Discount has been removed because you no longer meet the eligibility requirements.

DEC_PAGE (03-14) (Page 3 of 4) Renewal Page 17 of 125

DEC_PAGE (03-14) (Page 4 of 4) Renewal Page 18 of 125