EFTA01077973

WensFargo Insurance Services USA, Inc. SWELLS 330 Madison Avenue FARG 0 7th Floor New York NY 10017-5001 July 25, 2013 RE: Automobile Insurance Dear Leon: Enclosed please fmd Fireman's Fund Insurance Company policy_ renewing your automobile insurance for a further period of one year from July 26, 2013. Also attached is our invoice in the amount of $21,075 representing the annual premium. The policy covers on eleven vehicles which are as follows: 1989 Mercedes Benz 560 SL 2009 Honda Pilot 2004 Mercedes Benz S600 2011 Chevrolet K1500 Silverado 2004 Toyota Highlander 2012 Mercedes Benz 8350 2004 Acura TL 2012 Chevrolet Tahoe LT 2007 Bentley 2013 Mercedes Benz S600 2008 Jeep Patriot All of these vehicles are garaged in Bedford Hills, New York. There is $1,000 deductible comprehensive fire, theft and collision coverages. Liability protection is afforded with a limit of $500,000 bodily injury/property damage. You have excess umbrella liability covering over and above this primary insurance. I trust you will fmd all in order and remain Sincerely, Jeffrey A. Haber JAH:ya Encl. Together we'll go far G trice Am41‘1744, Las L Drbid.Atmowc RencwalLea do: EFTA01077973 Declarations Personal Auto Po!ley Policy Number Fireman's Fond Insurance Companies Coverage is provided in the following cotnpany, Policyl iod: From 07/26/2013 To 07/26/2014 a stock company (120) Tie* a the AMISS eflerezet secedes acedHas) 13 - Associated Indemnity Corporation insured's Name and Mailing Address I Auto(s) principally garaged at mailing address unless Zip Code Leon D Black otherwise stated_ # 200 The Narrows Bedford Hills, NY 10506 MIN lLon Payee Per Auto TAX TERRITORY: 05704 DESCRIPTION OF AUTO(5) OR TRAIL AM° Model ass- No. kJ Aim Class /Tier Year Trade Name, Model, Body Type Identification Number Tea. = 1 2011 Chevrolet K1500 Silvered° 1GCNKPEA8BZ116619 A 2011 883120H 65 2 1989 Mercedes Benz 56051. WDBBA48D3KA100433 A 1989 89112214 65 3 2012 Chevroke Tahoe LT 1GNSKBEO5CR302060 E • 2012 8831204 .. 65 15% Coverage Is Provided Where A Premium And Limit Of Liability Are Shown For The Coverage . Coverages Limit of Liability Fall Term Premium S AM I S Adel S PO63 A. liabftity (Single Limit) S 500,000 Each Accident 406 804 406 A. Liability (Split Limits) Boa bitty 5,000 Each Pawn S .000 Each Accident Property Damage S ,000 Each Accident B. Medical Payments S 100.000 Each Person 9 10 9 C ()uins-urecVLIndminsured Motorists (Sisk& Limit) S 500,000 Each Accident —170 "170 "170 C. Uninsured Bodily Injury S ,000 Each Pawn Motorists S ,000 Each Accident (Split Limits) Properly Damage 5 .000 Each Accident D. Damage Collision Loss (ACV Means Actual Cah Value) To Auto I: ACV Minus 51000 Deductible 341 457 389 Your Auto 2: ACV Minus 51000 Deductible Auto Auto 3: ACV Nimus 51000 Deductible Ober Than Auto : 5 ACV Minus 5 wenuate Collision Loss Auto 1: S Minus S1010 oceeuake 93 291 98 Auto 2: S Minus $1000 Mambo Auto 3:3 Minus SI003 Cedtcale Towing and Labor Costs- Each Disablement 'Ind 'Ind incl Rental Rein:lbws:anent or Eat Tousponstioa See Eadersemem 'Ind and inel 'Personal Injury Protection see attached See Endorsement 76 189 76 NY Motor VeNcle Enforcement Fee 10 10 10 'Prestige Auto 'incl and lid "Supplemental Endorsement (SUM) Endorsements Attached Total Premium Per Auto 1105 1901 1138 PP0001 PP0179 PP0346 PP0364 PP0409 PP0476 Eadorsement Premium s '257 PP0587 PP0588 PP0593 PP1301 102164 102173 102192 Total Policy Premium Sams pg.4 Discounts: See attached Data ofIssue Countasignatina of Authorized Agenr 7/18/13 CEB 5965.%95 This Declarations Page Is Issued in Coop:nom With And Is Part Of The Pascual Auto Policy INSURED COPY Page 1of 4 EFTA01077974 Declaration Personal Auto Policy Policy NumberIMM Fireman's Fund Insurance Companies Coverage is provided in the following company, Potty Period: From 07/26/2013 To 07/26/2014 a stock company (12.0=t Staird Trees Oil Attu ofNmet hb000f AO 510(4 Hem,) 13 - Associated Indemnity Corporation Insured's Name and Mailing Address Auto(s) principally garaged at mailing address unless Zip Code Leon D Black otherwise stated. Debra R Black 64-6 200 The Narrows Bedford Hills, NY 10506 Loss Payee Per Auto TAX TERRITORY 05704 DESCRIPTION OF AUTO OR TRAILERS Aug Model see No. Year Trade Name, Model, Body Type klenrifIcatica Number tot Age Class / Tier TeTea. Mat 4 2012 Chevrolet Silverado K2500H0 1GC1KX038CF189577 .1 2012 815120H 65 15% 5 2004 Mercedes Benz 5600 WDENG76J74A3.99157 Y 2004 883120H 65 15% 6 2004 Toyota Highlander _JTEEP21A840031177 A 2004 883121H 65 15% Coverage Is Provided Where A Premium And Limit Of Liability Are Shown For The Coverage Coverages Limn of Liability Fall Term Premium s Asa S Asa 3 Ause6 A. Liability (Single Limit) S 500,000 Each Accident 452 416 406 A. Liability (Split Limits) Bodily Injury S ,000 Each Person 5,000 Each Accident Property Damage S NO Each Accident B. Medical Payments S 100,000 Each Person 9 9 9 C UninsmerlfUnderinsured Motorists (Sink Limit) S 500,000 Each Accident "170 "170 "170 C. Uninsured Bodily Injury S ,000 Each Person Motorists S .000 Each Accident (Split Limits) Property Damage $ ,000 Each Accident D. Damage Collision Loss (ACV Means Actual Cash Value) To Auto 4: ACV Minus $1000 Deductible 537 769 228 Your Auto 5: ACV Minus $1000 Deductible Auto Auto 6: ACV Minus $1000 Deductible Other Than Auto :5 ACV Minus S osaaahic Collision Loss Auto 4:5 Minus 51000 Dolvenble 159 401 68 Auto 5: 5 Minus $1000 Doltcak Auto 6: $ Minus 51000 Dedorobk Towing and Labor Costs Each Disablement 'Ind rind Ind Rental Reimbursement or Ext. Transportation Soo Endorsement Ind Ind 'Ind Personal Injury Protection sec attached See Endorsement 83 79 76 NY Motor Vehicle Enforcement Fee 10 10 10 'Prestige Auto Ind Ind 'Intl "Supplemental Endorsement (SUM) Endorsements Attached Total Premium Per Auto 1420 1854 967 Endorsement Premium Stine' Teal Policy Premium S see ps4 Discounts: see attached Daze of blue Countersignature of Authorized Agent 7/18/'13 CEB 5965.5-95 This Declarations Page is Issued In Conjunction With And Is Pan Of The Personal Auto Policy INSURED COPY Page 2 of 4 EFTA01077975 Declarations Personal Auto Policy Policy Number Fireman's Fund Insurance Companies Coverage is provided in the Mains company, Poligleriod: From 07/26/2013 To 07/26/2014 a stock company maim Sudard Thant itc Addnu orSamcd eased as Voce Hay) 13 - Associated Indemnity Corporation Insured's Name and Mailing Address Auto(s) principally garaged at mailing address unless Zip Code Leon D Black otherwise stated. #7-9 200 The Narrows Bedford Hills, NY 10506 Loss Payee Per Auto TAX TERRITORY. 05704 DESCRIPTION OF AUTOS) OR TRAILEFt(S) Aate Model Syr ta NO Year Trade Name, Model Body Type identifiatice Number Age Class I Tier Ten. M. 7 2007 Bentley Continental GTC SCBDR33W17C046196 Y 2007 816120H 65 15% 8 2008 Jeep Patriot Limited 1J8FT48W08D700745 E 2008 883120H 65 15% 9 2009 Honda Piot 5FNYF48269B053993 E 2009 815120H 65 15% Coverage Is Provided Where A Premium And Limit OfLiabilitYAre Shown For The Coverage Coverages Limit of Liability Fall Term Premium S Awes S AM 8 5 Aurae A. liability (Single limit) $ 500,000 Each Accident 452 416 464 A. Liability (Split Limits) Bodily Injury $ ,000 Each Pence S ,000 Each Accident Propaty Damage 5.000 Each Accident B. Medical Payments S 180,000 Each Person 9 9 9 C Uninsuredflindainsured Motorists (Single Limit) S 500,000 Each Accident "170 "170 *-170 C. Vain:lad Bodily Injury $ ,000 Each Perna Motoras $ ,000 Each Accident (Split Limits) Property Damage 5,000 Each Accident D. Damage Collision Loss (ACV Meats Actual Cub Value) To Auto 7: ACV Minus $1000 Deductible 1657 315 382 Your Auto 8: ACV Maus SI000 Deductible Auto Auto 9: ACV Minus S WOO Deductible Other Than Auto : $ ACV Maus S Oinvento Caftan Lass Ante 7:3 Maus 51000 Mantic 1215 85 108 Auto 8: $ Minus $1000 Deter& Auto 9:$ Minus 51000 Delta* Towing and Labor Coss Each Disablement *Ind *kid *kid Rental Reimbursement or Ext. Transportation Sec Endorsement Ind mid *Ind Personal Injmy Macedon see attached See Endorsement 8.3 79 86 NY Motor Vehicle EnforcerneM Fee 10 10 10 *Prestige Auto 'Ind Ind Ind ''Supplemental Endorsement (SUM) Endorsements Attached Total Premium Per Auto 3596 1084 1229 Endorsement Premium S Ind Total Policy Premium S see pg 4 Discounts: see attached Date of Issue Counteralmatum of Authorized Agent 7/18/13 CEB 5965.5-95 This Declarations Page Is I sued In Conjunction With And Is Pit Of The Personal Auto Policy INSURED COPY Page 3 of 4 EFTA01077976 Declarations Personal Auto Policy Policy Number AAE 12263565 Fireman's Fund Insurance Companies Coverage is provided in the following company, Poligferiod: From 07/26/2013 To 07/26/2014 a stock company (12:01M Sumbld Ties *I ere Mins of Nimbi inns' a Slats Herrn) 13 - Associated Indemnity Corporation Insured's Name and Mailing Address Auto(s) principally garaged at mailing address unless Zip Code Leon D Black otherwise stated. 8 #10-12 200 The Narrows Bedford Hills, NY 10506 Loss Payee Per Auto TAX TERRITORY 05704 DESCRIPTION OF AUTO(S) OR FRAME Arro Model Sse- we. identification Number wet Age Class / Tier Ten. Year Trade Name, Model, Body Type 10 2012 Mercedes Benz R350 GL 4JGCB5HE9CA146170 U 2012 883120H 65 15% 11 2004 Acura TL 19UUA68284A046329 K 2004 861120H 65 15% 12 2013 Mercedes Benz 5600 VADDNG7G84DA515347 Y 2013 802120H 65 15% Coverage Is Provided Where A Premium And Limit Of Liability Are Shown For The Coverage Coverages Limit of Liability Full Term Premium S Ate 10 a Aare II S Aso n A. Liability (Single Limit) 5 500,000 Each Aecidaw 406 677 406 A. liability (Split limits) Bodily Injury S ,000 Each Pasco S ,000 Each Accident Property Damage S ,000 Each Accident B. Medical Payments S 100.000 Each Person 9 9 9 C- Uninsured/Undcrinsured Motorists (Single Limit) S 500,000 Each Accident —170 '170 "170 C. Uninsured Bodily Injury 5 ,000 Each Person Motorists S .000 Each Accident (Split Limits) Property Damage S ,000 Each Accident D. Damage Collision Loss (ACV Means Actual Cash Value) To Auto ICI: ACV Minus 51000 Deductible 705 526 1738 Your Auto II: ACV Minus 51000 Deductible Auto Auto 12: ACV Minus S1000 Deductible Other Than Auto :5 ACV Minus $ Detlimile Collision Loss Auto 10:3 Minus 51000 Detcale 226 125 855 Auto lit 5 Minus $1000 mato* Auto 12: 51,000 Minus S Cdocnble Towing and Labor Costs Each Disablement 'Ind 'ind 'Intl Banal Reimbursement or Ext. TIIIOSpatit(011 Sec Endorsement 'Ind eel 'incl Personal Injury Protection see attached See Endowment 76 121 76 NY Motor Vehicle Enforcement Fee 10 10 10 'Prestige Auto 'Ind 'Ind 'Intl "Supplemental Endorsement (SUM) Endorsements Attached Total Premium Pc Antra 1602 1638 3264 Endorsement Premium S 'Ind Taal Policy Premium S 21075 Discounts: see attached - Dane of Issue Camtasignature of Authorized Agent 7/18/13 CEB 5965-5-95 This Declarations Page Is Issued Li Conjunction WM And Is Part Of The Personal Auto Policy INSURED COPY Page a of 4 EFTA01077977 Fireman% Fund PERSONAL AUTOMOBILE POLICY DECLARATIONS SUPPLEMENT EFFECTIVE DATE COMPANY 07/26/2013 ASSOCIATED INDEMNITY CORPORATION NAMED INSURED YOUR AGENT IS LEON D BLACK WELLS FARGO INS SVCS USA. INC DEBRA R BLACK .31-576.750 POLICY PERIOD: FROM 07/26/2013 TO 07/26/2014 THE FOLLOWING INFORMATION CONCERNING CREDIT, SURCHARGES, OR MINIMUM COVERAGE IS REQUIRED BY LAW. ***THE MAXIMUM AMOUNT PAYABLE UNDER THE SUM COVERAGE SHALL BE THE POLICY'S SUM LIMIT REDUCED AM) THUS OFFSET BY MOTOR VEHICLE BODILY INJURY LIABILITY INSURANCE POLICY OR BOND PAYMENTS RECEIVED PROM, OR ON BEHALF OF, ANY NEGLIGENT PARTY INVOLVED IN THE ACCIDENT. DISCOUNTS VEE 1 VEH 2 VEH 3 VEH 4 VEH 5 VEE 6 Passive Restraint $ 57 $ 40 S 57 S 57 $ 57 S 57 Anti-Theft Device $ N/A $ N/A S 25 S 36 S 141 314 Anti-Lock Brakes $ 33 3 61 S 36 S 47 3 57 3 28 Accident Free $ 73 S 146 S 78 S 103 S 140 $ 59 Daytime Running Lights $ 23 $ N/A S 24 S 30 S N/A S 19 Tier Factor S INCL S INCL S INCL S INCL $ INCL S INCL Multi-Car S INCL S INCL S INCL $ INCL $ INCL S INCL $ $ S $ $ S 3 S S S $ $ S S $ $ $ S $ $ $ $ S $ S S $ $ $ S SURCHARGES INCLUDED IN THE TOTAL PREMIUM CHARGE IS A SURCHARGE OF S 254 CHARGED AS A RESULT OF VIOLATION ACTIVITY OR ACCIDENT INVOLVMENT. Violations: 4/12/10, 9/24/10 & 1/21/11 NEW YORK REGULATIONS REQUIRE THAT EACH DISCOUNT OR SURCHARGE BE SHOWN AS IF IT WERE THE ONLY DISCOUNT OR SURCHARGE APPLICABLE. IF A POLICY HAS MULTIPLE DISCOUNTS OR SURCHARGES, THEIR COMBINATION MAY RESULT IN A TOTAL AMOUNT THAT DIFFERS FROM THOSE SHOWN INDIVIDUALLY. NYSUPPI Page 1 of 2 EFTA01077978 A Firemads Fiord PERSONAL AUTOMOBILE POLICY DECLARATIONS SUPPLEMENT POLICY NUMBER EFFECTIVE DATE COMPANY 07/26/2013 ASSOCIATED INDEMNITY CORPORATION NAMED INSURED YOUR AGENT IS LEON O BLACK • WELLS FARGO INS SVCS USA, INC DEBRA R BLACK 31-576-750 POLICY PERIOD: FROM 07/26/2013 TO 07/26/2014 THE FOLLOWING INFORMATION CONCERNING CREDIT, SURCHARGES, OR MINIMUM COVERAGE IS REQUIRED BY LAW. ***THE MAXIMUM AMOUNT PAYABLE UNDER THE SUM COVERAGE SHALL BE THE POLICY'S SUM IIMIT REDUCED AND THUS OFFSET BY MOTOR VEHICLE BODILY INJURY LIABILITY INSURANCE POLICY OR BOND PAYMENTS RECEIVED FROM, OR ON BEHALF OF, ANY NEGLIGENT PARTY INVOLVED IN THE ACCIDENT. DISCOUNTS VEH 7 VEB 8 VEH 9 VE13 10 YEE! 11 VEH 12 Passive Restraint $ 57 S 57 S 57 S 57 5 57 S 57 Anti-Theft Device $ 338 $ 21 S 22 $ 74 $ 26 $ 342 Ann-Lock Brakes $ 106 S 33 $ 39 - $ 53 $ 58 $ 107 Accident Free $ 309 $ 69 $ 83 S 121 S 68 S 279 Daytime Running Lights S 66 $ N/A $ N/A S 34 S N/A S 68 Tier Factor S INCL SINCL $ INCL SINCL SINCL SINCL Multi-Cat S INCL SINCL SINCL SINCL SINCL MCI S• $ $ $ $ $ $ $ S $ S S $ S $ $ S $ $ $ $ $ S $ $ S $ S $ $ SURCHARGES INCLUDED IN THE TOTAL PREMIUM CHARGE IS A SURCHARGE OF S 254 CHARGED AS A RESULT OF VIOLATION ACTIVITY OR ACCIDENT INVOLVMENT. Violations: 4/12/10, 9/24/10 & 1/21/11 NEW YORK REGULATIONS REQUIRE THAT EACH DISCOUNT OR SURCHARGE BE SHOWN AS IP rr WERE THE ONLY DISCOUNT OR SURCHARGE APPLICABLE. IF A POLICY HAS MULTIPLE DISCOUNTS OR SURCHARGES, THEIR COMBINATION MAY RESULT IN A TOTAL AMOUNT THAT DIFFERS FROM THOSE SHOWN INDIVIDUALLY. NYSUPPI Page 2 of 2 EFTA01077979 Firemiut Fund PERSONAL AUTOMOBILE POLICY DECLARATIONS SUPPLEMENT PERSONAL INJURY PROTECTION POLICY UMB t. EFFECTIVE DATE COMPANY 07/26/2013 ASSOCIATED INDEMNITY. CORPORATION NAMED INSURED YOUR AGENT IS LEON D BLACK WELLS FARGO INS SVCS USA, INC DEBRA R BLACK 31-576-750 VEJ3 VEH 2 VEH 3 VEH 4 VEH 5 MANDATORY BASIC ECON LOSS LIMIT: S 50,000 S 57 S 138 S 57 S64 S 59 ADDITIONAL PERSONAL INJURY S 100,000 S 15 S16 S15 S IS S IS OPTIONAL BASIC ECON LOSS S 25,000 S4 $5 S4 $4 S5 AGGREGATE NO-FAULT BENEFITS LIMIT: S 175,000 S 76 S 159 S 76 S 83 S 79 WORK LOSS COORD DOES NOT APPLY DEDUCTIBLE OF S ND. APPLIES MAXIMUM MONTHLY WORK LOSS LEIZT: S 4,000 S 1NCL S 1NCL S INCL S INCL S 1NCL DEATH BENEFIT LIMIT: 3 2,000 S INCL S INCL S RICL S INCL S INCL OTHER NECESSARY EXPENSES S 25 per day EXCLUSION OF MEDICAL EXPENSE FROM PERSONAL 1NTURY PROTECTION COVERAGE PER ENDORSEMENT Registrant No.1 Registrant No.2 Vehicle I Leon D Black 788071306 Debra R Black 539647350 Vehicle 2 Leon D Black 788071306 Debra 12 Black 539647350 Vehicle 3 Leon D Black 738071306 Debra R Black 539647350 Vehicle 4 Leon D Black 788071306 Debra 12 Black 539647350 Vehicle 5 Leon D Black 788071306 Debra 12 Black 539647350 Vehicle 6 NYSUPP2 Page I of 3 EFTA01077980 S Firemarts Fund PERSONAL AUTOMOBILE POLICY DECLARATIONS SUPPLEMENT PERSONAL INJURY PROTECTION EFFECTIVE DATE COMPANY 07/26/2013 ASSOCIATED INDEMNITY CORPORATION NAMED INSURED YOUR AGENT IS LEON D BLACK WELLS FARGO INS SVCS USA, INC 31-576-750 VEH 6 VEX 7 YE; 8 VE11 9 vEH 10 MANDATORY BASIC ECON LOSS LTh4IT: S 50,000 S 57 5 64 S 59 366 S 57 ADDITIONAL PERSONAL INJURY LJMIT: S 100,000 S 15 515 S15 S15 S15 OPTIONAL BASIC WON LOSS S 25,000 S4 S4 35 $5 S4 AGGREGATE NO-FAULT BENEFITS LACE: S 175,000 S 76 S 83 S 79 586 I 76 WORK LOSS COORD DOES NOT APPLY DEDUCTIBLE OF S NIL APPLES MAXIMUM MONTHLY WORK LOSS LIMIT: S 4,000 S INCL S INCL S INCL S INCL S INCL DEATH BENEFIT LIMIT: S 2,000S INCL S INCL S INCL S INCL S INCL OTHER NECESSARY EXPENSES S 25 per day EXCLUSION OF MEDICAL EXPENSE FROM PERSONAL INJURY PROTECTION COVERAGE PER ENDORSEMENT Registrant No.1 Registrant No.2 Vehicle 1 Leon D Black Debra Ft Black Vehicle 2 Leon D Black Debra It Black Vehicle 3 Leon D Black Debra It Black Vehicle 4 Leon D Black Debra R Bleak Vehicle 5 Leon D Black Debra R Black Vehicle 6 NYSUPP2 Page 2 of 3 EFTA01077981 S Fireman's Fund PERSONAL AUTOMOBILE POLICY DECLARATIONS SUPPLEMENT PERSONAL INJURY PROTECTION EFFECTIVE DATE COMPANY 07/26/2013 ASSOCIATED INDEMNITY CORPORATION NAMED INSURED YOUR AGENT IS LEON D BLACK WELLS FARGO INS SVCS USA, INC 31-576-750 VER II VEH 12 YEA VEll Via t MANDATORY BASIC ECON LOSS LIMIT: 5 50,000 S 101 S 57 S S S ADDITIONAL PERSONAL INJURY S 100,000 5 15 S I5 OPTIONAL BASIC ECON LOSS LIMIT: S 25,000 55 S4 AGGREGATE NO-FAULT BENEFITS S 175,000 S 121 S 76 WORK LOSS COORD DOES NOT APPLY DEDUCTIBLE OF S NIL APPLIES MAMMUM MONTHLY WORK LOSS LIMIT: S 4,000 S INCL • S INCL DEATH BENEFIT MITT: S 2,000 S NCL SINCL S S S OTHER NECESSARY EXPENSES S 25 per day EXCLUSION OP MEDICAL EXPENSE FROM PERSONAL INJURY PROTECTION COVERAGE PER ENDORSEMENT Registrant No.1 Registrant No.2 Vehicle 1 Leon D Black Debra R Black Vehicle 2 Leon I) Black Debra R Black Vehicle 3 Vehicle 4 Vehicle S Vehicle 6 NYSUPP2 Page 3 of 3 EFTA01077982 Prestige Autos Premier Coverage Endorsement - New York With respect to the coverage provided by this endorsement, the provisions of the policy apply unless modified by this endorsement. ValueLocke COVERAGE SCHEDULE Auto Description ValueLocke Limit of liability 1) 2011 Chevrolet K1500 Silverado $ 14,053 2) 1989 Mercedes Benz 560SL $ 15,950 3) 2012 Chevrolet Tahoe LT $ 55,677 4) .2012 Chevrolet Silverado K2500BD $ 45,270 5) 2004 Mercedes Benz $600 $ 13,337 6) 2004 Toyota Highlander $ 10,589 7) 2007 Bentley Continental GTC $ 108,575 8).2008 Jeep Patriot Limited $ 14,807 9) 2009 Honda Pilot $ 19,945 1O;2012 Mercedes Benz R350GL $ 63,000 11) 2004 Acura TL $ 11,381 .12) 2013 Mercedes Benz 5600 $ 180,000 DEFINITIONS EXTENDED NON-OWNED AUTO COVERAGE The following provisions are added to and replace any COVERAGE FOR VEHICLES FURNISHED FOR conflicting provisions in Definition Ja, and Definition YOUR REGULAR USE K.2. when includectin your policy: Part A and Part B are amended as follows with respect The broadest coverage of any of your covered autos to you: shown in the Declarations will apply to a newly ac- quired ;vehicle provided you ask us to insure it within A. PART A - LIABILITY COVERAGE 30 days after you become the owner if: Exclusions Al. and 13.2.b. do not apply. 1. The vehicle is in addition to any vehicle shown in the Declarations; or B. PART B - MEDICAL PAYMENTS COVER- AGE 2. You ward Collision and Other Than Collision coverage. Exclusion 5.b. does not'apply. The last sentence of Exclusion 8. is replaced by the following However, if Collision or Other Than. Collision coverage does not apply to any vehicle already shown in the This exclusion (8.) does not apply to bodily injury • Declarations, you must ask us to insure it within 4 days sustained while occupying r. • after you become the owner. We will provide these 1. Private passenger auto, pickup, or van, or coverages with a deductible of $500 to the newly ac- quired vehicle. . 2. Trailer- used with a vehicle described in 1. above. Coverage begins from the date you become the owner if you ask us to insure the vehicle within the specified WORLDWIDE COVERAGE FOR OWNED, time period. NON-OWNED, AND NEWLY ACQUIRED VEHI- CLES 102173 1-06 Mt IradocIes copyrighted Mate-121s of losuranoe Sealers Office, lac., rib in perroisslco, 1997 Page) of 7 EFTA01077983 WARMNG 1. The occurrence involves the unlawful forced re- moval or detention of you or a family member In Mexico, and other countries, only liability coverage while operating or occupying your covered auto purchased from a local licensed insurance company will or non-owned auto during the theft or attempted meet the auto insurance requirements of that country. theft of the vehicle; and Failure to ptirchase any required insurance policy could result .in fines or other penalties. Check with your 2. The carjarking occurrence is reported promptly to rental car provider. the police or other law enforcement agency. If you rent, borrow, or lease a non-owned auto, pur- Carjarking expenses include the reasonable and neces- chase an auto, or temporarily relocate an auto shown sary costs for: in the Schedule or Declarations outside the United 1. Merliml or psychiatric expenses incurred within. States of America, its territories or possessions, Puerto one year of the ca jacking occurrence for you or a Rico, or Canada, your coverage under Part A .- Liabil- family member who witnessed the ea:jacking oc- ity Coverage, Part B - Medical Payments, and Part D currence; and - Collision, Other Than Collision, and Transportation Expenses for loss of use will apply to the operation or 2. Income continuation benefits if unable to resume use of that vehicle by you or any family member pro- the duties of you or a family member usual occu- vided: pation during the first 60 days following a canarking occurrence. This coverage is .exens 1. An underlying policy of automobile liability in- over any other valid and collectible benefits in- surance is purchased or provided to the extent re- chiding quired by the country or jurisdiction in which the vehicle is being operated. . We will pay only that A. disability insurance, part of a covered loss that exceeds the limit of li- ability of that underlying policy. B. workers compensation, 2. The rental, lease, or use of the non-owned auto is C. unemployment compensation, fora period of not more than 90 days. D. salary or wage continuation plans; or 3. You notify us. within 30 days after you purchase or relocate a vehicle. E. other similar plans. EXCESS MEDICAL PAYMENTS COVERAGE 3. Funeral Expenses up to $10,000 per person. The following is added to the LIMIT OF LIABILITY LIMIT OF LIABILITY protion of PART B: Our limit of liability as a result of any one carjer-king C. In addition to any limit of liability shown in the occurrence shall be the lesser of: ' Declarations for this.coverage, we will pay up to 1. The actual reasonable and necessary =jacking $10,000 for each person injured in any one aCci- expenses incurred; or dent. However, this additional limit shall be excess over any other collectible auto insurance providing 2. $100,000 payments for Medical of funeral .expenses. This is. the most we will pay regardless of the number CARJACENG COVERAGE of: We will pay, without a deductible, carjacking expenses 1. Insureds; incurred by you or a family member solely and directly as a result of a carjackbag occurrence provide& 2. Policies applicable; • • 102173 1-06 TN Induda copyrighted ;uteri* of [Pittance Services Office, Ines, with itr pecrlisier, 1997 Page 2 of 7 . . • • EFTA01077984 I 24-hour For Roadside Response call 24 -hour Emergency For Roadside Response call Service 1.866.FUNDTOW (1.866.386.3869') Emergency 1.866.FUNDTOW (1.866.386.3889') Service Policy Number: Policy Number: Policy Period: 07-26-2013 Policy Period: to 07-26-2013 07-26-2014 to 07-26-2014 Named Insured: Named Insured: LEON D & DEBRA It BLACK LEON D & DEBRA R BLACK "For emergency roadside assistance 'For emergency roadside assistance dispatch only. Fund dispatch only. . 24- hour For Roadside Response call 24-hour Emergency For Roadside Response call 1.866.FUNDTOW (1.866.386.3869') Emergency 1.866.FUNDTOW (1.866.386.3869') Service Service Policy Number: Policy Number: Policy Period: 07-26-2013 Policy Period: 07-26-2013 to 07-26-2014 to 07-26-2014 Named Insured: Named Insured: LEON D & DEBRA R BLACK LEON D & DEBRA It BLACK rFuF1rerdsaah 'For emergency roadside assistance Thema 'For emergency roadside assistance n dispatch only. Fund dispatch only. THIS TOLL-FREE NUMBER IS THE DISPATCH FOR EMERGENCY ROADSIDE ASSISTANCE ONLY. FOR ALL OTHER INSURANCE MATTERS, PLEASE CONTACT YOUR INSURANCE REPRESENTATIVE. These services are provided by an Independent company under contract to Fireman's Fund. EFTA01077985 EFTA01077986 ROADSIDE HELP: Can 1.866.FUNDTOW {1.866.386.3869) anytime for ROADSIDE HELP: Call 1.866.FUNDTOW (1.866.386.3869) anytime for emergency roadside assistance. emergency roadside assistance. CLAIMS SERVICE: Call 1.888.FIREHAT {1.888.347.3428) anytime to CLAIMS SERVICE: Call 1.008.FIREHAT (1.888.347.3428) anytime to report claims. report claims. Provide the operator with the: Provide the operator with the: • exact location in the United Stales ct Canada: • exact location in tho United States or Canada; • description of the auto: • description of the auto: • ownership (e.g., yours, borrowed or rented); • ownership (e.g., yours, borrowed or rented);' • cause of disablement (e.g.. accident); and • cause of disablement (e.g., accident); and • whore you can be reached by phone • where you can be reached by phone Note Fireman's Fund provides roadside response coverage for autos Note: Fireman's Fund provides roadside response coverage for autos you insure with us for Towing And Labor Costs coverage (includes you insure with us for Towing And Labor Costs coverage (includes autos you don't own, but are temporarily using). autos you don't own, but are temporarily using). THIS CARD IS NOT EVIDENCE OF LIABILITY INSURANCE COVERAGE. THIS CARD IS NOT EVIDENCE OF LIABILITY INSURANCE COVERAGE. 302659 01.03 302659 01-03 ROADSIDE HELP: Call 1.866.FUNDTON (1.868,386.3869) anytime for ROADSIDE HELP: Call 1.866.FUNDTOW (1.866.386.3869) anytime for emergency roadside assistance. emergency roadside assistance. CLAIMS SERVICE: Call 1.888.F1REHAT (1.888.347.3428) anytime to CLAIMS SERVICE: Call 1.8B8.FIREHAT (1.888.347.3428) anytime to report claims. report claims. Provide the operator with the: Provide the operator with the • exact location in the United States or Canada: • exact location in the United States or Canada; • • description of the auto: • description of the auto: • ownership (e.g., yours, borrowed or rented):" • ownership (e.g., yours, borrowed or rented): • cause of disablement (e.g., accident); and • cause of disablement (e.g., accident): and • where you can be reached by phone • where you can be reached by phone Note Fireman's Fund provides roadside response coverage for autos Note: Fireman's Fund provides roadside response coverage for autos you insure with us for Towing And Labor Costs coverage (includes you insure with us for Towing And Labor Costs coverage (includes autos you don't own, but are temporarily using). autos you don't own, but are temporarily using). THIS CARD IS NOT EVIDENCE OF LIABILITY INSURANCE COVERAGE. THIS CARD IS NOT EVIDENCE OF LIABILITY INSURANCE COVERAGE. 302659 01-03 3021159 01.03 67 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED Pahay Ne7ter IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND Name & Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARMNG: Any person who issues 777 SAN MARIN DRIVE 0712 2013 07/2612014 or pre* as an ID card knowing that NOVATO, CA 94998 an Owners Policy of Insurance is not in 12:01 .13707. effect may be committing a misdemeanor. (401actorS- te to °blab reastraton In addition, a person who presents An authorized NEW YORK insurer has blued an °vein P05O/ of SW 45 days from effective dab.) an ID card if insurance is not in Liability Insurance candying with Ara* 6 (Moser Vehicle FiriandU Agor:able with respect to the fo5oWing Security Act) of the NEW YORK Vehicle and Traffic Law to: Motor Venda: effect may be committing a misdemeanor. 2011 CHEVR BLACK.LEON,D Year Make The name of the registrant and the name of the insured must coincide. Vehicle Identdcatico Nuttier 11111. REPLACEMENT VEHICLE NOTATION: CMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. r Flea NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRED Policy Number IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. AAE12263565 PRODUCTION UPON DEMAND Name & Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 0 /26/2 13 07/26/2014 or produces an ID card knowing that NOVATO, CA 94998 an Owners Policy of insurance is not in 12:01 effect may be cornmitting a misdemeanor. (Not acceptable to obtain registration In addition, a person who presents An atuthcrized NEW YORK Meurer has issued an Owner's Poky of alter 45 days from effective date.) an ID card if insurance is not in Uribirey Insurance complying with Ark* 6 (Motor Vehicle Financial AP050ist4e with reseed to the following Security Ad) of the NEW YORK Vehicle and Traffic taw to: Motor Vehida: effect may be committing a misdemeanor. IT 3t.ACK,LEON,D — 2011 CHEVR The name of the registrant and the name of the insured must coincide. ide Idonlacalion Numoer REPLACEMENT VEHICLE NOTATION: CMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. OEM FS-20 FAX: Scanable Bar Code FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. II submitted to DMV, either the entire page or the second ID card and large scanable bar code will be retained 3. A faxed ID card must be replaced with a scanable ID card within 14 days of the effective date. 4. DMV Mg not accept a faxed ID card without a scanable barcode 11 EFTA01077987 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. Antic14(PS)-7.01 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 300534(PS).74:11 EFTA01077988 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED Pot Number IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND Name & Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 07/26/2013 or produces an ID card knowing that 07/ 1 NOVATO, CA 94998 an Owners Policy of insurance is not in 12:01 effect may be committing a misdemeanor. (Not aoseclatble to ob.,m In addition, a person who presents An authorized NEW YORK insurer has issued en Owners Poky of after 45 days from ellectIvedele.) Loamy Insurance compfying with Article 8 (lector VeNde Financial an ID card if insurance is not in Secuity Act) of the NEW YORK Vehide and Traffic Law to: Applicable with respect to the following Motor Vehicle: effect may be committing a misdemeanor. 1989 ME/BE BLACK,LEON,D The name of the registrant and the BLACK,DEBRA,R name of the insured must coincide. Vetscie aesedcalion artier REPLACEMENT VEHICLE NOTATION. DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. FS•20 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED 043 Associated Indemnity Corp. Policy Number IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND Mama & Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARMNG: Any person who issues 777 SAN MARIN DRIVE 07/28/2013 or produces an ID card knowing that 14 NOVATO, CA 94998 an Owner's Policy of Insurance is not in 1201 Not acceptable to obtain reparation effect may be committing a misdemeanor. An aAhorized NEW YORK insures hes issued an Owner's Pao/ of after 45 days from effective date.) In addition, a person who presents Jabley Insurance complying with All* 6 (Motor Vehicle Flrendel Acioscsbie with respect to the following an ID card if insurance Is not in irscunty Act) of file NEW YORK Vehicle and Trat Law to: Motor Vehicie: effect may be committing a misdemeanor. 1989 ME/BE BLADK.LEON,D The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. LEM 11 FS-20 FAX: Scanable Bar Code FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. If submitted to DMV, ether the entire page or the second ID card and large scanable bar code will be retained 3. A faxed ID card must be repiaoed with a scanable ID card within 14 days of the effective date. 4. DMV WA not accept a faxed ID card without a =enable baroode EFTA01077989 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. 300534(PS).7.01 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 303534(Psjd41 EFTA01077990 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED Policy Number IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. AAE12263599 PRODUCTION UPON DEMAND Nitre 8. Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: My person who issues 777 SAN MARIN DRIVE 07/26/2013 LOIr or produces an ID card knowing that an Owner's Policy of insurance is not in NOVATO, CA 94998 ;tar 12:01 effect may be committing a misdemeanor. (Nol acceptable to obtain registration In addftion, a person who presents An authorized NEW YORK Insurer has Issued an Owner's Pc4cy or after 45 days from effective date.) an ID card if insurance is not In Liabley In:sprain* complying with Mile 6 Woke Vehicle Franca AoprcaMe with rasped to the folloning Security Act) of me NEW YORK Vehicle and 7ratec Law to: Motor VON*: effect may be committing a misdemeanor. 2012 CHEVR BLACK,LEON,D The name of the registrant and the name of the insured must coincide. Vehicle icantikation Number REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 11111111 I NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED FS.20 Policy Number IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. AAE12263565 PRODUCTION UPON DEMAND Name & Address of Issuer FIREMAN'S FUND INSURANCE CO Effedive Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE at126at or produces an ID card knowing that NOVATO, CA 94998 12:01 07126/2013 12:01 (Not acceptaae to °titan registration an Owner's Policy of insurance is not in effect may be committing a misdemeanor. In addition, a person who presorts An authorized NEW YORK insurer has issued an Owneas Poicy of after 45 days from effective date.) inID card if insurance Is not in Lately insurance complying with Arti e 6 (Motor Vehicle Financial Aopkable with reseed to the following Searity Act) or me NEW YORK Vehicle and Traffic Law to: Motor Vehicle: effect may be committing a misdemeanor. 2012 CHEVR BLACK,LEON,D Year Make The name of the registrant and the name of the inured must coincide. MOM Vehicle Identifealico Number REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. MEM F8-20 FAX: Scanable Bar Code FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. If submitted to DMV, either the entire page or the second ID card and large scanable bar code will be retained 11111 3. A faxed ID card must be replaced with a scanable ID card within 14 days of the effective dale. r 4. DMV will not accept a faxed ID card without a scanable barcode • .1 EFTA01077991 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 3006344PS).7-01 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who Issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 3CC634(PS).74)1 EFTA01077992 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND Nagle & Address or Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 07/26/2013 07/2et .014 or produces an ID card knowing that NOVATO, CA 94998 an Owner's Policy of Insurance Is not In 1201 12:01 M. effect may be committing a misdemeanor. (Not =eatable to obtain registration In addition, a person who presents en authorized NEW YORK Inner has issued on Owners Poky of after 45 days from effedive dale.) anID card N Insurance is not in jabity Insurance complying with Article 6 (Motor Vehicle Financial Aookagie Win respect b the folloWng Seaelly Act) of the NEW YORK Vehicle and Traffic law to: Motor Violist: effect may be committing a misdemeanor. 2012 CHEVR BLACK,LEON,D Year Make The name of the registrant and the BLACK,DEBRA,R name of the insured must coincide. ence ldemttcabon Nunber REPLACEMENT VEHICLE NOTATION: DIN WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 111 NEW YORK STATE INSURANCE IDENTIFICATION CARD fills ID CARD MUST BE CARRIED FS.20 Policy Number IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. AAE12263566 PRODUCTION UPON DEMAND Qum & Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 07/26/2013 a( /Z314 or Produces an ID card knowing that NOVATO, CA 94998 an Owner's Policy of insurance is not in 12:01M. effect may be committing a misdemeanor. (Not ameotable to obtain registration In addition, a person who presents in authorized NEW YORK ksuner has issued an Ownees Poky of after 45 days from effecSye date.) an ID card If insurance is not in !ability Internee complying with Ntede 6 (Motor vehicle FlnancIN Aocicae4e with leaped to the toDoning isicsity Ad) of the NEW YORK Vehicle and Traffic Law to: Motor Vehiae: effect may be committing a misdemeanor. 2012 CHEVR BLACK,LEON,D Year M The name of the registrant and the name of the insured must coincide. Which) Identification Number REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. HEM FS-20 FAX: Scanable Bar Code FAX INSTRUCTIONS: 1. The entre page must be faxed. 2 If submitted to DMV, either the entire page or the second ID card and large scanable bar code will be retained 3. A faxed ID card must be replaced with a scanable ID card within 14 days of the effective date. • 4. DMV will not accept a faxed ID card without a scanab$e barcode EFTA01077993 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 300534(PSY7•01 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 300534(PS).7-01 EFTA01077994 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND qarrie & Address of FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 04013 0n2 u or produces an ID card knowing that NOVATO, CA 94998 an Owner's Policy of insurance is not in 12:0 . 12:01.n. effect may be committing a misdemeanor. 0401 eoceotabie to obtain a— ation In addibon, a person who presents VI authorized NEW YORK insurer has issued an Owners Pc6cy of after 45 days corn effectve date.) an ID card if assurance is not in jataty Insurance complying with Article 6 (Motor White Financial Applicable with rasped tO the blowing Securtty AM) of the NEW YORK Vehicle and T, Law la Motor Vehicle' effect may be committing a misdemeanor. 2004 ME/SE BLACK,LEON,ID Year Make The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: Okay WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. • t i• ll 11 PS-20 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED aF st. IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND Jerre & Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 07/2612014 or produces an ID card knowing that 07/26/2013 an Owner's PoScy of insurance is not in NOVATO, CA 94998 12:00. 120 effect may be committing a misdemeanor. (Not acceptable to obtain rat- atm In addition, a person who presents el authorized NEW YORK insurer has issued an Owners Patsy of after 45 days from effective date.) anID card if insurance is not in Jebeity Insurance complying With Article 6 (Motor Wilde Financial Applicable 440 cusped to the following )(catty Ad) of the NEW YORK Vehicle and Traffc Law to: Motor VehiMe effect may be committing a misdemeanor. 2004 MEJBE BLACIC,LEON,1:0 The name of the registrant end the name of the insured must coincide. n umber REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT r. REGISTRATION. PS-20 FAX: Scanable Bar Code UL r FAX INSTRUCTIONS: 1. The entire page must be faxed. it ■ 2. If submItted to DMV, either the entire page or the second ID card and large scanable bar code wiz be retained 3. A faxed ID card west be replaced with a scanable ID card within 14 days of the effective date. 4. DMV Ml not accept a faxed ID card without a erasable barcode t, • EFTA01077995 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 303534(PS)-141 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. acossies).7.01 EFTA01077996 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED Poiic IN THE INSURED VEHICLE FOR 04.3 Associated Indemnity Corp. PRODUCTION UPON DEMAND Name & Address 04 Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who sues 777 SAN MARIN DRIVE 07/2612013 gl izoirs or produces an ID card knowing that NOVATO, CA 94998 an Owner's Policy of Insurance is not in izot a.m. effect may be committing a mdemeanor. (Not acceptable to obtain registation In addition, a person who presents sin authorized NEW YORK insurer has issued an Owner's Poicy of after 45 days from effective date.) an lT) card if Insurance is not in Liabity Insurance complying with Article 6 (Motor Vehicle Finerthal *coSmola wt rasped a, the knowing Stagy Act) of the NEW YORK Vehicle and Traffe Law to: Motor Vehklei effect may be committing a BLACK,LEON,D 1 2004 TOYOT misdemeanor. The name of the registrant and the name of the insured must coincide. on NUmoer REPLACEMENT VEHICLE NOTATION: 1111. DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. F3-20 NEW YORK STATE INSURANCE IDENTIFICATION CARD tHtS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND lame 8 Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: My person who issues 777 SAN MARIN DRIVE 07/2U013 0712 014 or produces an ID card knowing that NOVATO, CA 94998 anpyrnets Policy of insurance is not in 1201n. 12-01 effect may be committing a misdemeanor. (Not acceptable to obtain reoistration In addition, a person who presents Vi authorized NEW YORK insurer has issued an Omer& Paw of alter 45 days from effective date.) iabilay Inflames complying with Mitts 6 (Motor Vehicle Financial an ID card if insurance is not In Applicable MI respect to the leacniring effect may be committing a Many Act) of rte NEW YORK Vehicle and Traffic Law to: Motor Vehicle: misdemeanor. 2004 TOYOT BLACK,LEON,D r aerir iv make The name of the registrant and the name dent insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. i s .• F5-20 FAX: Scanable Bar Code 1 • FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. It submitted to DMV, either the entire page or the second ID card and large scanable bar code voll be retained 3. A faxed ID card must be replaced with a scanable card within 14 days cd the effective date. 4. DMV will not accept a faxed ID card without a scanable barcode EFTA01077997 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 303s3dres).7.01 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. 300534(n).7-01 EFTA01077998 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND lone & Address of law FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: My person who issues 777 SAN MARIN DRIVE or produces an ID card knowing that 2/261p NOVATO, CA 94998 ,2„:„or- 07/26/2013 12.01 an Owner's Policy of insurance is not In effect may be committing a misdemeanor. (Not wadable to obtain feats:flew In addition, a person who presents th &honied NEW YORK insurer has esued an Ovineri Percy of «her 45 days from effective date) an ID card If Insurance is not in Seery Insurance COmplying with Mica 6 (Motor Vehicle Financial ~Scable with respect to the Wowing ≥aasity Ad) of the NEW YORK Vehicle and Traffic Law to: effect may be committing a Maim Vehicle: misdemeanor. 2007 SEMI BLACK,LEON,D The name of the registrant and the BLACK,DEBRA,R name of the insured must coSicide. 760 PARK AVE REPLACEMENT VEHICLE NOTATION: NEW YORK NY 10021 DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 1 J FS-20 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED Policy Number IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND tame & Acoire-45 of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 0712612014 or produces an ID card knowing that 07/26/2013 NOVATO, CA 94998 an Owner's Policy of insurance is not in 12311.— 7207er effect may be committing a misdemeanor. (Not ectedriale to obtain regent:at« In addition, a person who presents ut auttorized NEW YORK insurer has issued an Owners Policy of after 45 days (ram effective dare.) labitay Instance candying with Article 6 (Motor Vehicle Financial an ID card If insurance is not in 4404oebta wah maned to the icaowng effect may be committing a Recurly Athol the NEW YORK Vehicle and Traffic Law to: /Astor Vehicle: misdemeanor. 2007 BENTL BLACKLEON,D The name of the registrant and the name of the insured must coincide. Vebutle kionbficebon Number REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. MEE FS -20 FAX: Scanable Bar Code FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. If submitted to DMV, either the entire page or the second ID card and large scanable bar code will be retained 3. A faxed ID card must be replaced with a scanable ID card within 14 days of the effective date. 4. DMV will not accept a faxed ID card without a 11111011111 scanable barcode EFTA01077999 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 3D0534(PS)-7-01 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 3006344PS).7-01 EFTA01078000 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED Policy Number IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND !a Tr* 8 Addrers of FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 07/26/201 or produces an ID card knowing that 07/28/2013 NOVATO, CA 94998 an Owners Policy of insurance is not in 1201 12:01M. effect may be committing a misdemeanor. (Not Steebbin 10 Whin regisaatipn In addition, a person who presents avauxtred NEW YORK hewer has issued an Chimes Policy of after 45 days from effective date.) an ID mutt If insurance Is not in iabiky Insurance complying with Adds 6 (Motor Vehicle Financial Applicable wkrl respect to the icilowM9 effect may be committing a ecurey Act) cd the NEW YORK Vehicle and 'Daffy Law to: Motor Vehicle. misdemeanor. . 2008 JEEP BLACK,LEON,D The name of the registrant and the BLACK DEB R name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. FS-.20 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED Policy Number IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND tame & Addess d Water FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: My person who issues 777 SAN MARIN DRIVE 07126/2013 07/28/2014 or produces an ID card knowing that NOVATO, CA 94998 an Owners Policy of insurance is not in 731IF 12 1201 effect may be committing a misdemeanor. (Not acceptable to obtain registration In addition, a person who presents aultiorized NEW YORK insurer has issued an Owner's Poky of after 45 days from effective date.) an ID card if insurance is not in lability Insurance complying with Article a (Motor Vehicle Flnancird Applicable with raped to the Wowing effect may be committing a iecuity Ad) of Lhe NEW YORK Vehicle and Trarrec Law to: Motor Vehicle: misdemeanor. 2008 JEEP BLACK,LEON,D Yaw Make The name of the registrant and the BLACK.DEBRA.R name of the insured must coincide. Veihde Conti/cation Number REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING TIE REPLACED VEHICLES CURRENT REGISTRATION. FS-20 FAX: Scanable Bar Code FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. If submitted to DMV, either the entire page or the second ID card and large scanable bar code will be retained 3. A faxed ID card must be replaced with a scanable ID card within 14 days of the effective date. 4. DMV will not accept a faxed ID card without a scanable barcode EFTA01078001 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. ocios34cps)-741 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 3Awt4{PS).7-01 EFTA01078002 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED sirr IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND Vane & Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 07/26f2013 071268a or produces an ID card knowing that NOVATO, CA 94998 an Owner's Policy of insurance is not in W1 /1.7 12:01M effect may be committing a misdemeanor. (Not 8=er/table to obtain registration In addition. a person who presents in authorized NEW YORK Maurer has rssued an Owner's Poky of after 45 days from effective dale.) an ID card if insurance is not in Jab/fly Insurance complying with Article 6 (Motor Vend* Financial Applicable vnTh respect to the bllowMg Secuity Act) of the NEW YORK Vehicle and Traffic Law to: Motor Vehicle: effect may be committing a • misdemeanor. 2009 HONDA BLACK,LEON,D Year Make The name of the registrant and the • IIII II II III BLACK DEBRA R name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WV. ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. FS-20 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. Vanes & Address of Issuer FIREMAN'S FUND INSURANCE CO III III I II Effective Date Expiration Date PRODUCTION UPON DEMAND WARNING: Any person who issues 777 SAN MARIN DRIVE 07/2612013 07126/2014 or produces an ID card knowing that NOVATO, CA 94998 an Owner's Policy of insurance is not in effect may be committing a misdemeanor. (Not acceptable to obtain reStrabon In addition, a person who presents in authorized NEW YORK nsurer has issued an Comers Poky of after s5 days from effective date.) an card if insurance is not in Jabigy Insurance complymg with Article 6 (Moro( Vehicle Financier Acollobble wlh respect to the following Secuoity Ad) of the NEW YORK Veit* and Traffic Law to: Motor Vehicle: effect may be committing a misdemeanor. 2009 HONDA BLACK,LEON,D The name of the registrant and the BLACK DEB R name of the insured must coincide. ethic a }den Don Number REPLACEMENT VEHICLE NOTATION: DMV WALL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. FS-20 FAX: Scanable Bar Code FAX INSTRUCTIONS: 11 1. The entire page must be faxed. 2. If submitted to DMV, either the entire page or the second ID card and large scanable bar code will be retained 3. A faxed ID card must be replaced with a scanable ID card within 14 days of the effective dale. 4. DMV will not accept a faxed ID card without a scanable barcode r EFTA01078003 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 3005340'8)-74M THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 503534(PS}.7-01 EFTA01078004 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND Nan* & Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: My person who issues 777 SAN MARIN DRIVE 07/26/2013 07/2 14 or produces an ID card knowing that NOVATO, CA 94998 an Owner's Policy of insurance Is not in t2.011Ir tzot effect may be committing a misdemeanor. (Not aoceotabis to ob4S, registration In addition, a person who presents u rahorired NEW YORK insurer has issued an Deimos Poky of attar t5 days from effective dote.) an ID card It insurance is not in Liab•ty Insurance complying with Arndt $ (Motor vehicle Financial Apoliabie nth respect to the locoing effect may be committing a Smutty Act) of the NEW YORK Vehicle and Trafk Lew to: Moto: vehicle: misdemeanor. 2012 ME/BE BLACK,LEON,D Year M The name of the registrant and the BLACK DEBRA name of the insured must condde. Vehicle identification Nutter REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 111 F5.20 NEW YORK STATE INSURANCE IDENTIFICATION CARD 1-11IS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND Varna & Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 07/26/2013 or produces an ID card knowing that NOVATO, CA 94998 an Owner's Policy of insurance is not in 1201 effect may be committing a misdemeanor (Not acceptable to obtain regetration In addition, a person who presents knagoorireo NEW YORK Cisurm has issued an Owner's Pofcy of after 45 days from effective date.) an ID card If insurance is not in .labaty Insurance oomptyina with Article 6 (Motor Vehicle Financial Applicable with respect to the following &acute Act) of the NEW YORK Vehicle and Traffic Law to: Motor vehide: effect may be committing a misdemeanor. 2012 ME/BE BLACK,LEON,D The name of the registrant and the BLACK.DEBRA R name of the insured must coincide. Vehicle ideNthcation Nwnter REPLACEMENT VEHICLE NOTATION: DWV VVILL ONLY PROCESS A VEHICLE CHANGE (RE•REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. FS•20 FAX: Scanable Bar Code FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. It submitted to DMV, either the entire page or the second ID card and large scanable bar code will be retained 3. A faxed ID card must be replaced with a scanable ID card within 14 days or the effective date. 4. DMV will not accept a faxed ID card without a scanable barcode EFTA01078005 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 3C0534(PS)-7.01 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 3CC634(PS)-7-01 EFTA01078006 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED policy Nu—ter IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND Name & Address of Issuer FIREMAN'S FUND INSURANCE CO Effedive Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 07/2U014 or produces an ID card knowing that NOVATO, CA 94998 an Owner's Policy of Insurance is not in 12:01 12:01I. effect may be committing a misdemeanor. INot a=rintabla to obtain repatratian In addition, a parson who presents An authorized NEW YORK insurer hes issued an Owner's Policy of alter 45 days from offedive date) an ID card if insurance is not in -Macy Insurance complying with Article 6 (Motor Vehicle Fnancial Applicable with rasped to the following Security Act) of the NEW YORK Vehide and Trot Law to: Motor Vehicle: MLitt may be committing a misdemeanor. 2004 ACURA BLACK,LEON,D The name of the registrant and the BLACK,DEBRA R name of the insured must coincide. moom VeNde identification Number REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (REREGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 11/1 1 NEW YORK STATE INSURANCE IDENTIFICATION CARD fi l 11 THIS ID CARD MUST BE CARRIED F8.28 Policy Number IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND Jame & Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 07/26I201 07/2612014 or produces an ID card knovAng that NOVATO, CA 94998 anOymer's Policy of insurance is not in 12:01 121).7 effect may be committing a misdemeanor. (Not acceptable to obtain reoistratior. In addition, a person who presents adliorized NEW YORK insurer has issued an Owner's Poky of after 45 days from effeave date.) Jabilly Insurance complying with Article 6 (Motor Vehicle Financial an ID card if insurance is not in Applicable wet respect to the ttlarang effect may be committing a Security Act) of tie NEW YORK Vehicle and Traffic Lew to: Motor Vehicle' misdemeanor. 2004 ACURA SLACK,LEON,D Yew Make The name of the registrant and the BLACK DEBRA R name of the insured must coindde. Vetcte identification Number REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. FS to FAX: Scanable Bar Code FAX INSTRUCTIONS: 1. The entire page must be fazed. 2. If submitted to DMV, ether the entire page or the second ID card and large scanable bar code vaTi be retained 3. A faxed ID card must be replaced with a scanable ID card within 14 days of the effective date. 4. DMV WI not accept a faxed ID card Without a scanable barcode EFTA01078007 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. • REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 3005341PS)-741 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. vosums).7.01 EFTA01078008 NEW YORK STATE INSURANCE IDENTIFICATION CARD THIS ID CARD MUST BE CARRIED Policy %ate- IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND Name & Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date WARNING: Any person who issues 777 SAN MARIN DRIVE 07/26(2013 07/26/2014 or produces an ID card knowing that NOVATO, CA 94998 an Ovmers Policy of insurance Is not in 701. — 12 effect may be committing a misdemeanor. CNC =eatable to cbtae registration In addition, a person who presents On authorized NEW YORK insurer has issued an Choate Poesy of ;rear 45 days from effective date.) uactey Insuranm complying with Arlin 6 (Motor Vehicle Financial an ID card If insurance is not in Andicable with respect to the bane; effect may be committing a Security Act) of the NEW YORK Vehicle and Traffe Law to: Motor Vehicle: misdemeanor. 2013 ME/BE BLACK.LEON,D The name of the registrant and the name of the insured must coincide. Vehicle Identification Number REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. a' 1 r Its FS-20 NEW YORK STATE INSURANCE IDENTIFICATION CARD THS ID CARD MUST BE CARRIED Policy Number IN THE INSURED VEHICLE FOR 043 Associated Indemnity Corp. PRODUCTION UPON DEMAND vent & Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expirabon Date WARNING: Any person who issues 7'77 SAN MARIN DRIVE 07/26/2013 07/26/2014 or produces an ID card knowing that NOVATO, CA 94998 anOwner's Policy of insurance is not in 7207 tzot effect may be committing a misdemeanor. (trot isoceptable to obtain retention In addition, a person who presents VI authorized NEW YORK erasure, has issued an One's Poky of ate 45 days from endive date.) .iabilly Insurance complying with Artide 6 radar Vehicle Friedel an ID card if insurance is not in Aoolicable with rend to the biloyMg effect may be committing a Seosity AC) of the NEW YORK Vehicle and Traffic Law to: Motor Vehicle: misdemeanor. 2013 ME/BE r 11111111 BLACK,LEON,D The name of the registrant and the MIS Vatter Identification Number name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. F$-20 FAX: Scanable Bar Code FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. If submitted to DMV, either the entire page or the second ID card and large scanable bar code wit be retained , 3. A faxed ID card must be replaced with a scanable ID card within 14 days of the effective date. 4. DMV wit not accept a faxed ID card without a scanabk barcode EFTA01078009 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 307634(PS).7.01 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 300534(PS).7-01 EFTA01078010