Laserfiche WebLink
Policy number 02533419-0 <br />CROSSOVER MISSION INC <br />Page 2 of 2 <br />Auto coverage schedule <br />1. 2013 Ford Econo/Club Wgn Actual Cash Value (plus $2,000.00 Permanently Attached Equip) <br />VIN: 1FBSS3Bl0DDA73898 <br />Garaging Zip Code: 32960 Radius: 50 <br />Liability t.iabihty UMrt,nM61 PIP Med Pay <br />Premium $1,888 $557 $178 $63 <br />Physical Damage <br />Premium <br />FT/CAC FT/CAC Collision Collision <br />Deductible Premium Deductible Premium <br />$500 $89 $500 $116 <br />Premium discounts <br />Vehicle <br />• <br />2013 Ford Econo/Club Wgn <br />Agent signature <br />Company officers <br />Secretary <br />Form 6489 n.(11/12) <br />Anti -Lock Brakes and Air Bag <br />Auto Total <br />$2,891 <br />110 <br />A .111S1111111•1= <br />Esse <br />C 008 002 <br />PGULA021 004184 <br />OMINSIMIIMM <br />) <br />