Form_SCTNID_CTGRY.

FL03156489_DECPAGE

911539392 E N244406 INS DECPAGE E POLWHITEFONT P2SDNVLQDCWKEN2WOSXIKPD3IE0001 RPUID TRACWHITEFONT

ACG SOUTH INS AGENCY

PO BOX 31087
TAMPA, FL 33631

Policy Number: 911539392

Underwritten by:
Progressive American Insurance Co
December 2, 2016
NICHOLAS REYNOLDS-DIONNE
Policy Period: Sep 8, 2016 - Mar 8, 2017
11245 WINTHROP LAKE DR
RIVERVIEW, FL 33578 Page 1 of 2

1-800-891-4222
ACG SOUTH INS AGENCY
Contact your agent for personalized service.

progressiveagent.com
Auto Insurance Online Service

Coverage Summary
Make payments, check billing activity, update
policy information or check status of a claim.

This is your Declarations Page 1-800-274-4499

To report a claim.

Your policy information has changed

Your coverage began on September 8, 2016 at the later of 12:01 a.m. or the effective time shown on your application. This policy
period ends on March 8, 2017 at 12:01 a.m.
This coverage summary replaces your prior one. Your insurance policy and any policy endorsements contain a full explanation of your
coverage. The policy contract is form 9611A FL (07/13). The contract is modified by form A139 FL (06/14).

Policy changes effective November 3, 2016

..
Changes requested on: Dec 2, 2016
..
Requested by: Progressive
..
Premium change: -$55.70
..
Changes: A Snapshot Participation discount has been added to the 2015 KIA SOUL.
Your payment option was changed to Electronic Funds Transfer (EFT).

Drivers and ..
resident relatives Additional information
NICHOLAS REYNOLDS-DIONNE Named insured

Form 6489 FL (03/15)

4
Continued
911539392 E N244406 INS DECPAGE E POLWHITEFONT P2SDNVLQDCWKEN2WOSXIKPD3IE0001 RPUID TRACWHITEFONT

Policy Number: 911539392

NICHOLAS REYNOLDS-DIONNE
Page 2 of 2

Outline of coverage
2015 KIA SOUL 4 DOOR WAGON
VIN: KNDJN2A27F7808640
Garaging ZIP Code: 33578
Primary use of the vehicle: Commute
Number of years owned/leased when policy started or vehicle added: 1-2 years
This vehicle is currently enrolled in the SnapshotH Program.
Limits Deductible Premium
..
Liability To Others
Bodily Injury Liability $10,000 each person/$20,000 each accident $112
Property Damage Liability $10,000 each accident
..
129
Personal Injury Protection/Deductible applies to $10,000 $0 126
Named Insured/Spouse/Dependent Resident Relatives
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Uninsured Motorist Rejected --
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Comprehensive Actual Cash Value $250
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80
Collision Actual Cash Value $500
..
272
Rental Reimbursement up to $30 each day/maximum 30 days 30
..
Total 6 month policy premium $749.00

Premium discounts
Policy
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911539392 Electronic Funds Transfer (EFT), Continuous Insurance: Gold, Paperless and
Three-Year Safe Driving
Vehicle
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2015 KIA Anti-Lock Brakes, Driver and Passenger-side Airbag and Snapshot Participation
SOUL

Lienholder information
Vehicle Lienholder
..
2015 KIA SOUL SUNCOAST CU
KNDJN2A27F7808640 TAMPA, FL 33680

Policyholder inquiries
You may call your agent at 1-800-891-4222 to present inquiries or obtain information about coverage, and to obtain
assistance with any complaints.

Agent signature

Company officers

Secretary

Form 6489 FL (03/15)