This policy is issued by: Item 1: This policy is issued to: JOSCHA HACH Item 2: This policy is in effect from: Item 3: Description of your Auto: Auto 1 06 HONDA CR-V SE 4D WAGON SHSRD78986U414640 COVERAGE SELECTIONS PAGE Commerce This page and any attached endorsements form a part of your policy INSURANCE QA MAteritr COMPANY The Commerce Insurance Company Webster, MA 01570-0758 www.Commerceinsurance.com Massachusetts Personal Automobile Policy Number: DWL496 Agent: 886 W. GOCH I S INS AGENCY, MA 02139-2717 APRIL 28, 2015 to Auto INC 113 CAMBRIDGE ST BURLINGTON MA 01803 APRIL 28, 2016(12 01 AM Eastern Standard Time) DIRECT BILL Item 4: This policy provides only the coverages for which a premium charge is shown: Coverages. Parts 1-12 AUTO 1 AUTO COMPULSORY INSURANCE LIMITS Deduction Annual Premium Adjusted Premium UMITS Deductible Annual Premium Adjusted Premium 1 Bodily Injury To Others PA $ PencA 20000 Pee $ 40000 Accident None $ 328 328 per Pe $ rson raw $ Acc.unt None $ 2 Personal Injury Protection Per $ 8000 Pelson $ NONE _miner — Ina ......... $ 109 109 Pet S Person $ _ snot s.......d inennars $ 3 Bodily Injury Caused By An Uninsured Auto (Compulsory Limas $20,000 / $40,000) Per $ 100000 PI' $ 300000 .<0«,,, None $ 24 24 PM $ Penal None $ Pere ACtAlent $ 4 Damage To Someone Else's Property (Compulsory Limits $5D00) Pr $ 100000 Acc' 'I None $ 425 425 Peet s Academe None $ OPTIONAL INSURANCE 5 Optional Bodily Injury To Others „. $ 100000 Person Pee $ 300000 c ent None $ 191 191 Per $ PeriCel PM $ Aosident None $ 6 Medical Payments car $ person None $ Pee $ non None $ 7 Collision Actual Cash Value *$ 1000 $ 458 458 Actual Cash Value $ $ 8 Limited Collision Actual Cash Value $ $ Actual Cash Value $ $ 9 Comprehensive Actual Cash Value $ 300 $ 154 154 Actual Cash Value $ $ 10 Substitute Transportation Up to $ 15 aday. Z " Tn ) None $ 25 25 Uplo$ a day, maximum $ None $ 11 Towing and Labor Up to $ for each disablement None $ Up lo $ for each disablement None $ 12 Bodily Injury Caused By An Underinsured Auto Per $ 100000 Pomp° $ 300000 Pe Zee' ,„,„ None s 28 28 Pei $ PersP" S Per Accident None $ MERIT RATING PLAN Premium Adjustment $ J Premium Adjustment $ PREMIUM (per AUTO) AUTO $ 1742 1742 1 AUTO s TOTAL PREMIUM (POLICY) * INCL WAIVER OF DED $ 1742.00 -LC - LU1D: DISCOUNTS Account Age 65£ Ceder Annual Mang* Are TINA Good Student Ma) StPrt Student e a MCZNAacyCle PUP% Sr Omer nan °earn3n W.Itt eacr AUTO 1 20% 1% AUTO REFER TO OTHER SIDE FOR ADDITIONAL INFORMATION INSURED PAGE 1 OF 1 12/14 ovals*, 07/18/14 EFTA01136396