This policy is issued by: COVERAGE SELECTIONS PAGE Commerce This page and any attached endorsements form a part of your policy I N S U R A N C E &1)A . MAPP- Hr COMPANY The Commerce Insurance Company Webster, MA 01570-0758 vwiew.Commerceinsurance.corn Item 1: This policy is issued to: Massachusetts Personal Automobile TncrmA IIACH Item 2: This policy Is in effect from: Item 3: Description of your Auto: Auto 1 06 HONDA CR—V SE 4D WAGON SHSRD78986U414640 Policy Number: DWL496 Agent: 886 et nnimuic rut • GENCY, INC MA 02139-2717 APRIL 28, 2015 to 113 CAMBRIDGE ST BURLINGTON MA 01803 APRIL 28, 2016(1201 A M Eastern Standard Time) DIRECT BILL Auto Item 4: This policy provides only the coverages for which a premium charge is shown: Coverages, Parts 1-12 AUTO 3, AUTO COMPULSORY INSURANCE LIMITS 0educbbl. Annual A/aniline Adjustedd P remium UMITS 0cclude,* Annual Prennturn Adjusted Prernsurn 1 Bodily Injury To Others pee $ Person 20000 Per $ 40000 Aciodom None $ 328 $ Person r s A.den, None $ 2 Personal Injury Protection $ 8000 Person $ NONE _.,..... ',Ammn end --AnAnnne e 109 $ anon _ r>ois• $ youmel and __,... " $ . 3 Bodily Injury Caused By An Uninsured Auto (Compulsory Limits $20.000 / $40.O00) pet $ 100000 Pe"'°' pm $ 300000 ACC'der None S 24 Per $ Persc, $ Pe, Accident None $ a Damage To Someone Else's Property (Compulsory Limits $5.000) Pf $ 100000 A""en' e None $ 425 S ACarCAent None $ OPTIONAL INSURANCE 5 Optional Bodily Injury To Others Pet $ 100000 Pe--°' Pe $ 300000 AOC,Ient None S 191 Pe, $ PerbOn PN $ Accident None $ 6 Medical Payments Pee $ a $ CH $ pe,„ None $ 7 Collision Actual Cash Value * $ 1000 $ 458 Actual Cash Value $ $ 8 Limited Collision Actual Cash Value $ 5 Adual Cash Value $ $ 9 Comprehensive Actual Cash Value $ 300 $ 154 Actual Cash Value $ $ 10 Substitute Transportation Uplo$ 15 aday. r"Vb None $ 25 Up [QS aday. $ Maximum None $ ii Towing and Labor uptog fee each disablement None Up to $ tor each disablement None e. a 12 Bodily Injury Caused By An Underinsured Auto Per $ 100000 Peron $ 300000 o de,,, None $ 28 Pe, $ Peqw $ Ao we coent None $ MERIT RATING PLAN Premium Adjustment $ 265 I Premium Adjustment $ PREMIUM (per AUTO) AUTO $1742 265 I AUTO TOTAL PREMIUM (POLICY) * INCL WAIVER OF DED 265.00 DISCOUNT$ Ai:co:int Age 653 Oen; Traprno vAiren:20al Inert Antl Student G0OCI Nco sSma hOpa Sit ayrit MOIciCycle Pay Plan Smart Driver Clean In 3 Welcome Ban AUTO 1 20% 1% AUTO REFER TO OTHER SIDE FOR ADDITIONAL INFORMATION INSURED AMENDED 04/28/15 PAGE 1 OF 1 CA \',1 EFTA01136399