2022/02/15 Interinsurance Exchange of the Automobile Club Binder of InsuranceDESCRIPTION OF AUTOMOBILE,BOAT,OR TRAILER
Car No.Year Trade Name Type of Body or Boat Identification Number
1 2020 GMC ACADIA AT4 1GKKNLLSXLZ155300
30510 (12/10)
LCAA0400A
021422
Name and Address of Lienholder or Additional Insured Policy Number:CAA108013629
CITY OF MENIFEE
29844 HAUN RD
MENIFEE CA 92586
NOTICE TO LIENHOLDER
IN THE EVENT OF CANCELLATION OF THIS
BINDER,THE EXCHANGE W ILL GIVE THE
LIENHOLDER 10 DAYS’W RITTEN NOTICE OF
CANCELLATION.
Loan Number:
The Interinsurance Exchange of the Automobile Club hereby acknowledges itself bound to the named insured for the coverages specified in the
schedule subject to all the provisions of the Exchange’s applicable policy form.The issuance of a policy to the named insured or,if a policy is in force,
the issuance of an endorsement covering the automobile,boat or trailer described herein shall void this binder.A pro rata premium charge computed for
the term of coverage in accordance with the current rates of the Exchange in effect at inception of the binder will be made unless such a policy or policy
endorsement is issued.This binder shall not be construed to afford cumulative insurance with any existing policy.
Name of Insured:SIDI,SEBASTIAN
“ü”indicates coverage bound and afforded.
Car #1 Car #
Bodily Injury Liability $100 thousand dollars,each person
$300 thousand dollars,each occurrence þ ¨
Property Damage Liability $50 thousand dollars,each occurrence þ ¨
Medical Payments ¨¨
Underinsured/Uninsured Motorists Not Less Than $15,000 each person/$30,000 each accident ¨¨
(a)Actual Cash Value less $250 deductible þ ¨
¨¨
Collision (a)Actual Cash Value less $1,000 deductible þ ¨
þ Uninsured Deductible Waiver ¨¨
Uninsured Collision ¨¨
Effective Date of Binder:02/15/2022 12:01 A.M.Pacific Standard Time
This binder shall expire 30 days from the effective date or may be cancelled by the named insured at any time during such 30-day period.The Exchange
may cancel this binder by mailing to the named insured at the address shown above written notice stating when,not less than 10 days thereafter,such
cancellation shall be effective.The mailing of such notice shall be sufficient proof of notice.
District Office:
By:
(Authorized Representative)
ACSC Management Services,Inc.
ATTORNEY-IN-FACT
AUTOMOBILE INSURANCE LIMITS OF LIABILITY
Comprehensive (incl.Fire and Theft)
DocuSign Envelope ID: 0749DAA6-A994-45E2-91B9-4D48A2974276