2021/11/09 Southern State Ins SvcsPRODUCER
NUMBER
PERSONS INSURED
NAMED INSURED
DRIVERS
POLICY PERIOD
12:01AM 12:01AM
AUTOMOBILE POLICY DECLARATIONS
IMPORTANT COVERAGE EXCLUSION
APPLICABLE TO ALL COVERAGES, INCLUDING BUT NOT LIMITED TO, LIABILITY
AND UNINSURED MOTORISTS, PROVIDED NOW OR LATER.
MAILING
ADDRESS
CAR YEAR VEHICLE DESCRIPTION SERIAL NUMBER COST OR VALUE NEW/USED PURCH. DATE H.P./CID
CAR LP-AI-LA
GA-RO LOSS PAYEES (LP), ADDITIONAL INTERESTS (AI), LOSS PAYEES AND ADDITIONAL INTERESTS (LA), GARAGING ADDRESSES (GA) AND REGISTERED OWNERS (RO) OTHER THAN THOSE LISTED ABOVE.
COVERAGES LIMITS OF LIABILITY PREMIUMS NON-FACTORY EQUIPMENT
CAR CAR CAR
PREMIUMS PER CAR
POLICY FEE
CAR #ITEMS INSURED LIMIT
TOTAL PREMIUM
BODILY INJURY LIABILITY
PROPERTY DAMAGE LIABILITY
UNINSURED MOTORISTS
BODILY INJURY LIABILITY
UNINSURED MOTORISTS
PROPERTY DAMAGE LIABILITY
COLLISION DEDUCTIBLE WAIVER
MEDICAL EXPENSE
COMPREHENSIVE
COLLISION
ROADSIDE ASSISTANCE
RENTAL CAR BENEFIT
ENDORSEMENTS ATTACHED TO THE POLICY
$
$
$
$
$
$
$
$
$$$
$$$
EACH PERSON
EACH ACCIDENT
EACH PERSON
EACH ACCIDENT
EACH ACCIDENT
MAXIMUM
DEDUCTIBLE
DEDUCTIBLE
PER DAY DAYS
CAR
CAR CAR CAR
CAR CAR
LEASE/LOAN GAP COVERAGE CAR CAR CAR
CALIFORNIA ASSESMENTS
CA FRAUD FEE
CIGA FEE
Coverage applies only if premium charge is listed below. Coverage/Limits are subject to all policy terms.
TOFROM
REPAIR OR REPLACEMENT CAR CAR CAR
COST COVERAGE
CAR CAR CAR
INTERVENOR FEE
EACH
OCCURRENCE
It is agreed that the insurance afforded by this policy
shall not apply nor accrue to the benefit of any insured or any
third party claimant when any motor vehicle is being used or
operated by a person listed below regardless of where the
person resides or whether the person is licensed to drive.
ITEMS INSURED AND AMOUNTS OF
INSURANCE FOR EACH ITEM ARE STATED
HEREIN. ITEMS INSURED ARE SUBJECT TO
THE DEDUCTIBLE.
MARCELINO J SERNA
MARISSA S NIEVES
ANDREW SERNA
JESSE J SERNA
TOYOTA TUNDRA DOUBLE CA PICKUP 4D
TOYOTA 4RUNNER SR5/LMT/ UTL 4X4 4D
TOYOTA COROLLA SE XSE HCHBK 4DR
MARCELINO J SERNA
U-10 12/2018 U-179
1,986.64
100,000 300,000
50,000
1,000
1,000
15,000 30,000
174 152 225
22 20 29
2 4 8
27 17 19
160 169 378
4 4 4
22 22 22
561 522 901
6 6 6
2.64
0401 27 200132484
144 128 210
SOUTHERN STATE INS SVCS 04C106 27
11/09/2021 05/09/2022
15902 WIBERT DR
FONTANA, CA 92336-4623
1 2013 5TFRY5F12DX137970 U 05/2013
2 2018 JTEBU5JR2J5510308 N 11/2017
3 2019 JTNK4RBEXK3040075 N 03/2019
1 LP ALTURA FCU PO BOX 790408 SAN ANTONIO TX 78279
2 LP ALTURA CREDIT UNION PO BOX 790408 SAN ANTONIO TX 78279
1,000
1,000 1,000
1,000 1,000
30 30
1 2 3
POLICY
2401 HIGHLAND AVE STE 108
NATIONAL CITY, CA 91950
TELEPHONE:(619) 336-3810
1 2 3
1 2 3
$751 $752 $753(FOR TOWING SERVICES)*
A
MAILING DATE :
MAILED TO:
IMPORTANT INFORMATION
U-176
POLICY NUMBER:
10/08/2021
MARCELINO J SERNA
15902 WIBERT DR
FONTANA, CA 92336-4623 0401 27 200132484
INSURED COPY
07/2019
*For Non-Towing Services, Limit of Liability is $75 per Occurrence. Maximum 5 Occurrences in total for
Towing and Non-Towing services per policy period.
EFFECTIVE 11/09/2021
The enclosed Auto Insurance Renewal Bill and the U251 IMPORTANT NOTICE are part of this policy. These
specify the amount of your premium, your payment options, any applicable fees, and the due date.
Your automobile insurance expires and coverage ceases at 12:01AM on 11/09/2021. Coverage under
this policy will become effective provided you pay the premium and any applicable fees as indicated
on the Auto Insurance Renewal Bill. If you have any questions, please contact your agent or broker at
the phone number provided above.
DocuSign Envelope ID: F2EA4A5E-920C-401C-9DD1-2C9577A418AC
NOTICE
LOSS PAYABLE ENDORSEMENT
ADDITIONAL INTEREST ENDORSEMENT
This policy is continuous until cancelled or nonrenewed with respect to the interest of the Loss Payee(s) or Additional
Interest(s) named on the reverse side hereof.
Loss or damage, if any, to the property described in this policy shall be payable firstly to the Lien-Holder and secondly to the insured, as
their interests may appear, provided nevertheless that upon demand by the Lien-Holder upon the Company for separate settlement the
amount of said loss shall be paid directly to the Lien-Holder to the extent of its interest and the balance, if any, shall be payable to the
insured.
The insurance under this policy as to the interest only of the Lien-Holder shall not be impaired in any way by any change in the title or
ownership of the property or by any breach of warranty or condition of the policy, or by any omission or neglect, or by the performance
of any act in violation of any terms or conditions of the policy or because of the failure to perform any act required by the terms or
conditions of the policy or because of the subjection of the property to any conditions, use or operation not permitted by the policy or
because of any false statement concerning this policy or the subject thereof, by the insured or the insured's employees, agents or
representatives; whether occuring before or after the attachment of this agreement, or whether before or after the loss;
PROVIDED, however, that the wrongful conversion, embezzlement or secretion by the Purchaser, Mortgagor, or Lessee in possession of
the insured property under mortgage, conditional sale contract, lease agreement, or other contract is not covered under this policy,
unless specifically insured against and premium paid therefor.
In the event of failure of the insured to pay any premium or additional premium which shall be or become due under the terms of this
policy, this Company agrees to give written notice to the Lien-Holder of such nonpayment of premium. The rights of the Lien-Holder
under this Automobile Loss Payable Endorsement shall not be terminated before ten (10) days after the mailing of such notice.
If the Company elects to cancel this policy in whole or in part for nonpayment of premium, or for any other reason, the Company will
forward a copy of the cancellation notice to the Lien-Holder at its office specified hereinafter concurrently with the sending of notice to
the insured but in such case this policy shall continue in force for the benefit of the Lien-Holder only for ten (10) days after written
notice of such cancellation. In no event, as to the interest only of the Lien-Holder, shall cancellation of any insurance under this policy
covering the property described in the policy be effected at the request of the insured before ten (10) days after written notice of
cancellation shall have been given to the Lien-Holder by the Company. In the event of cancellation of this policy the unearned premium
shall be paid to the Lien-Holder, provided the said Lien-Holder has advanced the premium.
If there be any other insurance upon the within-described property, this Company shall be liable under this policy as to the Lien-Holder
only for the proportion of such loss or damage that the sum hereby insured bears to the whole amount of valid and collectible insurance
of similar character on said property under policies held by, payable to and expressly consented to by the Lien-Holder, and to the extent
of payment so made this Company shall be subrogated (pro rata with all other insurers contributing to said payment) to all of the
Lien-Holder's rights of contribution under said other insurance.
Whenever this Company shall pay to the Lien-Holder any sum for loss or damage under this policy and shall claim that as to the insured
no liability therefor exists, this Company at its option, may pay to the Lien-Holder the whole principal sum and interest due or to
become due from the insured on the obligation secured by the property insured under this policy, (with refund of all interest not
accrued), and this Company shall thereupon receive a full assignment and transfer, without recourse, of said obligation and the security
held as collateral thereto; but no subrogation shall impair the right of the Lien-Holder to recover the full amount of its claim.
The coverage granted under this policy shall continue in full force and effect as to the interest of the Lien-holder only, for a period of
ten (10) days after expiration of said policy unless an acceptable policy in renewal thereof with loss thereunder payable to the
Lien-Holder in accordance with the terms of this Automobile Loss Payable Endorsement shall have been issued by some insurance
company and accepted by the Lien-Holder. In the event of a loss not otherwise covered during the extended ten (10) day period herein
referred to, an annual policy covering the same hazards to the property insured under the original policy shall be issued and accepted by
the Lien-Holder and Mortgagor.
Should the ownership and right of possession of any of the property covered under this policy become vested in the Lien-Holder or its
agent, this policy shall continue for the term thereof for the benefit of the Lien-Holder (with all incidents of ownership of the policy) but,
in such event, Paragraphs two (2), five (5), and six (6) of this Automobile Loss Payable Endorsement shall no longer apply; provided,
nevertheless, all privileges and endorsements which, by reason of the printed conditions of this policy, are or may be necessary to
maintain the validity of the contract, and hereby granted for a period of thirty (30) days and all notices likewise required to be given to
the Company by the insured are hereby waived for a period of thirty (30) days with the exception of requirements applying at the time
of or subsequent to a loss.
All notices herein provided to be given by the Company to the Lien-Holder in connection with this policy and this Automobile Loss
Payable Endorsement shall be mailed to or delivered to the Lien-Holder at its office or branch as set forth on the reverse side hereof.
If this policy is cancelled, prior to its expiration date, ten (10) days advance notice of such cancellation will be given to the additional interest
named on the reverse side. Only the bodily injury and property damage liability insurance provided by the policy, to "any other person or
organization" extends to the additional interest. This does not affect the coverage provided by the policy, to any other insured.
With respect to the interest of the loss payee named on the reverse side hereof, its successors and assigns, (hereinafter called the
Lien-Holder) in its capacity as conditional Vendor or Mortgagee or otherwise, in the property insured under this policy, this Company hereby
agrees as follows:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, agreements or limitations of the above
mentioned policy, other than as above stated.
U-49A (Revised)
DocuSign Envelope ID: F2EA4A5E-920C-401C-9DD1-2C9577A418AC