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HomeMy WebLinkAbout20260407_PJA26-0112_Truck Insurance State Farm Mutual Automobile Insurance Company PO Box 2368 A Sta to Farm Bloomington IL 61702-2368 A-2883 A AUTO RENEWAL PUPUSERIA Y TIENDA LATINA 17202 51ST AVE NE ARLINGTON WA 98223 PREMIUM PAID: $1,395.20 DO NOT PAY. Your premium is billed through the State Farm Payment Plan State Farm Payment Plan Number: 1705744969 Your State Farm Agent LUIS SANCHEZ Policy Number: 526 5864-D05-476 Office: 360-653-7560 Policy Period:April 5,2026 to October 5, 2026 Address: 10525 STATE AVE STE 101 Vehicle: MARYSVILLE,WA 98271-7224 2015 FORD F59 SD Ifyouhaveanewordifferentcar,have added any drivers,,orhavemoved, please contact your agent. Thank you for choosing State Farm. Location used to determine rate charged-17202 51 ST process the payment as a check transaction.When we use AVE NE,ARLINGTON WA 98223. information from your check to make an electronic fund Your premium has increased by$136.41. transfer,funds may be withdrawn from your account as soon When you provide a check as payment, you authorize us as the same day we receive your payment, and you will not either to use information from your check to make a receive your check back from your financial institution. one-time electronic fund transfer from your account or to Policy Number:526 5864-D05-47B Page number 1 of 9 Prepared February 11,2026 1004583 143562 202 01-15-2018 CONVENIENCE SAVES Y TIME, MONEY . . . AND TREES. You have the option to pay your bills online by opting for ePayment on statefarm.corl Get to a better State'. -Ft,; - StateFarm VEHICLE INFORMATION Review your policy information carefully. If anything is incorrect,or if there are any changes to your vehicle information, please let us know right away. Vehicle Identification Vehicle Description Number(VIN) Who principally drives this vehicle? How is this vehicle normally used? 2015 FORD F59 SD 1 F65F5KY6F0A04781 For this commercial vehicle,contact your agent for a full review of drivers. Vehicle Body Type:Vending/Concession Truck, Vehicle Use:Delivery to non-business locations-Food,Business Description:Specialty-Fast Food Restaurants(Franchise),Radius of Operation:50 miles,Annual Distance Driven:12000 miles, Gross Vehicle Weight,Manufacturer's Suggested Retail Price, Year Business established:2021 It is your responsibility to inform us of all regular For business related vehicles, also include the drivers of your vehicles and changes to those drivers business owner(s)and employee(s)that drive the throughout the life of your policy. Failure to disclose vehicle(s) in any capacity drivers may result in denial of coverage. Regular Premium Adjustment drivers, regardless of their relationship to the primary Each year,we review our medical payments and personal named insured or their residence address, include: injury protection coverages claim experience to determine • All drivers who drive the vehicle(s)on the policy the vehicle safety discount that is applied to each make and once or more in a typical month model. In addition,we review the comprehensive, collision, • All drivers who regularly drive the vehicle(s)at bodily injury and property damage claim experience least three months of the year annually to determine which makes and models have earned decreases or increases from State Farm's standard rates. If any changes result from our reviews, adjustments are reflected in the rates shown on this renewal notice. COVERAGE AND LIMITS See yourpolicy for an explanation of these coverages. A Liability Bodily Injury 1,000,000/1,000,000 Property Damage 1,000,000 $509.54 P1 Personal Injury Protection Includes Medical 10,000 Income Loss 200/wk/lyr $10.04 D Comprehensive $310.95 G 500 Deductible Collision $525.08 U Underinsured Motor Vehicle Bodily Injury 100,000/300,000 $37.79 U1 Underinsured Motor Vehicle Property Damage 1,000,0 $1.80 Total Premium $1,395.20 Policy Number:526 5864-D05-47B Page number 2 of 9 Prepared February 11,2026 - kateFarm If any coverage you carry is changed to give broader you the broader protection without issuing a new policy, protection with no additional premium charge,we will give starting on the date we adopt the broader protection. SURCHARGES AND DISCOUNTS AUTOMOBILE RATING PLAN -Applies to private property damage liability and collision coverages for an passenger cars only. at-fault accident. Accident-Free Discount —Once your policy has been in Surcharges —If there are chargeable accidents, you may force for at least three years with no chargeable accidents, lose your Good Driving Discount or Accident-Free Discount you may qualify for our Accident-Free Discount. Once you and receive accident surcharges. But if the accident is the qualify, this discount applies as long as there are no first to become chargeable in nine years and this policy has chargeable accidents, and may even increase over time. been in force for at least that long, the Accident-Free Good Driving Discount -Newer policyholders who do not Discount will continue and no surcharge will apply.The yet qualify for our Accident-Free Discount (available after surcharge for each accident depends upon the number and three years with no chargeable accidents) may already be timing of the accidents, and each accident surcharge will receiving a Good Driving Discount. This discount continues remain in effect up to three years. to apply until your policy qualifies for the Accident-Free Surcharges will be removed if the company is given Discount as long as there are no chargeable accidents and satisfactory evidence that the driver involved is no longer a no new drivers. If you add new drivers,they must also member of the household or will not be driving the car in the qualify in order for your Good Driving Discount to continue. future. If that driver is insured on another State Farm policy, Chargeable Accidents - For new business rating, an his or her driving record will be considered in the rating of accident is chargeable if it results in $750 or more of the other policy. damage to any property. For renewal business, an accident These discounts and surcharges do not apply to all is chargeable as of the date State Farm pays at least$750 coverages. For complete details, see your State Farm agent. (for accidents occurring on or after April 1, 1999) under Buying a new car? Remember to contact your agent! When you buy an additional car or one that replaces a car already on your policy, you need to report the change to your agent promptly. Even though the dealership you purchased the car from may offer to notify your agent or insurance company, you, as the named insured, are responsible for reporting all changes to your auto policy. By contacting your agent,you can help: • avoid any complications or lack of coverage in the event of an accident or loss, • avoid insurance verification problems with a Iienholder,the police, or the department of motor vehicles, and • ensure that you receive any new discounts you may be entitled to. Your current State Farm policy automatically provides certain coverages for a new or replacement car for up to a specified, limited number of days after you take possession of the car. Please refer to your policy for the number of days that applies in your state. If you have any questions about coverage for a newly acquired car, please contact your State Farm agent. Disclaimer. This message is provided for informational purposes only and does not grant any insurance coverage. The terms and conditions of coverage are set forth in your State Farm Car Policy booklet, the most recently issued Declarations Page, and any applicable endorsements. Policy Number:526 5864-D05-47B Page number 3 of 9 Prepared February 11,2026 A State Farm 153-7772 WA IMPORTANT NOTICE Regarding Changes to Your Policy The attached AMENDATORY ENDORSEMENT is added to your State Farm®Car Policy. It is your responsibility to inform us of all regular drivers of your vehicles and changes to those drivers throughout the life of your policy. Failure to disclose drivers may result in denial of coverage or other adverse action. Regular drivers, regardless of their relationship to the primary named insured or their residence address, include: • All drivers who drive the vehicle(s)on the policy once or more in a typical month • All drivers who regularly drive the vehicle(s)at least three months of the year • For business related vehicles, also include the business owner(s)and employee(s)that drive the vehicle(s) in any capacity The drivers disclosed to us are listed on the most recent copy of your Auto Renewal. Review the drivers and contact your Agent if you need to add or remove any listed drivers. Additionally,the following policy changes have been made: PHYSICAL DAMAGE COVERAGES The appraisal provision has been updated. Either the covered vehicle owner or we may make a written demand for an appraisal.Each party must select an appraiser who is competent and disinterested in the loss.Should the appraisers be unable to reach agreement, they shall appoint a competent and disinterested umpire to resolve the disagreement(s). Each party bears their own appraisal costs,while the umpire expenses shall be equally shared. Please read the Amendatory Endorsement and place it with your policy. If you have any questions, please contact your agent. DISCLAIMER: This notice only provides a general summary of changes to your State Farm policy. This notice is not a statement of contract. This notice does not change,modify,or invalidate the provisions,terms,or conditions as set forth in your State Farm policy booklet,the most recently issued declarations,and any applicable endorsements. State Farm Mutual Automobile Insurance Company State Farm Fire and Casualty Company Bloomington, IL 153-7772 WA (06/2025) Page 1 of 1 613ON Page 1 of 5 AMENDATORY ENDORSEMENT This endorsement is a part of the policy. Except for the changes this endorsement makes, all other provisions of the policy remain the same and apply to this endorsement. 1. THIS POLICY a. Item 3. is changed to read: We agree to provide insurance according to the terms of this policy: a. based on payment of premium for the coverages carried, the applicable limits, and deducti- bles chosen; b. in reliance upon information that affects eligibility and premium provided by you or other sources to us in the application for this policy and during the policy period.This includes, but is not limited to: (1) vehicles insured; (2) use of your car, (3) primary garaging location; and (4) drivers of any vehicle insured under this policy; and c. unless otherwise stated on the Declarations Page, in reliance on the following statements: (1) Neither you nor any member of your household has, within the past three years, had either: (a) a license to drive; or (b) a vehicle registration suspended, revoked, or refused. (2) Your car is used for pleasure and business. b. Item 4. is changed to read: All named insureds shown on the Declarations Page and all applicants agree by acceptance of this policy that: a. the statements in 3. above are made by such named insured or applicant and are true; b. all information provided to us in the application for this policy was true,correct,and complete; c. all information on the Declarations Page and Auto Renewal is: (1) true, correct, and complete; and (2) any changes to information described in 3. above have been provided to us by you if changed during any policy period; and d. we provide this insurance on the basis the above statements and information are true,correct, and complete. ©,Copyright,State Farm Mutual Automobile Insurance Company,2025 6130N Page 2 of 5 Concealing or misleading material information that affects eligibility or premium may be fraudulent, resulting in voiding or rescission of the policy or denial of coverage under the policy. 2. PHYSICAL DAMAGE COVERAGES a. Additional Definitions The following definitions are added: (1) Appraiser means a person selected by us or the insured to place a value on or estimate the amount of loss under an appraisal clause in an insurance contract. (2) Competent means the person has subject matter expertise, relevant training, and experience to make decisions and valuations relating to the amount of loss. (3) Disinterested means the person does not have a direct financial interest in the outcome of the appraisal process. (4) Umpire means a person selected by the appraisers representing us and the insured, or, if the appraisers cannot agree, by the commissioner, who is charged with resolving issues that the appraisers are unable to agree upon during the course of an appraisal. b. Limit and Loss Settlement—Comprehensive Coverage and Collision Coverage item 1., wherever it may be found in the policy, is changed to read: 1. We have the right to choose to settle with you or the owner of the covered vehicle in one of the following ways: a. Pay the cost to repair the covered vehicle minus any applicable deductible. No deductible applies to the repair of windshield glass. (1) We have the right to choose one of the following to determine the cost to repair the covered vehicle: (a) The cost agreed to by both the owner of the covered vehicle and us; (b) A bid or repair estimate approved by us; or (c) A repair estimate that is written based upon or adjusted to: (i) reasonable repair costs and labor rates as determined by us for the repair mar- ket where the covered vehicle is to be repaired; (ii) the prevailing competitive price. Prevailing competitive price means prices charged by a majority of the repair market as determined by a survey made by us for the area where the covered vehicle is to be repaired; (iii) the lower of paintless dent repair pricing established by an agreement we have with a third party or the paintless dent repair price that is competitive in the market; or (iv) a combination of(i), (ii), or(iii)above. If asked, we will identify at least one facility that will perform the repairs with the pricing and labor rates identified by us. The repair estimate will include parts sufficient to restore the covered vehicle to its pre- loss condition. You agree with us that the repair estimate may include new, used, recy- ©,Copyright,State Farm Mutual Automobile Insurance Company,2025 613ON Page 3 of 5 cled, and reconditioned parts.Any of these parts may be either original equipment man- ufacturer parts or non-original equipment manufacturer parts,and you agree these parts are sufficient to restore the covered vehicle to its pre-loss condition. You also agree that replacement glass need not have any insignia, logo, trademark, etching, or other marking that was on the replaced glass. (2) If the repair or replacement of parts normally subject to repair and replacement during the useful life of the covered vehicle results in the vehicle being better than its pre-loss condition, then you must pay for the amount of the betterment. Betterment shall be limited to the lesser of: (a) an amount equal to the proportion that the expired life of the part to be repaired or replaced bears to the normal useful life of that part, or (b) the amount which the resale value of the vehicle is increased by the repair or re- placement. b. Pay the actual cash value of the covered vehicle minus any applicable deductible. The damaged covered vehicle must be given to us in exchange for our payment, unless we agree that the owner may keep it. If the owner keeps the covered vehicle,then our payment will be reduced by the value of the covered vehicle after the loss; or c. Return the stolen covered vehicle to its owner and pay, as described in 1.a. above, for any direct, sudden, and accidental damage that resulted from the theft. The owner of the covered vehicle and we must agree upon the actual cash value of the covered vehicle and the amount of the loss. If there is disagreement as to the actual cash value of the covered vehicle or the amount of the loss, then the disagreement will be resolved by appraisal using the following procedures: (1) Either party may make a written demand for an appraisal,and within 10 days each party shall select a competent and disinterested appraiser and notify the other party of its selection. (2) The appraisers shall then each appraise the actual cash value of the covered vehicle and the amount of loss, make separate findings regarding the amount of loss for each element of loss, and exchange their completed appraisals. If the appraisers are unable to agree on the losses, the selected appraisers shall appoint a competent and disinterested umpire and submit their differences to the umpire. If the appraisers do not appoint a competent and disinterested umpire within 15 days, either appraiser may notify the commissioner, and the commissioner shall identify a registered competent and disinterested umpire that will be used according to the process that the commissioner specifies by rule. (3) The appraisers must make their appraisals within 30 calendar days of selection. If an ap- praiser needs more than 30 days,the appraisershall provide a reasonable basis to the other appraiser before 25 days has passed.The appraiser must document the reason or reasons for the extension in their file. (4) The amount of loss must be determined either by agreement of the appraisers or by agree- ment of one appraiser and the umpire.An agreement of any two is binding. (5) Each party is responsible for their appraisal expenses, and each party is equally responsible for the cost of the umpire. ©,Copyright,State Farm Mutual Automobile Insurance Company,2025 613ON Page 4 of 5 (6) The appraisers shall only determine the actual cash value of the covered vehicle and the amount of the loss.Appraisers shall have no authority to decide any other questions of fact, decide any questions of law, or conduct appraisal on a class-wide or class-representative basis. (7) Neither we nor the owner of the covered vehicle waive any of our rights by submitting to an appraisal. 3. INSURED'S DUTIES The following is added: Duty to Notify Us of Changes You must notify us if there are changes to any information shown on the Declarations Page or Auto Renewal,or to information that affects eligibility or premium.This includes,but is not limited to changes in: a. use of your car, b. primary garaging location; c. drivers of any vehicle insured under this policy; or d. driver's license status of any driver. You must notify us of a newly acquired car within the timing described in the newly acquired car definition. You must notify us of all other changes within 90 days of that change. Failure to notify us of changes that affect eligibility or premium may be fraudulent, resulting in voiding or rescission of the policy or denial of coverage under the policy. 4. GENERAL TERMS a. Premium (1) Item c. is changed to read: The renewal premium for this policy will be based upon the rates in effect, the coverages carried, the applicable limits, deductibles, and other elements that affect the premium that apply at the time of renewal including, but not limited to: (1) vehicles insured; (2) use of your car, (3) primary garaging location; and (4) drivers of any vehicle insured under this policy. (2) Item e. is changed to read: The premium for this policy is based upon the coverages carried, the applicable limits, de- ductibles, and information we have received from you or other sources. You must inform us if any information regarding the following is incorrect or incomplete, or changes during the policy period, and you must answer questions we ask regarding the following: (1) Your car, or its use, including annual mileage; (2) The persons who regularly drive your car, including newly licensed family members; ©,Copyright,State Farm Mutual Automobile Insurance Company,2025 613ON Page 5 of 5 (3) Your marital status; or (4) The location where your car is primarily garaged. If the above information or any other information used to determine the premium is incorrect, incomplete, changes during the policy period, or is not provided to us when we ask, then we may decrease or increase the premium during the policy period. If we decrease the premium during the policy period, then we will provide a refund or a credit in the amount of the de- crease. If we increase the premium during the policy period, then you must pay the amount of the increase. b. Cancellation Item b.(4),wherever it may appear in the policy, is changed to read: After this policy has been in force for more than 60 days, we may cancel this policy before the end of the current policy period: (a) if the premium is not paid when due; (b) if you, any resident relative, or any other person who usually drives a your car has had their driver's license under suspension or revocation during the policy period or during the 180 days immediately before the effective date of the policy renewal; or (c) for any other reason allowed by law. c. Concealment or Fraud The Concealment or Fraud provision is replaced by: Concealment, Misrepresentation, or Fraud a. To determine your eligibility for coverage under this policy and to determine your premium, we relied upon statements and representations you or the applicant provided to us. b. There is no coverage under this policy and we may void or rescind this policy, if you or an applicant have made false statements with the intent to conceal or misrepresent any material fact or circumstance in connection with: (1) the application for this policy; or (2) any change to this policy or elements that affect eligibility or premium including, but not limited to: (a) vehicles insured; (b) use of your car, (c) primary garaging location; and (d) drivers of any vehicle insured under this policy. c. There is no coverage under this policy if you or any other person insured under this policy has made false statements with the intent to conceal or misrepresent any material fact or circumstance in connection with any claim under this policy. 613ON ©,Copyright,State Farm Mutual Automobile Insurance Company,2025