HomeMy WebLinkAbout20260225_PJA26-0128_Insurance PREMIUM FINANCE AOREEMENI
Paym°r'l R�m(ftanoo NIC Premium FEnanco, LLC
Address: $270 NE Bothell Way ttanmtllar WA 08028
I L so'.92430 PHONE'(2061 441.8171 FAX(2081 44ll-3141
Kenn„err 0.14 WA6'r �nlapf,aam 105313
NIC A F04." 4 OVA O1"2712026 C4638", 1 2-17 90 Contract�
INSURED TACOS Et PACIFICO i_LC AGENT: Afnvt Wang(Mutarn00 Agency,Inc I
DRAiC O: ADDRESS: 23020 Edmonds".Su"112 ill
I ADDRESS. ":It,17 1SNO,F? Nf.•A Edmonds WA OM
Mswine WA 96271 PHONE (4251•718•-4W
EXPIRATION PR E W U M
f\lt I+Y
17F SCR)PTION INSURANCE CO I MANAGING GENERAt AGENT
Ai1MPCR DATE
d Pa0goe 1r'79,207i Noilhrield Insurance Company 19 PaciCie International Und*rwtlfars,Inc 2.445 00
1 E ll�k t Tt•r,. l: 011ie,Taies and Ices AixALbla'•Y44 5801
Firhy Gained 1 axes Ind I tits
�vf t Fee NA Administrative Fee 200.00
I
-- ` fin• TOTAL PREMIUM
tTEMIZATIQN OF DOWN PAYMENT — —� -- Y- A- s 3.13&01 —
® PERSONAL(JCS DOWN pgYMENT
' _ »�rr ortFu�ii?re,^7Tiur�i$- 8.�.-g 1�52.7fi
[] (:�?i.4 !E>�C1AL t.1N€ S _6277b
Taxes and Fork STCAMP TAX
( l
Loa 1 425DO r+ ON(Y)
Agfeomeril Caa$cuia:ad 2 FUty Earned Taxes anO Fees 5 s 000
1'lhth Effccvve Cale of
a1 g D fIN/:NCED
3 Administrative Foos 5 200.00 alrlo(A-
4.Totsl Cash Down Payment Required $ 1.252 76' s 1.88325
FINANCE CHARGE
'Insured to Send and Make Chock Payable to NIC Premium Finance £ s 14t75
SALANCE PAYABLE
F Total of paymrntt
NIC to Fund: MGA S# 3 i 2,033.00
YOUR PAYMENT SCHEDULE WILL BE:NO ADVANCED NOTICE OF PAYMENTS WILL BE SENT ANNUAL
10.0F_PR.-BENTS AMOUNT OF INSTALLMENTS PAYMENTS ARE DUE:MONTHLY PERCENTAGE
RATE
10 % S 203.3f) MO.DUEDATE BEGINNING _ ENDING IS."% i
I—� 2gTH 2t=026 1129,026
Iy(11 tCI DO NO 51(3N IIiIS AGkkI IJFNI BEFORE YOU REAR I OR If I CONTAINS ANY BLANK SPACES 2 YOU ARL LNIIif EO TO A COMPL E I C LY
f it LED IN COPY OF JwS AGREEMENT 3 UNDER THE LAW,YOU HAVE THE RIGHT TO PAY OFF IN ADVANCE THE FULL-AMOUNT DOE UNDER CERTAIN r
CiINOiTir7f11 TO C)nIAIN A PARTIAL REFUND OF 114F SI-RVICf CIIARGC 4 KFFP YOUR COPY 01 1111%AGREEMFNT TO PROTECT YOUR LEGAL.RIGIIIS
Frtrr�,n is OPTIONAL and not a required conditiotr for any Insur&nee policy Baled heroin In consideration of the loan midi to the above named
fN%dRf:L-Ly NiC Premium f,nanae,LLC(hereon'NIL-),Me INSURLU unconditionally promises to pay NIL,at the address set lorih above,the 101e1 OF payrirenlr.
;z Nc■F ,r.a,esreance with the above FAYMENT SCHEDULE,subject to all provisions set forth herein Including provisions on PAGE 2 1he undersigned INSURLU
r as,Yrr.`zr'r c nett epser,"nl ar.d recerved a copy(hereof on the dale Innicaled beIDW
Tim:ra7r•s '•rn A�s*k%rep._*•re 11117 00 on aDmptrnssuan hom NiC fw a4rig in the prr•par;rhon of this agrreweril and fac wal nl;f.ayrnerl or 3 p1001111rr;
TACOS EL PACIFICO LLC
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tort:'r are eon fully tR"1tQ uvon towdrap or ds•rnf e+tlde,all tignulifes air genuine Ihr C,,wn peylnenl bat bite rrarved In avaltablt fJndt..tend thnl Me
r coteltl••••�ncy bill iM&Coal or 64o►tr apfws•I9 folrna any ono ail un•srnrd premium: It arid untAll tpmmrtt ont to NIC
1/28/2026
Signature of Irlsur Agent or Picker Date --
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