Scribd
Upload
551 views

Declarations Page (Auto Insurance Coverage Summary) : © 2012-2021 Metromile Inc. All Rights Reserved. OR-AD-0618

Uploaded by

Srinivasan P
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
551 views

Declarations Page (Auto Insurance Coverage Summary) : © 2012-2021 Metromile Inc. All Rights Reserved. OR-AD-0618

Uploaded by

Srinivasan P
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

DECLARATIONS PAGE (AUTO INSURANCE COVERAGE SUMMARY)

Metromile Insurance Company Policy Number: 33-092384-05-01

POLICY INFORMATION

Insurance Agent Metromile Insurance Services, LLC Insurance Company


425 Market Street, Suite 700 Metromile Insurance Company
San Francisco, CA 94105 425 Market Street, Suite 700
1-888-244-1702 or www.metromile.com San Francisco, CA 94105

Named Insured Srinivasan Pushpanathan Policy Address


18750 NW Rock Creek Cir
Effective Date & Time 05/14/2021 12:01 AM PDT Apt 80
Portland, OR 97229
847-922-6498
Expiration Date & Time 11/14/2021 12:01 AM PST [email protected]

Endorsement Date & Time 05/14/2021 12:01 AM PDT

Total Policy Premium (6 mo.) $283.36 plus $0.104 per mile (2018 Toyota RAV4)

DRIVER INFORMATION

Date Marital
Name of Birth Gender Status
Srinivasan Pushpanathan 04/26/1978 Male Single

For any driver in the "Excluded Drivers" section above, we will not provide coverage for any claim for damages under Part I - Liability To
Others of this policy, or for loss under Part IV - Damage To A Vehicle of this policy, arising from an accident or loss involving a
motorized vehicle being operated by that excluded driver. This includes any claim for damages made against you, a relative, or any
other person or organization that is vicariously liable for an accident arising out of the operation of a motorized vehicle by the excluded
driver.

© 2012-2021 Metromile Inc. All rights reserved. OR-AD-0618


COVERAGE INFORMATION

Your insurance policy (OR-AC-0618) contains a full explanation of your coverage. The policy limits shown for a vehicle may not be
combined with the limits for the same coverage on another vehicle.

Vehicle 2018 Toyota RAV4 (4-cylinder | 2WD)


VIN JTMZFREV3JD114941
Garaging Zip Code 97229
Vehicle Use Personal

Coverage Limit Deductible Premium Per Mile*


Bodily Injury $100,000 / $300,000 $126.96 $0.020
Property Damage $100,000 $29.44 $0.024
Comprehensive Actual cash value $500 $9.20 $0.003
Collision Actual cash value $250 $58.88 $0.047
Personal Injury Protection $15,000 $12.88 $0.010
Uninsured/Underinsured Motorist Bodily Injury $100,000 / $300,000 $18.40 $0.000
Uninsured Motorist Property Damage $20,000 ** $11.04 $0.000
Rental Reimbursement $30/day up to 30 days $12.88 $0.000
Roadside Assistance Included $3.68 $0.000
Vehicle Total (6 months) | 2018 Toyota RAV4 $283.36 $0.104

* This portion of the premium is determined at end of each billing cycle by multiplying daily per mile rate by daily miles driven.
** A $300 deductible applies for accidents caused by hit-and-run/phantom vehicles; a $200 deductible applies in all other cases.

© 2012-2021 Metromile Inc. All rights reserved. OR-AD-0618

Powered by TCPDF (www.tcpdf.org)

You might also like