Form_SCTNID_CTGRY.

TN03196489_DECPAGE

942580683 E RW06723 INS DECPAGE E POLWHITEFONT W7GLBGC3OKDZE52DJL6VWC4YDD0001 RPUID TRACWHITEFONT

CLAY & LAND INS INC

PO BOX 171356
MEMPHIS, TN 38187

Policy Number: 942580683

Underwritten by:
Progressive Casualty Insurance Co
November 23, 2020
JAMES JONES
Policy Period: Oct 4, 2020 - Oct 4, 2021
4530 MAIDS MORTON LN
MEMPHIS, TN 38125 Page 1 of 3

1-901-767-3600
CLAY & LAND INS INC
Contact your agent for personalized service.

progressiveagent.com
Auto Insurance Online Service

Coverage Summary
Make payments, check billing activity, update
policy information or check status of a claim.

This is your Declarations Page 1-800-274-4499

To report a claim.

Your policy information has changed

Your coverage began on October 4, 2020 at the later of 12:01 a.m. or the effective time shown on your application. This policy period
ends on October 4, 2021 at 12:01 a.m.
This coverage summary replaces your prior one. Your insurance policy and any policy endorsements contain 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. The
policy contract is form 9611A TN (12/15). The contract is modified by forms 4884 (10/08) and A264 (10/18).

Policy changes effective October 4, 2020

………………………………………………………………………………………………………………………………………………………..
Changes requested on: Nov 23, 2020
………………………………………………………………………………………………………………………………………………………..
Requested by: Progressive
………………………………………………………………………………………………………………………………………………………..
Premium change: $390.25
………………………………………………………………………………………………………………………………………………………..
Changes: The Multi-Policy discount has been removed from your policy.

Drivers and ………………………………………………………………………………………………………………………………………………………..

household residents Additional information
JAMES JONES Named insured
………………………………………………………………………………………………………………………………………………………..
BARBARA T kizer-Jones

Form 6489 TN (03/19)

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942580683 E RW06723 INS DECPAGE E POLWHITEFONT W7GLBGC3OKDZE52DJL6VWC4YDD0001 RPUID TRACWHITEFONT

Policy Number: 942580683

JAMES JONES
Page 2 of 3

Outline of coverage
Your insurance policy and any policy endorsements contain 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.
2014 MERCEDES-BENZ E350 4 DOOR SEDAN
VIN: WDDHF8JB0EA949345
Garaging ZIP Code: 38125
Primary use of the vehicle: Pleasure
Length of vehicle ownership when policy started or vehicle added: At least 1 year but less than 3 years
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $796
Bodily Injury Liability $25,000 each person/$50,000 each accident
Property Damage Liability $25,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Bodily Injury $25,000 each person/$50,000 each accident
………………………………………………………………………………………………………………………………………………………..
179
Uninsured Motorist Property Damage $25,000 each accident
………………………………………………………………………………………………………………………………………………………..
$200 359
Medical Payments $2,000 each person
………………………………………………………………………………………………………………………………………………………..
50
Comprehensive Actual Cash Value $1000 345
Comprehensive Window Glass $50 glass
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $500 1,139
………………………………………………………………………………………………………………………………………………………..
Roadside Assistance 10
………………………………………………………………………………………………………………………………………………………..
Total premium for 2014 MERCEDES-BENZ $2,878
2011 NISSAN MAXIMA 4 DOOR SEDAN
VIN: 1N4AA5AP7BC846580
Garaging ZIP Code: 38125
Primary use of the vehicle: Pleasure
Length of vehicle ownership when policy started or vehicle added: At least 3 years but less than 5 years
Information regarding your vehicle history (prior damage, theft or title issues) has impacted how we determine your premium.
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $992
Bodily Injury Liability $25,000 each person/$50,000 each accident
Property Damage Liability $25,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Bodily Injury $25,000 each person/$50,000 each accident
………………………………………………………………………………………………………………………………………………………..
268
Uninsured Motorist Property Damage $25,000 each accident
………………………………………………………………………………………………………………………………………………………..
$200 206
Medical Payments $2,000 each person
………………………………………………………………………………………………………………………………………………………..
78
Comprehensive Actual Cash Value $1000 227
Comprehensive Window Glass $50 glass
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $500 654
………………………………………………………………………………………………………………………………………………………..
Roadside Assistance 10
………………………………………………………………………………………………………………………………………………………..
Total premium for 2011 NISSAN $2,435

Form 6489 TN (03/19)

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Policy Number: 942580683

JAMES JONES
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2004 GMC YUKON 4 DOOR WAGON
VIN: 1GKEC13Z14R243917
Garaging ZIP Code: 38125
Primary use of the vehicle: Commute
Length of vehicle ownership when policy started or vehicle added: 5 years or more
Information regarding your vehicle history (prior damage, theft or title issues) has impacted how we determine your premium.
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $772
Bodily Injury Liability $25,000 each person/$50,000 each accident
Property Damage Liability $25,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Bodily Injury $25,000 each person/$50,000 each accident
………………………………………………………………………………………………………………………………………………………..
93
Uninsured Motorist Property Damage $25,000 each accident
………………………………………………………………………………………………………………………………………………………..
$200 59
Medical Payments $2,000 each person
………………………………………………………………………………………………………………………………………………………..
28
Total premium for 2004 GMC $952
2004 MERCEDES-BENZ C240 4 DOOR SEDAN
VIN: WDBRF61J14E016733
Garaging ZIP Code: 38125
Primary use of the vehicle: Pleasure
Length of vehicle ownership when policy started or vehicle added: 5 years or more
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $505
Bodily Injury Liability $25,000 each person/$50,000 each accident
Property Damage Liability $25,000 each accident
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Bodily Injury $25,000 each person/$50,000 each accident 86
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Property Damage $25,000 each accident $200 85
………………………………………………………………………………………………………………………………………………………..
Medical Payments $2,000 each person 26
………………………………………………………………………………………………………………………………………………………..
Total premium for 2004 MERCEDES-BENZ $702
………………………………………………………………………………………………………………………………………………………..
+ Total 12 month policy premium $6,967.00
+ Includes the Deductible Savings Bank ® feature

Other features and benefits

………………………………………………………………………………………………………………………………………………………..
Deductible Savings Bank ® Current balance: $0

Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
942580683 Home Owner, Multi-Car, Continuous Insurance: Silver and Paperless
Vehicle
………………………………………………………………………………………………………………………………………………………..
2014 MERCEDES-BENZ Smart Technology Discount and Snapshot Participation
E350
2011 NISSAN Snapshot Participation
MAXIMA
2004 GMC Snapshot Participation
YUKON
2004 MERCEDES-BENZ Snapshot Participation
C240

Smart Technology Discount ℠ is a service mark of Progressive Casualty Ins. Co.

Customer Service office information
You may contact Customer Service at 1-800-876-5581 or by mail at P.O. Box 6807, Cleveland, OH 44101.

Form 6489 TN (03/19)