State Farm Fire and Casualty Company

PO Box 2358
Bloomington IL 61702-2358

AT1 A-6570 A
TRAVIS, LYNN
55 DANIELS RD AUTO RENEWAL
HONESDALE PA 18431-3076

PREMIUM PAID: $354.88

DO NOT PAY.
Your premium is billed through the State Farm Payment Plan
State Farm Payment Plan Number: 1378560613

Your State Farm Agent

ROBINSON INSURANCE AGCY INC
Policy Number: 590 0050-B20-38 Office: 570-253-5700
Policy Period: August 20, 2024 to February 20, 2025
Address: 114 7TH ST
Vehicle: HONESDALE, PA 18431-1835
2005 HYUNDAI SONATA If you have a new or different car, have added any drivers, or have moved,
please contact your agent.
Principal Driver:
LYNN TRAVIS Thank you for choosing State Farm.

When you provide a check as payment, you authorize us transfer, funds may be withdrawn from your account as soon
either to use information from your check to make a as the same day we receive your payment, and you will not
one-time electronic fund transfer from your account or to receive your check back from your financial institution.
process the payment as a check transaction. When we use
information from your check to make an electronic fund

Policy Number: 590 0050-B20-38 Page number 1 of 4

Prepared June 27, 2024
1004583 143562 202 01-15-2018

Drive Safe & Save™ puts you in

the driver's seat of your discount.
Get a discount just for enrolling. From there,
how you drive determines how much you save.

If you haven't already, download the app

and enroll. Text SAVEMORE to 42407;
contact your agent, ROBINSON
INSURANCE AGCY INC , at
570-253-5700; or scan this QR code.

Discounts may exceed 30% and vary state-to-state (NY capped at

30%). Not available in CA, MA, RI. A discount may not be available in NC
depending on individual facts and circumstances. Setup required.

TP41
 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?
2005 HYUNDAI SONATA KMHWF25S85A172515 LYNN TRAVIS, a divorced female, who will To Work, School or Pleasure.
be age 59 as of August 20, 2024.

Vehicle(s) 1 - The premium for this renewal was determined Premium Adjustment
using an annual mileage this vehicle is expected to be Each year, we review our medical payments and personal
driven that was developed from information we obtained or injury protection coverages claim experience to determine
was provided by you. The national average is more than the vehicle safety discount that is applied to each make and
12,000 miles driven annually according to the U.S. model. In addition, we review the comprehensive, collision,
Department of Transportation. Please contact us if you bodily injury and property damage claim experience
expect your annual mileage to change over the next 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.

DRIVER INFORMATION
Assigned Driver(s)
The following driver(s) are assigned to the vehicle(s) on this policy.

Age as of Marital
Name August 20, 2024 Gender Status
LYNN TRAVIS 59 Female Divorced

Principal Driver & Assigned Drivers premium may be influenced by the information shown for
For each automobile, the Principal Driver is the individual these drivers.
who most frequently drives it.
Each driver is designated as an Assigned Driver on the
household automobile that they most frequently drive. Your

IMPORTANT NOTICE REGARDING YOUR PREMIUM

State Farm works hard to offer you the best combination of You have the right to request, no more than once during a
price, service, and protection. The amount you pay for 12-month period, that your policy be re-rated using a current
automobile insurance is determined by many factors such credit-based insurance score. The resulting impact due to
as the coverages you have, where you live, the kind of car the credit portion of the re-rated insurance score will not
you drive, how your car is used, who drives the car, and increase your premium; however, your overall premium may
information from consumer reports. decrease, remain the same, or increase due to other factors
impacting your total premium.

Policy Number: 590 0050-B20-38 Page number 2 of 4

Prepared June 27, 2024
 COVERAGE AND LIMITS See your policy for an explanation of these coverages.
A Liability Bodily Injury 50,000/100,000 $238.60
Property Damage 50,000 Included
C2 Medical Payments 5,000 $37.11
H Emergency Road Service $18.45
U3 Uninsured Motorist Bodily Injury 50,000/100,000 $14.38
W3 Underinsured Motorist Bodily Injury 50,000/100,000 $46.34
Total Premium $354.88

WARNING... Any person who knowingly and with intent excess of the limits required by law are provided only at
to injure or defraud any insurer files an application or your request as enhancements to basic coverages.
claim containing any false, incomplete or misleading The premium for basic liability coverage of
information shall, upon conviction, be subject to $15,000/30,000/5,000 is $197.10 and medical payments
imprisonment for up to seven years and payment of a coverage of $5,000 is $37.11.
fine of up to $15,000. If any coverage you carry is changed to give broader
THIS POLICY PROVIDES LIMITED TORT OPTION. protection with no additional premium charge, we will give
The laws of the Commonwealth of Pennsylvania, as you the broader protection without issuing a new policy,
enacted by the General Assembly, only require that you starting on the date we adopt the broader protection.
purchase liability and first-party medical benefit
coverages. Any additional coverages or coverages in

DISCOUNTS These adjustments have already been applied to your premium.

3-STAR P
Vehicle Safety P
Total Discounts $213.46

SURCHARGES AND DISCOUNTS

AUTOMOBILE RATING PLAN - Applies to private total at least $2,100 ($1,900 or more if the accident occurred
passenger cars only. on or after July 1, 2022 and prior to July 1, 2023).
3-Star Discount – Your policy may be eligible for our 3-Star For renewal business, an at-fault accident is chargeable as
Discount. To qualify, assigned drivers must have had no of the date State Farm paid at least $2,100 or more ($1,900
at-fault accidents and no minor violations during the past or more for accidents occurring on or after July 1, 2022 and
three years, and no major violations during the past five prior to July 1, 2023; $1,800 or more for accidents occurring
years. There must also be at least one driver who has been on or after July 1, 2020 and prior to July 1, 2022; $1,700 or
licensed in the United States or Canada for at least three more for accidents occurring on or after July 1, 2017 and
years, and the vehicles in your household must not have prior to July 1, 2020; $1,550 or more for accidents occurring
been driven without liability insurance. on or after July 1, 2014 and prior to July 1, 2017; $1,450 or
2-Star Discount - If your policy does not qualify for our more for accidents occurring on or after July 1, 2011 and
3-Star Discount, the 2-Star Discount applies unless the prior to July 1, 2014; $1,350 or more for accidents occurring
insured vehicle (or the vehicle it replaced) has been driven on or after July 1, 2008 and prior to July 1, 2011; $1,150 or
without liability insurance during the past twelve months. more for accidents occurring on or after July 1, 2005 and
prior to July 1, 2008; $1,050 or more for accidents occurring
Chargeable Accidents - For new business rating, an
on or after July 1, 2002 and prior to July 1, 2005; or $950 or
at-fault accident is chargeable if it resulted in death or bodily
more for accidents occuring on or after July 1, 1999 and
injury or damage to any property in which the insurer paid in
(continued on next page)

Policy Number: 590 0050-B20-38 Page number 3 of 4

Prepared June 27, 2024
 prior to July 1, 2002) under property damage liability and level, which results in the lowest premium, is Driver Record
collision coverages combined. Level 1. Accidents and violations generally result in higher
A multiple vehicle accident shall not be considered Driver Record Levels and higher premiums. We may adjust
chargeable if State Farm is furnished sufficient evidence that the Driver Record Level based on each driver's most recent
the driver involved in the accident was less than 50% at driving record. If more than one driver is assigned to the
fault. same car, we consider each of their Driver Record Levels to
determine the final premium.
Driver Record Levels – Based on accident and violation
records over the past three years, State Farm sets a Driver
Record Level for each driver assigned to a car. The lowest

ADDITIONAL INFORMATION
If any information on this renewal notice is incomplete or information regarding discounts or coverages, see your
inaccurate, or if you want to confirm the information we have State Farm agent or visit statefarm.com®.
in our records, please contact your agent. For additional

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 lienholder, 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: 590 0050-B20-38 Page number 4 of 4

Prepared June 27, 2024