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{ ~ .~ i <br />0 <br />0 <br />e <br />N <br />O <br />m <br />0 <br />~ <br />< <br />~ <br />0 <br />0 <br />0 <br />0 <br />U <br />N <br />s <br />s <br />0 <br />LL <br />O <br />0 <br />PAGE 1 OF 2 <br />::~ Au o032802 14 ~ FROM: SEPT 09, 199~ TO: MAR o9, 1992 ~ 0564176 03 ~: <br />NAGAO, KENNETH T EUGENE INSURANCE AGENCY <br />P.o. Box to126 ~ <br />1680 PEARL ST EUGENE, OR <br />EUGENE~ OR <br />9740~ 97440 <br />AcCOUNT ~{910~06856801 PHONE: 503-686-2722 <br />VEHICLES COVERED <br />VEH ST TER YR MAKE-MODEL SERIAL NUMBER SYM CLA55 ST AM CHG DATE <br />001 OR 012 87 AMER CHEROKEE LA 1JC~t78L9HT160884 11 885129 09/09/91 <br />002 OR 012 90 HONDA CIVIC JHFIE.E4768LS001221 08 8872206 09/09/91 <br />INSURANCE IS PROVIDED WHERE A PREMIl9N 15 SHOWN FOR THE COVERAGE FROM THE <br />EFFECTIVE DATE TO THE EXPIRATION DAT~ AT 12:01 A.M. STANDARD TIME <br />COVERAGE LIMITS OF LIABILITY PREMIUMS <br />~ VEH# l 2 <br />PaRT A <br />BODILY INJURY-PROPERTY DAMAGE $500,Q00 EACH ACCIDENT 109.00 182.00 <br />PART C <br />UNINSURED MOTORIST COVERAGE <br />BODILY INJURY <br />PERSONAL INJURY PROTECTION <br />PART D <br />DAMAGE TO YOUR AUTO <br />OTHER THAN COLLISION LOSS <br />COLLISION LOSS <br />TOWING AND LABOR COSTS <br />$500,000 EACH ACCIDENT <br />$10.000 (COV. P2) <br />27.00 27.00 <br />15.00 24.00 <br />DRIVER ID DRIVER NAME <br />O1 KENNETH T NAGAO <br />02 IRENE K NAGAO <br />ACV M~:NUS $50 DED. 37.00 75.00 <br />ACV:MiNUS $200 DEO. 89.00 183.00 <br />S50 EA~H DISABLEMENT 3.00 3.00 <br />TOTAL BY VEH# 280.00 494.00 <br />TOTAL TERM PREMIUM $774.00 <br />LICENSE NUMBER BIRTH DATE <br />~265765 ~2/23/39 <br />1214618 07/16/42 <br />APPLICABLE FORMS <br />FORM ~ DATE VEH!/ FORM i~ DATE VE~1;~ FORM # DATE VEH~I FORM ~ DATE VEH~ <br />WJP6913.01/79 ALL AUT2272 Ol/90 ALL AuT2284 06/79 ALL AUT2279 O1/79 ALL <br />AUT1145 O1/79 ALL <br />~ <br />m <br />~ <br />8 <br />W <br />~ <br />