State Farm Mutual Automobile Insurance Company

State Farm Mutual Automobile Insurance Company PO Box 8000 Ballston Spa, NY 12020.8000 0 aStateFarm° AT2 0003550038 DARREN K INDYKE PLLC 575 LEXINGTON AVE FL 4 NEW YORK NY 10022-6146 A-1775 A Policy Number: Policy Period: September 18, 2016 to September 18, 2017 Vehicle: 2015 MERCEDES ML350 Principal Driver: K GROFF AUTO RENEWAL AMOUNT DU Payment is du ew,„6 ember 18, 2016 Your State Farm Agent ANGELA CARLUCCI Office: Address. 16 ELM PL STE 210 RYE, NY 1058O.2968 If you have a new or dieted cer, have added eny dose wham med. please conies t your agent 76/10/k°K44°`'l °11-PY CONVENIENT PAYMENT OPTION: You may use one of State Farm's alternate payment plans which divides your present premium into two separate payments. You may pay one half of the amount due, $1,052.57, plus a handling charge of $2.00. The amount due on SEP 18 2016 will be $1,054.57. The remaining half will be due on NOV 17 2016. Well send you a reminder notice. The amount you pay is for 12 months. Policy Number 235 0873-C18-52 Prepared July 7.2016 1004583 Customer Rating Index Tier: Elite 1649 When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment, and you will not receive your check back from your financial institution. I Please fold and tear here + Page number 1 ol 6 143562 201 11424014 Power To Pay Your Way Online PC or noble debase aStateFarm . Insured: DARREN K INDYKE PLLC Policy Nurnber: Amount Due: $2,105.14 Please pay by September 18, 2016 Make payment to State Farm Main Owes ata Pocket Agent Asp For Office Use Only 3-A3 A 1775-F80D APP DT 10-28-2016 MUTL VOL MS Seed us a died Call your April 9144674250 Automated hit WOO-440-MS Key code 9[74950528 2809610103 Insurance Support Center P.O. Box 588002 North Metro, GA 30029-8002 AUTO REN $2,105.14 we In See your Slate Farm AgeM 010 60105457 559626200210514 352300235087311128> EFTA00298063 aState Farm. VEHICLE INFORMATION Review your policy information carefully. If anything is incorrect, or if there are any changes, please let us know right away. How is this vehicle normally used? Vehicle Identification National average: 12,000 miles driven Vehicle Description Number ( 1N) Who principally drives this vehicle? annually per vehicle 2015 MERCEDES ML350 vrill To. Work. School ar Pleastre Driven 7,500 oa age miles or less annually. Premium Adjustment Each year, we review our medical payments and personal injury protection coverages claim experience to determine the vehicle safety discount that is applied to each make and model. In addition, we review the comprehensive, collision, bodily injury and property damage claim experience 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 vehide(s) on this policy. Age es of Name September 18.2016 Gender Annual Mileage Verification Your auto insurance rates have been reduced through our low mileage rating. To ensure we've priced our insurance coverage accurately, we verify odometer readings through a third party provider. If we're unable to verify the information needed, we may follow up with you to provide your odometer reading information. Please contact your State Farm agent with questions. Marital Status DARREN K INDYKE Male Single Female Single K GROFF Policy Number: illit= Prepared Jut, • Page number 2 of > It's What You Know. Your auto insurance premium is $2,105.14. Did you know you may qualify for a discount? Call State Fare Agent ANGELA CARLUCCI at 914-967-9250 'Not all discounts are available in every state, and discount amounts may vary by slate. EFTA00298064 0 StateFarm - Principal Driver & Assigned Drivers For each automobile, the Principal Driver is the individual who most frequently drives it Each driver is designated as an Assigned Driver on the household automobile that he or she most frequently drives. Your premium may be influenced by the information shown for these drivers. COVERAGE AND LIMITS See sour policy for en explanation of these coverages. A Uabilky Bodily Unify 300.000/300,000 WIthibt Supplemental Spousal Properly Damage 300,000 5784.96 P11 Personal Injury Protection And Optional Basic Economic Loss $236.74 CO Addtional Personal Injury Protection 524.12 D-WG 0 H R1 1000 Ded Comprehensive 1000 Deductible Collision Emergency Road Service Car Rental & Travel Expense 80% Per Day. S1.000 Max UninswedAlndemsured Motorist 5178.44 5786.82 S4.20 $25.16 Bodily Injury 100.000/300,000 $74.70 Plus NY Law Enbrcement Fee $2.095.14 $10.00 ArnouM Due $2,105.14 The claim experience on your make and model of vehicle has resulted in a reduction to your vehicle rating group for collision coverage. The claim experience on your make and model of vehicle has resulted in a reduction to your liability rating group for bodily injury and/or property damage coverages. DISCOUNTS These adjustments have already been applied to your premium. If any coverage you carry is changed to give broader protection with no additional premium charge, we will give you the broader protection without issuing a new policy, starting on the date we adopt the broader protection. Antiock Brakes 595.40 Antitheft $19.82 Running Light 558.08 Vehicle Safety $173.68 Annual Mileage $317.82 Pcficy Nunterill Prepared July , Page number 3 or 6 EFTA00298065 StateFarm- Other Available Discount(s) You may be eligible for additional discounts See the enclosed insert for more information. Accident Prevention SURCHARGES AND DISCOUNTS Your Vehicle Safety Discount has been inaeased for your basic and additional personal injury protection and optional basic economic loss coverage. ADDITIONAL INFORMATION MULTI-TIER RATING PROGRAM DISCLOSURE NOTICE factors such as the number of years since your initial State Farm Mutual Automobile Insurance Company uses a application, the drivers in your household, and your multi-tier rating program in New York. Your policy premium household's claim history. Certain rates may be higher than depends in part on the pricing level, or 'tier, for which the the New York Automobile Insurance Plan. vehide(s) in your household quaify. Based on certain risk Please ask your State Farm agent if you have questions characteristics, each vehicle in the household will be about the tier for which you qualify. Your agents contact assigned to one of our Customer Rating Index tiers. Your information can be found on the first page of this renewal premium is also influenced by other factors including the notice. coverages you have, where your vehicle is garaged, how If the above information is incomplete or inaccurate, or if you your vehicle is used, and who drives it want to confirm the information we have in our records Your renewal notice shows the Customer Rating Index tier please contact your agent. assigned to each of your vehicles. Private passenger vehicles or motorcycles may be placed higher- or lower- rated tiers depending on household, policy and claims SUPPLEMENTAL SPOUSAL LIABILITY COVERAGE PREMIUM NOTICE New York State law requires that upon written request of an insured, and upon payment of the premium, an Insurer issuing or delivering a policy that satisfies the requirements of Article 6 of the New York Vehicle and Traffic Law shall provide Supplemental Spousal Liability Insurance Coverage. Supplemental spousal liability insurance provides bodily injury liability coverage under a motor vehicle insurance policy to cover the liability of an insured spouse because of the death of or injury to his or her spouse, even where the injured spouse must prove the culpable conduct of the Insured spouse. This coverage Is Included within the policy's bodily injury limits and does not increase the amount of those limits. For example: Insured's bodily injury policy coverage limit 8100,000!S300,000 Insured's bodily injury damage claim paid to spouse: $75,000 Insured's bodily injury policy coverage limit available to all other claimants subject to a maximum of S100,000 per person: S225,000 This example assumes the spouse and other claimants involved in the accident have a right to sue the insured for economic loss or for non-economic loss (i.e., pain and suffering) sustained as a result of a "serious injury" as defined in Section 5102 (d) of the Insurance Law. It must also have been shown that there was negligence on the part of the insured. The additional annual premium for SSL coverage is $31.20. If you do not elect to purchase this coverage and do not pay the additional premium, SSL coverage is not included in your motor vehicle insurance policy. Please contact your agent If you wish to purchase SSL coverage. Rates adjusted for auto insurance in New York Auto insurance rates for New York policyholders have been adjusted to better reflect changing clam costs. Overall, some customers will see a decrease in their premium, while others will see a premium increase. The amount your premium may have changed depends on many factors, including: (continued on next page) Policy µrater Page number 4 of 6 Prepared Jup 7. EFTA00298066 0 00 StateFarm • the coverages you have • where you live • the kind of car you drive • how the car is used • who drives the car Any premium adjustment is reflected on your enclosed billing notice. IMPORTANT NOTICE: SINCE YOUR LAST PREMIUM BILL, RATE CHANGES FOR OUR COMPANY HAVE BECOME EFFECTIVE IN NEW YORK AND MAY HAVE INCREASED YOUR PREMIUM. IF YOU HAVE ANY QUESTIONS ABOUT YOUR PREMIUM RATES, YOU MAY WISH TO CONTACT YOUR AGENT. Buying a new car? Remember to contact your agentl 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 fa 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 automaticaly 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 fora newly acquired car, please contact your Slate 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. Save money with our Drive Safe & Save" Discountl Empowering Your Drive" You can receive a discount on your premium by participating in our Drive Safe & Save Program. This program recognizes how much your vehicle is driven. There are several ways you can participate depending on the vehicle you drive. You'll receive an initial participation discount just for enrolling. At each six-month renewal, your discount will be adjusted based on information collected from your car. Contact your State Farm agent or visit for details. Anti-lock braking system discount available If your car is equipped with a factory-installed anti-lock braking system, you can receive a 5 percent discount on the basic premium for bodily injury and property damage liability, basic personal injury protection, additional persons injury protection, medical payments and collision coverages. We want to make sure you don't MISS the opportunity to take advantage of this savings. If your vehicle qualifies for this discount and it has not been applied, please contact your agent. Young drivers "steer clear" for discounts If your household includes a driver under age 25 who is rated on a qualifying State Farmer auto policy and has had no accidents or violations in the past three years, ask your agent about our Steer Clear® Safe Driver program'. You can earn a substantial discount on your policy premium if the young driver qualifies and successfully completes this program. This program does not teach driving skills like a driver education course. Instead, it helps build road-worthy habits and promotes a healthy attitude toward driving. To complete the program, the driver must complete a Self-Assessment Survey aid an extensive driver's log to document driving experiences. These activities demonstrate how driving Is a complex skill, requiring focus, (continued on next page) Policy Numtter. Prepared July 7, 2016 Page number 5 of 6 EFTA00298067 O 00 State Farm awareness of other drivers and roadway hazards, and the understanding that everyone has a responsibility to each other to drive safely. Drivers under age 19 must also watch a video presentation and have parent or guardian participation. To get more information about our Steer Clear Safe Driver program, please contact your State Farm agent In some states, certain accidents and moving violations may not disqualify you. Policy Number: Page number 6 of 6 Prepared July 7. EFTA00298068 PLEASE CHECK NAMEIS) LISTED FORACCURACY The name(s) printed bebw must match the mint) shown on your registration with newt) 13 MmHg and number of cherectom for the insured vehicle. II they do not muck Nu may not he able to register your whicleor trey besubject» other acten by ma OMV. Please contact your mien' tar information and assistance d the remes(s)du rot match. 0792-ST.I218.%12 1 110326 0006 loleasee I 1S:0143 162a3114 lolesnylal lolpenytel 51 01Q2.8T.1290Jl12 • • .PLLC PLEASE CHECK NAME(S) LISTED FUR ACCURACY The namels) printed bebw must match the na mo(s) shown on Nur man lion Nth regard to spelling and number of characters lor the Insured vehicle. II they do not match. you may not ho able to registeryour »hick o r may be subjects Ober o fib n by the DRAV. Please contact your agent lor inlometen and assistance E the nameds) do notmatch. DARREN•K•INDYKEPLLC 1 649/10326 I ocolgiieniam 1.31243 1a2Y211a lelpcnyldl F6.26 la.ra NEW YORK S IAI I INSURANCE IU tN IIPICAl WN CAW Nina &Mien el lamer Company State k? 5coprm Mutual Automobile Insurance Company Code po 3211 Ittallsem Spa NY 1220 An auttorized NEWYORK insurer has issued an Ovmer's Policy of LiabMy gateFilrin Insurance complying wah Article a (Motor Vehicle Financial Security Anita the NEW YORK Vehicle and Traffic leer ø: POUCY NUMBER EFFECTIVE DATE EXPIRATION DATE SEP18201? 1211 ant SEP 11120111 1201am. (Not acceptableto obtain rug Stirlen after 115 days from oltoctet date) Applicable with respect m the Jo lowing MeterVehicle rar e ms MERCEDESponto, Win PHONE OARMILMINDYKLPI IC I 'urn VOL 11/5-1110 I FS telam NEW YORK STATE INSURANCE IDENTIFICATION CARD Musa Adages of Kama State Farm *tint Automatslb blurb«, Company PU Bose= Sofist,, Spa NY 1Ø2D All aurhunred NEW YORK mariner has issued en Owner's Policy el Liability Insurance complying whh Article 6 (Moto r Vehicle %unmet Security Act) of the NEW YORK Vehicle end Tillie law et: POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE SEP112011 It01 a.m. SEP 112017 'Wins (Not a Ceara/me ID obtain registration after 45 days from effective date) Applicable "nth respect to the telemetry Motor Vuhrclo Yea leeks 2015 MERCEDES Vol sicCompany Code 721 Nag 76171 DMRFP/SiallYKelje I MUTI. VOL 111 ACErit PHONE 17/5-DOD Nate MA LA SYS EVIDS StateFarm n Ili 1I ( I. ‘ . Ø i ' i / i 1 wpi art) t ... 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