July 25, 2013

SWELLS FARG 0 July 25, 2013 RE: Automobile Insurance WensFargo Insurance Services USA, Inc. 330 Madison Avenue 7th Floor New York NY 10017-5001 Dear Leon: Enclosed please fmd Fireman's Fund Insurance Company policy_ renewing your automobile insurance for a further period of one year from July 26, 2013. Also attached is our invoice in the amount of $21,075 representing the annual premium. The policy covers on eleven vehicles which are as follows: 1989 Mercedes Benz 560 SL 2004 Mercedes Benz S600 2004 Toyota Highlander 2004 Acura TL 2007 Bentley 2008 Jeep Patriot 2009 Honda Pilot 2011 Chevrolet K1500 Silverado 2012 Mercedes Benz 8350 2012 Chevrolet Tahoe LT 2013 Mercedes Benz S600 All of these vehicles are garaged in Bedford Hills, New York. There is $1,000 deductible comprehensive fire, theft and collision coverages. Liability protection is afforded with a limit of $500,000 bodily injury/property damage. You have excess umbrella liability covering over and above this primary insurance. I trust you will fmd all in order and remain Sincerely, Jeffrey A. Haber JAH:ya Encl. G trice Am41‘1744, Las L Drbid.Atmowc RencwalLea do: Together we'll go far EFTA01077973 Declarations Personal Auto Po!ley Policy Number Policyl iod: From 07/26/2013 To 07/26/2014 (120) Tie* a the AMISS eflerezet secedes aced Has) insured's Name and Mailing Address Leon D Black MIN lLon Payee Per Auto Fireman's Fond Insurance Companies Coverage is provided in the following cotnpany, a stock company 13 - Associated Indemnity Corporation I #Auto(s) principally garaged at mailing address unless otherwise stated_ 200 The Narrows Bedford Hills, NY Zip Code 10506 TAX TERRITORY: 05704 DESCRIPTION OF AUTO(5) OR TRAIL AM° Model ass-No. Year Trade Name, Model, Body Type Identification Number kJ Aim Class /Tier Tea. = 1 2011 Chevrolet K1500 Silvered° 1GCNKPEA8BZ116619 A 2011 883120H 65 2 1989 Mercedes Benz 56051. WDBBA48D3KA100433 A 1989 89112214 65 3 2012 Chevroke Tahoe LT 1GNSKBEO5CR302060 E • 2012 8831204 .. 65 15% Coverage Is Provided Where A Premium And Limit Of Liability Are Shown For The Coverage . Coverages Limit of Liability Fall Term Premium S AM I S Adel S PO63 A. liabftity (Single Limit) S 500,000 Each Accident 406 804 406 A. Liability (Split Limits) Boa bitty 5,000 Each Pawn S .000 Each Accident Property Damage S ,000 Each Accident B. Medical Payments S 100.000 Each Person 9 10 9 C ()uins-urecVLIndminsured Motorists (Sisk& Limit) S 500,000 Each Accident —170 "170 "170 C. Uninsured Motorists (Split Limits) Bodily Injury S ,000 Each Pawn S ,000 Each Accident Properly Damage 5 .000 Each Accident D. Damage To Your Auto Collision Loss (ACV Means Actual Cah Value) Auto I: ACV Minus 51000 Deductible Auto 2: ACV Minus 51000 Deductible Auto 3: ACV Nimus 51000 Deductible 341 457 389 Ober Than Collision Loss Auto : 5 ACV Minus 5 wenuate Auto 1: S Minus S1010 oceeuake Auto 2: S Minus $1000 Mambo Auto 3:3 Minus SI003 Cedtcale 93 291 98 Towing and Labor Costs- Each Disablement 'Ind 'Ind incl Rental Rein:lbws:anent or Eat Tousponstioa 'Ind and in el See Eadersemem 'Personal Injury Protection see attached See Endorsement 76 189 76 NY Motor VeNcle Enforcement Fee 10 10 10 'Prestige Auto 'incl and lid "Supplemental Endorsement (SUM) Endorsements Attached PP0001 PP0179 PP0346 PP0364 PP0409 PP0476 PP0587 PP0588 PP0593 PP1301 102164 102173 102192 Total Premium Per Auto 1105 1901 1138 Eadorsement Premium s '257 Total Policy Premium Sams pg.4 Discounts: See attached Data of Issue 7/18/13 CEB Countasignatina of Authorized Agenr 5965.%95 This Declarations Page Is Issued in Coop:nom With And Is Part Of The Pascual Auto Policy INSURED COPY Page 1 of 4 EFTA01077974 Declaration Policy NumberIMM Potty Period: From 07/26/2013 To 07/26/2014 (12.0=t Staird Trees Oil Attu ofNmet hb000f AO 510(4 Hem,) Insured's Name and Mailing Address Leon D Black Debra R Black Loss Payee Per Auto TAX TERRITORY 05704 Personal Auto Policy Fireman's Fund Insurance Companies Coverage is provided in the following company, a stock company 13 - Associated Indemnity Corporation Auto(s) principally garaged at mailing address unless otherwise stated. 64-6 200 The Narrows Bedford Hills, NY Zip Code 10506 DESCRIPTION OF AUTO OR TRAILERS Aug No. Model Year Trade Name, Model, Body Type klenrifIcatica Number see tot Age Class / Tier TeTea. Mat 4 2012 Chevrolet Silverado K2500H0 1GC1KX038CF189577 .1 2012 815120H 65 15% 5 2004 Mercedes Benz 5600 WDENG76J74A3.99157 Y 2004 883120H 65 15% 6 2004 Toyota Highlander _JTEEP21A840031177 A 2004 883121H 65 15% Coverage Is Provided Where A Premium And Limit Of Liability Are Shown For The Coverage Coverages Limn of Liability Fall Term Premium s Asa S Asa 3 Ause6 A. Liability (Single Limit) S 500,000 Each Accident 452 416 406 A. Liability (Split Limits) Bodily Injury S ,000 Each Person 5,000 Each Accident Property Damage S NO Each Accident B. Medical Payments S 100,000 Each Person 9 9 9 C UninsmerlfUnderinsured Motorists (Sink Limit) S 500,000 Each Accident "170 "170 "170 C. Uninsured Motorists (Split Limits) Bodily Injury S ,000 Each Person S .000 Each Accident Property Damage $ ,000 Each Accident D. Damage To Your Auto Collision Loss (ACV Means Actual Cash Value) Auto 4: ACV Minus $1000 Deductible Auto 5: ACV Minus $1000 Deductible Auto 6: ACV Minus $1000 Deductible 537 769 228 Other Than Collision Loss Auto :5 ACV Minus S osaaahic Auto 4:5 Minus 51000 Dolvenble Auto 5: 5 Minus $1000 Doltcak Auto 6: $ Minus 51000 Dedorobk 159 401 68 Towing and Labor Costs Each Disablement 'Ind rind Ind Rental Reimbursement or Ext. Transportation Soo Endorsement Ind Ind 'Ind Personal Injury Protection sec attached See Endorsement 83 79 76 NY Motor Vehicle Enforcement Fee 10 10 10 'Prestige Auto Ind Ind 'Intl "Supplemental Endorsement (SUM) Endorsements Attached Total Premium Per Auto 1420 1854 967 Endorsement Premium Stine' Teal Policy Premium S see ps4 Discounts: see attached Daze of blue 7/18/'13 CEB Countersignature of Authorized Agent 5965.5-95 Page 2 of 4 This Declarations Page is Issued In Conjunction With And Is Pan Of The Personal Auto Policy INSURED COPY EFTA01077975 Declarations Personal Auto Policy Policy Number Poligleriod: From 07/26/2013 To 07/26/2014 maim Sudard Thant itc Addnu orSamcd eased as Voce Hay) Insured's Name and Mailing Address Leon D Black Fireman's Fund Insurance Companies Coverage is provided in the Mains company, a stock company 13 - Associated Indemnity Corporation Auto(s) principally garaged at mailing address unless otherwise stated. #7-9 200 The Narrows Bedford Hills, NY Zip Code 10506 Loss Payee Per Auto TAX TERRITORY. 05704 DESCRIPTION OF AUTOS) OR TRAILEFt(S) Aate NOModel Year Trade Name, Model Body Type identifiatice Number Syr ta Age Class I Tier Ten. M. 7 8 9 2007 2008 2009 Bentley Continental GTC Jeep Patriot Limited Honda Piot SCBDR33W17C046196 1J8FT48W08D700745 5FNYF48269B053993 Y E E 2007 2008 2009 816120H 883120H 815120H 65 65 65 15% 15% 15% Coverage Is Provided Where A Premium And Limit OfLiabilitYAre Shown For The Coverage Coverages Limit of Liability Fall Term Premium S Awes S AM 8 5 Aurae A. liability (Single limit) $ 500,000 Each Accident 452 416 464 A. Liability (Split Limits) Bodily Injury $ ,000 Each Pence S ,000 Each Accident Propaty Damage 5.000 Each Accident B. Medical Payments S 180,000 Each Person 9 9 9 C Uninsuredflindainsured Motorists (Single Limit) S 500,000 Each Accident "170 "170 *-170 C. Vain:lad Motoras (Split Limits) Bodily Injury $ ,000 Each Perna $ ,000 Each Accident Property Damage 5,000 Each Accident D. Damage To Your Auto Collision Loss (ACV Meats Actual Cub Value) Auto 7: ACV Minus $1000 Deductible Auto 8: ACV Maus SI000 Deductible Auto 9: ACV Minus S WOO Deductible 1657 315 382 Other Than Caftan Lass Auto : $ ACV Maus S Oinvento Ante 7:3 Maus 51000 Mantic Auto 8: $ Minus $1000 Deter& Auto 9:$ Minus 51000 Delta* 1215 85 108 Towing and Labor Coss Each Disablement *Ind *kid *kid Rental Reimbursement or Ext. Transportation Sec Endorsement Ind mid *Ind Personal Injmy Macedon see attached See Endorsement 8.3 79 86 NY Motor Vehicle EnforcerneM Fee 10 10 10 *Prestige Auto 'Ind Ind Ind ''Supplemental Endorsement (SUM) Endorsements Attached Total Premium Per Auto 3596 1084 1229 Endorsement Premium S Ind Total Policy Premium S see pg 4 Discounts: see attached Date of Issue 7/18/13 CEB Counteralmatum of Authorized Agent 5965.5-95 This Declarations Page Is I sued In Conjunction With And Is Pit Of The Personal Auto Policy INSURED COPY Page 3 of 4 EFTA01077976 Declarations Personal Auto Policy Policy Number AAE 12263565 Poligferiod: From 07/26/2013 To 07/26/2014 (12:01M Sumbld Ties *I ere Mins of Nimbi inns' a Slats Herrn) Insured's Name and Mailing Address Leon D Black 8 Fireman's Fund Insurance Companies Coverage is provided in the following company, a stock company 13 - Associated Indemnity Corporation Auto(s) principally garaged at mailing address unless otherwise stated. #10-12 200 The Narrows Bedford Hills, NY Zip Code 10506 Loss Payee Per Auto TAX TERRITORY 05704 DESCRIPTION OF AUTO(S) OR FRAME Arro Model Sse-we. Year Trade Name, Model, Body Type identification Number wet Age Class / Tier Ten. 10 2012 Mercedes Benz R350 GL 4JGCB5HE9CA146170 U 2012 883120H 65 15% 11 2004 Acura TL 19UUA68284A046329 K 2004 861120H 65 15% 12 2013 Mercedes Benz 5600 VADDNG7G84DA515347 Y 2013 802120H 65 15% Coverage Is Provided Where A Premium And Limit Of Liability Are Shown For The Coverage Coverages Limit of Liability Full Term Premium S Ate 10 a Aare II S Aso n A. Liability (Single Limit) 5 500,000 Each Aecidaw 406 677 406 A. liability (Split limits) Bodily Injury S ,000 Each Pasco S ,000 Each Accident Property Damage S ,000 Each Accident B. Medical Payments S 100.000 Each Person 9 9 9 C- Uninsured/Undcrinsured Motorists (Single Limit) S 500,000 Each Accident —170 '170 "170 C. Uninsured Motorists (Split Limits) Bodily Injury 5 ,000 Each Person S .000 Each Accident Property Damage S ,000 Each Accident D. Damage To Your Auto Collision Loss (ACV Means Actual Cash Value) Auto ICI: ACV Minus 51000 Deductible Auto II: ACV Minus 51000 Deductible Auto 12: ACV Minus S 1000 Deductible 705 526 1738 Other Than Collision Loss Auto :5 ACV Minus $ Detlimile Auto 10:3 Minus 51000 Detcale Auto lit 5 Minus $1000 mato* Auto 12: 51,000 Minus S Cdocnble 226 125 855 Towing and Labor Costs Each Disablement 'Ind 'ind 'Intl Banal Reimbursement or Ext. TIIIOSpatit(011 Sec Endorsement 'Ind eel 'incl Personal Injury Protection see attached See Endowment 76 121 76 NY Motor Vehicle Enforcement Fee 10 10 10 'Prestige Auto 'Ind 'In d 'Intl "Supplemental Endorsement (SUM) Endorsements Attached Total Premium Pc Antra 1602 1638 3264 Endorsement Premium S 'Ind Taal Policy Premium S 21075 Discounts: see attached - Dane of Issue 7/18/13 CEB Camtasignature of Authorized Agent 5965-5-95 This Declarations Page Is Issued Li Conjunction WM And Is Part Of The Personal Auto Policy INSURED COPY Page a of 4 EFTA01077977 Fireman% Fund PERSONAL AUTOMOBILE POLICY DECLARATIONS SUPPLEMENT EFFECTIVE DATE 07/26/2013 COMPANY ASSOCIATED INDEMNITY CORPORATION NAMED INSURED YOUR AGENT IS LEON D BLACK WELLS FARGO INS SVCS USA. INC DEBRA R BLACK .31-576.750 POLICY PERIOD: FROM 07/26/2013 TO 07/26/2014 THE FOLLOWING INFORMATION CONCERNING CREDIT, SURCHARGES, OR MINIMUM COVERAGE IS REQUIRED BY LAW. ***THE MAXIMUM AMOUNT PAYABLE UNDER THE SUM COVERAGE SHALL BE THE POLICY'S SUM LIMIT REDUCED AM) THUS OFFSET BY MOTOR VEHICLE BODILY INJURY LIABILITY INSURANCE POLICY OR BOND PAYMENTS RECEIVED PROM, OR ON BEHALF OF, ANY NEGLIGENT PARTY INVOLVED IN THE ACCIDENT. DISCOUNTS VEE 1 VEH 2 VEH 3 VEH 4 VEH 5 VEE 6 Passive Restraint $ 57 $ 40 S 57 S 57 $ 57 S 57 Anti-Theft Device $ N/A $ N/A S 25 S 36 S 141 314 Anti-Lock Brakes $ 33 3 61 S 36 S 47 3 57 3 28 Accident Free $ 73 S 146 S 78 S 103 S 140 $ 59 Daytime Running Lights $ 23 $ N/A S 24 S 30 S N/A S 19 Tier Factor S INCL S INCL S INCL S INCL $ INCL S INCL Multi-Car S INCL S INCL S INCL $ INCL $ INCL S INCL $ $ S $ $ S 3 S S S $ $ S S $ $ $ S $ $ $ $ S $ S S $ $ $ S SURCHARGES INCLUDED IN THE TOTAL PREMIUM CHARGE IS A SURCHARGE OF S 254 CHARGED AS A RESULT OF VIOLATION ACTIVITY OR ACCIDENT INVOLVMENT. Violations: 4/12/10, 9/24/10 & 1/21/11 NEW YORK REGULATIONS REQUIRE THAT EACH DISCOUNT OR SURCHARGE BE SHOWN AS IF IT WERE THE ONLY DISCOUNT OR SURCHARGE APPLICABLE. IF A POLICY HAS MULTIPLE DISCOUNTS OR SURCHARGES, THEIR COMBINATION MAY RESULT IN A TOTAL AMOUNT THAT DIFFERS FROM THOSE SHOWN INDIVIDUALLY. NYSUPPI Page 1 of 2 EFTA01077978 A Firemads Fiord PERSONAL AUTOMOBILE POLICY DECLARATIONS SUPPLEMENT POLICY NUMBER EFFECTIVE DATE COMPANY 07/26/2013 ASSOCIATED INDEMNITY CORPORATION NAMED INSURED YOUR AGENT IS LEON O BLACK • WELLS FARGO INS SVCS USA, INC DEBRA R BLACK 31-576-750 POLICY PERIOD: FROM 07/26/2013 TO 07/26/2014 THE FOLLOWING INFORMATION CONCERNING CREDIT, SURCHARGES, OR MINIMUM COVERAGE IS REQUIRED BY LAW. ***THE MAXIMUM AMOUNT PAYABLE UNDER THE SUM COVERAGE SHALL BE THE POLICY'S SUM IIMIT REDUCED AND THUS OFFSET BY MOTOR VEHICLE BODILY INJURY LIABILITY INSURANCE POLICY OR BOND PAYMENTS RECEIVED FROM, OR ON BEHALF OF, ANY NEGLIGENT PARTY INVOLVED IN THE ACCIDENT. DISCOUNTS VEH 7 VEB 8 VEH 9 VE13 10 YEE! 11 VEH 12 Passive Restraint $ 57 S 57 S 57 S 57 5 57 S 57 Anti-Theft Device $ 338 $ 21 S 22 $ 74 $ 26 $ 342 Ann-Lock Brakes $ 106 S 33 $ 39 - $ 53 $ 58 $ 107 Accident Free $ 309 $ 69 $ 83 S 121 S 68 S 279 Daytime Running Lights S 66 $ N/A $ N/A S 34 S N/A S 68 Tier Factor S INCL SINCL $ INCL SINCL SINCL SINCL Multi-Cat S INCL SINCL SINCL SINCL SINCL MCI S • $ $ $ $ $ $ $ S $ S S $ S $ $ S $ $ $ $ $ S $ $ S $ S $ $ SURCHARGES INCLUDED IN THE TOTAL PREMIUM CHARGE IS A SURCHARGE OF S 254 CHARGED AS A RESULT OF VIOLATION ACTIVITY OR ACCIDENT INVOLVMENT. Violations: 4/12/10, 9/24/10 & 1/21/11 NEW YORK REGULATIONS REQUIRE THAT EACH DISCOUNT OR SURCHARGE BE SHOWN AS IP rr WERE THE ONLY DISCOUNT OR SURCHARGE APPLICABLE. IF A POLICY HAS MULTIPLE DISCOUNTS OR SURCHARGES, THEIR COMBINATION MAY RESULT IN A TOTAL AMOUNT THAT DIFFERS FROM THOSE SHOWN INDIVIDUALLY. NYSUPPI Page 2 of 2 EFTA01077979 Firemiut Fund PERSONAL AUTOMOBILE POLICY DECLARATIONS SUPPLEMENT PERSONAL INJURY PROTECTION POLICY t.UMB EFFECTIVE DATE COMPANY 07/26/2013 ASSOCIATED INDEMNITY. CORPORATION NAMED INSURED YOUR AGENT IS LEON D BLACK WELLS FARGO INS SVCS USA, INC DEBRA R BLACK 31-576-750 VEJ3 MANDATORY BASIC ECON LOSS LIMIT: S 50,000 S 57 ADDITIONAL PERSONAL INJURY S 100,000 S 15 OPTIONAL BASIC ECON LOSS S 25,000 S 4 AGGREGATE NO-FAULT BENEFITS LIMIT: S 175,000 S 76 WORK LOSS COORD DOES NOT APPLY DEDUCTIBLE OF S ND. APPLIES MAXIMUM MONTHLY WORK LOSS LEIZT: S 4,000 S 1NCL DEATH BENEFIT LIMIT: 3 2,000 S INCL OTHER NECESSARY EXPENSES S 25 per day VEH 2 VEH 3 VEH 4 VEH 5 S 138 S 57 S64 S 59 S16 S15 S IS S IS $5 S4 $4 S5 S 159 S 76 S 83 S 79 S 1NCL S INCL S INCL S 1NCL S INCL S RICL S INCL S INCL EXCLUSION OF MEDICAL EXPENSE FROM PERSONAL 1NTURY PROTECTION COVERAGE PER ENDORSEMENT Registrant No.1 Registrant No.2 Vehicle I Leon D Black 788071306 Debra R Black 539647350 Vehicle 2 Leon D Black 788071306 Debra 12 Black 539647350 Vehicle 3 Leon D Black 738071306 Debra R Black 539647350 Vehicle 4 Leon D Black 788071306 Debra 12 Black 539647350 Vehicle 5 Leon D Black 788071306 Debra 12 Black 539647350 Vehicle 6 NYSUPP2 Page I of 3 EFTA01077980 S Firemarts Fund PERSONAL AUTOMOBILE POLICY DECLARATIONS SUPPLEMENT PERSONAL INJURY PROTECTION NAMED INSURED LEON D BLACK EFFECTIVE DATE 07/26/2013 VEH 6 MANDATORY BASIC ECON LOSS LTh4IT: S 50,000 S 57 ADDITIONAL PERSONAL INJURY LJMIT: S 100,000 S 15 OPTIONAL BASIC WON LOSS S 25,000 S 4 AGGREGATE NO-FAULT BENEFITS LACE: S 175,000 S 76 WORK LOSS COORD DOES NOT APPLY DEDUCTIBLE OF S NIL APPLES MAXIMUM MONTHLY WORK LOSS LIMIT: S 4,000 S INCL DEATH BENEFIT LIMIT: S 2,000 S INCL OTHER NECESSARY EXPENSES S 25 per day EXCLUSION OF MEDICAL EXPENSE FROM PERSONAL INJURY PROTECTION COVERAGE PER ENDORSEMENT COMPANY ASSOCIATED INDEMNITY CORPORATION YOUR AGENT IS WELLS FARGO INS SVCS USA, INC 31-576-750 VEX 7 YE; 8 VE11 9 vEH 10 5 64 S 59 366 S 57 515 S15 S15 S15 S4 35 $5 S4 S 83 S 79 586 I 76 Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle 6 NYSUPP2 Registrant No.1 Leon D Black Leon D Black Leon D Black Leon D Black Leon D Black S INCL S INCL S INCL S INCL S INCL S INCL S INCL S INCL Registrant No.2 Debra Ft Black Debra It Black Debra It Black Debra R Bleak Debra R Black Page 2 of 3 EFTA01077981 S Fireman's Fund PERSONAL AUTOMOBILE POLICY DECLARATIONS SUPPLEMENT PERSONAL INJURY PROTECTION EFFECTIVE DATE 07/26/2013 NAMED INSURED LEON D BLACK COMPANY ASSOCIATED INDEMNITY CORPORATION YOUR AGENT IS WELLS FARGO INS SVCS USA, INC 31-576-750 VER II VEH 12 YEA VEll Via t MANDATORY BASIC ECON LOSS LIMIT: 5 50,000 S 101 S 57 S S S ADDITIONAL PERSONAL INJURY S 100,000 5 15 S I5 OPTIONAL BASIC ECON LOSS LIMIT: S 25,000 5 5 S 4 AGGREGATE NO-FAULT BENEFITS S 175,000 S 121 S 76 WORK LOSS COORD DOES NOT APPLY DEDUCTIBLE OF S NIL APPLIES MAMMUM MONTHLY WORK LOSS LIMIT: S 4,000 S INCL • S INCL DEATH BENEFIT MITT: S 2,000 S NCL SINCL S S S OTHER NECESSARY EXPENSES S 25 per day EXCLUSION OP MEDICAL EXPENSE FROM PERSONAL INJURY PROTECTION COVERAGE PER ENDORSEMENT Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle S Vehicle 6 NYSUPP2 Registrant No.1 Leon D Black Leon I) Black Registrant No.2 Debra R Black Debra R Black Page 3 of 3 EFTA01077982 Prestige Autos Premier Coverage Endorsement - New York With respect to the coverage provided by this endorsement, the provisions of the policy apply unless modified by this endorsement. ValueLocke COVERAGE SCHEDULE Auto Description 1) 2011 2) 1989 3) 2012 4) .2012 5) 2004 6) 2004 Toyota Highlander 7) 2007 Bentley Continental GTC 8).2008 Jeep Patriot Limited 9) 2009 Honda Pilot 1O;2012 Mercedes Benz R350GL 11) 2004 Acura TL .12) 2013 Mercedes Benz 5600 DEFINITIONS Chevrolet K1500 Silverado Mercedes Benz 560SL Chevrolet Tahoe LT Chevrolet Silverado K2500BD Mercedes Benz $600 The following provisions are added to and replace any conflicting provisions in Definition Ja, and Definition K.2. when includectin your policy: The broadest coverage of any of your covered autos shown in the Declarations will apply to a newly ac- quired ;vehicle provided you ask us to insure it within 30 days after you become the owner if: 1. The vehicle is in addition to any vehicle shown in the Declarations; or 2. You ward Collision and Other Than Collision coverage. However, if Collision or Other Than. Collision coverage does not apply to any vehicle already shown in the • Declarations, you must ask us to insure it within 4 days after you become the owner. We will provide these coverages with a deductible of $500 to the newly ac- quired vehicle. . Coverage begins from the date you become the owner if you ask us to insure the vehicle within the specified time period. ValueLocke Limit of liability $ 14,053 $ 15,950 $ 55,677 $ 45,270 $ 13,337 $ 10,589 $ 108,575 $ 14,807 $ 19,945 $ 63,000 $ 11,381 $ 180,000 EXTENDED NON-OWNED AUTO COVERAGE COVERAGE FOR VEHICLES FURNISHED FOR YOUR REGULAR USE Part A and Part B are amended as follows with respect to you: A. PART A - LIABILITY COVERAGE Exclusions Al. and 13.2.b. do not apply. B. PART B - MEDICAL PAYMENTS COVER- AGE Exclusion 5.b. does not'apply. The last sentence of Exclusion 8. is replaced by the following This exclusion (8.) does not apply to bodily injury sustained while occupying r. • 1. Private passenger auto, pickup, or van, or 2. Trailer- used with a vehicle described in 1. above. WORLDWIDE COVERAGE FOR OWNED, NON-OWNED, AND NEWLY ACQUIRED VEHI- CLES 102173 1-06 Mt IradocIes copyrighted Mate-121s of losuranoe Sealers Office, lac., rib in perroisslco, 1997 Page) of 7 EFTA01077983 WARMNG In Mexico, and other countries, only liability coverage purchased from a local licensed insurance company will meet the auto insurance requirements of that country. Failure to ptirchase any required insurance policy could result .in fines or other penalties. Check with your rental car provider. If you rent, borrow, or lease a non-owned auto, pur- chase an auto, or temporarily relocate an auto shown in the Schedule or Declarations outside the United States of America, its territories or possessions, Puerto Rico, or Canada, your coverage under Part A.- Liabil- ity Coverage, Part B - Medical Payments, and Part D - Collision, Other Than Collision, and Transportation Expenses for loss of use will apply to the operation or use of that vehicle by you or any family member pro- vided: 1. An underlying policy of automobile liability in- surance is purchased or provided to the extent re- quired by the country or jurisdiction in which the vehicle is being operated. . We will pay only that part of a covered loss that exceeds the limit of li- ability of that underlying policy. 2. The rental, lease, or use of the non-owned auto is fora period of not more than 90 days. 3. You notify us. within 30 days after you purchase or relocate a vehicle. EXCESS MEDICAL PAYMENTS COVERAGE The following is added to the LIMIT OF LIABILITY protion of PART B: C. In addition to any limit of liability shown in the Declarations for this.coverage, we will pay up to $10,000 for each person injured in any one aCci- dent. However, this additional limit shall be excess over any other collectible auto insurance providing payments for Medical of funeral .expenses. CARJACENG COVERAGE We will pay, without a deductible, carjacking expenses incurred by you or a family member solely and directly as a result of a carjackbag occurrence provide& 1. The occurrence involves the unlawful forced re- moval or detention of you or a family member while operating or occupying your covered auto or non-owned auto during the theft or attempted theft of the vehicle; and 2. The carjarking occurrence is reported promptly to the police or other law enforcement agency. Carjarking expenses include the reasonable and neces- sary costs for: 1. Merliml or psychiatric expenses incurred within. one year of the ca jacking occurrence for you or a family member who witnessed the ea:jacking oc- currence; and 2. Income continuation benefits if unable to resume the duties of you or a family member usual occu- pation during the first 60 days following a canarking occurrence. This coverage is .exens over any other valid and collectible benefits in- chiding A. disability insurance, B. workers compensation, C. unemployment compensation, D. salary or wage continuation plans; or E. other similar plans. 3. Funeral Expenses up to $10,000 per person. LIMIT OF LIABILITY Our limit of liability as a result of any one carjer-king occurrence shall be the lesser of: ' 1. The actual reasonable and necessary =jacking expenses incurred; or 2. $100,000 This is. the most we will pay regardless of the number of: 1. Insureds; 2. Policies applicable; • • 102173 1-06 TN Induda copyrighted ;uteri* of [Pittance Services Office, Ines, with itr pecrlisier, 1997 . . • • Page 2 of 7 EFTA01077984 I 24-hour Emergency Service For Roadside Response call 1.866.FUNDTOW (1.866.386.3869') 24-hour Emergency Service For Roadside Response call 1.866.FUNDTOW (1.866.386.3889') Policy Number: Policy Number: Policy Period: 07-26-2013 Policy Period: 07-26-2013 to 07-26-2014 to 07-26-2014 Named Insured: LEON D & DEBRA It BLACK "For emergency roadside assistance dispatch only. . 24-hour Emergency Service rFuF1rerdsaah n For Roadside Response call 1.866.FUNDTOW (1.866.386.3869') Policy Number: Policy Period: 07-26-2013 to 07-26-2014 Named Insured: LEON D & DEBRA R BLACK 'For emergency roadside assistance dispatch only. Fund Named Insured: LEON D & DEBRA R BLACK 'For emergency roadside assistance dispatch only. 24-hour For Roadside Response call Emergency 1.866.FUNDTOW (1.866.386.3869') Service Thema Fund Policy Number: Policy Period: 07-26-2013 to 07-26-2014 Named Insured: LEON D & DEBRA It BLACK 'For emergency roadside assistance dispatch only. THIS TOLL-FREE NUMBER IS THE DISPATCH FOR EMERGENCY ROADSIDE ASSISTANCE ONLY. FOR ALL OTHER INSURANCE MATTERS, PLEASE CONTACT YOUR INSURANCE REPRESENTATIVE. These services are provided by an Independent company under contract to Fireman's Fund. EFTA01077985 ROADSIDE HELP: Can 1.866.FUNDTOW {1.866.386.3869) anytime for emergency roadside assistance. CLAIMS SERVICE: Call 1.888.FIREHAT {1.888.347.3428) anytime to report claims. Provide the operator with the: • exact location in the United Stales ct Canada: • description of the auto: • ownership (e.g., yours, borrowed or rented); • cause of disablement (e.g.. accident); and • whore you can be reached by phone Note Fireman's Fund provides roadside response coverage for autos you insure with us for Towing And Labor Costs coverage (includes autos you don't own, but are temporarily using). THIS CARD IS NOT EVIDENCE OF LIABILITY INSURANCE COVERAGE. 302659 01.03 ROADSIDE HELP: Call 1.866.FUNDTON (1.868,386.3869) anytime for emergency roadside assistance. CLAIMS SERVICE: Call 1.888.F1REHAT (1.888.347.3428) anytime to report claims. Provide the operator with the: • exact location in the United States or Canada: • • • ownership (e.g., yours, borrowed or rented):" • cause of disablement (e.g., accident); and • where you can be reached by phone Note Fireman's Fund provides roadside response coverage for autos you insure with us for Towing And Labor Costs coverage (includes autos you don't own, but are temporarily using). THIS CARD IS NOT EVIDENCE OF LIABILITY INSURANCE COVERAGE. 302659 01-03 description of the auto: ROADSIDE HELP: Call 1.866.FUNDTOW (1.866.386.3869) anytime for emergency roadside assistance. CLAIMS SERVICE: Call 1.008.FIREHAT (1.888.347.3428) anytime to report claims. Provide the operator with the: • exact location in tho United States or Canada; • description of the auto: • ownership (e.g., yours, borrowed or rented);' • cause of disablement (e.g., accident); and • where you can be reached by phone Note: Fireman's Fund provides roadside response coverage for autos you insure with us for Towing And Labor Costs coverage (includes autos you don't own, but are temporarily using). THIS CARD IS NOT EVIDENCE OF LIABILITY INSURANCE COVERAGE. 302659 01-03 ROADSIDE HELP: Call 1.866.FUNDTOW (1.866.386.3869) anytime for emergency roadside assistance. CLAIMS SERVICE: Call 1.8B8.FIREHAT (1.888.347.3428) anytime to report claims. Provide the operator with the • exact location in the United States or Canada; • description of the auto: • ownership (e.g., yours, borrowed or rented): • cause of disablement (e.g., accident): and • where you can be reached by phone Note: Fireman's Fund provides roadside response coverage for autos you insure with us for Towing And Labor Costs coverage (includes autos you don't own, but are temporarily using). THIS CARD IS NOT EVIDENCE OF LIABILITY INSURANCE COVERAGE. 3021159 01.03 67 EFTA01077986 043 Associated Indemnity Corp. Name & Address of Issuer FIREMAN'S FUND INSURANCE CO 777 SAN MARIN DRIVE NOVATO, CA 94998 An atuthcrized NEW YORK Meurer has issued an Owner's Poky of Uribirey Insurance complying with Ark* 6 (Motor Vehicle Financial Security Ad) of the NEW YORK Vehicle and Traffic taw to: IT3t—.ACK,LEON,D 043 Associated Indemnity Corp. Name & Address of Issuer FIREMAN'S FUND INSURANCE CO 777 SAN MARIN DRIVE NOVATO, CA 94998 An authorized NEW YORK insurer has blued an °vein P05O/ of Liability Insurance candying with Ara* 6 (Moser Vehicle FiriandU Security Act) of the NEW YORK Vehicle and Traffic Law to: BLACK.LEON,D 11111. r NEW YORK STATE INSURANCE IDENTIFICATION CARD Pa hay Ne7ter Effective Date Expiration Date 0712 2013 07/2612014 12:01 .13707. (401 actorS-te to °blab reastraton SW 45 days from effective dab.) Agor:able with respect to the fo5oWing Motor Venda: 2011 CHEVR Year Make Vehicle Identdcatico Nuttier THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARMNG: Any person who issues or pre* as an ID card knowing that an Owners Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: CMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. Flea NEW YORK STATE INSURANCE IDENTIFICATION CARD Policy Number AAE12263565 Effective Date Expiration Date 0 /26/2 13 07/26/2014 12:01 (Not acceptable to obtain registration alter 45 days from effective date.) AP050ist4e with reseed to the following Motor Vehida: 2011 CHEVR ide Idonlacalion Numoer OEM THIS ID CARD MUST BE CARRED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owners Policy of insurance is not in effect may be cornmitting a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: CMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. FS-20 FAX: Scanable Bar Code 11 FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. II submitted to DMV, either the entire page or the second ID card and large scanable bar code will be retained 3. A faxed ID card must be replaced with a scanable ID card within 14 days of the effective date. 4. DMV Mg not accept a faxed ID card without a scanable barcode EFTA01077987 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. Antic14(PS)-7.01 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 300534(PS).74:11 EFTA01077988 NEW YORK STATE INSURANCE IDENTIFICATION CARD 043 Associated Indemnity Corp. Name & Address of Issuer FIREMAN'S FUND INSURANCE CO 777 SAN MARIN DRIVE NOVATO, CA 94998 An authorized NEW YORK insurer has issued en Owners Poky of Loamy Insurance compfying with Article 8 (lector VeNde Financial Secuity Act) of the NEW YORK Vehide and Traffic Law to: BLACK,LEON,D BLACK, DEBRA,R Pot Number Effective Date Expiration Date 07/26/2013 07/ 1 12:01 (Not aoseclatble to ob.,m after 45 days from ellectIvedele.) Applicable with respect to the following Motor Vehicle: 1989 ME/BE Vetscie aesedcalion artier THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owners Policy of insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION. DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. FS•20 NEW YORK STATE INSURANCE IDENTIFICATION CARD Policy Number 043 Associated Indemnity Corp. Mama & Address of Issuer FIREMAN'S FUND INSURANCE CO 777 SAN MARIN DRIVE NOVATO, CA 94998 An aAhorized NEW YORK insures hes issued an Owner's Pao/ of Jabley Insurance complying with All* 6 (Motor Vehicle Flrendel irscunty Act) of file NEW YORK Vehicle and Trat Law to: BLA DK.LEON, D LEM Effective Date Expiration Date 07/28/2013 14 1201 Not acceptable to obtain reparation after 45 days from effective date.) Acioscsbie with respect to the following Motor Vehicie: 1989 ME/BE 11 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARMNG: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance Is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. FS-20 FAX: Scanable Bar Code FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. If submitted to DMV, ether the entire page or the second ID card and large scanable bar code will be retained 3. A faxed ID card must be repiaoed with a scanable ID card within 14 days of the effective date. 4. DMV WA not accept a faxed ID card without a =enable baroode EFTA01077989 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. 300534(PS).7.01 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 303534(Psjd41 EFTA01077990 043 Associated Indemnity Corp. Name & Address of Issuer FIREMAN'S FUND INSURANCE CO 777 SAN MARIN DRIVE NOVATO, CA 94998 An authorized NEW YORK insurer has issued an Owneas Poicy of Lately insurance complying with Artie 6 (Motor Vehicle Financial Searity Act) or me NEW YORK Vehicle and Traffic Law to: BLACK,LEON,D MOM 043 Associated Indemnity Corp. Nitre 8. Address of Issuer FIREMAN'S FUND INSURANCE CO 777 SAN MARIN DRIVE NOVATO, CA 94998 An authorized NEW YORK Insurer has Issued an Owner's Pc4cy or Liabley In:sprain* complying with Mile 6 Woke Vehicle Franca Security Act) of me NEW YORK Vehicle and 7ratec Law to: BLACK,LEON,D NEW YORK STATE INSURANCE IDENTIFICATION CARD Policy Number AAE12263599 Effective Date Expiration Date 07/26/2013 LOIr ;tar 12:01 (Nol acceptable to obtain registration after 45 days from effective date.) AoprcaMe with rasped to the folloning Motor VON*: 2012 CHEVR Vehicle icantikation Number 11111111 I THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: My person who issues or produces an ID card knowing that an Owner's Policy of insurance is not in effect may be committing a misdemeanor. In addftion, a person who presents an ID card if insurance is not In effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. FS.20 NEW YORK STATE INSURANCE IDENTIFICATION CARD Policy Number AAE12263565 Effedive Date 07126/2013 12:01 (Not acceptaae to °titan registration after 45 days from effective date.) Aopkable with reseed to the following Motor Vehicle: 2012 CHEVR Expiration Date at126at 12:01 Year Make Vehicle Identifealico Number MEM THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of insurance is not in effect may be committing a misdemeanor. In addition, a person who presorts inID card if insurance Is not in effect may be committing a misdemeanor. The name of the registrant and the name of the inured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. F8-20 FAX: Scanable Bar Code 11111 r • .1 FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. If submitted to DMV, either the entire page or the second ID card and large scanable bar code will be retained 3. A faxed ID card must be replaced with a scanable ID card within 14 days of the effective dale. 4. DMV will not accept a faxed ID card without a scanable barcode EFTA01077991 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 3006344PS).7-01 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who Issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 3CC634(PS).74)1 EFTA01077992 043 Associated Indemnity Corp. Qum & Address of Issuer FIREMAN'S FUND INSURANCE CO 777 SAN MARIN DRIVE NOVATO, CA 94998 in authorized NEW YORK ksuner has issued an Ownees Poky of !ability Internee complying with Ntede 6 (Motor vehicle FlnancIN isicsity Ad) of the NEW YORK Vehicle and Traffic Law to: BLACK,LEON,D HEM NEW YORK STATE INSURANCE IDENTIFICATION CARD 043 Associated Indemnity Corp. Nagle & Address or Issuer FIREMAN'S FUND INSURANCE CO 777 SAN MARIN DRIVE NOVATO, CA 94998 en authorized NEW YORK Inner has issued on Owners Poky of jabity Insurance complying with Article 6 (Motor Vehicle Financial Seaelly Act) of the NEW YORK Vehicle and Traffic law to: BLACK,LEON,D BLACK,DEBRA,R 111 Effective Date Expiration Date 07/26/2013 07/2 et.014 1201 12:01 M. (Not =eatable to obtain registration after 45 days from effedive dale.) Aookagie Win respect b the folloWng Motor Violist: 2012 CHEVR Year Make ence ldemttcabon Nunber THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance Is not In effect may be committing a misdemeanor. In addition, a person who presents an ID card N Insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DIN WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. FS.20 NEW YORK STATE INSURANCE IDENTIFICATION CARD Policy Number AAE12263566 Effective Date Expiration Date 07/26/2013 a( 1/Z3 4 12:01 M. (Not ameotable to obtain registration after 45 days from effecSye date.) Aocicae4e with leaped to the toDoning Motor Vehiae: 2012 CHEVR Year M Which) Identification Number fills ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or Produces an ID card knowing that an Owner's Policy of insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card If insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. FS-20 FAX: Scanable Bar Code FAX INSTRUCTIONS: 1. The entre page must be faxed. 2 If submitted to DMV, either the entire page or the second ID card and large scanable bar code will be retained 3. A faxed ID card must be replaced with a scanable ID card within 14 days of the effective date. • 4. DMV will not accept a faxed ID card without a scanab$e barcode EFTA01077993 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 300534(PSY7•01 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 300534(PS).7-01 EFTA01077994 NEW YORK STATE INSURANCE IDENTIFICATION CARD 043 Associated Indemnity Corp. qarrie & Address of FIREMAN'S FUND INSURANCE CO 777 SAN MARIN DRIVE NOVATO, CA 94998 VI authorized NEW YORK insurer has issued an Owners Pc6cy of jataty Insurance complying with Article 6 (Motor White Financial Securtty AM) of the NEW YORK Vehicle and T, Law la BLACK,LEON,ID • till 11 •Effective Date Expiration Date 04013 0n2 u 12:0 . 12:01.n. 0401 eoceotabie to obtain a— ation after 45 days corn effectve date.) Applicable with rasped tO the blowing Motor Vehicle' 2004 ME/SE Year Make THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of insurance is not in effect may be committing a misdemeanor. In addibon, a person who presents an ID card if assurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: Okay WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. PS-20 NEW YORK STATE INSURANCE IDENTIFICATION CARD 043 Associated Indemnity Corp. Jerre & Address of Issuer FIREMAN'S FUND INSURANCE CO 777 SAN MARIN DRIVE NOVATO, CA 94998 el authorized NEW YORK insurer has issued an Owners Patsy of Jebeity Insurance complying With Article 6 (Motor Wilde Financial )(catty Ad) of the NEW YORK Vehicle and Traffc Law to: B LAC IC,LE ON ,1:0 r. aFst. Effective Date Expiration Date 07/26/2013 07/2612014 12:00. 120 (Not acceptable to obtain rat- atm after 45 days from effective date.) Applicable 440 cusped to the following Motor VehiMe 2004 MEJBE n umber THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's PoScy of insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant end the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. PS-20 FAX: Scanable Bar Code it t, UL r ■ • FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. If submItted to DMV, either the entire page or the second ID card and large scanable bar code wiz be retained 3. A faxed ID card west be replaced with a scanable ID card within 14 days of the effective date. 4. DMV Ml not accept a faxed ID card without a erasable barcode EFTA01077995 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. 303534(PS)-141 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. acossies).7.01 EFTA01077996 04.3 Associated Indemnity Corp. Name & Address 04 Issuer NEW YORK STATE INSURANCE IDENTIFICATION CARD Poiic FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date 777 SAN MARIN DRIVE 07/2612013 NOVATO, CA 94998 izot a.m. gl izoirs sin authorized NEW YORK insurer has issued an Owner's Poicy of Liabity Insurance complying with Article 6 (Motor Vehicle Finerthal Stagy Act) of the NEW YORK Vehicle and Traffe Law to: BLACK,LEON,D 1111. 1 (Not acceptable to obtain registation after 45 days from effective date.) *coSmola wt rasped a, the knowing Motor Vehklei 2004 TOYOT on NUmoer THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who sues or produces an ID card knowing that an Owner's Policy of Insurance is not in effect may be committing a mdemeanor. In addition, a person who presents an lT) card if Insurance is not in effect may be committing a misdemeanor. The name of the registrant and the name of the insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLES CURRENT REGISTRATION. F3-20 NEW YORK STATE INSURANCE IDENTIFICATION CARD 043 Associated Indemnity Corp. lame 8 Address of Issuer FIREMAN'S FUND INSURANCE CO Effective Date Expiration Date 777 SAN MARIN DRIVE 07/2U013 0712 014 NOVATO, CA 94998 1201n. 12-01 Vi authorized NEW YORK insurer has issued an Omer& Paw of iabilay Inflames complying with Mitts 6 (Motor Vehicle Financial Many Act) of rte NEW YORK Vehicle and Traffic Law to: BLACK,LEON,D is.• (Not acceptable to obtain reoistration alter 45 days from effective date.) Applicable MI respect to the leacniring Motor Vehicle: 2004 TOYOT ra iv erir make tHtS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: My person who issues or produces an ID card knowing that anpyrnets Policy of insurance is not in effect may be committing a misdemeanor. In addition, a person who presents an ID card if insurance is not In effect may be committing a misdemeanor. The name of the registrant and the name dent insured must coincide. REPLACEMENT VEHICLE NOTATION: DMV WILL ONLY PROCESS A VEHICLE CHANGE (RE-REGISTRATION) USING THE REPLACED VEHICLE'S CURRENT REGISTRATION. F5-20 FAX: Scanable Bar Code 1 • FAX INSTRUCTIONS: 1. The entire page must be faxed. 2. It submitted to DMV, either the entire page or the second ID card and large scanable bar code voll be retained 3. A faxed ID card must be replaced with a scanable card within 14 days cd the effective date. 4. DMV will not accept a faxed ID card without a scanable barcode EFTA01077997 THIS ID CARD MUST BE CARRIED IN THE INSURED VEHICLE FOR PRODUCTION UPON DEMAND WARNING: Any person who issues or pr