California Auto Insurance Proposal
Prepared For:
Prepared By:
John T Smith
4505 Industrial St #2d
Simi Valley, CA 93063
(805) 522-9629
Farmers Insurance
4505 Industrial St. # 2D
Simi Valley, CA 93063
Bus: (877) 773-4353 Fax: (805) 522-4397
agent1@farmersagent.com
Rates Effective : 10/1/2005
Proposal Date : 5/19/2006
CA License No. : 123456789
Zipcode: 93063
Driver: John
Age:37, Male, Married Exp.: 21 Yrs.
Co.: Mid-Cent.
Use: Long Com.
Car Year: 2004
Car Symbol: 4
One Way: 0
# Days: 0
Miles: 14612
Driver: Jane
Age:36, Female, Married Exp.: 20 Yrs.
Co.: Mid-Cent.
Use: Short Com.
Car Year: 2002
Car Symbol: X
One Way: 0
# Days: 0
Miles: 7752
Liability
UM/UIM
Medical
Comprehensive
Collision
Um/Pd
Ford Mustang Gt Conv
100/300/100
303.70
50/100
30.80
2,000
33.30
750
84.20
750
315.20
6.90
Chevrolet Tahoe 4wd 4dr
100/300/100
170.50
30/60
18.60
2,000
18.70
750
27.20
750
100.20
4.90
Multiple Car
Good Driver
Both Side/Air
DSL - 0
High Performance
Multiple Car
Good Driver
Both Side/Air
Educator
DSL - 0
Towing
8.30
8.30
Coll. Plus
K5
57.10
K5
53.40
Glass Buybk
100 Ded
8.40
100 Ded
2.70
Additional Equipment
1000
.00
1000
.00
Discounts and Surcharges
Discounts and Surcharges
Optional Coverages
Optional Coverages
Total 6 Mo. Prem.
Policy Fee
Total
847.90
404.50
15.00
15.00
862.90
419.50
Total Premium
Std. Downpayment
1,282.40
641.20
EasyPay Monthly Payments
EasyPay Downpayment
213.73
452.46
Easy Pay W/Bank Plan
EasyPay Downpayment
210.73
345.10
Total 6 Mo. Savings for Multi-Line (if applied to all vehicles)
Home
Rent
Mobilehome
Life
Home/Life
Rent/Life
Mobile/Life
Savings
Auto Total w/Savings
228.10
1,054.30
111.10
1,171.30
111.10
1,171.30
55.70
1,226.70
283.70
998.70
167.00
1,115.40
167.00
1,115.40
This is merely a proposal and is not a policy of insurance or offer to insure. Rates quoted reflect the rates in effect as of the date of this proposal and are
subject to revision. The Company reser