Form_SCTNID_CTGRY.

FL12236489_DECPAGE

961130149 E F828583 INS DECPAGE E POLWHITEFONT KUIUBMEIE35RU7KW35FZGK6EOD0001 RPUID TRACWHITEFONT BDF_AA

LUDLAM INSURANCE AGE

2504 SW 67TH AVE
MIAMI, FL 33155

Policy Number: 961130149

Underwritten by:
Progressive American Insurance Co
December 11, 2024
JAVIER HERNANDEZ VEGA
Policy Period: Sep 4, 2024 - Mar 4, 2025
6820 N AUGUSTA DR
HIALEAH, FL 33015 Page 1 of 3

1-305-669-8823
LUDLAM INSURANCE AGE
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Coverage Summary
Make payments, check billing activity, update
policy information or check status of a claim.

This is your Declarations Page 1-800-274-4499

To report a claim.
Your coverage has changed
Your coverage began on September 4, 2024 at 12:01 a.m. This policy expires on March 4, 2025 at 12:01 a.m.
This coverage summary replaces your prior one. Your insurance policy and any policy endorsements contain a full explanation of your
coverage. The policy limits shown for a vehicle may not be combined with the limits for the same coverage on another vehicle, unless
the policy contract or endorsements indicate otherwise. The policy contract is form 9611A FL (07/17). The contract is modified by
forms A340 (01/22), A261 FL (09/22), A379 FL (02/23), A264 (02/22), A331 (11/21) and A229 FL (07/23).

Policy changes effective December 11, 2024

………………………………………………………………………………………………………………………………………………………..
Changes requested on: Dec 11, 2024 01:12 p.m.
………………………………………………………………………………………………………………………………………………………..
Requested by: JAVIER HERNANDEZ VEGA
………………………………………………………………………………………………………………………………………………………..
Premium change: $304.78
………………………………………………………………………………………………………………………………………………………..
Changes: The 2023 RAM RAM 3500 has been added.

The changes take effect as of the date and time requested shown above.
Drivers and household residents
JAVIER HERNANDEZ VEGA
Additional information: Named insured
YAUSELIN BORREGO
MELISSA HERNANDEZ
ALAIN ESPINOSA GONZALEZ

Form 6489 FL (12/23)

4
Continued
961130149 E F828583 INS DECPAGE E POLWHITEFONT KUIUBMEIE35RU7KW35FZGK6EOD0001 RPUID TRACWHITEFONT BDF_AA

Policy Number: 961130149

JAVIER HERNANDEZ VEGA
Page 2 of 3

Outline of coverage
2012 NISSAN ROGUE 4 DOOR WAGON
VIN: JN8AS5MT4CW266255
Garaging ZIP Code: 33015
Primary use of the vehicle: Commute
Annual miles: 4,000 - 5,999
Length of vehicle ownership when policy started or vehicle added: 5 years or more
Information regarding your vehicle history (prior damage or title issues) has impacted how we determine your premium.
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others
Bodily Injury Liability $10,000 each person/$20,000 each accident $164
Property Damage Liability $10,000 each accident 210
………………………………………………………………………………………………………………………………………………………..
Personal Injury Protection/Deductible applies to $10,000 $1,000/person 344
Named Insured/Spouse/Dependent Resident Relatives Work Loss Excluded
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Total premium for 2012 NISSAN $718
2022 HYUNDAI ELANTRA 4 DOOR SEDAN
VIN: 5NPLN4AG8NH060376
Garaging ZIP Code: 33015
Primary use of the vehicle: Commute
Annual miles: 4,000 - 5,999
Length of vehicle ownership when policy started or vehicle added: At least 6 months but less than 1 year
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others
Bodily Injury Liability $10,000 each person/$20,000 each accident $169
Property Damage Liability $10,000 each accident 188
………………………………………………………………………………………………………………………………………………………..
Personal Injury Protection/Deductible applies to $10,000 $1,000/person 289
Named Insured/Spouse/Dependent Resident Relatives Work Loss Excluded
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $1,000 138
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $1,000 459
………………………………………………………………………………………………………………………………………………………..
Total premium for 2022 HYUNDAI $1,243
2022 HYUNDAI TUCSON 4 DOOR WAGON
VIN: 5NMJA3AEXNH039117
Garaging ZIP Code: 33015
Primary use of the vehicle: Commute
Annual miles: 6,000 - 7,999
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others
Bodily Injury Liability $10,000 each person/$20,000 each accident $144
Property Damage Liability $10,000
………………………………………………………………………………………………………………………………………………………..
each accident 176
Personal Injury Protection/Deductible applies to $10,000 $1,000/person 220
Named Insured/Spouse/Dependent Resident Relatives Work Loss Excluded
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $1,000 111
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $1,000 347
………………………………………………………………………………………………………………………………………………………..
Total premium for 2022 HYUNDAI $998

Form 6489 FL (12/23)

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961130149 E F828583 INS DECPAGE E POLWHITEFONT KUIUBMEIE35RU7KW35FZGK6EOD0001 RPUID TRACWHITEFONT BDF_AA

Policy Number: 961130149

JAVIER HERNANDEZ VEGA
Page 3 of 3
2023 RAM RAM 3500 CREW PICKUP
VIN: 3C63RRRL0PG555788
Garaging ZIP Code: 33015
Primary use of the vehicle: Commute
Annual miles: 6,000 - 7,999
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others
Bodily Injury Liability $10,000 each person/$20,000 each accident $213
Property Damage Liability $10,000
………………………………………………………………………………………………………………………………………………………..
each accident 248
Personal Injury Protection/Deductible applies to $10,000 $1,000/person 214
Named Insured/Spouse/Dependent Resident Relatives Work Loss Excluded
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $1,000 290
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $1,000 481
………………………………………………………………………………………………………………………………………………………..
Total premium for 2023 RAM $1,446
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium $4,405.00

Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
961130149 Five-Year Accident Free, Electronic Funds Transfer (EFT), Multi-Car, Continuous
Insurance: Gold, Paperless and Three-Year Safe Driving
Vehicle
………………………………………………………………………………………………………………………………………………………..
2012 NISSAN Anti-Lock Brakes and Driver and Passenger-side Airbag
ROGUE
2022 HYUNDAI Anti-Lock Brakes, Driver and Passenger-side Airbag and Passive Anti-theft
ELANTRA Device
2022 HYUNDAI Anti-Lock Brakes, Driver and Passenger-side Airbag and Passive Anti-theft
TUCSON Device
2023 RAM Anti-Lock Brakes, Driver and Passenger-side Airbag and Passive Anti-theft
RAM 3500 Device

Policyholder inquiries
You may call your agent at 1-305-669-8823 to present inquiries or obtain information about coverage, and to obtain
assistance with any complaints.

Agent signature

Company officers

Secretary

Form 6489 FL (12/23)