ࡱ> #`  5bjbj5G5G 0W-W-+t&&&:"8"8"8"8|8:P9(9999+;.Y;m; /P1P1P1P1P1P1P$fRhTUP&? ;"+;??UP993jPBBB?l9&9/PB?/PBBHh,&I99 3"8@4-ICJP0P=IX`UE@V`U II&`U&Iy;_<B==ny;y;y;UPUPBy;y;y;P????:::$+D :::+::: Huggins/Dreckman Ins Agency, Inc. Yes: I want to save up to 19% 12535 Seal Beach Blvd., Seal Beach, CA 90740 or More on Car Insurance! the other auto insurance specialists! YOUR NAME:______________________________________________________Email:___________________________ ADDRESS: __________________________________________________________________________________________ HOME PHONE # ( ) __________________________________ WORK PHONE # ( ) _________________________________ BEST TIME/PLACE TO CALL___________________________ FAX # ( ) ____________________________________________ Please Tell Us About ALL LICENSED DRIVERS in the Household Names of All Drivers Including Yourself Relationship Birth Date Mo/Date/Yr Male or Female OccupationDriver is Principal User of Car ## of At Fault Accidents Last 5 YearsNo. of Traffic Citations in the Last 3 YearsNo. of Major Violations in past 5 years (DUI, etc.)Date First Licensed in U.S. Month/Year Drivers License #1. / /  2. / / 3. / / 4. / /  Please Tell Us About Your Vehicles:  Yr Make Model Sub- Model  Body Style  Vehicle Identification Number Used in Business  # of Miles One Way to work / Total Miles  Estimated Miles Driven Annually1.  (Yes (No/2. (Yes (No/3. (Yes (No/4. (Yes (No/ Notes:_________________________________________________________________ How Easy Is It to Return This Insurance Info to Us? Email: this Questionnaire to  HYPERLINK "mailto:quote@safeco.com" quote@safeco.com Call: our representatives at 800-841-5914 Fax: this questionnaire to 562-594-0376 12535 Seal Beach Blvd., Seal Beach, CA 90740 CA License No. 0212199 / Agency 17-8252 Huggins/Dreckman Insurance Agency, Inc. Auto Insurance Coverage Descriptions: What Does This Mean? Note: The following review of policy terms and issues is for your information only. This is not a complete description of your policys exact coverage terms, conditions, exclusions and limitations; please see your policy for exact coverage afforded under this policy or call us with your questions. For definition of terms, visit our website at  HYPERLINK "http://www.hdinsure.com/" www.hdinsure.com & click on Have a Question about an Insurance Term, found on our home page. Bodily Injury Liability (Occasionally referred to as BI)Pays when you are legally liable for injury or death caused by your vehicle. Legal fees & court costs are also included. Pays up to the first limit for each person and up to the second limit toward injuries in the accident for which you are legally liable. Property Damage Liability (Occasionally referred to as PD)Pays when you are legally liable for damage to the property of others caused by your vehicle. Combined Single Limit (Occasionally referred to as CSL)Means the Bodily Injury and Property Damage are combined into one single limit, without sub-limits imposed Uninsured Motorist (Occasionally referred to as UM)Pay damages that you, household relatives, and passengers in the insured motor vehicle are legally entitled to recover because of bodily injury caused by an uninsured motor vehicle. Pays up to the first limit for any one person and subject to the first limit for any one person up to the second limit for all persons injured or killed in an accident. This could also be single limit coverage. Underinsured Motorist (Occasionally referred to as UM)Pays you, household relatives, and passengers in your insured motor vehicle against damages arising out of accidents with motorist who have motor vehicle insurance with lower limits of liability coverage than those damages suffered by you. Medical Payments (Each Person Limit)Pays medical, hospital, and funeral expenses for you, household relatives, and guest passengers injured in a motor vehicle accident regardless of fault. Comprehensive (Often referred to as other than Collision)Pays for loss or damage to your vehicle caused by fire, theft, vandalism, hail, windstorm, riot, falling objects, flood, etc. The deductible applies to damages not excluded; see your policy for the amount of your deductible. Does not pay for collision or upset. That is paid under your collision if you carry collision. Collision or Upset Pays for loss or damage to your vehicle caused by a collision with another object, or by upset of the vehicle. Payments are made on actual cash value basis for the amount of each loss. Your deductible applies to this coverage, too. See your policy for the amount of your deductible. Towing and Labor Costs Pays up to the stated limit on your policy for each claim for towing your vehicle and any labor costs, such as changing a tire or a jump start at the place of disablement. Does not pay for parts or subsequent repair costs. Check your policy to determine if you have adequate protection. Rental Reimbursement Pays towards expenses to rent a vehicle if you have a covered collision loss and your vehicle is disabled longer than 24 hours. Usually a per diem limit; check your policy to determine if you have enough protection.Lease GAP coverage Additional coverage for your leased auto may be added to provide limits in excess of actual cash value of the auto. This coverage would apply if the lease agreement makes the insured liable for the amount greater than the actual cash value of the car at the time of a covered theft or total loss.Standard Equipment vs. After Market Equipment: Applies to Sound Systems & Accessories, Wheels, Covers, Beds, Paint, and Other Vehicle AccessoriesInsurance will generally repair or replace items that are standard equipment sold and permanently installed on a vehicle as it is normally delivered for sale as the manufacturer intended. After-Market can be described as items that cost extra to enhance your cars value and appearance. To properly insure these items often requires a stated, proved value and an endorsement on your policy. If you have any after-market items (including but not limited to upgraded sound equipment, wheels, covers, beds, paint, and other accessories that did not come with the vehicle in its original condition), you may wish to endorse these items to your policy and pay the extra premium to cover them in the event of theft or damage. Personal Property in Your Vehicle Your auto insurance policy does not cover any personal items in your car; items not covered include CDs, Tapes & any type of phone as well as any other personal property. Campers & Travel Trailers, and personal items and equipment inside these vehicles Protection for campers attached to trucks must be added to your auto policy whether rented, borrowed, or purchased. Liability protection may be provided by the trucks liability insurance (the truck on which the camper is placed for travel); for an additional premium you can add comprehensive and collision protection for the camper. The liability insurance for a trailer may extend from the auto or truck towing it unless the weight of the trailer exceeds a specified weight restriction found in your policy, but this does not automatically extend to damage to the camper or trailer itself. Comprehensive & Collision coverage for the trailer must be added by endorsement. Personal items and equipment inside a trailer or camper must have a valued stated on the policy to be covered. The safest way to determine how best to insure your camper or trailer is to call your insurance representatives at DRIVE RIGHT and Huggins/Dreckman. Motor Homes, and personal items and equipment inside these vehiclesInsurance for a Motor Home is not automatic; borrowed, rented, or purchased, the motor home must be added to your auto policy just like any other vehicle. Personal items and equipment inside the motor home must have a valued stated on the policy to be covered. The safest way to determine how best to insure your camper or trailer is to call your insurance representatives at DRIVE RIGHT and Huggins/Dreckman. Motor Home, Camper and Trailer RentalsIf you rent, buy or borrow these types of vehicles or equipment, tour insurance will not automatically cover these vehicles. It is best to presume that your policy does not automatically provide you with insurance coverage for these types of rentals. Check your policy or call your insurance representatives at Huggins/ Dreckman at least two weeks before you leave for your trip to determine how best to ensure your protection Automobiles You Do Not OwnYour policy may not provide you with protection if you borrow a vehicle from a friend or acquaintance (Mercury Insurance Company, for instance, has this limitation); check your policy before you borrow a friends car and check theirs! Other People Driving Your CarProtection to drivers not listed on your policy may be limited to the states minimum coverage regardless of your policy limitsIf Your Vehicle is Owned by a CorporationYou must advise your insurance representatives if any entity or any one other than you owns your car (leasing company, loss payee, or perhaps your own business, a parent, etc) and verify that the entity is added to your policy! Who is insured under the policy could be a big issue at claim time. If Your Vehicle is Used in Business or as a Delivery Vehicle:You must advise your insurance representatives if this is the case. Your policy as written may not cover cars or trucks used in business or as a delivery vehicle (this includes teenagers delivering pizza, for example). Reporting a Newly Purchased Vehicle: Vehicles Purchased from a Dealer (new or used vehicles)Insurance for newly purchased vehicles may not be automatic. You should advise your insurance company at the point of purchase about this vehicle and have the car sales rep fax us a copy of your sales agreement. Regardless, you must advise us no later than 3 days from the time you purchase a new vehicle or you risk not having any coverage at all. For instance, Mercury Ins. Co. requires notification in writing within 7 days from purchase or there is no coverage; if not notified in 7 days, Mercury requires that you present the vehicle for photo inspection with insurance coverage starting from the date of inspection. Reporting a Newly Purchased Vehicle: Vehicles NOT Purchased from a Dealer (new or used vehicles)Insurance for newly purchased vehicles may not be automatic The insurance company must be advised in writing within 3 days from the time you purchase a vehicle or you risk not having any coverage at all. Some companies (such as Mercury) require that you present the vehicle for inspection if Physical Damage Coverage is desired (collision, fire, theft, etc). Coverage may not be in force until the vehicle is inspected if there is such a requirement in your policy. 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