Declaration Page

Tel: 1-800-841-3000 Declarations Page
This is a description of your coverage.

Please retain for your records.
GEICO Secure Insurance Company
One GEICO Center Policy Number: 6173-30-92-01
Macon, GA 31295-0001
Coverage Period:
08-17-24 through 02-17-25
Your coverage begins and ends at 12:01am local time at the
address of the named insured.
Date Issued: August 17, 2024
DEE D COBRA
1823 CLINTON PL APT 14
LOUISVILLE KY 40216
Email Address: [email protected]
Named Insured Additional Drivers

Dee D Cobra None
Vehicle VIN Vehicle Location Finance Company/

Lienholder
1 2006 Chev Uplander 1GNDV23L56D185868 LOUISVILLE KY 40216
Coverages* Limits and/or Deductibles Vehicle 1
Bodily Injury Liability

Each Person/Each Occurrence $100,000/$300,000 $1,512.50
Property Damage Liability $50,000 $491.41
Basic Personal Injury Protection $10,000 - $1,000 Ded $269.93
Uninsured Motorist
Each Person/Each Occurrence $25,000/$50,000 $109.52
Underinsured Motorist
Each Person/Each Occurrence $25,000/$50,000 $319.31
Total Six Month Premium $2,702.67
*Coverage applies where a premium or $0.00 is shown for a vehicle.
If you elect to pay your premium in installments, you may be subject to an additional fee for each installment. The fee amount
will be shown on your billing statements and is subject to change.
Total Six Month Premium ............................................................................... $2,702.67

Kentucky 1.8% Surcharge ................................................................................... $48.65
T-T
Continued on Back
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SHIVELY Tax (includes collection fee) .............................................................. $388.37
Total Premium ................................................................................................. $3,139.69
Discounts
The total value of your discounts is $2,415.98
Good Driver .................................................................................................................................................$674.13
Driving Experience ...................................................................................................................................$1,530.95
Financial Responsibility .................................................................................................................................$91.21
Telematics Discount ....................................................................................................................................$119.69
Contract Type: FAMILY AUTO
Contract Amendments: ALL VEHICLES - A30KYA(06-23) SIGPGCW(07-20)
Important Policy Information

- Your policy has been assessed a surcharge per Kentucky Statute 136.392. It requires insurance companies, other
than life and health insurers, to impose and collect a surcharge of $1.80 on each $100 of premium. The surcharge
collected will support the Professional Fire Fighters Foundation Program Fund and the Law Enforcement Foundation
Program Fund. The Surcharge is identified separately as 'Kentucky 1.8% Surcharge' on the above Declaration Page.
The surcharge is determined by applying 1.8% against the total premium excluding Kentucky Tax. Thus, if your
premium is $150, the surcharge amount will be $2.70.
- Please review the front and/or back of this page for your coverage and discount information.
- You are currently carrying the Limited Tort option on your policy.
- A credit or discount has been applied to this policy: Financial Responsibility. A credit or discount has been applied to
this policy: Telematics Discount.
- Subject to the policy carrying Comprehensive and/or Collision Coverage, if a non-owned auto or temporary
substitute auto, in operation while leased or rented for a fee, has a Manufacturer Suggested Retail Price above
$100,000, the limits of liability for loss to the non-owned auto or temporary substitute auto is the highest of the
actual cash value of any owned auto shown on the Declarations page.
- We welcome you to our GEICO family in the Auto Voluntary DU0 rate program.
- Claims incurred while an insured vehicle is being used to carry passengers for hire may not be covered by this
contract. Please review the contract for a full list of exclusions and contact us if you plan to use any of your insured
vehicles for this purpose.
- We have processed your enrollment in our paperless policy service. Thank you for your enrollment.
- Information about your vehicle history (title issues or prior damage) impacted how we determined your premium.
- General Policy Coverages: Please be advised of your new Uninsured Motorists (UM) and/or Underinsured Motorist
(UIM) coverages. In the past, premiums for these coverages have been charged on a per-vehicle basis. Customers
paid a separate premium for each vehicle insured and coverage was determined by adding the number of vehicles
and multiplying this amount by the limits of UM/UIM coverage. The amount of coverage would be based on the
number of vehicles on the policy.
- We have since revised the way we charge for these coverages. For multi-vehicle policies, only one charge is made
for each of these coverages per policy, and coverage is limited to the coverage limits shown on the declarations
page. The premium for these coverages is actuarially based and not determined by the number of vehicles covered.
By paying the applicable premiums, you accept the terms of this new policy.
DEC_PAGE (11-22) (Page 2 of 2) New Business Page 6 of 56

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Tel: 1-800-841-3000 Declarations Page

This is a description of your coverage.

Date Issued: August 17, 2024

Email Address: [email protected]

Named Insured Additional Drivers

Vehicle VIN Vehicle Location Finance Company/

Coverages* Limits and/or Deductibles Vehicle 1

Bodily Injury Liability

Total Six Month Premium $2,702.67

*Coverage applies where a premium or $0.00 is shown for a vehicle.

Total Six Month Premium ............................................................................... $2,702.67

Contract Type: FAMILY AUTO

Contract Amendments: ALL VEHICLES - A30KYA(06-23) SIGPGCW(07-20)

Important Policy Information

DEC_PAGE (11-22) (Page 2 of 2) New Business Page 6 of 56

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