AALL Insurance - 16TH

1602 E Roosevelt Street

Phoenix, Arizona 85006

Aspire General Insurance Services

UNDERWRITTEN BY ASPIRE GENERAL INSURANCE COMPANY

NEW BUSINESS CHECKLIST

Policy Number: PAAZ-00007444-00

For your reference, here is a quick checklist on Aspire’s document retention policy and required uploads. Please ensure that all forms are completed with all required
information, initials, and signatures.

Document Retain On File Upload To Policy

� Signed - Application & Driver Exclusion Forms Required Optional

� Signed Point of Sale Forms (Waivers, Business Exclusion, Accident Certification, Payment Required Optional
Authorization, etc.)

� Photos - Vehicle(s) w/ Physical Damage Coverage* Required Optional

� Proof of Foreign License Required Optional

� Photos – Salvaged Vehicle(s) w/ Physical Damage Coverage* Required Required

� Photos – Artisan/Business Usage Vehicle(s)* Required Required

� Business or Artisan Usage Form & Registration Required Required

� Proof of No-Fault Accident(s) for challenged accidents Required Required

*Clear photos showing all four sides of vehicle(s) required

Please note that all documents retained on file are subject to request by Aspire’s Underwriting or Quality Assurance department.

X Applicant’s Initials

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 AALL Insurance - 16TH
1602 E Roosevelt Street
Phoenix, AZ 85006

Aspire General Insurance Services

UNDERWRITTEN BY ASPIRE GENERAL INSURANCE COMPANY

APPLICATION FOR INSURANCE

Policy Information Policy Premium

Policy Number: PAAZ-00007444-00 Policy Premium Subtotal $1,147.75

Effective Date: 2/28/2026 10:20 AM Fully Earned Policy Fee $30.00
Expiration Date: 8/28/2026 12:01 AM Arizona Anti-Theft Authority Fee $0.50
Transmit Date: 2/28/2026 10:21 AM CT Auto Club Membership* $36.00
Other Fees $0.00
Named Insured: Dominic Armenta Policy Premium & Fee Total: $1,214.25
8248 N 19th Ave 254
Phoenix, AZ 85021

Home: Mobile: (602) 907-1724 Additional fees when applicable:

Work: Email: dominicarmenta62@[Link] Non-Sufficient Funds $25, EFT/RCCP Installment $6, Non-EFT/RCCP
Installment $10, AATA Fee $1.00 per vehicle per year, Policy Fee $30,
Agent: AALL Insurance - 16TH Renewal/Rewrite Policy Fee $20, Late Fee $10
1602 E Roosevelt Street
Phoenix, AZ 85006 *If applicable, CT Auto Club Membership is your separate roadside
(602) 233-3333 membership club and not part of your Aspire Insurance policy

Driver Information

Name Date of Birth Gender/Marital Status Relation To Insured DL#/State DL Status

Dominic Armenta XX/XX/1993 Male / Single Applicant XXXXX3307 / AZ Valid

Occupation: Work Address: ,

Vehicle Information
All vehicles on this policy must be garaged in the same residential location.
Garaging Address: 8248 N 19th Ave 254, Phoenix, AZ 85021

# Year/Make/Model VIN Usage Annual Mileage

1 2011 GMC ACADIA 1GKKRNED4BJ271006 Commute<15 14325

Lienholder/Additional Interest

Vehicle: Lienholder/Additional Interest: Type:

Coverages and Limits of Liability

Vehicle/Coverage

V1 - 2011 GMC ACADIA Limit/Deductible Premium

Bodily Injury $25,000 / $50,000 $675.34
Property Damage $15,000 $472.41
----------- ----------- -----------
Vehicle Subtotal $1,147.75
Policy Total $1,147.75

Underwriting Information

# Underwriting Information Notes Y N Not

required
1 Are any vehicles used in your business or occupation? Coverage is void during business or X
artisan use unless such use is indicated and acceptable by Aspire General Insurance Company.
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 2 Is any vehicle on the policy used for ridesharing (including but not limited to Uber or Lyft) or X
deliveries (including but not limited to pizza delivery, DoorDash, or Grubhub)?

Occupation Information

Driver Notes Y N

UNDERWRITING CERTIFICATION

Statement Under Penalty of Perjury:

I certify under penalty of perjury that the foregoing is true and correct:
1. The insured vehicle(s) will not be driven by employees.
2. The insured vehicle(s) will not be used to transport children/patients being cared for.
3. The insured vehicle(s) will not be used to transport flammable liquids, chemicals, or explosive materials.
4. The insured vehicle(s) will not be used for racing, delivery (pizza, food, newspaper, etc.), or taxi service (Uber, Lyft, Zipcar, etc.) or as an emergency vehicle.
5. I understand and agree that coverage is void during business or artisan use unless such use is indicated and acceptable by Aspire General Insurance
Services.
6. All residents of my household 14 years or older, including roommates and all regular drivers of the vehicles, and all names currently showing on the
registration of any listed vehicle, are either added to the policy or excluded from coverage.
7. All drivers such as children away from home or in college, who may operate my vehicle on a regular or infrequent basis are listed on this application.
8. I understand that if any operator(s)’ job, occupational duties, or occupancy changes, I agree to provide in writing the updated information.

I certify that all information provided above is true and correct, and that failure to provide correct information may result in denial or cancellation of coverage.

X Signature of Applicant Date

ASPIRE GENERAL INSURANCE COMPANY ELECTRONIC DOCUMENT DISCLOSURE AGREEMENT

By accepting the Aspire General Insurance Company Electronic Document Disclosure Agreement, you consent and agree that we may provide certain
disclosures and notices to you in electronic form in lieu of paper form. You retain the right to withdraw your consent for electronic delivery. You may withdraw
your consent at any time by giving us at least ten (10) days prior notice. Contact us by phone or by mail. Once you have withdrawn your consent, we will then
discontinue the online document service for the account and paper documents and notices will be resumed. The cancellation of Online E-Documents in no way
affects the validity or legal effect of all Online E-Document and disclosures which have been previously delivered electronically under the Online E-Document
Service.

Provided Email: dominicarmenta62@[Link]

X Signature of Applicant Date

ASPIRE GENERAL INSURANCE COMPANY COMMUNICATION AND TEXT MESSAGE AGREEMENT

I AGREE that representatives of Aspire General Insurance can call or text message me at the number provided on the application document PAAZ-002 even if I
am on a federal or state do not call registry for any purpose, including marketing. There is no separate charge for this service; however, my carrier’s message
and data rates may apply. I agree that the calls and text messages may be generated using an automatic telephone dialing system and may contain pre-
recorded messages. I understand that consenting to receive calls or texts is not required as a condition of purchasing any goods, services, or property.

By consenting, I agree that if I change the mobile phone number for which I am consenting to receive text messages, I will notify Aspire General
Insurance immediately of any such change in number. To stop receiving text messages, I can reply via text to 53987 with “STOP”. I understand that
following such a request to unsubscribe, I will receive a final message from Aspire General Insurance confirming that I have been inactivated in our
system. If I have any questions or need help, I can contact customer service at (916) 503-6313 or email customerservice@[Link].

X Signature of Applicant Date

COMMERCIAL, BUSINESS, AND PROFESSIONAL USE EXCLUSION

I represent that the vehicle(s) listed on the policy to be insured by Aspire General Insurance Company is (are) NOT used commercially or in a business or
professional endeavor. I fully understand and agree that the insurance to be extended on the policy applied for shall not benefit either the insured(s) or a third-
party claimant when the vehicles(s) for which coverage is requested is (are) used commercially or in a business or professional endeavor. I further understand

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 and agree that there will be NO INSURANCE COVERAGE IN FORCE from Aspire General Insurance Services on the policy hereby applied for if I, or any person
using the vehicle(s) for which coverage is requested, am (is) involved in an accident while using the vehicle(s) in the course of any commercial, business, or
professional endeavor.

X Signature of Applicant Date

NOTICE OF INSURANCE INFORMATION PRACTICES

If you have any questions concerning this policy or its coverages, please contact your agent. Your agent has a copy of your policy and will be able to provide
assistance to you.

Your Privacy and its Protection

In order to protect your privacy, we want you to be aware of the following information:

1. Personal information may be collected from persons other than you or individuals proposed for coverage.
2. If an investigative consumer report is ordered in connection with your insurance transaction, you will be given an opportunity to be interviewed in
connection with it. You also have the right to obtain a copy of the report. You may also personally review the report by contacting the reporting
insurance support organization.
3. I agree and understand that the Company will use electronic means to contact me for a variety of reasons, including, but not limited to, when my policy
cancels due to nonpayment of premium or other lapse or expiration of the policy. I hereby authorize the Company to contact me via any provided email
address, phone, cell phone, or other communication systems and authorize the Company to email, SMS (I understand that carrier charges may apply),
make automated dialer telephone calls to my cell phone or and line, instant message me, or otherwise contact me electronically.
4. You have the right of access and correction with respect to all personal information collected which is contained in our files.
5. Personal information and other privileged information collected by us or our agents may be, in certain circumstances, disclosed to certain parties
without your authorization, as permitted or required by law.
6. In the normal course of business, we may utilize third-party service providers, including personnel located outside of the United States, who assist in
providing services related to your policy. These individuals may have access to personal information as necessary to perform their duties, and we require
them to adhere to strict confidentiality and data protection standards in accordance with applicable laws.

Aspire General Insurance Services is concerned about the protection of your privacy. A more detailed description of our information practices and your right to
privacy is available at your written request.

X Signature of Applicant Date

ANNUAL MILEAGE SELF-CERTIFICATION FORM

Below is an estimate of the annual miles per vehicle that will be driven in 12 months following the inception of my policy. I understand that the company may
verify my commute mileage based on my garaging and work addresses provided on the application. This estimate will be used to calculate my overall estimate
of mileage. I may elect to change the estimate below and I understand that proof of mileage may be required.

Vehicle Year/Make/Model Annual Miles Odometer

2011 GMC ACADIA 14325

POLICY ACCIDENTS/VIOLATIONS

The following accidents/violations will be charged. I confirm that I have no undisclosed driving activity.

Driver Name Date Description Source

X Signature of Applicant Date

APPLICANT’S CERTIFICATION

I agree all answers to all questions in this Application are true and correct. I understand, recognize, and agree said answers are given and made for the purpose
of inducing the Company to issue the policy for which I have applied. I further agree that ALL residents of my household age 14 years or over, registered
owners, as well as ALL operators who regularly operate my vehicles and do not reside in my household, are shown above. I agree that my principal residence
and place of vehicle garaging is correctly shown above and is in the state for which I am applying for insurance at least 10 months each year. I understand the

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 Company may rescind this policy if said answers on this Application are false or misleading, and materially affect the risk the Company assumes by issuing the
policy. In addition, I understand that I have a continuing duty to notify the Company of any changes of: (1) address; (2) location of vehicles; (3) members of my
household of eligible driving age or permit age; (4) operators of any vehicles listed on the policy; or (5) use of any vehicles listed on the policy. I must notify the
company if I acquire a new or replacement vehicle within 3 days and understand there is no coverage for a new or replacement vehicle after 3 days unless I
specifically endorse the car to the policy and pay the premium for coverage. I understand the Company may rescind this policy if I do not comply with my
continuing duty of advising the Company of any change as noted above.

I understand and agree that in connection with my request for a premium quotation and Application for insurance: (1) the Company may obtain consumer
reports which may include a credit report, driver history report, or personal or privileged information from third parties to underwrite and rate the policy;
(2) such information may be disclosed to Company staff or to affiliated or unaffiliated third parties without my prior permission but only as permitted or
required by law; (3) upon my written request, the Company will inform me if a consumer report was requested and the name and address of the consumer
reporting agency that furnished the report; (4) I may also request access to and correction of information the Company has collected on me; (5) the Company
may request and use subsequent consumer reports in updating and renewing any insurance afforded in connection with this Application; (6) the Company will
furnish a more detailed explanation of its information practices upon my request; and (7) refusal to authorize the Company to obtain a consumer report may
give the Company the right to decline insurance to me.

I hereby authorize the Company to obtain consumer reports on me. I agree the named members of my household and all other operators listed under this
policy have authorized me to consent on their behalf to all coverages provided herein and to authorize the Company to obtain consumer reports on them for
the rating and/or underwriting of the insurance for which I am applying and for any renewal thereof. I agree to pay any additional premium owed if the amount
of premium shown is inaccurate for any reason. This authorization is valid for one year from the date it is signed.

I have had the liability coverages and limits available for the purchase fully explained to me and have selected the limits shown on the Application. I have had
the different policy coverage levels available to me fully explained. I understand that coverage for Damage to a Vehicle only applies when my vehicle is driven
by a person listed on the Declarations Page. There will not be coverage under Damage to a Vehicle if the person driving your vehicle is not listed on the
Declarations Page. I made an informed decision and have selected the policy coverage level shown on the Application.

I understand the policy may be rescinded and no coverage provided if my premium down payment or full payment is paid by check, credit card, or debit card
and the bank returns said check unpaid or fails to honor the credit charge or debit charge in full. I understand there may be a processing fee imposed on any
returned checks.

I understand processing fees may be included with my down payment and installment payments, and additional fees may be charged for late payments. I
understand my payments are first applied to the fees owed and then to the premium.

FRAUD WARNING: Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties.

X Signature of Applicant Date

I ACKNOWLEDGE, AGREE, AND UNDERSTAND THAT ONLY MINIMUM STATUTORY LIMITS IN THE STATE OF ARIZONA OF $25,000 PER PERSON UP TO A
MAXIMUM OF $50,000 PER ACCIDENT AND $15,000 IN PROPERTY DAMAGE WILL BE PROVIDED FOR BODILY INJURY AND/OR PROPERTY DAMAGE resulting
from losses due to the operation or use of a motor vehicle by persons other than a named insured, a relative or a person listed as a driver on the declarations
page with the express or implied permission of a named insured or relative.

X Signature of Applicant Date

AGENT’S STATEMENT: PLEASE READ CAREFULLY

I, the Agent, accept full responsibility for collecting, completing and obtaining necessary signatures on the application and all of the supporting documents
which will form a part of this application for insurance. I accept full responsibility for the storage of the signed Arizona Auto Insurance Application and all
supporting documentation. These documents will be maintained by the Agent and available for the periodic review by Aspire General Insurance Services.

For vehicles with physical damage coverages, I have identified all pre-existing damage on the Vehicle Inspection and I understand that I am required to obtain
and keep photos in my files. I understand that I will be required to provide copies, upon request of the damaged areas.

For vehicles with physical damage coverages or vehicles with business/artisan use I understand that I am required to obtain and keep photos in my files. I
understand that I will be required to provide copies, upon request. (New vehicles written within 72 hours of purchase only require a Window Sticker or Bill of
Sale.)

I, the Agent will disclose to the applicant that any incomplete information gathered during the application process such as an incomplete VIN and/or an
undelivered MVR request, will be reviewed by underwriting and any discovered information may result in a premium change, cancelation and/or declination of
coverage.

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I understand international licenses must have never been licensed in the US. I have listed any violations and accidents and collected signed International Driver
Certifications and supporting documentation (document number is listed on this application), if applicable.

I understand all vehicles listed on this policy must be garaged in the same location, and the garaging address is listed on this application.

I have asked the applicant(s) all questions on this Application and these are the applicant(s) responses. To the best of my knowledge, all the information on this
Application is true, correct and complete.

AGENT’S NAME: (Please Print) AALL Insurance - 16TH

AGENT'S SIGNATURE: Date/Time:

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 UM AND UIM COVERAGE OFFER – ARIZONA
PERSONAL AUTO PROGRAM

Aspire General Insurance Services

Underwritten by ASPIRE GENERAL INSURANCE COMPANY

P.O. Box 2426 • Rancho Cucamonga, CA 91729-2426 • (916) 503-6313 • [Link]

Policy Number: PAAZ-00007444-00

Dominic Armenta

UNINSURED AND UNDERINSURED MOTORISTS COVERAGE OFFER

The Arizona insurance code requires an insurer to provide Uninsured and Underinsured Motorists coverage with each Bodily Injury Liability insurance policy in any
amount from $25,000/$50,000 up to your policy’s Bodily Injury Liability limits.

Uninsured Motorists Coverage

Uninsured Motorists coverage insures the insured, their heirs, or their legal representatives for all sums within the limits established by law that the person or
persons are legally entitled to recover as damages for bodily injury, including any resulting sickness, disease, or death, to the insured from the owner or operator
of an uninsured motor vehicle not owned or operated by the insured or a resident of the same household.

An uninsured motor vehicle is one that does not have liability insurance or a bond that complies with the Arizona financial responsibility law.

Underinsured Motorists Coverage

Underinsured Motorists coverage is separate and distinct from Uninsured Motorists coverage. It insures the insured, their heirs, or their legal representatives for all
sums within the limits established by law that the person or persons are legally entitled to recover as damages for bodily injury, including any resulting sickness,
disease, or death, to the insured from the owner or operator of an underinsured motor vehicle not owned or operated by the insured or a resident of the same
household.

An underinsured motor vehicle is one with liability insurance or a bond that complies with the Arizona financial responsibility law but whose limits are not sufficient
to cover the damages.

A. Mandatory Offer of Uninsured Motorists Coverage B. Mandatory Offer of Underinsured Motorists Coverage

Your Options Your Options

$25,000/$50,000 $25,000/$50,000
No Uninsured Motorists Coverage No Uninsured Motorists Coverage

Your Selection Your Selection

I select Uninsured Motorists coverage at the following limits: Not chosen I select Uninsured Motorists coverage at the following limits: Not chosen
Premium: Not chosen Premium: Not chosen

IF YOU HAVE ANY QUESTIONS REGARDING THESE SELECTIONS, PLEASE CALL US AT (916) 503-6313.

I understand that this form reflects the offer of Uninsured Motorist and Underinsured Motorist coverage options made to me. I understand that my policy
declarations page will be sent to me, and I need to review it to confirm that my policy contains the Uninsured Motorist and Underinsured Motorist coverages I
selected. I further understand and agree that these selections or rejections of Uninsured and/or Underinsured Motorists coverage shall be binding on all
persons insured under this policy, and that this election shall also apply to any renewal, reinstatement, substitute, amended, altered, modified, or replacement
policy with this company or any affiliated company, unless a named insured submits a request to add the coverage and pays the additional premium.

X Signature of Applicant Date

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 P.O Box 2426
Rancho Cucamonga, CA 91729-2426
P (916) 503-6313

Aspire General Insurance Services

UNDERWRITTEN BY ASPIRE GENERAL INSURANCE COMPANY

AUTOMATIC RECURRING CREDIT CARD MONTHLY PAYMENT AUTHORIZATION

I authorize Aspire to initiate scheduled deductions from the credit card identified by the last 4 numbers listed below for payment of premium on
the insurance policy issued to me and any renewals thereof.

I authorize the financial institution for the credit card identified by the last 4 numbers listed below to accept the post entries to the account.

I represent that I am the owner and/or an authorized signer of the account.

I understand that this authorization allows Aspire to adjust the scheduled deductions to reflect any premium changes to my policy. Aspire agrees
that it shall notify me in writing at least seven days prior to making any deduction if there is a premium change or seven days if there is a due
date change. Please note that although payment will typically be processed on the recurring credit card schedule dates, please allow several
days for processing of the credit card payment from your account. Additionally, Aspire may electronically charge your account.

I understand that Aspire will not send me a bill before scheduled deductions are made and that it is my responsibility to ensure sufficient funds
are available at the time of each scheduled deduction. The charges will appear on my bank statement as “Aspire.”

I also understand that my policy may cancel or expire if the payment is declined, which could cancel this agreement and remove my policy from
automatic recurring credit card processing. In addition to any fees charged by the credit card company, Aspire will charge an NSF fee of up to
$25.00 if my payment is dishonored or returned for any reason. Additionally, I may be removed from the Recurring Credit Card Payment
Authorization program.

This authorization is to remain in full force and effect until Aspire receives a written request from me to cancel my recurring credit card payment
or until Aspire elects to cancel this agreement.

All of the information requested below is required and very important for the accurate processing of your recurring credit card monthly payment
plan. If any of the information is missing or inaccurate, please be aware that this may delay the processing.

Please note that your monthly recurring credit card payments are subject to change depending on any changes that cause an increase or
decrease to your written premium which are made to the existing policy during the term.

Named Insured: Dominic Armenta Policy # PAAZ-00007444-00

Last 4 digits of Credit card: 2791 Cell: (602) 907-1724
Expiration: Home:
Cardholder Address: Work:
Cardholder: _______________________________
(If different from Named
Insured)

Signature of Applicant Date

PLEASE NOTE THAT IF YOUR DUE DATE FALLS ON A WEEKEND OR HOLIDAY WE WILL MAKE THE PAYMENT ON THE NEXT
BUSINESS DAY FOLLOWING THE HOLIDAY/WEEKEND.

Please allow up to 7 days for changes or termination of electronic payment withdrawal to ensure changes are made prior to the withdrawal of
your installment.

If you have any questions or concerns about this transaction, you can email customerservice@[Link] or call Customer Service at
(916) 503-6313.

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PAAZ-00007444-00
AALL Insurance - 16TH
1602 E Roosevelt Street
Phoenix, Arizona 85006

Aspire General Insurance Services

Underwritten by ASPIRE GENERAL INSURANCE COMPANY

Printed on: 2/28/2026

Policy Number: PAAZ-00007444-00
Dominic Armenta
8248 N 19th Ave 254
Phoenix, AZ 85021

AUTOMATIC PAYMENTS NOTICE - THIS IS FOR YOUR RECORDS

You have agreed and are currently set up on Automatic Payments from your bank or credit card. Your Minimum Amount Due will be automatically withdrawn from
your bank account on the Due Dates listed below. The charges will appear on your bank statement as “Aspire.”

If your payment is returned or declined for any reason, it will not be considered received for all purposes and the payment will be ignored with respect to all time
frames, accordingly, return item fees will apply. Additionally, your policy may be subject to cancellation.

Please note that due to payment processing time, your transaction may not post to your account immediately. If your scheduled due date falls on a weekend or
holiday, your payment will be posted on the next business day.

You will not be receiving any further billing notices. Please keep this notice for your records.

As you have elected to have Electronic Funds Transfers withdrawn from your bank or Recurring Credit Card Payments, your policy now qualifies for a reduced
installment fee.

To make an immediate payment:

Pay by Phone
Call (916) 503-6313
Available for Credit Cards and Check Payments

SCHEDULE OF PAYMENT WITHDRAWALS

*Dates subject to change **Includes Installment Fee
Installment No Due Date* Minimum Amount Due**

1 4/3/2026 $200.44
2 5/3/2026 $200.44
3 6/3/2026 $200.44
4 7/3/2026 $200.44
5 8/3/2026 $200.44

Your policy is currently set up on Automatic Payments from your bank.

• Your Minimum Amount Due will be automatically withdrawn from your bank account on the withdrawal date.
• If you have any questions please contact Customer Service (916) 503-6313
• To make a change to your Automatic Payments, seven (7) days notice prior to your Due Date is required.

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 ARIZONA EVIDENCE OF LIABILITY INSURANCE IMPORTANT INFORMATION

⚠ What to Do if You’re Involved in an Accident:

Insurance Company: Aspire General Insurance Company
1. Stay at the scene.
PO Box 2426
2. Do not admit fault or reveal your coverage limits at any time.
Rancho Cucamonga, CA 91729-2426 3. Move to a safe location if possible.
4. Call the police if necessary and exchange driver and insurance information.
Policy #: PAAZ-00007444-00 5. Report your claim to Aspire!

Effective Date: 2/28/2026 - Expiration Date: 8/28/2026  Need to report a claim?

Contact our Claims Department at (916) 306-1831.

Named Insured: Dominic Armenta Evidence of financial responsibility shall at all times be carried in the
vehicle. Displaying a digital image of this card on a wireless device
meets this requirement. This card or an image of this card that is
Year/Make/Model Vehicle Identification Number
displayed on a wireless communication device is satisfactory
2011 GMC ACADIA 1GKKRNED4BJ271006
evidence if a person is asked by the department of transportation to
verify financial responsibility on the motor vehicle listed.
Customer Service Assistance: (916) 503-6313
THIS CARD PROVIDES NO GUARANTEE OF COVERAGE IN THE EVENT OF AN
ACCIDENT. IT IS ONLY VALID WHILE YOUR INSURANCE POLICY REMAINS
NAIC Code: 15290 ACTIVE; AND DOES NOT AMEND, EXTEND, OR ALTER ANY TERMS,
CONDITIONS, EXCLUSIONS, LIMITS, OR COVERAGE AFFORDED BY YOUR
ADOT #2057
POLICY.

ARIZONA EVIDENCE OF LIABILITY INSURANCE IMPORTANT INFORMATION

⚠ What to Do if You’re Involved in an Accident:

Insurance Company: Aspire General Insurance Company 1. Stay at the scene.
PO Box 2426 2. Do not admit fault or reveal your coverage limits at any time.
Rancho Cucamonga, CA 91729-2426 3. Move to a safe location if possible.
4. Call the police if necessary and exchange driver and insurance information.
Policy #: PAAZ-00007444-00 5. Report your claim to Aspire!

Effective Date: 2/28/2026 - Expiration Date: 8/28/2026  Need to report a claim?

Contact our Claims Department at (916) 306-1831.

Named Insured: Dominic Armenta Evidence of financial responsibility shall at all times be carried in the
vehicle. Displaying a digital image of this card on a wireless device
Vehicle Identification Number meets this requirement. This card or an image of this card that is
Year/Make/Model
1GKKRNED4BJ271006 displayed on a wireless communication device is satisfactory
2011 GMC ACADIA
evidence if a person is asked by the department of transportation to
verify financial responsibility on the motor vehicle listed.
Customer Service Assistance: (916) 503-6313
THIS CARD PROVIDES NO GUARANTEE OF COVERAGE IN THE EVENT OF AN
ACCIDENT. IT IS ONLY VALID WHILE YOUR INSURANCE POLICY REMAINS
NAIC Code: 15290
ACTIVE; AND DOES NOT AMEND, EXTEND, OR ALTER ANY TERMS,
ADOT #2057 CONDITIONS, EXCLUSIONS, LIMITS, OR COVERAGE AFFORDED BY YOUR
POLICY.

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 Page 1 of 3

24 HOUR EMERGENCY TOWING

P.O. Box 830008  Miami, FL  33283-0008

First Name Last Name

Dominic Armenta Towing Assistance
Address
8248 N 19th Ave 254 1-877-335-7897
City State Zip
Phoenix Arizona 85021 Program ID: 15568
Effective Date Membership ID Producer ID:
2/28/2026 10:20 AM PAAZ-00007444-00 Benefit: $50
Covered Vehicle(s) VIN(S) License
2011 GMC ACADIA 1GKKRNED4BJ271006

…………………………………………………………………………………………………………………………………

Welcome!
Aspire General Insurance Services has arranged for CT Auto Club, Inc., to bring you the best in roadside services. We are dedicated to
keeping you, our valued member, on the road – safe, secure and smiling. This document outlines the benefits of your program.

MEMBER SERVICES & INFORMATION

For all questions on Member Benefits and Services call us toll-free, 24 hours a day at 877-335-7897.

MEMBERSHIP AGREEMENT

1. These Membership Terms & Conditions describe the Membership benefits and services You will have under Your Aspire General
Insurance Membership (“Membership”). Services are provided by CT Auto Club, Inc. and are subject to all the terms of these
Terms & Conditions.
2. Your Club membership begins on the date you are enrolled, and services will continue for the term you selected at enrollment,
unless either you or the Club indicates, in writing, that membership is cancelled.
3. Services provided must be a Covered service under these Terms & Conditions as described and will be provided to the Covered
Vehicle on file.
4. Emergency road service providers and locksmiths are independent contractors and are not employees, agents, or representatives
of CT Auto Club, Inc. and damage claims related to the service provider or locksmith will not be the responsibility of CT Auto Club,
Inc.

Note: As part of our continuing effort to maintain high-quality service to our members, telephone calls between our employees and our
members are periodically monitored or recorded on a random basis by our supervisory personnel. We also collect information through GPS
from your cell phone to find the approximate location of your vehicle for our service providers when you use your cell phone to call for
roadside assistance. By accepting our services, you have indicated that you understand this and give your consent to any such monitoring
or recording regarding any telephone calls you may have with us, and for our use of GPS from your cell phone to help identify your vehicle’s
location.

IMPORTANT NOTICE!

This member document represents your agreement with CT Auto Club, Inc. for benefits and services. All of these benefits are available in
the United States. The following disclaimers apply to this agreement:
A. This is not an insurance contract.
B. This is not an automobile liability contract.
C. This is not an automobile liability or physical damage insurance contract and does not comply with any financial responsibility laws.
D. This membership is OPTIONAL and is not a condition to buy any related insurance product or contract.

OUR SERVICE PLEDGE

We pledge to provide courteous, friendly service to you 24 hours a day, seven days a week, every day of the year. We are here to provide a
friendly, helping hand when you experience a roadside incident anywhere in the USA. We are here to provide prompt dispatch of
professional roadside service – to back you up in an emergency and to do our best to make your next roadside emergency as stress-free as
possible.

Emergency Dispatch of Roadside Service:

You’re covered up to $50!

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 Emergency Towing to any destination you select. – As an auto club member you have no restrictions on where you can be
towed – to your home, a dealership, your favorite mechanic – the choice is yours! You are covered up to your benefit allowance of
$50 per incident.
 Battery Jump-Start – Send help to jump-start your battery if it is dead or weak.
 Flat Tire Change – Change your flat tire and install your inflated spare for you.
 Lockout Service – If you lock your keys inside your vehicle, we will dispatch qualified assistance to get you back in.
 Fuel Delivery – Out of gas? We’ll deliver an emergency supply. (Member is responsible for cost of fuel)

COVERAGE DETAILS
1. Coverage is for your covered vehicle and driven by an eligible Member at the time of disablement, with the following exceptions:
Trucks over one-ton capacity, taxis, vehicles used for commercial purposes, camping trailers, travel trailers, mobile or motor
homes, motorcycles, RVs or any vehicles in tow.
2. Coverage for the services outlined in this document includes expenses up to the Member Benefit Allowance of a total of $50 per
incident, including any sales tax. Costs in excess of $50 for covered services is at the driver/Member’s expense.
3. The $50 Member Benefit Allowance does not cover: Parts, key replacement, fuel, tire repair, rental of towing equipment, storage
fees, labor costs for repairs performed at disablement site, garage or service facility., any form of towing by someone other than a
licensed service station or garage, or a private citizen’s assistance. Towing results from an accident, vandalism, or fire as well as
towing at the direction of a law enforcement officer relating to traffic obstruction, impoundment, abandonment, illegal parking, or
other violations of law.
4. Your benefit limit is a maximum per disablement, regardless of services performed. Emergency roadside service claims are limited
to one service within 72 hours and a max of three (3) in any twelve (12) month period.
5. Membership is intended to cover emergencies and is not intended to be a substitute for proper vehicle maintenance or repair.
Repeated calls which are considered excessive may, at the discretion of CT Auto Club, Inc., result in cancellation of membership.
More than three claims in a 12-month period may, at our discretion, result in a cancellation of your membership.

Auto Theft Reward: A $5,000 reward is offered for information to a law enforcement agency that leads to the arrest and conviction of
anyone who steals a member’s Covered Vehicle. Member, including family members and law enforcement personnel are ineligible for this
reward. The reward does not cover loss from vandalism or stolen contents. Auto Theft claims are limited to one per membership term.

BenefitHub – National Values and Discounts - As a member, you receive at no extra cost a BenefitHub membership which entitles you to
have access to great savings and Cash Back offers on a wide variety of products and services members use every day. From discounts on
hotel and car rentals to health & wellness, sports & fitness, travel, food and even apparel & accessories. BenefitHub makes it easy for you
to save on the things you want and need the most.

To start saving and enhancing your daily life, simply visit [Link]

For first-time users, create an account by entering your email address. You will then be prompted to create a password and enter your name
and ZIP code for local deals. If you have already created an account, please enter your email address and password.
*Discounts subject to change.
Change of Address Procedures: Please call Roadside Assistance to notify us of your address change.

GENERAL PROVISIONS
A. BANK FEES – We and/or Our authorized agent(s) are not responsible for any fees or charges imposed by any bank or credit/debit
card issuer relating to the use of Your credit/debit card for payment of Your Membership dues including, but not limited to, credit
limit fees.

B. CHANGE OF YOUR PERSONAL INFORMATION – If there are changes to Your personal information, including name, address,
telephone number, e-mail address please notify Us so that We may keep Your Membership active and send You information that
may affect Your Membership.

C. PROGRAM BENEFITS AND DUES – We may decide to offer additional benefits and services for this Program in the future. If so,
We will send You, at Your address in Our membership records, at least thirty (30) days’ advance written notice of any changes to
benefits or dues for this Membership along with new Terms & Conditions. Any such change will take effect the calendar month
following expiration of the thirty (30) days’ advance notice given You.

D. CANCELLATION - Cancellation by You: As a Member of the Program, You may cancel this membership by contacting your
insurance agent at 916-503-6313 at any time during the first thirty (30) days from the agreement date, and You will receive a full
refund of the amount paid, less any paid claims. After thirty (30) days this Membership is non-cancelable, and all associated fees from the
Membership are deemed earned as received at the point of sale.
Thank You for joining our club!

Patrick J. O’Brien, President

CT Auto Club, Inc.
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WE ARE HERE WHEN YOU NEED US!

Please call us any time: 877-335-7897. Or write us at: Member Services - Claims, P.O. Box 830008 Miami, FL 33283-0008.

NOTICE TO WISCONSIN AND UTAH RESIDENTS: Renewals on Altered Terms or Non-renewal of your auto club membership; Cancellation for non-
payment 60 days prior to the renewal of your auto club membership, we will mail written notice to you explaining any changes in benefits or increase in
membership fees (unless the fee increase is less than 25%). Any changes to your contract will not take effect until 60 days after notice to you is given. If we
decide not to renew your membership, your benefits and services will continue until 60 days following your written notification of non-renewal. Should you fail
to pay your motor club membership fee, we will notify you in writing that your benefits will be suspended 10 days following such notification.

NOTICE TO WISCONSIN RESIDENTS KEEP THIS NOTICE WITH YOUR INSURANCE PAPERS PROBLEMS WITH YOUR INSURANCE?
If you are having problems with your insurance company or agent, do not hesitate to contact the insurance company or agent to resolve your problem. You
can also contact the OFFICE OF THE COMMISSIONER OF INSURANCE, a state agency which enforces Wisconsin’s insurance laws, and file a complaint.
You can contact the OFFICE OF THE COMMISSIONER OF INSURANCE by contacting Office of the Commissioner of Insurance Complaints
Department P. O. Box 7873 Madison, WI 53707-7873 1-800-236-8517 or 608-266-0103

Notice for Mississippi Residents: This membership may be canceled at any time by providing written notice thereof by either the club or the member, and
that the member will, if the dues or membership fee has been paid thereupon, be entitled to a refund of the unused portion of the consideration paid for such
contract, calculated on a pro rata basis over the period of the contract, without any deductions, provided that CT Auto Club, Inc. may make a reasonable
minimum charge.

Notice to Oklahoma, Montana, Wyoming, Massachusetts, & Nevada Residents: This membership may be canceled at any time by either CT Auto Club,
Inc. or by Member. Upon cancellation, Member will be entitled to the unused portion of the membership fee paid, calculated on a pro rata basis without any
deductions.

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 PERMISSIVE USE ENDORSEMENT – ARIZONA
PERSONAL AUTO PROGRAM

Aspire General Insurance Services

Underwritten by ASPIRE GENERAL INSURANCE COMPANY

P.O. Box 2426 • Rancho Cucamonga, CA 91729-2426 • (916) 503-6313 • [Link]

Policy Information

Insured Name: Dominic Armenta

Policy Number: PAAZ-00007444-00

THIS ENDORSEMENT CHANGES YOUR POLICY. PLEASE READ CAREFULLY.

PERMISSIVE USE ENDORSEMENT

By electing the Permissive Use Endorsement, you agree with us that this policy is amended as follows:

Paragraph 1 of the REDUCTION IN COVERAGE is removed from Part I:

The Limits of Liability shown on the Declarations Page for coverage provided under Part I are amended and reduced to the minimum limits required by the
Arizona financial responsibility law for any coverage provided to:

1. a person other than you or a driver listed on the Declarations Page; or

The following exclusion is removed from Part II – Medical Payments Coverage:

Coverage under Part II does not apply to:

10. bodily injury sustained when your covered vehicle is being operated by a person who is not listed as a driver on the Declarations Page;

The following exclusion is removed from Part IV – Damage to a Vehicle:

16. to a covered vehicle when it is being operated by a person who is not listed on the Declarations Page.

The following exclusion is added to Part IV – Damage to a Vehicle:

Coverage under Part IV does not apply for loss:

16. to a covered vehicle when it is being operated by a person who is not listed on the Declarations Page who:
a. is not licensed to operate a motor vehicle;
b. operates your covered vehicle on a regular basis; or
c. is a resident of your household.

X Signature of Applicant Date

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