PDF Document
PDF Document
PO Box 2358
Bloomington, IL 61702-2358
IMPORTANT NOTICE
Policy Information
State Farm® policy number : 1850554-SFP-13
May 3, 2024
JOSEFINA,
We're enclosing the Declarations for this policy for the period July 13, 2024, to January 13, 2025. Please
keep it for your records. It shows you are receiving our new State Farm Personal Car Policy booklet 9813C,
which replaces the State Farm Car Policy booklet 9813B previously provided. Your new policy is a multicar
policy, meaning more than one vehicle may be insured on this policy. Other coverage changes are
explained in the separate Important Notice in this mailing.
The change to the new policy booklet and Declarations means the policy number of your policy has
changed to the number above. As a result, we're providing you with the new policy booklet and new
endorsements, if any, that apply to your policy. We also are including other important messages, such as
information about your premium, discounts, drivers, and additional coverage options. You can view your
policy booklet and endorsements at [Link]/policy-library without logging in. For a free paper copy
of your policy and endorsements, contact your agent.
This is not a bill . The policy premium is being added to your new billing account (see enclosed Billing and
Payment Agreement). If you'd like to pay now, you can pay at [Link]/pay1 or contact your agent.
YOUR PREMIUM
The amount you pay for automobile insurance is determined by many factors, including who drives your
car, the claims you’ve had on this policy, and other policies you have with State Farm. If you have an
accident when responding to an emergency as a law enforcement officer, firefighter, or ambulance driver,
your premium will not be impacted.
DRIVER INFORMATION
Your premium may be influenced by the drivers shown below and the other individuals permitted to drive
your vehicle(s). This list does not extend or expand coverage beyond that contained in this automobile
policy. The drivers listed below are the drivers reported to us that frequently drive vehicles on this policy
and their information, as of July 13, 2024, which may impact the premium:
Name Age Gender Years licensed Driver tenure
JOSEFINA CISNEROS 51 Female 35 06
We offer Uninsured Motor Vehicle Property Damage Coverage U1 (Damages for Property Damage Caused
by Uninsured Motor Vehicles) to policyholders.
Coverage U1 provides protection for damage to your car caused by an at-fault uninsured driver up to actual
cash value or $15,000 (whichever is less) subject to a $250 deductible. There must be actual physical
contact between the vehicles and identification of the person responsible. This coverage does not pay for
loss of use of a motor vehicle or for damage to personal property that was in the vehicle. Coverage U1 is
not available when customers also carry Collision Coverage on a vehicle with a deductible of $250 or less.
The semiannual premium for this additional coverage ranges from $0.68 to $27.93. If you have any
questions about this coverage or if you do not have this coverage and want to purchase it, please contact
your agent.
Higher deductibles can help reduce your premium
You can reduce the amount you pay for Comprehensive and/or Collision Coverage if you choose a higher
deductible. Higher deductibles save premium dollars. The theory behind deductibles is a simple one: You
assume the cost of losses under the deductible amount, while State Farm continues to protect against the
losses over the deductible amount.
Your deductibles, if any, are shown on your Declarations. There are other deductible options available.
Some lienholders may require a minimum deductible. Please check with your lienholder for approval if you
are interested in raising your deductible. If you would like to change your deductible, please contact your
agent.
For information or assistance with any insurance problem, be sure to contact your STATE FARM AGENT
first.
This message is provided by State Farm® in compliance with Illinois law. Section 143c of the Illinois
Insurance Code requires notification of the following addresses:
Email: [Link]@[Link]
If any information on this notice is incomplete or inaccurate, or if you want to confirm the information we
have in our records, please contact your agent. For additional information regarding discounts or
coverages, see your State Farm agent or visit [Link] ®.
You can view your policy booklet and endorsements at [Link]/policy-library without logging in.
For a free paper copy of your policy and endorsements, contact your agent.
DISCLAIMER: This message is provided for informational purposes only and does not grant any insurance
coverage. The terms and conditions of coverage are set forth in your State Farm Personal Car Policy
booklet, the most recently issued Declarations, and any applicable endorsements.
Declarations
Policy number: 1850554-SFP-13
Named insured: JOSEFINA CISNEROS
Policy period: July 13, 2024 to January 13, 2025
The policy period begins and ends at 12:01 am standard time.
POLICY PREMIUM
This is not a bill . If an amount is due, then a separate statement will be sent prior to the due date. The premiums shown in the
table(s) below are for the policy period and the policy characteristics as described in this Declarations.
TOTAL PREMIUM $1,066.79
Coverage Symbols
A C U W
Premium $514.16 $22.69 $34.62 $15.27
Coverage Symbols
Vehicle D G H R1
001 Premium $134.42 $310.50 $19.03 $16.10
Deductible $500 $500
Your premium and eligibility was determined by information on drivers, driving records, and other information you provided, as well as
consumer report information, including: Number of accounts currently paid as agreed, Number of National Consumer Telecom &
Utilities Exchange satisfactory occurrences reported in the last 12 months, Total charge-off amount on National Consumer Telecom &
Utilities Exchange accounts reported in the last 6 months, Percent balance to high credit for bank revolving accounts reported in the
last 6 months, Total of latest balances for National Consumer Telecom & Utilities Exchange accounts reported in the last 2 months,
Notice of insurance information collection practices - personal, family, or household insurance transactions: We often collect
personal information from persons other than the individual or individuals listed on the policy. Such personal information may, in
certain circumstances, be disclosed to third parties without your authorization. If you would like additional information concerning the
collection and disclosure of personal information - and your right to see and correct any personal information in your files - it will be
furnished upon request.
MUTUAL CONDITIONS
Membership. While this policy is in force, the first named insured shown on the Declarations is entitled to vote at all meetings of
members and to receive dividends the Board of Directors in its discretion may declare in accordance with reasonable classifications
and groupings of policyholders established by such Board.
No contingent liability. This policy is non-assessable.
Annual meeting. The annual meeting of the members of the Company shall be held at its home office in Bloomington, Illinois, on the
second Monday of June at the hour of 10 a.m., unless the Board of Directors shall elect to change the time and place of such meeting,
in which case, but not otherwise, due notice shall be provided to members at least 10 days prior thereto.
In Witness Whereof, the State Farm Mutual Automobile Insurance Company has caused this policy to be signed by its President and
Secretary at Bloomington, Illinois.
President Secretary
We encourage the named insured whose consumer reports were used to obtain a free copy of the consumer reports. The named
insured whose consumer credit reports were used can be found on your Declarations. For other consumer reports such as loss
history, any driver who you indicate operates your vehicle can request their report. A free copy of consumer reports can be obtained
by contacting LexisNexis within 60 days of receiving this notice. Please send any questions or comments about your consumer
reports, along with the reports' reference numbers (if shown) on the Declarations to:
In an effort to protect consumer privacy, the consumer reporting agency will only release consumer report information to the
consumer. If you contact the vendor listed above to obtain the consumer report information used by State Farm to determine the
company in which your policy could be written or to rate your policy, the vendor will attempt to verify that you are the person whose
consumer report information was obtained by asking you to answer one or more questions regarding that information. If the named
insured's consumer report information was not used, a driver who you indicate operates your vehicle can request the information from
the vendor.
If due to your military service your prior insurance history was not continuous, or if your credit history was adversely influenced by
certain life events, please talk to your agent about requesting an additional review of your information. Examples of such life events
may include, but are not limited to, serious illness or injury, death of an immediate family member, temporary loss of employment,
divorce, military deployment overseas, or identity theft. Or, if the information in your consumer reports is incomplete or inaccurate, you
have the right to dispute it with LexisNexis. If a correction is made as a result of your dispute, please tell your agent so State Farm
may reconsider its decision.
If you are a new customer, we are pleased to provide you insurance coverage in the State Farm company indicated on your
Declarations. State Farm Mutual Automobile Insurance Company has our most favorable policy conditions and rating plan. If your
policy is in our State Farm Fire and Casualty Company, it is because you could not be written in our State Farm Mutual Automobile
Insurance Company. This is, in part, because of information in your consumer reports.
Based upon consumer report information, including credit, the premium for your newly issued policy is higher than it would have
otherwise been if State Farm had not used consumer report information. If you would like additional information related to this action,
please call or submit a written request to your State Farm agent within 90 days.
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In addition to consumer report information used when your policy was newly written, renewed, or revised based on your request to
make a policy change, other factors such as the coverages you have, where you live, the kind of car you drive, how your car is used,
who drives the car, and the likelihood of future claims also impact your premium. Please refer to your Declarations for information
about factors including credit history that affect your premium. You have the most competitive rate State Farm can offer you at this
time.
The names and addresses of any institutional sources that supplied this information are listed above. In order to obtain this information
in the future, you may make a written request for it. Here is the procedure:
1. After you submit a written request for access to recorded personal information which is reasonably locatable and retrievable,
within 21 days we will:
a. inform you of the nature and substance of the recorded personal information in writing, by telephone or by other oral
communication.
b. permit you to see and copy, in person, the recorded personal information which applies to you, or provide you with copies of
this information by mail, whichever you prefer.
c. inform you of the persons, if recorded, to which the personal information has been disclosed within two years of your request.
If the identities have not been recorded, we will provide you with the names of those insurance institutions, agents,
insurance-support organizations or other persons to whom such information is normally disclosed.
d. provide you with a summary of the procedures by which you may request correction, amendment or deletion of recorded
personal information.
2. State Farm may charge you a reasonable fee to cover the costs incurred in providing you with a copy of recorded personal
information. If the information applies to reasons for an adverse underwriting decision, there will be no charge.
3. In some circumstances, our obligations to you regarding access to recorded personal information may be satisfied by referring
you to an insurance-support organization.
4. Access to recorded personal information may be denied to the extent that the information is collected in connection with or in
reasonable anticipation of a claim or civil or criminal proceeding.
Finally, we want you to know you have the following rights in regard to the correction, amendment or deletion of recorded personal
information:
1. Within 30 days of receiving your written request to correct, amend or delete any recorded personal information we have, State
Farm will:
a. correct, amend or delete the portion of the recorded personal information in dispute, or
b. notify you of our refusal to make the correction, amendment or deletion, the reasons for the refusal and your right to file a
protest statement.
2. If the recorded personal information is corrected, amended or deleted, you will be notified in writing and this information will be
furnished to:
a. any person you've designated who may, have within the preceding 2 years, received such recorded personal information.
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151910.5 01-02-2024
Continuing coverage depends on you paying the of $25 for residents in all states, except it is $20 for
full amount(s) of the billed premium amount(s) residents of Colorado, Connecticut, Idaho, Indiana, New
and any applicable fees as required by this York and Utah; $15 for residents of Florida and Nebraska;
Agreement. and $10 for residents of Massachusetts.
You agree to accept electronic payment(s) for Payments are processed in Eastern Time.
payments made pursuant to the insurance policy
terms. You acknowledge the financial account may not Cancellation Notice
be an account held by all parties with rights to receive
9. When a cancellation notice is issued for a policy due to
payments under the policy. To the extent the account
non-payment of premium, the amount due on the
is not jointly owned by all parties, you agree electronic
cancellation notice will not be included on subsequent
payment transmission to the selected financial account
billing notices.
is a satisfactory method and manner for payment.
Any full or partial payment mailed on a policy under
You further authorize debits or credits to the financial
cancellation notice without the remittance slip from the
account resulting from reversing entries to correct
cancellation notice will be applied to policies that are
erroneous transactions. You agree State Farm is not
not under cancellation notice remaining on a Billing
responsible for any loss or delay due to the submission of
Account pursuant to the appropriate payment
erroneous information. You understand the date of the
allocation method described in paragraph 8. The full or
actual payment may vary based on the processing times
partial payment mailed without the remittance slip will
of the financial institution.
not be applied to the policy under cancellation notice
6. A “Billing Account” will be established with a unique and coverage will terminate if an acceptable full
account number. Your Billing Account is not a financial or payment is not made before the cancellation effective
banking account. All policies on a Billing Account are date.
required to be paid on the same date and with the same
If a full payment on a policy under cancellation notice
payment method. A Billing Account does not provide
is made by mail with the remittance slip from the
credit or hold monetary value or create a consumer
cancellation notice, the full payment will be applied in
transaction.
accordance with the policy provisions and cancellation
notice.
Fees
7. Late Payments: If your full payment is not received by If a partial payment on a policy under cancellation notice
the Due Date on your bill, you agree to pay a late is made by mail with the remittance slip from the
payment fee of $10, except in the following states in cancellation notice, the partial payment amount will be
which no late fee has been implemented: Kentucky. returned, as full payment is needed. Coverage will
terminate for the policy under cancellation notice and
Returned payments: If your payment is rejected by your coverage will terminate if an acceptable full payment is
financial institution for nonsufficient funds or a declined not made before the cancellation effective date.
debit/credit charge, you agree to pay a return payment fee
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For purposes of this paragraph 9, “a policy under unless otherwise required by law.
cancellation notice" means a policy that has been
issued a cancellation notice due to non-payment of Any premium amount paid that is considered unearned
premium. by State Farm as a result of you canceling your policy is
not treated as premium credit. Any such paid amount of
For purposes of this paragraph 9, “full payment” unearned premium for a canceled policy will be refunded
means a payment amount equaling the amount pursuant to the policy terms.
indicated as being owed on the issued cancellation
notice. 11. State Farm has the right, upon sending notification, to
change the terms and conditions of this Agreement
For purposes of this paragraph 9, “partial payment” including your frequency and method of payment.
means a payment amount less than the amount
indicated as being owed on the issued cancellation 12. Any fee and earned premium paid are not refundable.
notice. 13. This Agreement does not in any way affect the terms and
For purposes of this paragraph 9, “remittance slip” means conditions of the Automated Payments Authorization form
the portion of the cancellation notice that indicates it or policy provisions unless otherwise noted.
needs to be removed and returned to State Farm with the 1State Farm refers to the listed entities but could include future entities
full payment. that may offer this Agreement. Please note that a currently listed entity
may also stop offering this Agreement.
Premium Credit
State Farm Mutual Automobile Insurance Company
10. If a premium credit is generated on a policy, the credit State Farm Indemnity Company
will first be applied against the future amount owed on State Farm Fire and Casualty Company
the policy. If credit remains after applying it to the policy State Farm General Insurance Company
State Farm Life Insurance Company (Not licensed in MA, NY or WI)
generating the credit, the remaining credit will be applied State Farm Life and Accident Assurance Company (Licensed in NY and WI)
to other amounts currently owed for another policy(ies) State Farm Guaranty Insurance Company
on the Billing Account or applied toward an amount owed State Farm Florida Insurance Company
at a future date. A premium credit that is not used to pay State Farm Lloyds
State Farm County Mutual Insurance Company of Texas
amounts owed will be refunded to the named payor if State Farm Classic Insurance Company
held on the Billing Account for longer than 90 days,
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