September 29, 2023 CREDIT/DEBIT CARD NOTICE
AIGIMCKCMOOK
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Tan V Vo
Mai Tran
431 SACRAMENTO AVE
SPRING VALLEY, CA 91977-5939
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Policy Number: BX09929205
Dear Tan V Vo:
Due to an overpayment, we will credit the amount of $51.86 to your credit/charge card account on
09/29/2023.
Any changes made on or after the date of this letter will be reflected in future installments.
We'll notify you of any adjustment at least 15 days prior to the next installment date.
If you have any questions, please contact our Client Service department toll free at 1-888-404-5365. Our
associates are available to assist you Monday through Friday from 7 a.m. to 10 p.m. and Saturday from
8:30 a.m. to 7 p.m. Central time.
Thank you for allowing us to continue serving your insurance needs.
Sincerely,
The Customer Care Team
blgn02 09/29/2023
September 29, 2023
Amount credited to your
Credit Card: $51.86
AIGIMCKCMOOK
AKBPGFFFMHDK
AKGPGODPHIGK
Tan V Vo
Mai Tran
431 SACRAMENTO AVE
SPRING VALLEY, CA 91977-5939
ACOMIMGKAKEOKOAOIECEEACEIK
ALFMFDOPINMBMLNGGLFNJECPJK
APBMBIEIDLHOBJDNDIGKEIEJGK
Policy Number: BX09929205
Policy Type: AUTOMOBILE
Dear Tan V Vo:
Your auto insurance policy has been revised due to a driver change.
The enclosed declaration page shows the effective date of the change for your current policy, as well as
your coverages and premium information.
If you have any questions, please call our Client Service department at 1-888-404-5365. Our associates are
able to assist you Monday through Friday from 7 a.m. to 10 p.m. and Saturday from 8:30 a.m. to 7 p.m.
Central time. Our online service center also offers a variety of tools and resources to help you manage
your policy. Visit [Link]/costco to get started.
We appreciate your business and look forward to continuing to serve your insurance needs.
Sincerely,
The Customer Care Team
American Family Connect Property and Casualty Insurance Company
xlxx05 (004)
American Family Connect Property and AMENDED DECLARATION
Casualty Insurance Company POLICY CHANGE OF EFFECTIVE DATE IS 09/30/2023
3500 Packerland Drive
De Pere, WI 54115-9070
CALIFORNIA
POLICY NUMBER: BX09929205
POLICY PERIOD: 04/18/2023 - 10/18/2023
12:01 AM Standard Time
LAPSE IN COVERAGE: NONE
Tan V Vo
Mai Tran FOR CLAIMS SERVICE CALL:
431 SACRAMENTO AVE 1-888-404-5365
FOR CLIENT SERVICE CALL:
SPRING VALLEY, CA 91977-5939 1-888-404-5365
2 2005 TYTA 5 2019 AUDI 7 2022 PORS
COVERAGE/LIMIT SIENNA CE/S Q7 QUATTRO MACAN AWD
BODILY INJURY LIABILITY $107.00 $131.00 $125.00
ACOMIMGKAKEOKOAOIECEEACEIK
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$50,000 EACH PERSON
$100,000 EACH ACCIDENT
PROPERTY DAMAGE LIABILITY INCL INCL INCL
$50,000 EACH ACCIDENT
MEDICAL EXPENSE - EXCESS COVERAGE INCL INCL INCL
$5,000 EACH PERSON
UNINSURED MOTORIST BODILY INJURY $32.00 $44.00 $44.00
$50,000 EACH PERSON
$100,000 EACH ACCIDENT
UNINSURED MOTORIST PROPERTY DAMAGE $1.00 $1.00 $1.00
CAR 2-WAIVER OF COLLISION DEDUCTIBLE
CAR 5-WAIVER OF COLLISION DEDUCTIBLE
CAR 7-WAIVER OF COLLISION DEDUCTIBLE
COLLISION $31.00 $199.00 $209.00
DEDUCTIBLES CAR 2-$500 5-$500 7-$500
COMPREHENSIVE $13.00 $86.00 $91.00
DEDUCTIBLES CAR 2-$250 5-$250 7-$250
TOWING AND LABOR COSTS INCL INCL INCL
$75 PER DISABLEMENT
RENTAL EXPENSE $2.00 $10.00 $10.00
$30 PER DAY/$900 PER OCCURRENCE
CONSOLIDATED VEHICLE ASSESSMENT FEE $0.87 $0.87 $0.87
TOTAL SEMIANNUAL PREMIUM PER VEHICLE $186.87 $471.87 $480.87
TOTAL SEMIANNUAL PREMIUM ALL VEHICLES - $1,139.61
Coverage is provided only when both a premium and limit are shown.
adca01a (001) 09/29/2023
DRIVER INFORMATION
1. Tan V Vo 4.
2. Mai Tran 5.
# * 3. Raymond Vo 6.
* QUALIFIES FOR GOOD STUDENT DISCOUNT # EXCLUDED DRIVER
CAR INFORMATION CARS KEPT AT LOCATION OTHER THAN RESIDENCE
2005 TYTA 5TDZA23C75S346525
2019 AUDI WA1AHAF79KD046326
2022 PORS WP1AA2A59NLB04045
YOUR POLICY HAS THE FOLLOWING DISCOUNTS:
MULTI-CAR, PREMIER SAFETY, FULL COVERAGE, FULL PAYMENT PLAN, TENURE, COSTCO
2005 TYTA - GOOD DRIVER, ANTI-THEFT DEVICE, DUAL AND SIDE AIRBAGS
2019 AUDI - GOOD DRIVER, ANTI-THEFT DEVICE, DUAL AND SIDE AIRBAGS
2022 PORS - GOOD DRIVER, ANTI-THEFT DEVICE, DUAL AND SIDE AIRBAGS
YOUR POLICY HAS THE FOLLOWING ENDORSEMENTS:
AMENDATORY ENDORSEMENT
SPECIAL EQUIPMENT/CUSTOMIZATION: NONE
NAMED DRIVER EXCLUSION
LIENHOLDER INFORMATION
LIENHOLDER - 2019 AUDI Q7 QUATTRO PREMIUM
Audi Financial Services, PO Box 258, Minneapolis, MN 55440-0258
LIENHOLDER - 2022 PORS MACAN AWD
Jpmorgan Chase Bank, NA, PO Box 80015, Atlanta, GA 30366
cdec09 - CA
California Auto Insurance Identification Card ID Cards
Issued by
American Family Connect Property and 2005 TYTA SIENNA CE/S You can get ID cards and
5TDZA23C75S346525
Casualty Insurance Company Declaration pages online — any
NAIC 29068 Policy Number
3500 Packerland Drive BX09929205 time you need them!
De Pere, WI 54115-9070 Effective
04/18/2023 - 10/18/2023
Just visit:
[Link]/costco
Named Insured(s) Drivers (# excluded driver)
Tan V Vo Tan V Vo Click on: Access My Policy
Mai Tran Mai Tran
# Raymond Vo
Client Service hours (Central time):
Monday - Friday: 7 a.m. - 10 p.m.
Saturday: 8:30 a.m. - 7 p.m.
ACOMIMGKAKEOKOAOIECEEACEIK
ALFMFDOPINMBMLNGGLFNJECPJK
APBMBIEIDLHOBJDNDIGKEIEJGK
California Auto Insurance Identification Card
Issued by
American Family Connect Property and 2005 TYTA SIENNA CE/S
Casualty Insurance Company 5TDZA23C75S346525
NAIC 29068 Policy Number
3500 Packerland Drive BX09929205
De Pere, WI 54115-9070 Effective
04/18/2023 - 10/18/2023
Named Insured(s) Drivers (# excluded driver)
Tan V Vo Tan V Vo
Mai Tran Mai Tran
# Raymond Vo
Directions:
State law requires each driver to keep an
insurance ID card in his or her vehicle at all times.
Carefully separate the cards along the perforations
and place one in your vehicle's glove box.
If you insure more than one vehicle with us, a set
of ID cards has been issued for each vehicle.
idca01 (003)
Claims 1-888-404-5365
Client Service 1-888-404-5365
Roadside Assistance 1-888-742-4572
[Link]/costco
The policy complies with Section 16056 of the California Vehicle Code.
THIS CARD MUST BE CARRIED IN THE INSURED MOTOR VEHICLE
FOR PRODUCTION UPON DEMAND
Claims 1-888-404-5365
Client Service 1-888-404-5365
Roadside Assistance 1-888-742-4572
[Link]/costco
The policy complies with Section 16056 of the California Vehicle Code.
THIS CARD MUST BE CARRIED IN THE INSURED MOTOR VEHICLE
FOR PRODUCTION UPON DEMAND
idca01 (003)
California Auto Insurance Identification Card ID Cards
Issued by
American Family Connect Property and 2019 AUDI Q7 QUATTRO You can get ID cards and
WA1AHAF79KD046326
Casualty Insurance Company Declaration pages online — any
NAIC 29068 Policy Number
3500 Packerland Drive BX09929205 time you need them!
De Pere, WI 54115-9070 Effective
04/18/2023 - 10/18/2023
Just visit:
[Link]/costco
Named Insured(s) Drivers (# excluded driver)
Tan V Vo Tan V Vo Click on: Access My Policy
Mai Tran Mai Tran
# Raymond Vo
Client Service hours (Central time):
Monday - Friday: 7 a.m. - 10 p.m.
Saturday: 8:30 a.m. - 7 p.m.
ACOMIMGKAKEOKOAOIECEEACEIK
ALFMFDOPINMBMLNGGLFNJECPJK
APBMBIEIDLHOBJDNDIGKEIEJGK
California Auto Insurance Identification Card
Issued by
American Family Connect Property and 2019 AUDI Q7 QUATTRO
Casualty Insurance Company WA1AHAF79KD046326
NAIC 29068 Policy Number
3500 Packerland Drive BX09929205
De Pere, WI 54115-9070 Effective
04/18/2023 - 10/18/2023
Named Insured(s) Drivers (# excluded driver)
Tan V Vo Tan V Vo
Mai Tran Mai Tran
# Raymond Vo
Directions:
State law requires each driver to keep an
insurance ID card in his or her vehicle at all times.
Carefully separate the cards along the perforations
and place one in your vehicle's glove box.
If you insure more than one vehicle with us, a set
of ID cards has been issued for each vehicle.
idca01 (003)
Claims 1-888-404-5365
Client Service 1-888-404-5365
Roadside Assistance 1-888-742-4572
[Link]/costco
The policy complies with Section 16056 of the California Vehicle Code.
THIS CARD MUST BE CARRIED IN THE INSURED MOTOR VEHICLE
FOR PRODUCTION UPON DEMAND
Claims 1-888-404-5365
Client Service 1-888-404-5365
Roadside Assistance 1-888-742-4572
[Link]/costco
The policy complies with Section 16056 of the California Vehicle Code.
THIS CARD MUST BE CARRIED IN THE INSURED MOTOR VEHICLE
FOR PRODUCTION UPON DEMAND
idca01 (003)
California Auto Insurance Identification Card ID Cards
Issued by
American Family Connect Property and 2022 PORS MACAN AWD You can get ID cards and
WP1AA2A59NLB04045
Casualty Insurance Company Declaration pages online — any
NAIC 29068 Policy Number
3500 Packerland Drive BX09929205 time you need them!
De Pere, WI 54115-9070 Effective
04/18/2023 - 10/18/2023
Just visit:
[Link]/costco
Named Insured(s) Drivers (# excluded driver)
Tan V Vo Tan V Vo Click on: Access My Policy
Mai Tran Mai Tran
# Raymond Vo
Client Service hours (Central time):
Monday - Friday: 7 a.m. - 10 p.m.
Saturday: 8:30 a.m. - 7 p.m.
ACOMIMGKAKEOKOAOIECEEACEIK
ALFMFDOPINMBMLNGGLFNJECPJK
APBMBIEIDLHOBJDNDIGKEIEJGK
California Auto Insurance Identification Card
Issued by
American Family Connect Property and 2022 PORS MACAN AWD
Casualty Insurance Company WP1AA2A59NLB04045
NAIC 29068 Policy Number
3500 Packerland Drive BX09929205
De Pere, WI 54115-9070 Effective
04/18/2023 - 10/18/2023
Named Insured(s) Drivers (# excluded driver)
Tan V Vo Tan V Vo
Mai Tran Mai Tran
# Raymond Vo
Directions:
State law requires each driver to keep an
insurance ID card in his or her vehicle at all times.
Carefully separate the cards along the perforations
and place one in your vehicle's glove box.
If you insure more than one vehicle with us, a set
of ID cards has been issued for each vehicle.
idca01 (003)
Claims 1-888-404-5365
Client Service 1-888-404-5365
Roadside Assistance 1-888-742-4572
[Link]/costco
The policy complies with Section 16056 of the California Vehicle Code.
THIS CARD MUST BE CARRIED IN THE INSURED MOTOR VEHICLE
FOR PRODUCTION UPON DEMAND
Claims 1-888-404-5365
Client Service 1-888-404-5365
Roadside Assistance 1-888-742-4572
[Link]/costco
The policy complies with Section 16056 of the California Vehicle Code.
THIS CARD MUST BE CARRIED IN THE INSURED MOTOR VEHICLE
FOR PRODUCTION UPON DEMAND
idca01 (003)
American Family Connect Property and
Casualty Insurance Company
3500 Packerland Drive
De Pere, WI 54115-9070 Policy Number: BX09929205
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NAMED DRIVER EXCLUSION ENDORSEMENT – CALIFORNIA
With respect to the coverages for which the Named Driver Exclusion applies, the provisions of the policy apply unless modified by
this endorsement.
SCHEDULE
The Named Driver Exclusion Endorsement applies with respect to the named excluded driver indicated below or in the
Declarations.
ACOMIMGKAKEOKOAOIECEEACEIK
ALFMFDOPINMBMLNGGLFNJECPJK
APBMBIEIDLHOBJDNDIGKEIEJGK
Raymond Vo
Definitions
The following definition is added:
Named excluded driver means a person who is shown in the
Schedule or in the Declarations as a named excluded driver.
Named Driver Exclusion
With respect to all coverages under this policy, we will not
pay damages, expenses, benefits or loss arising out of the
maintenance or use of any vehicle or trailer by the named
excluded driver whether or not such maintenance or use was
with the express or implied permission of an insured.
However, we will defend the named insured when all of the
following apply:
1. The named excluded driver is a resident of the same
household as the named insured;
2. As a result of operating your insured vehicle, the named
excluded driver is jointly sued with the named insured;
and
3. The named excluded driver is insured under a separate
automobile liability insurance policy issued to that
named excluded driver as a named insured, and that
policy does not provide a defense to the named insured
shown in the Declarations of this policy.
Page 1 of 1
aeca01 (001)
09/29/2023
American Family Connect Property and
Casualty Insurance Company
3500 Packerland Drive
De Pere, WI 54115-9070
Important information about your insurance coverage
Fraud Notice
FOR YOUR PROTECTION, CALIFORNIA LAW REQUIRES WE COMMUNICATE THE FOLLOWING
INFORMATION:
ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT INFORMATION TO OBTAIN
OR AMEND INSURANCE COVERAGE OR TO MAKE A CLAIM FOR THE PAYMENT OF A LOSS IS
GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON.
xdifrdca (001)
ACOMIMGKAKEOKOAOIECEEACEIK
ALFMFDOPINMBMLNGGLFNJECPJK
APBMBIEIDLHOBJDNDIGKEIEJGK
09/29/2023