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Other Household Driver(s) <br />In addition to the Principal Driver(s) and Assigned <br />Driver(s), your premium may be influenced by the <br />drivers shown below and other individuals permitted to <br />drive your vehicle . This list does not extend or expand <br />coverage beyond that contained in this automobile <br />policy. The drivers listed below are the drivers reported <br />to us that most frequenHy drive other vehicles in your <br />household . <br />CAITLYN GARRISON <br />DAVID GARRISON <br />It is your responsibility to inform us of all regular <br />drivers of your vehicles and changes to those drivers <br />throughout the life of your policy. Failure to disclose <br />drivers may result in denial of coverage. Regular <br />drivers, regardless of their relationship to the primary <br />named insured or their residence address, include: <br />• All drivers who drive the vehicle(s) on the policy <br />once or more in a typical month <br />• All drivers who regularly drive the vehicle(s) at <br />least three months of the year <br />A State Farm <br />• For business related vehicles, also include the <br />business owner(s) and employee(s) that drive the <br />vehicle(s) in any capacity <br />Principal Driver & Assigned Drivers <br />For each automobile , the Principal Driver is the individual <br />who most frequently drives it. <br />Each driver is designated as an Assigned Driver on the <br />household automobile that they most frequently drive . Your <br />premium may be influenced by the information shown for <br />these drivers . <br />COVERAGE AND LIMITS See your policy for an explanation of these coverages. <br />A Liability <br />Bodily Injury 250 ,000/500 ,000 <br />Property Damage 100 ,000 <br />C Medical Payments 100 ,000 <br />D 1000 Ded Comprehensive <br />G 1000 Deductible Collision <br />H Emergency Road Service <br />u Un insured Motor Veh icle <br />Bodily Injury 250 ,000/500 ,000 <br />U1 Un insured Motor Veh icle <br />Property Damage <br />rf otal Premium <br />If any coverage you carry is changed to give broader <br />protection with no additional premium charge , we will give <br />Policy Number: 414 5475-F29-05A <br />Prepared November 6, 2025 <br />$262.47 <br />$66 .02 <br />$65 .84 <br />$200 .39 <br />$6.42 <br />$89.71 <br />$8.45 <br />$699.30 <br />you the broader protection without issuing a new policy, <br />starting on the date we adopt the broader protection. <br />Page number 3 of 5 <br />Docusign Envelope ID: B1A2B84F-219F-40B7-B41B-2FF5FEF8647B