Form_SCTNID_CTGRY.
PA06226489_DECPAGE
<docindex><index>DECPAGE</index></docindex> BDF_AA
PROGRESSIVE
P.O. BOX 31260
TAMPA, FL 33631
Policy Number: 862409528
Underwritten by:
Progressive Advanced Insurance Co
December 5, 2025
JACCON JUNIOR ETIENNE
Policy Period: Nov 1, 2025 - May 1, 2026
424 W SOMERVILLE AVE
PHILADELPHIA, PA 19120 Page 1 of 2
progressive.com
Online Service
Make payments, check billing activity, update
policy information or check status of a claim.
Auto Insurance 1-800-776-4737
Coverage Summary
For customer service and claims service,
24 hours a day, 7 days a week.
This is a copy of your
Declarations Page
THIS FORM IS NONPARTICIPATING WITH REGARD TO PAYING DIVIDENDS TO POLICYHOLDERS.
Your coverage began on November 1, 2025 at the later of 12:01 a.m. or the effective time shown on your application. This policy
period ends on May 1, 2026 at 12:01 a.m.
This coverage summary replaces your prior one. Your insurance policy and any policy endorsements contain a full explanation of your
coverage. The policy contract is form 9611D PA (02/16). The contract is modified by forms Z357 (01/07), A230 (11/16) and A331
(11/21).
COLLISION COVERAGE FOR RENTAL VEHICLES
IF THIS POLICY PROVIDES COLLISION COVERAGE, IT WILL APPLY TO VEHICLES YOU RENT, BUT NOT TO
VEHICLES RENTED FOR 6 MONTHS OR MORE.
FRAUD NOTICE
Any person who knowingly and with intent to defraud any insurance company or other person files an application for
insurance or statement of claim containing any materially false information or conceals for the purpose of misleading,
information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such
person to criminal and civil penalties.
Underwriting Company
Progressive Advanced Insurance Co
P.O. Box 31260
Tampa , FL 33631
1-800-776-4737
Drivers and household residents
JACCON JUNIOR ETIENNE
Additional information: First Named insured
Form 6489 PA (06/22)
4
Continued
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Policy Number: 862409528
JACCON JUNIOR ETIENNE
Page 2 of 2
Outline of coverage
2026 CHEVROLET TRAX 4 DOOR WAGON
VIN: KL77LJEP2TC001541
Garaging ZIP Code: 19120
Primary use of the vehicle: Commute
Annual miles: 4,000 - 5,999
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
This vehicle is currently enrolled in the Snapshot® Program.
Limits Deductible Premium
………………………………………………………………………………………………………………………………………………………..
Liability To Others $494
Bodily Injury Liability $15,000 each person/$30,000 each accident
Property Damage Liability $5,000 each accident
………………………………………………………………………………………………………………………………………………………..
First Party Benefits 152
Medical Expenses $5,000 each person
………………………………………………………………………………………………………………………………………………………..
Uninsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Underinsured Motorist Rejected --
………………………………………………………………………………………………………………………………………………………..
Comprehensive Actual Cash Value $1,000 194
………………………………………………………………………………………………………………………………………………………..
Collision Actual Cash Value $1,000 1,109
………………………………………………………………………………………………………………………………………………………..
Total 6 month policy premium $1,949.00
Premium discounts
Policy
………………………………………………………………………………………………………………………………………………………..
862409528 Paid in Full, Online Signature - First Policy Period Only, Online Quote and
Paperless
Vehicle
………………………………………………………………………………………………………………………………………………………..
2026 CHEVROLET Driver and Passenger-side Airbag, Passive Anti-theft Device and Snapshot
TRAX Driving
Lienholder information
Vehicle Lienholder
………………………………………………………………………………………………………………………………………………………..
2026 CHEVROLET TRAX Citadel Credit Union
KL77LJEP2TC001541 Exton, PA 19341
A11Y LEH End Locator
Tort Option
This policy provides limited tort insurance.
Company officers
President Secretary
Form 6489 PA (06/22)
