Is Your Insurance Identification Card Correct?

It is important that the information appearing on your Insurance Identification Card(s) is correct.
Please take a few minutes to verify the information. Of particular importance are your name, vehicle
description and vehicle identification number. If any of this information is incorrect please contact the
agent listed on your policy.

CERTIFICATE OF NO-FAULT INSURANCE - STATE OF MICHIGAN

CITIZENS INSURANCE COMPANY OF THE MIDWEST

POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE

A6H H931855 02 02/17/2024 02/17/2025
YEAR MAKE/MODEL VEHICLE IDENTIFICATION NUMBER
2022 LEXS ES 58AD11D11NU008782

AGENCY/COMPANY ISSUING CARD

CG INSURANCE AGENCY 0302832
148 E GRAND RIVER RD S206, WILLIAMSTON, MI 48895 PHONE: (855) 269-4035

INSURED
REGINA TRAVICK, STEPHEN ADOLPH

If this vehicle is driven by the person(s) named below, residual liability insurance does not
apply and the vehicle will be considered uninsured:

EXCLUDED DRIVER(S)

WARNING - When a named excluded person operates a vehicle, all liability coverage is void - no
one is insured. Owners of the vehicle and others legally responsible for the acts of the named
excluded person remain fully personally liable.

WARNING - KEEP THIS CERTIFICATE IN YOUR VEHICLE AT ALL TIMES. If you fail to
produce it upon a police officer's request, you will be responsible for a civil infraction.

WHEN AN ACCIDENT OCCURS!

In case of accident, report all accidents to the Company as soon as possible. Obtain the
following information:
1. Name, address and phone number of each driver, passenger, injured person and witness.
2. Name of Insurance Company and policy number for each vehicle involved. Do not assume
or admit liability. Make no payments or promises to anyone, since it is the Company's
obligation to determine responsibility and to defend you.

IF YOU HAVE AN EMERGENCY and are unable to contact your agent, please call Citizens'
emergency claims line: 1-800-628-0250 (US and Canada).

PENALTY FOR OPERATION WITHOUT INSURANCE

Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle registered in this state
must have insurance or other approved security for the payment of no-fault benefits on the vehicle at all times.
An owner or registrant who drives or permits a vehicle to be driven upon a public highway without the proper
insurance or other security is guilty of a misdemeanor.
A person convicted of such a misdemeanor shall be fined not less than $200.00 nor more than $500.00,
imprisoned for not more than 1 year, or both.
A person who supplies false information to the Secretary of State under this section or who issues or uses an
invalid certificate of insurance is guilty of a misdemeanor punishable by imprisonment for not more than 1
year, or a fine of not more than $1,000.00, or both.

V-5 (01/08)

271-5681 (01/08)
 CERTIFICATE OF NO-FAULT INSURANCE - STATE OF MICHIGAN
CITIZENS INSURANCE COMPANY OF THE MIDWEST

POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE

A6H H931855 02 02/17/2024 02/17/2025
YEAR MAKE/MODEL VEHICLE IDENTIFICATION NUMBER
2022 LEXS ES 58AD11D11NU008782

AGENCY/COMPANY ISSUING CARD

CG INSURANCE AGENCY 0302832
148 E GRAND RIVER RD S206, WILLIAMSTON, MI 48895 PHONE: (855) 269-4035

INSURED
REGINA TRAVICK, STEPHEN ADOLPH

If this vehicle is driven by the person(s) named below, residual liability insurance does not
apply and the vehicle will be considered uninsured:

EXCLUDED DRIVER(S)

WARNING - When a named excluded person operates a vehicle, all liability coverage is void - no
one is insured. Owners of the vehicle and others legally responsible for the acts of the named
excluded person remain fully personally liable.

WARNING - KEEP THIS CERTIFICATE IN YOUR VEHICLE AT ALL TIMES. If you fail to
produce it upon a police officer's request, you will be responsible for a civil infraction.
SECRETARY OF STATE'S COPY

WHEN AN ACCIDENT OCCURS!

In case of accident, report all accidents to the Company as soon as possible. Obtain the
following information:
1. Name, address and phone number of each driver, passenger, injured person and witness.
2. Name of Insurance Company and policy number for each vehicle involved. Do not assume
or admit liability. Make no payments or promises to anyone, since it is the Company's
obligation to determine responsibility and to defend you.

IF YOU HAVE AN EMERGENCY and are unable to contact your agent, please call Citizens'
emergency claims line: 1-800-628-0250 (US and Canada).

PENALTY FOR OPERATION WITHOUT INSURANCE

Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle registered in this state
must have insurance or other approved security for the payment of no-fault benefits on the vehicle at all times.
An owner or registrant who drives or permits a vehicle to be driven upon a public highway without the proper
insurance or other security is guilty of a misdemeanor.
A person convicted of such a misdemeanor shall be fined not less than $200.00 nor more than $500.00,
imprisoned for not more than 1 year, or both.
A person who supplies false information to the Secretary of State under this section or who issues or uses an
invalid certificate of insurance is guilty of a misdemeanor punishable by imprisonment for not more than 1
year, or a fine of not more than $1,000.00, or both.

V-5 (01/08)
271-5681 (01/08)
Is Your Insurance Identification Card Correct?

It is important that the information appearing on your Insurance Identification Card(s) is correct.
Please take a few minutes to verify the information. Of particular importance are your name, vehicle
description and vehicle identification number. If any of this information is incorrect please contact the
agent listed on your policy.

CERTIFICATE OF NO-FAULT INSURANCE - STATE OF MICHIGAN

CITIZENS INSURANCE COMPANY OF THE MIDWEST

POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE

A6H H931855 02 02/17/2024 02/17/2025
YEAR MAKE/MODEL VEHICLE IDENTIFICATION NUMBER
2013 TOYT CAMRY 4T4BF1FK7DR329400

AGENCY/COMPANY ISSUING CARD

CG INSURANCE AGENCY 0302832
148 E GRAND RIVER RD S206, WILLIAMSTON, MI 48895 PHONE: (855) 269-4035

INSURED
REGINA TRAVICK, STEPHEN ADOLPH

If this vehicle is driven by the person(s) named below, residual liability insurance does not
apply and the vehicle will be considered uninsured:

EXCLUDED DRIVER(S)

WARNING - When a named excluded person operates a vehicle, all liability coverage is void - no
one is insured. Owners of the vehicle and others legally responsible for the acts of the named
excluded person remain fully personally liable.

WARNING - KEEP THIS CERTIFICATE IN YOUR VEHICLE AT ALL TIMES. If you fail to
produce it upon a police officer's request, you will be responsible for a civil infraction.

WHEN AN ACCIDENT OCCURS!

In case of accident, report all accidents to the Company as soon as possible. Obtain the
following information:
1. Name, address and phone number of each driver, passenger, injured person and witness.
2. Name of Insurance Company and policy number for each vehicle involved. Do not assume
or admit liability. Make no payments or promises to anyone, since it is the Company's
obligation to determine responsibility and to defend you.

IF YOU HAVE AN EMERGENCY and are unable to contact your agent, please call Citizens'
emergency claims line: 1-800-628-0250 (US and Canada).

PENALTY FOR OPERATION WITHOUT INSURANCE

Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle registered in this state
must have insurance or other approved security for the payment of no-fault benefits on the vehicle at all times.
An owner or registrant who drives or permits a vehicle to be driven upon a public highway without the proper
insurance or other security is guilty of a misdemeanor.
A person convicted of such a misdemeanor shall be fined not less than $200.00 nor more than $500.00,
imprisoned for not more than 1 year, or both.
A person who supplies false information to the Secretary of State under this section or who issues or uses an
invalid certificate of insurance is guilty of a misdemeanor punishable by imprisonment for not more than 1
year, or a fine of not more than $1,000.00, or both.

V-5 (01/08)

271-5681 (01/08)
 CERTIFICATE OF NO-FAULT INSURANCE - STATE OF MICHIGAN
CITIZENS INSURANCE COMPANY OF THE MIDWEST

POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE

A6H H931855 02 02/17/2024 02/17/2025
YEAR MAKE/MODEL VEHICLE IDENTIFICATION NUMBER
2013 TOYT CAMRY 4T4BF1FK7DR329400

AGENCY/COMPANY ISSUING CARD

CG INSURANCE AGENCY 0302832
148 E GRAND RIVER RD S206, WILLIAMSTON, MI 48895 PHONE: (855) 269-4035

INSURED
REGINA TRAVICK, STEPHEN ADOLPH

If this vehicle is driven by the person(s) named below, residual liability insurance does not
apply and the vehicle will be considered uninsured:

EXCLUDED DRIVER(S)

WARNING - When a named excluded person operates a vehicle, all liability coverage is void - no
one is insured. Owners of the vehicle and others legally responsible for the acts of the named
excluded person remain fully personally liable.

WARNING - KEEP THIS CERTIFICATE IN YOUR VEHICLE AT ALL TIMES. If you fail to
produce it upon a police officer's request, you will be responsible for a civil infraction.
SECRETARY OF STATE'S COPY

WHEN AN ACCIDENT OCCURS!

In case of accident, report all accidents to the Company as soon as possible. Obtain the
following information:
1. Name, address and phone number of each driver, passenger, injured person and witness.
2. Name of Insurance Company and policy number for each vehicle involved. Do not assume
or admit liability. Make no payments or promises to anyone, since it is the Company's
obligation to determine responsibility and to defend you.

IF YOU HAVE AN EMERGENCY and are unable to contact your agent, please call Citizens'
emergency claims line: 1-800-628-0250 (US and Canada).

PENALTY FOR OPERATION WITHOUT INSURANCE

Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle registered in this state
must have insurance or other approved security for the payment of no-fault benefits on the vehicle at all times.
An owner or registrant who drives or permits a vehicle to be driven upon a public highway without the proper
insurance or other security is guilty of a misdemeanor.
A person convicted of such a misdemeanor shall be fined not less than $200.00 nor more than $500.00,
imprisoned for not more than 1 year, or both.
A person who supplies false information to the Secretary of State under this section or who issues or uses an
invalid certificate of insurance is guilty of a misdemeanor punishable by imprisonment for not more than 1
year, or a fine of not more than $1,000.00, or both.

V-5 (01/08)
271-5681 (01/08)