Policy Number: 2005996534

Named Insured:
PO Box 3199 • Winston Salem, NC 27102-3199 H & H EXPRESS LLC
mImi.hatcher@yahoo.com
Policy Period: 12:01 A.M.
1/8/2018 - 1/8/2019
H & H EXPRESS LLC
72 COUNTY ROAD 65 Date of Notice: 2/2/2018
VALLEY GRANDE AL 36701 Policy Underwritten By:
Integon National Insurance Company
24 Hour Claim Reporting: 1-800-468-3466
For Policy Information: 1-877-468-3466
www.MyNatGenPolicy.com
Your Agent:
Alabama Public Automobile Insurance
Inc
PO Box 321215
Birmingham AL 35232-1215
(205) 324-0406

AL COMMERCIAL VEHICLE DECLARATIONS PAGE

Endorsement Effective 2/2/2018
The following changes were made to your policy - Coverage(s) Updated

Drivers, Employees and Household Residents

#1 Mirian Hatcher
Driver Status License # Lic State Date of Birth Gender Marital Status Driver Pts Yrs. Licensed
Owner Driver XX9610 AL 3/14/1982 Female Single 0 19
#2 Donald Davis
Driver Status License # Lic State Date of Birth Gender Marital Status Driver Pts Yrs. Licensed
Employee XX1042 AL 12/20/1971 Male Single 4 30
Accidents/Violations Description
#2 Date: 6/12/2015 At Fault Generic Accident

Insured Vehicle(s) and Schedule of Coverages

#1 2014 GMC SIERRA K3500 DENALI VIN: Usage: Business and Radius: 500
1GT426C81EF142720 Personal Use
Garaging Location: 36701
Policy Coverage Level ScheduledAuto
Coverages Provided Limits/Deductibles Premium
Bodily Injury / Property Damage - $1,000,000 Combined Single Limit $4,690.00
Combined Single Limit
Medical Payments $5,000 Each Person / Each Accident $264.00
Uninsured / Underinsured Motorist Bodily $100,000 Each Person / $100,000 Each Accident $112.00
Injury
Comprehensive Stated Amount $43,000 - $1,000 Deductible $1,159.00
Collision Stated Amount $43,000 - $1,000 Deductible $3,365.00
Rental Reimbursement $50 Day, $1500 Occurrence $28.00
Roadside Assistance $100 Day, $500 Occurrence $22.00

10039AL (12012014)
 Total for this Vehicle $9,640.00
#2 2018 ECLN VIN: Usage: Business Radius: 500
42EDG2K20J1000199 Use Only
Garaging Location: 36701
Policy Coverage Level ScheduledAuto
Coverages Provided Limits/Deductibles Premium
Bodily Injury / Property Damage - $1,000,000 Combined Single Limit $293.00
Combined Single Limit
Comprehensive Stated Amount $18,000 - $1,000 Deductible $286.00
Collision Stated Amount $18,000 - $1,000 Deductible $749.00
Rental Reimbursement $50 Day, $1500 Occurrence $28.00
Roadside Assistance $100 Day, $500 Occurrence $22.00
Total for this Vehicle $1,378.00
Additional Policy Coverages Limits/Deductibles Premium
Cargo $100,000 Each Accident / $1000 Deductible $1,272.00
Combined Vehicle Premium $11,018.00
Combined Policy Coverages Premium $1,272.00
Federal Filing Fee $75.00
Policy Fee $30.00
Total 12 Month Policy Premium $12,395.00

Surcharges Applied
Policy Level
Business Type F
Federal Filing 2
Organization Type
Vehicle Level
#1 Personal Use

Additional Policy Information

Insured email: mImi.hatcher@yahoo.com
Rated Commodities
Building Supplies
Construction Materials (Raw)
Farming/Agriculture
Farming/Agriculture

Tier 5

Disclosure of Possible Additional Charges

The amounts below are authorized for use in this state. However, they are only charged if they apply to your policy.
Additional Insured Charge $50.00
Convenience Fee $5.00
Federal Filing Fee $75.00
Form E Filing Charge $50.00
FR Filing Charge $50.00
Late Charge $10.00
Nonsufficient Funds Charge $35.00
Policy Fee $30.00
Reinstatement Charge - Federal Filing $100.00
Reinstatement Charge - No Federal $25.00
Filing
10039AL (12012014)