1. 611884804 Q IC94544 INS NOTICE POLWHITEFONT XFZQB6XAQMCKUFO6NHK66K6QYD0003 RPUID
Policy Number: 61188480-4
GREG LOBKOWSKI
Form_SCTNID_CTGRY.CA12106481_NOTICE
Page 1 of 3
Driving history
Progressive uses driving and claims history to determine your premium. Driving and claims history may include events such as
motor vehicle violations, at-fault accidents, not-at-fault accidents and comprehensive claims. We obtain driving and claims
history from one or more of the following sources:
• Your application (APP) • Motor Vehicle Reports and/or court data (MVR) - provided by
a consumer reporting agency
• Progressive claims history (PROG) • Comprehensive Loss Underwriting Exchange (CLUE) - provided by
a consumer reporting agency
We considered the following events:
Driver and Description Date Source/Consumer reporting agency
………………………………………………………………………………………………………………………………………………………..
GREG LOBKOWSKI
at fault accident-property damage and/or collision Dec 7, 2009 APP, CLUE/LexisNexis
………………………………………………………………………………………………………………………………………………………..
GREG LOBKOWSKI
non-chargeable suspension May 8, 2010 MVR/LexisNexis
………………………………………………………………………………………………………………………………………………………..
GREG LOBKOWSKI
at fault accident-property damage and/or collision Apr 10, 2011 PROG
Where applicable, driving history and claim information provided by the following consumer reporting agencies:
LexisNexis Risk Solutions
P.O. Box 105108
Atlanta, GA 30348-5108
1-800-456-6004
www.consumerdisclosure.com
What should I do if I have a question?
If you have a question about the information in your driving or claims history, please contact the consumer reporting
agency who provided the information as shown above. You may obtain a free copy of your motor vehicle report, which
contains driving history information, for 60 days after you receive this notice. You may also dispute the report's accuracy or
completeness with the agency who provided the information. If your question concerns our use of information in your
driving history or if you need assistance with obtaining the report, please call us.
Form_SCTNID_CTGRY.CA09117883_NOTICE
Form 6481 CA (12/10)
Disclosure of Available Discounts
The discounts listed below are available to qualifying policyholders. If you have any questions concerning this policy or
the applicable discounts, please call Customer Service.
The term "Primary Coverages" is used throughout the form. When a discount applies to Primary Coverages, the
discount will apply only to Bodily Injury Liability, Property Damage Liability, Uninsured/Underinsured Motorist Bodily
Injury, Uninsured Motorist Property Damage, Medical Payments, Comprehensive, Collision, and Loan/Lease Payoff
Coverages.
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2. 611884804 Q IC94544 INS NOTICE POLWHITEFONT XFZQB6XAQMCKUFO6NHK66K6QYD0003 RPUID
Policy Number: 61188480-4
GREG LOBKOWSKI
Page 2 of 3
Good driver discount
A discount is applied to all vehicles assigned to drivers qualifying for "good driver" status under Section 1861.025 of the
California Insurance Code. To qualify as a good driver, a driver must be licensed for the past three (3) years and generally
have no more than one Department of Motor Vehicle violation point or at-fault property damage loss during the prior three
(3) years. If you've been convicted of a DUI-related offense within 10 years of the issuance or renewal of your policy, you
will be ineligible for this discount. These driving offenses are defined by Vehicle Code Sections 23140, 23152, 23153,
23550 or 23566, or a violation of Section 191.5 or paragraph (3) of subdivision (c) of Section 192 of the Penal Code.
Drivers not qualifying as "good drivers" may be excluded from coverage, which may qualify your policy for the "good
driver" discount. Please contact Customer Service for additional information or to request an exclusion.
If any driver on your policy had an at-fault bodily injury accident within the preceding thirty-six (36) months on his or her driving
record, that driver will not qualify for the Good Driver Discount. The California Code of Regulations mandate that a driver may
be considered to be principally at fault in an accident if the driver's actions or omissions were at least fifty-one percent (51%) of
the legal cause of the accident, and either the accident resulted in bodily injury, death or, for an accident resulting only in
damage to property, the total loss or damage caused by the accident exceeded seven hundred fifty dollars ($750.00) if the
accident occurred before December 11, 2011, or one thousand dollars ($1,000.00), if the accident occurred on or after
December 11, 2011. To have this policy further reviewed for Good Driver Discount eligibility, you must submit one or more of
the following forms with sufficient details of the loss to show that the driver should not be considered principally at fault in the
at-fault accident listed on the enclosed accident/violation history:
• A claims report regarding the loss
• Documentation from that driver's previous insurance company regarding the loss
• Documentation from the other party's insurance company regarding the loss
• A written declaration from the driver regarding the loss. This declaration will be made under penalty of perjury, and
any fraudulent or material misrepresentations may result in the voiding or cancellation of your policy.
Mature driver discount
A discount may apply if a listed driver who is fifty-five (55) years of age or older provides proof of successful completion of
a Mature Driver Improvement Course approved by the California Department of Motor Vehicles. Any Mature Driver
Discount provided only applies to Primary Coverages.
The discount is good for three years from the date of course completion. The discount will be discontinued if the listed
driver is at-fault in an accident or if the listed driver is convicted of a violation of Division 11 of the Vehicle Code, except
Chapter 9 of that Division, or of a traffic-related offense involving alcohol or narcotics. The discount does not apply if the
insured successfully completes the Mature Driver Improvement Course pursuant to a court order.
Multiple vehicle discount
Policies with more than one vehicle listed on the same policy will receive a Multiple Vehicle Discount. The discount
amount varies by coverage.
Multi-policy discount
A discount may apply when a named insured has purchased an additional policy from us. An additional policy may
include a Motorcycle, Snowmobile, Motor Home, Travel Trailer, Boat or Personal Watercraft, Commercial Vehicle, or
Umbrella policy. No more than one (1) Multi-Policy Discount may apply. Any Multi-Policy Discount provided only applies
to Primary Coverages.
Percentage use of vehicle by rated driver
A discount may apply for policies with an occasional operator. An occasional operator must be licensed, under nineteen
(19) years of age, reside in the named insured's household, and operate all vehicles on the policy less than fifty percent
(50%) of the time. The number of drivers must be greater than the number of covered vehicles on the policy, and the
number of principal operators must be greater than or equal to the number of covered vehicles on the policy. Any
Percentage Use Discount provided only applies to Primary Coverages.
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3. 611884804 Q IC94544 INS NOTICE POLWHITEFONT XFZQB6XAQMCKUFO6NHK66K6QYD0003 RPUID
Policy Number: 61188480-4
GREG LOBKOWSKI
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Recovery device (anti-theft discount)
A discount on Comprehensive Coverage and a proportional discount on Loan/Lease Coverage may apply to vehicles with
certain qualifying homing devices or tracking systems. A qualified tracking system must automatically contact a response
center in order to begin the process of vehicle recovery. Qualifying systems for the Recovery Device (Anti-Theft Discount)
include OnStar, OnGuard, Mr. Rescue, VEMS, and Lojack.
Form_SCTNID_CTGRY.XX1205Z271_NOTICE
Form 7883 CA (09/11)
Provider Network Program Notification
This notification is to advise you that, in the event you are injured as a result of an accident, you may have available to
you the services of First Health, a Coventry Health Care owned medical provider network. You can call 1-888-685-7774,
or visit www.FirstHealth.com, 24 hours a day, 7 days a week, to find out which medical providers are included in the First
Health network.
This program is designed to provide better customer service. You are under no obligation to use the network
above. You are free to see a medical service provider of your choice. This notice is for informational purposes
only. Using a provider within the network should not be considered confirmation of coverage.
Form Z271 (12/05)

4. Form_SCTNID_CTGRY.CA03076488_NOTICE
611884804 Q IC94544 INS NOTICE POLWHITEFONT XFZQB6XAQMCKUFO6NHK66K6QYD0004 RPUID TRACWHITEFONT
Policy Number: 61188480-4
GREG LOBKOWSKI
Page 1 of 2
Privacy Policy
About this notice
We are committed to protecting your privacy and earning your trust. This notice describes the personal information we
collect about you and how we use and protect it. It applies to our current and former customers who live in your state,
and replaces earlier versions that we may have given to you.
Summary
This section summarizes our privacy practices. For more detail, please read the entire privacy policy.
• We gather information from you, your transactions with us, and outside sources.
• We use your information only to conduct our business and provide insurance to you.
• We will not share your information with other companies for their marketing purposes without your consent.
• We limit access to your information and use safeguards to help protect it.
• You may review and correct your information.
What information do you collect about me?
We collect information about you to quote and service your insurance policy. This is called "Nonpublic Personal
Information" or "NPI" if it identifies you and is not available to the public. Depending on the product, we collect it from
some or all of the following sources. We have provided a few examples for each source, but not all may apply to you.
• Your application: You provide NPI on your application, through your agent or broker, by phone, or online. We may
also obtain it from directories and other outside sources. It includes your name, street and e-mail addresses, phone
number, driver's license number, Social Security number, date of birth, gender, marital status, type of vehicle, and NPI
about other drivers.
• Consumer reports: We obtain NPI from consumer reporting agencies. It includes your driving record, claims history
with other insurers, and credit report information. The information is kept by the consumer reporting agencies and
disclosed by them to others as permitted by law.
• Transactions: We obtain NPI about your transactions with us, our affiliates, or others. It includes your insurance
coverages, limits and rates, and payment and claims history. It also includes NPI that we require for billing and payment.
• Web site: This NPI is unique to Internet transactions. It includes the Web site that linked you to ours, your computer
operating system, and the pages you viewed on our site. Some Web sites, including ours, may also store "cookies" on
your computer. Cookies collect technical data, like your Internet protocol (IP) address, operating system, and session ID.
They can also save certain information entered by you. Some of our Web sites contain more information about our Web
site privacy practices. Please read it when using the sites.
Who might get information about me from you?
We will share NPI about you only as permitted by law. We will not share your NPI with other companies for their
marketing purposes without your consent. There is no need to "opt out" or tell us not to do this.
Disclosures include those that we feel are required to provide insurance claims or customer service, prevent fraud, perform
research or comply with the law. Recipients include, for example, our family of insurance companies, claims
representatives, service providers, consumer reporting agencies, insurance agents and brokers, law enforcement, courts
and government agencies. These parties may disclose the information to others as permitted by law. For example,
consumer reporting agencies may disclose Transaction Information received from us to other insurance companies with
which you do business.
Where permitted by law, we may also disclose Application or Transaction NPI to service providers that help us market our
products.
How do you protect my information?
We restrict access to your NPI to our employees and others who we feel must use it to provide our products and services.
Their use of NPI is limited by law, our employee code of conduct, and written agreements where appropriate. We also
maintain physical, electronic and procedural safeguards to protect your NPI.
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5. 611884804 Q IC94544 INS NOTICE POLWHITEFONT XFZQB6XAQMCKUFO6NHK66K6QYD0004 RPUID TRACWHITEFONT
Policy Number: 61188480-4
GREG LOBKOWSKI
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How can I review and correct information you have about me?
To review information we have about you, send a written request to Customer Service, P.O. Box 31260 Tampa, FL 33631.
You must describe the kind of information you want to review and state that your request is in response to this Privacy
Policy. Include your full name, mailing address, and policy number (if applicable). Within 30 business days, we will
describe what is available and how you may request corrections. We will also name anyone we show as having received
the information within two years prior to your request. Finally, we will identify the companies that have provided
Consumer Report Information about you.
You may review the information at our offices or receive a copy of it for a fee to cover our costs. We will not provide
information that we feel is privileged, such as information about insurance claims or lawsuits.
To correct information about you, send a written request as described above, explaining your desired correction. Within 30
business days, we will either make the requested correction or tell you why we will not. We cannot correct Consumer
Report Information, such as your credit report. To do this, you must contact the consumer reporting agency that provided
it.
If we make your requested correction, we will notify you in writing. We will also notify anyone named by you who may
have received the information within the previous two years. If required by law, we will also notify others who may have
given it to or received it from us. If we refuse to make the requested correction, you may file with us a concise written
statement about why you object, including the information you think is correct. Your statement will then become part of
your file. It will be sent to the same persons to whom we would send a copy of any correction or change.
Our family of insurance companies
This notice is from our family of insurance companies. As of the date of this Privacy Policy, this includes: Artisan and
Truckers Casualty Company, Drive New Jersey Insurance Company, Mountain Laurel Assurance Company, National
Continental Insurance Company, Progressive Advanced Insurance Company, Progressive American Insurance Company,
Progressive Bayside Insurance Company, Progressive Casualty Insurance Company, Progressive Choice Insurance
Company, Progressive Classic Insurance Company, Progressive County Mutual Insurance Company, Progressive Direct
Insurance Company, Progressive Express Insurance Company, Progressive Freedom Insurance Company, Progressive
Garden State Insurance Company, Progressive Gulf Insurance Company, Progressive Hawaii Insurance Corp., Progressive
Marathon Insurance Company, Progressive Max Insurance Company, Progressive Michigan Insurance Company,
Progressive Mountain Insurance Company, Progressive Northeastern Insurance Company, Progressive Northern Insurance
Company, Progressive Northwestern Insurance Company, Progressive Paloverde Insurance Company, Progressive Preferred
Insurance Company, Progressive Premier Insurance Company of Illinois, Progressive Professional Insurance Company,
Progressive Security Insurance Company, Progressive Select Insurance Company, Progressive Southeastern Insurance
Company, Progressive Specialty Insurance Company, Progressive Universal Insurance Company, Progressive West
Insurance Company, and United Financial Casualty Company.
Form 6488 CA (03/07)