CIA Auto NOT Choosing Endorsements

I am purchasing an auto insurance policy through Cypert Insurance Agency. Cypert Insurance has explained to me the coverages within the policy to my satisfaction. I understand that it is my responsibility to know and understand my policy coverages and limits.

Cypert Insurance has explained the following auto policy coverages to me and I have signed my initials next to the coverages I have decided to NOT add to my auto policy.

Comprehensive Coverage

Collision Coverage

Loss of Use (rental) Coverage

Cypert Insurance has explained the difference between low comprehensive and collision deductibles and high deductibles. I have signed my initials next to the coverages I have chosen to have deductibles higher than $1000.

Comprehensive

Collision

Cypert Insurance has encouraged me against the State minimum liability limits (30/60/25). I am choosing these liability limits.

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Name

Carrier

Signature

Policy Number

Date

CIA Producer Initial