By checking the box and submitting this form, I acknowledge and agree that:
I will not upload files containing viruses, malware, unlawful material, or content that infringes or violates another person’s intellectual property, privacy, or other legal rights. I represent that I am authorized to submit all uploaded documents. To the fullest extent permitted by law, I agree to be responsible for claims, damages, losses, or costs caused by content I upload or by my violation of this agreement and to indemnify and hold harmless Pacific Preferred Insurance Brokers, LLC from such claims.
I understand that submitting this form and uploading documents is only a request to reapply for insurance or apply for coverage for an additional vehicle through California’s Low Cost Automobile Insurance Program. This submission is not an insurance application, binder, policy, or confirmation of coverage. It does not bind, secure, issue, reinstate, renew, add, alter, amend, or extend insurance coverage, nor does it guarantee eligibility, acceptance, an insurer assignment, a premium, or an effective date.
I must speak with a California-licensed insurance producer to review eligibility and complete and finalize any application for new insurance. Coverage is not effective unless and until the application process has been completed, all Program requirements have been satisfied, any required payment has been accepted, and coverage and its effective date have been confirmed by an authorized party. I will not drive, cancel existing insurance, or otherwise rely on this submission as evidence that coverage is in effect.