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Yearly Mileage0-50005001 - 1000010001 - 1500015001 - 2000020001 - 2500025000 +
$30/60 BI / 25 PD$50/100 BI / 50 PD$100/300 BI / 50 PD$250/500 BI / 100 PD$1 MillionOthers
No Coverage$250 Deductible$500 Deductible$1000 DeductibleOthers
MaleFemale
SingleMarried
YesNo
Minor Violations - Speeding, Turn, Stop Sign, Red Light, etc.:
None012345
Accidents - Non Chargeable:
Accidents - Chargeable:
Chargeable Accident Cost ($):
Major Violations - Drunk driving, Reckless, Hit And Run, etc.:
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