Registration Plates Not Issued for a Specific Auto
NOTE: This worksheet is non-binding and may differ from the actual premium calculated for the policy once the application is submitted. Actual premium can only be calculated following receipt of a properly completed and executed application.
Instructions: If Experience Rating is applicable, use the Experience Rating Worksheet to determine the rating factor (CANNOT = 0!). Make selections, enter the requested information, and click the TOTAL PREMIUM button.
	Experience Rating Factor:
Rates Effective: July 1, 2008 Territory Select 11 12 13 17 18 19 23 24 25 26 28 30 31 32 33 34 35 Number of Plates: UM?  MLPD?	Note: Not all limits are available for all risks - click for more info. BI Limits $20/40,000 25/50 50/100 100/300 250/500 500/500 500/1,000 1,000/1,000 100,000 CSL 1,000,000 CSL   PD Limits $10,000 25,000 50,000 100,000 250,000 500,000 1,000,000 100,000 CSL 1,000,000 CSL     Select PIP Not Principally Operated by Employees Principally Operated by Employees Immediate Coverage?	Coverage/Base/Premiums BI  PD  PPI  PIP  UM  MLPD  TOTAL
		Minimum Deposit =