DEC

ENERGIE
ECOD THANK YOU FOR INSURING WITH ECONOMICAL MUTUAL
E
0000005606
ECON
HA
CAUTO INSURANCE
ENGLISH ACCOUNT NO.
2022559
MRS FEBYLYN RODRIGUEZ
ECONOPAY
000020689603
NBS MRS FEBYLYN RODRIGUEZ
3101-204 EGLINTON AVE E ACCOUNT STATEMENT
07/04/2018
SCARBOROUGH ON M1J 2G3
07/04/2019 DATE JUL.19 2018
07/19/2018
00001 POLICY NO: 20689603P
N EXPIRY DATE: JUL.04 2019
BROKERPLEASE NOTE THAT THE PERSON OR ENTITY PAYING THE
PREMIUM ON THIS ACCOUNT MUST BE NOTIFIED OF ANY
CHANGES TO THIS ACCOUNT.
MIN1
EFFECTIVE DESCRIPTION OF ACTIVITY PREMIUMS NUMBER OF REVISED SALES SERVICE MONTHLY
DATE MONTHLY MONTHLY TAX CHARGE WITHDRAWAL
WITHDRAWALS PREMIUM
PREVIOUS BALANCE/DEPOSIT $0.00
JUL.04 2018 AUTO NEW BUSINESS PREMIUM $1,932.00
20689603 POLICY BALANCE $1,932.00 11 $175.64 $175.64

THE WITHDRAWAL ON AUG.08 2018 WILL BE $175.64

REMAINING
POLICY EXPIRY MONTHLY MONTHLY SALES SERVICE MONTHLY
NUMBER DATE WITHDRAWALS PREMIUM TAX CHARGE WITHDRAWAL
20689603 JUL.04 2019 AUTO 11 $175.64 $175.64

EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE
MONTHLY WITHDRAWALS FROM AUG.08 2018 >>
EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE $175.64

FOR PROFESSIONAL SERVICE AND ADVICE ON COVERAGE, CHANGES, OR CLAIMS CONTACT YOUR BROKER.
BILLYARD INSURANCE GROUP INC. 905-593-1289
207-2255 DUNDAS ST. W.
MISSISSAUGA, ON L5K 1R6 #5606

553 000
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ENGLISHAbout Your Premium Payments
Payment
MRS FEBYLYN Options
RODRIGUEZ
Your insurance premium can be paid through a variety of convenient payment options as listed below. If you’d like to change between our
payment plans (Three Pay or Monthly) please contact your independent insurance broker (or Waterloo Insurance Call Centre representative if
000020689603
applicable) before your policy renews.
NBS
Three Pay Plan
07/04/2018
07/04/2019
This payment option allows you to pay your premium in one to three instalments. Where applicable, you can conveniently pay your premium
07/19/2018
through your financial institution’s:
00001 · Internet banking service
N · telephone banking service
BROKER ·· automated
local branch
teller machine (ATM)

You will require:

MIN1 · your account number, and
· the company name as it appears on your statement (i.e. Economical Mutual, Missisquoi Insurance, Perth Insurance, Waterloo Insurance).
Payments are also accepted by cheque and can be mailed in the enclosed return mail envelope. Please ensure the statement stub is included.
If you have misplaced the envelope, please send your payment to: The Economical Insurance Group, PO Box 4537, STN A, Toronto,
Ontario, M5W 4P3. Please do not include additional correspondence when sending payments to this address.

Monthly Pay Plan

This payment option allows you to automatically pay your premium in monthly instalments from your Financial Institution account. It can be
easily arranged by your independent insurance broker (or Waterloo Insurance Call Centre representative if applicable). For property policies
under the payment plan a 3% service charge will be applied to your monthly premium. This equates to a 3% annual percentage rate (APR). No
service charges apply to Waterloo Insurance property policies. No service charges apply to any automobile policies written in Ontario.
About preauthorized payments:
· Monthly withdrawals are made on the day selected.
· New statements are issued to you if additional payments are required or if the withdrawal amount changes.
· Changes to your banking information must be received at least 14 days prior to your withdrawal date. Please ensure you keep banking
information up-to-date with us to avoid any possible interruption in coverage.

Additional Information
· Down payments received but not yet applied will show on the next statement.
· Payments are applied to your oldest outstanding account balance at the time of receipt.
· Premium credits may only be issued to the named policyholder or applied to the account balance.
· If a preauthorized payment withdrawal returns, a second attempt to obtain the funds may be made a minimum of three days after our
financial institution has been notified. In addition, an NSF charge may apply if the second attempt to withdraw funds is unsuccessful.
· Depending on legislation in your province of residence, a payment not received by the due date, or returned as NSF, may result in
cancellation of your policy.
· QEF34 - The tax on this personal insurance endorsement has been eliminated for all contracts. The premium therefore has been reduced
to compensate for the tax exemption.

Policy Changes?
Keeping us informed of changes that may affect your policy is essential. Please remember to notify your independent insurance broker (or
Waterloo Insurance Call Centre representative if applicable) immediately if any of the following change on your policy:
· named insureds
· vehicle or property the insurance is for
· address
· banking information (if paid by preauthorized payments)
· contact information
· changes/sale in business (commercial policies)

BROKER COPY
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ENERGIE CERTIFICATE OF AUTOMOBILE INSURANCE
ECO D ECONOMICAL MUTUAL INSURANCE COMPANY
(ONTARIO)

E
HEAD OFFICE
0000005606 WATERLOO
ECON ONTARIO
This is your Certificate of Automobile Insurance. Contact your Broker/Agent PAGE 1
HA with any questions or if you require clarification regarding your coverage choices.
CAUTO 5606
ENGLISH
AGENCY BILLYARD
OR
INSURANCE GROUP INC. 19-07-2018 C 20689603P
BROKER TEL. DATE PREPARED REPLACING POLICY NO. POLICY NO.
MRS FEBYLYN RODRIGUEZ 905-593-1289
MRS FEBYLYN RODRIGUEZ AUTO (A) LESSOR(S) (OPCF 5) (B) LIENHOLDER(S) (OPCF 23A) TO WHOM LOSS MAY BE JOINTLY PAYABLE
NO. NAME, ADDRESS AND POSTAL CODE
INSURED'S
NAME 3101-204 EGLINTON AVE E
000020689603
& SCARBOROUGH ON
PRIMARY M1J 2G3
NBS
ADDRESS
07/04/2018
POLICY EFFECTIVE DATE DAY MO. YR. POLICY EXPIRY DATE DAY MO. YR. ALL TIMES ARE LOCAL TIMES AT THE NAMED INSURED'S
07/04/2019 04 07 2018 04 07 2019 12.01 A.M. PRIMARY ADDRESS SHOWN ON THIS CERTIFICATE
07/19/2018
AUTO VEHICLE
NO. CODE
DESCRIBED AUTOMOBILES
MODEL YEAR AND MAKE MODEL/BODY TYPE V.I.N(SERIAL NO.) C.C.
NO. OF
CYLINDERS
PURCHASE PRICE/
LIST PRICE NEW
00001 1 75873 2004 GMC TRUCK/VAN SAVANA 2500 CARGO VAN 1GTGG25V941182906
N
BROKER
INSURANCE COVERAGES AUTOMOBILE 1
MIN1
LIABILITY Limit Premium Limit Premium Limit Premium Limit Premium
BODILY INJURY 2,000,000 717
PROPERTY DAMAGE INCLUSIVE INCL.
ACCIDENT BENEFITS (STANDARD BENEFITS) As Stated in As Stated in As Stated in As Stated in
Section 4 Section 4 Section 4 Section 4
of Policy 853 of Policy of Policy of Policy
OPTIONAL INCREASED ACCIDENT BENEFITS up to $ up to $ up to $ up to $
Income Replacement ($600/$800/$1,000) per week per week per week per week
Medical, Rehabilitation & Attendant Care ($130,000)
Medical, Rehabilitation & Attendant Care ($1,000,000)
Optional Catastrophic Impairment (additional
$1,000,000 added to Standard Benefit or Optional As Stated in As Stated in
Medical, Rehabilitation & Attendant Care Benefit) Section 4 As Stated in As Stated in
of Policy Section 4 Section 4 Section 4
Caregiver, Housekeeping & Home Maintenance of Policy of Policy of Policy
Death & Funeral
Dependant Care
Indexation Benefit (Consumer Price Index)
As Stated in As Stated in As Stated in As Stated in
UNINSURED AUTOMOBILE Section 5 11 Section 5 Section 5 Section 5
of Policy of Policy of Policy of Policy
DIRECT COMPENSATION - PROPERTY DAMAGE Deductible Deductible Deductible Deductible
This policy contains partial payment of recovery clause for property damage
if a deductible is specified for direct compensation-property damage. 113
LOSS OR DAMAGE Deductible Premium Deductible Premium Deductible Premium Deductible Premium
This policy contains a partial payment of loss clause. A deductible
applies for each claim except as stated in your policy.
ALL PERILS
COLLISION OR UPSET 500 136
COMPREHENSIVE ) EXCLUDING 500 59
)
SPECIFIED PERILS COLLISION OR UPSET
OPCF 44R FAMILY PROTECTION COVERAGE 2,000,000 43
PREMIUM SUBTOTALS $1932
AUTO POLICY CHANGE FORMS (OPCF No. and Name, including limit if applicable)
NO. OPCF PREMIUM
1 EPCF 20A TRANSPORTATION REPLACEMENT/DOWNTIME ENDORSEMENT TOTAL LIMIT $3000 75
1 SEASONAL SNOW PLOWING - NO

Total Policy Premium $1,932 FOR THIS NEW POLICY

Minimum Non-Refundable Premium
METHOD OF PAYMENT (ECONOPAY REF. NO.: 0002022559) - SEE ATTACHED INVOICE $15
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ENGLISH This is a brief explanation of the insurance outlined in this Certificate.
Liability
MRS FEBYLYN RODRIGUEZ
Provides coverage for you or other insured persons if someone else is killed or injured or their property is damaged in an automobile incident.
It will pay for legitimate claims against you or other insured persons up to the limit of your coverage, and the cost of settling claims.
Accident Benefits
Your insurance company is obligated to explain details of Accident Benefits coverage to you.
000020689603
Provides benefits that you and other insured persons are entitled to receive if injured or killed in an automobile accident. These benefits may
NBS include: income replacement for persons who have lost income; payments to non-earners who suffer complete inability to carry on a normal life;
payment of medical, rehabilitation and attendant care expenses; payment of certain other expenses; payment of funeral expenses and payments to
07/04/2018
survivors of a person who is killed. You may also purchase optional benefits to increase the standard level of benefits provided in the policy.
The optional benefits your insurance company must offer are: income replacement; medical, rehabilitation and attendant care; optional
07/04/2019
catastrophic impairment; caregiver, housekeeping and home maintenance; death and funeral; dependant care; and an indexation benefit.
07/19/2018
Uninsured Automobile
00001 Provides coverage if you or other insured persons are injured or killed by an uninsured motorist or by a hit-and-run driver. It covers damage
N to your automobile and its contents caused by an identified uninsured motorist.
BROKER
Direct Compensation - Property Damage
Provides coverage in Ontario, under certain conditions, for damage to your automobile and to property it is carrying, when another motorist is
responsible. It is called Direct Compensation because you will collect from us, your insurance company, even though you are not at fault for
the accident. There may be a deductible amount, and this amount is either paid by you toward the cost of repairs or is deducted from the loss
settlement. Higher deductibles may reduce your premium.
MIN1Loss or Damage
Provides a selection of optional coverages for your own automobile. Payments cover direct and accidental loss of, or damage to, a described
automobile and its equipment. There is usually a deductible amount indicated for each coverage and this amount is either paid by you toward
the cost of repairs or is deducted from the loss settlement. Higher deductibles may reduce your premium.
There are four types of coverages:
Specified Perils:
Covers the described automobile against loss or damage caused by certain specific perils. They are fire; theft or attempted
theft; lightning; windstorm; hail or rising water; earthquake; explosion; riot or civil disturbance; falling or forced landing of aircraft or parts of
aircraft; or the stranding, sinking, burning, derailment or collision of any kind of transport in or upon which the described automobile is being
transported.
Comprehensive:
Covers a described automobile against loss or damage other than those covered by Collision or Upset, including perils listed under Specified
Perils, falling or flying objects, missiles and vandalism.
\
Collision or Upset:
Covers damage when a described automobile is involved in a collision with another object or tips over.
All Perils:
Combines the Collision or Upset and Comprehensive coverages.

Warning: The Insurance Act provides that where (a) an Applicant for a contract, (i) gives false
particulars of the described automobile to be insured to the prejudice of the Insurer, or (ii) knowingly
misrepresents or fails to disclose in the application any fact required to be stated therein; or (b) the
Insured contravenes a term of the contract or commits a fraud; or (c) the Insured wilfully makes a
false statement in respect of a claim under the contract, a claim by the Insured, for other than such
statutory accident benefits as are set out in the Statutory Accident Benefits Schedule, is invalid and
the right of the Insured to recover indemnity is forfeited.
Warning - Offences
It is an offence under the Insurance Act to knowingly make a false or misleading statement or
representation to an Insurer in connection with the person's entitlement to a benefit under a
contract of insurance, or to wilfully fail to inform the Insurer of a material change in circumstances
within 14 days, in connection with such entitlement. The offence is punishable on conviction by a
maximum fine of $250,000 for the first offence and a maximum fine of $500,000 for any subsequent
conviction.
It is an offence under the federal Criminal Code for anyone to knowingly make or use a false
document with the intent it be acted on as genuine and the offence is punishable, on conviction, by
a maximum of 10 years imprisonment.
It is an offence under the federal Criminal Code for anyone, by deceit, falsehood or other dishonest
act, to defraud or to attempt to defraud an insurance company. The offence is punishable, on
conviction, by a maximum of 14 years imprisonment for cases involving an amount over $5,000 or
otherwise a maximum of 2 years imprisonment.
CANCELLATION REQUEST
(Fill out and sign when you cancel your policy)
In return for the unearned portion of the premium, if any, this policy is cancelled. Any interim and renewal certificates are no
longer valid.

a.m. Policy Number Signature of Named Insured

Time p.m. Effective Date of Cancellation Signature of Lienholder/Mortgagee/Lessor

553AU02B
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ENERGIE CERTIFICATE OF AUTOMOBILE INSURANCE
ECOD ECONOMICAL MUTUAL INSURANCE COMPANY
(ONTARIO)

E
HEAD OFFICE
0000005606 WATERLOO
ECON ONTARIO
PAGE 3
HA
CAUTO
ENGLISH RATING INFORMATION C 20689603P
Policy No.
MRS FEBYLYN RODRIGUEZ
DRIVER Age Marital Yrs Driver's Assignment Auto No. Convictions
Driver Name Status Lic. Training
000020689603
NO.
Last Name Given Names Principal Secondary Occasional Excluded Serious Major Minor
NBS 1 RODRIGUEZ FEBYLYN 41 SGL 14 1
07/04/2018
07/04/2019
07/19/2018
00001
N
BROKER

MIN1
AUTO Chargeable Claims as Indicated (X) Surcharges Discounts
NO. Date of Loss Liability - Accident Collision/
(Bodily Injury and/or All Perils % Description % Description
Day Month Year Property Damage) Benefits

1 CONVICTION FREE DISC

Gross Vehicle
AUTO Kilometres Driven Weight Rating
Class Description
NO. (Commercial
Annually To Work 1-Way vehicles only) Class Description

1 NOT AVAIL. 1200 36 CONTRACTOR

AUTO Driving Record Rate Group Rating Territory

NO. DCPD/
BI PD AB DCPD COLL/ AB COLL/ SP/ Terr. Description
AP AP COMP Code

1 6 6 6 6 6 7 7 01 GREATER TORONTO AREA

This Certificate is proof of a contract of insurance between the Named Insured and the Insurer subject in all respects
to the Ontario Automobile Policy (OAP1). In return for the premium charged and the statements contained in the Application,
the contract provides the coverage outlined in this Certificate. You only have particular coverage for a specific
automobile if this Certificate shows a premium for it, or shows the coverage is provided at no cost. All other terms of
the Policy remain the same unless stated otherwise in this Certificate. Your Insurer will provide you with a copy of the
Policy if you request it. This Certificate is only valid if it is signed by an authorized representative of the Insurer.

A
PRESIDENT AND CHIEF EXECUTIVE OFFICER

This certificate contains important information about your automobile insurance.

For purposes of the Insurance Companies Act (Canada), this document was issued in the course
of the Insurer's insurance business in Canada.
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@ENGLISH PAGE 4

MRS FEBYLYN RODRIGUEZ

000020689603
NBS
07/04/2018
07/04/2019
07/19/2018
00001
N
BROKER

MIN1

COMM SUR-A SUR-C

1 12.5 $1,932

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