STATE 

OF MICHIGAN CERTIFICATE OF NO-FAULT INSURANCE Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle registered in
this state must have insurance or other approved security for the payment of no-fault benefits on the
COMPANY AGENCY/COMPANY ISSUING CARD vehicle at all times. An owner or registrant who drives or permits a vehicle to be driven upon a public
Esurance Property and Casualty Insurance Company Esurance Insurance Services, Inc. highway without the proper insurance or other security is guilty of a misdemeanor.
650 Davis Street P.O. Box 5250
San Francisco, CA 94111 An owner or registrant convicted of such a misdemeanor shall be fined not less than $200.00 nor more
Sioux Falls, SD 57117-5250
NAIC# 30210 than $500.00, or imprisonment for not more than 1 year, or both.
1-800-ESURANCE (1-800-378-7262)
POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE A PERSON WHO SUPPLIES FALSE INFORMATION TO THE SECRETARY OF STATE OR WHO
PAMI-008933116 January 22, 2021 July 22, 2021 ISSUES OR USES AN INVALID CERTIFICATE OF INSURANCE IS GUILTY OF A MISDEMEANOR
MAKE/MODEL PUNISHABLE BY IMPRISONMENT FOR NOT MORE THAN 1 YEAR, OR A FINE OF NOT MORE
YEAR VEHICLE IDENTIFICATION NUMBER
THAN $1,000.00, OR BOTH
2018 Ford/FUSION SE 3FA6P0H77JR217723
WARNING - when a named excluded person operates a vehicle, all liability coverage is void - no one is
INSURED ADDITIONAL LISTED DRIVER(S) insured. Owners of the vehicle and others legally responsible for the acts of the named excluded
person remain fully responsible.
ALEXANDER V WEIR-WITMER
624 E 4TH ST A named excluded driver is not entitled to be paid personal protection benefits for accidental bodily
MONROE, MI 48161 injury if at the time of the accident the named excluded driver was operating a motor vehicle as to
which he or she was named as an excluded driver.

An authorized Michigan insurer, certifies that it has issued a policy complying with Act 294, P.A. 1972, as
amended for the described motor vehicle.
WARNING: KEEP THIS CERTIFICATE IN YOUR VEHICLE AT ALL TIMES.
If you fail to produce it upon a police officer's request, you will be responsible
for a civil infraction.

 
 STATE OF MICHIGAN CERTIFICATE OF NO-FAULT INSURANCE Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle registered in
this state must have insurance or other approved security for the payment of no-fault benefits on the
COMPANY AGENCY/COMPANY ISSUING CARD vehicle at all times. An owner or registrant who drives or permits a vehicle to be driven upon a public
Esurance Property and Casualty Insurance Company Esurance Insurance Services, Inc. highway without the proper insurance or other security is guilty of a misdemeanor.
650 Davis Street P.O. Box 5250
San Francisco, CA 94111 An owner or registrant convicted of such a misdemeanor shall be fined not less than $200.00 nor more
Sioux Falls, SD 57117-5250
NAIC# 30210 than $500.00, or imprisonment for not more than 1 year, or both.
1-800-ESURANCE (1-800-378-7262)
POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE A PERSON WHO SUPPLIES FALSE INFORMATION TO THE SECRETARY OF STATE OR WHO
PAMI-008933116 January 22, 2021 July 22, 2021 ISSUES OR USES AN INVALID CERTIFICATE OF INSURANCE IS GUILTY OF A MISDEMEANOR
MAKE/MODEL PUNISHABLE BY IMPRISONMENT FOR NOT MORE THAN 1 YEAR, OR A FINE OF NOT MORE
YEAR VEHICLE IDENTIFICATION NUMBER
THAN $1,000.00, OR BOTH
2018 Ford/FUSION SE 3FA6P0H77JR217723
WARNING - when a named excluded person operates a vehicle, all liability coverage is void - no one is
INSURED ADDITIONAL LISTED DRIVER(S) insured. Owners of the vehicle and others legally responsible for the acts of the named excluded
person remain fully responsible.
ALEXANDER V WEIR-WITMER
624 E 4TH ST A named excluded driver is not entitled to be paid personal protection benefits for accidental bodily
MONROE, MI 48161 injury if at the time of the accident the named excluded driver was operating a motor vehicle as to
which he or she was named as an excluded driver.

An authorized Michigan insurer, certifies that it has issued a policy complying with Act 294,
P.A. 1972, as amended for the described motor vehicle.

SECRETARY OF STATES COPY