Executive Umbrella Insurance Invoice

--- ## Page 1 12-0025-00                                32130 (12-24) ### Agency Information **HUB INTERNATIONAL FLORIDA** 4830 W KENNEDY BLVD STE 850 TAMPA FL 33609-2593 **INVOICE** 00013024 **Agency phone:** (727) 797-0441 ### Insurance Company **Auto-Owners INSURANCE** LIFE · HOME · CAR · BUSINESS 1-800-288-8740 www.auto-owners.com ### Statement Details **Auto-Pay (EFT)** **Statement date:** 11/24/2025 **EXECUTIVE UMBRELLA 50-989154-01** see reverse side **Account:** 015413721 ### Insured Information JOHAN JONGSMA TATYANA JONGSMA 851 BRIGHTWATERS BLVD NE SAINT PETERSBURG FL 33704 ### Account Summary | **Payment Plan** | Full Pay | |:--|:--| | **Current Balance** | $2,108.88 | | **Minimum Due** | Auto-Pay | ### Automatic Payment Notice An automatic payment of $2,108.88 will be initiated on 12/12/2025. No action is required. 5104111 --- ## Page 2 ### Policies on Account 015413721 | Policy | Current Balance | Minimum Due | |--------|----------------|-------------| | EXECUTIVE UMBRELLA
50-989154-01 - effective 12/12/2024 | $0.00 | $0.00 | | EXECUTIVE UMBRELLA
50-989154-01 - effective 12/12/2025 | $2,108.88 | $2,108.88 | ### Access your policy at any time and on any device with online access View policy documents, make payments, check claim status and more. Visit **customercenter.auto-owners.com** to sign up or scan the QR code to get started. ### Important Billing Information - A fee of up to $15.00 may be charged if a cancellation bill is issued (except IL, IA, MI, ND, NC, & VA). - IL, IA, MI, ND, NC, & VA only - A fee of $15.00 is charged if a cancellation bill is issued and your insurance is continued or reinstated. No fee is charged if your insurance is cancelled and not reinstated. - A fee of up to $15.00 may be charged for returned items. Returned items may be represented as an electronic ACH transaction. - A fee of up to $0.00 may be charged when making a payment by phone. - A billing fee of up to $3.00 may be charged for each bill. No fee is charged for accounts on the full pay payment plan, or accounts on other payment plans when fully paperless and set up for automatic EFT payments. The fee is reduced to $2.00 for accounts receiving paper bills when set up for automatic EFT payments. - Payments and credits may be applied to all lines of business on the same billing account and may be applied from one policy term to another. Payments received for less than the billed amount may be pro-rated to each policy and may result in the cancellation of all policies for non-payment of premium.