The formats contained in this part must be used, but additional information may be included.
One vehicle insured.
Coverage | Premium with no accidents |
Premium including surcharge for one chargeable accident | Premium including surcharge for two chargeable accidents |
Bodily injury, property damage | $ 80 . | $ _ | $ _ |
Uninsured motorist | $ 5 . | $ _ | $ _ |
Personal injury protection | $ 40 . | $ _ | $ _ |
Comprehensive | $ 25 . | $ _ | $ _ |
Collision | $ 50 . | $ _ | $ _ |
Total Premium | $200 | $ | $ |
Two vehicles insured. Accidents chargeable to the principal operator of vehicle number one, while operating vehicle number one.
Vehicle number one.
Coverage | Premium with no accidents |
Premium including surcharge for one chargeable accident | Premium including surcharge for two chargeable accidents |
Bodily injury, property damage | $ 80 . | $ _ | $ _ |
Uninsured motorist | $ 5 . | $ _ | $ _ |
Personal injury protection | $ 40 . | $ _ | $ _ |
Comprehensive | $ 25 . | $ _ | $ _ |
Collision | $ 50 . | $ _ | $ _ |
Total Premium | $200 | $ | $ |
Vehicle number two.
Coverage | Premium with no accidents |
Premium including surcharge for one chargeable accident | Premium including surcharge for two chargeable accidents |
Bodily injury, property damage | $120 . | $ _ | $ _ |
Uninsured motorist | $ 5 . | $ _ | $ _ |
Personal injury protection | $ 60 . | $ _ | $ _ |
Comprehensive | $ 40 . | $ _ | $ _ |
Collision | $ 75 . | $ _ | $ _ |
Total Premium | $300 | $ | $ |
MS s 65B.133
September 14, 2007
Official Publication of the State of Minnesota
Revisor of Statutes