Missouri Auto Insurance

Having auto insurance coverage protects your family and property.
From liability coverages that protect your financial stability to
comprehensive and collision coverage that protect your investment in your car,
quality auto insurance coverage is the foundation of a solid financial plan.

Insurance can help:

•Protect your investment in your car or truck

•Help pay for medical expenses after an accident

•Provide financial protection from lawsuits

•Pay for losses caused by underinsured or uninsured drivers

•Pay for damage from theft, vandalism or natural disasters

Auto insurance coverage helps you to meet whatever might be coming down the road
with a greater peace of mind.

Remember, however, not all coverages are the same.
When determining what kind of Missouri auto insurance coverage applies to you,
consider your specific situation.
Different types of coverage options and limits fit the different needs a person might have.
Automobile Insurance
Jim Rice TOTAL Insurance, Inc.
816-630-7423
Copyright Jimricetotalinsuranceinc, 2012 All rights reserved
24-Hour Roadside Services

Services Include:
•Bi-lingual product support
•Towing and rental
reimbursement programs
•Flexible tow benefit levels
•Battery boosts, jumpstarts -
Includes minor adjustments to
cables or cable cleaning as may
available
•Lockout services - Involves
gaining entry to locked vehicle
•Tire changes - Changing a flat
tire from mount to wheel using a
good spare
•Essential fluids/ supply delivery -
We pay the cost of delivery of any
needed fluid or supply. The cost
of materials delivered is not
included
•Minor on-site mechanical
assistance/ adjustment - As may
be available from time to time

Separate from any auto
policy:
Pays for itself the first time
tow service is used.
Stop immediately. Keep calm. Do not argue, accuse anyone,
or make any admission of blame for the
accident. Do not leave the scene, however, if the vehicles are
operable, move them to the shoulder of the
road and out of the way of oncoming traffic.
Warn oncoming traffic.
Call medical assistance for anyone injured. Do what you can
to provide first aid, but do not move them
unless you know what you are doing.
Call appropriate law enforcement authorities.
Get information requested in this form.
Call the 800 claim # for your insurance company

Your Vehicle Information
Owner: __________________________________________
Phone: (________)_________________________________
Address: _________________________________________
_________________________________________________
Make/Model: ______________________________________
Vehicle ID:
________________________________________
License Plate #: ___________________________________
State License Issued: _______________________________
Driver's Name: ____________________________________
Phone: (________)_________________________________
Address: _________________________________________
_________________________________________________
Driver's License #
_________________________________________________
State License Issued:
_________________________________________________
Area of Damage:
_________________________________________________
Other Vehicle
Owner: __________________________________________
Phone: (________)_________________________________
Address: _________________________________________
_________________________________________________
Make/Model: ______________________________________
Vehicle ID:
________________________________________
License Plate #: ___________________________________
State License Issued: _______________________________
Driver's Name: ____________________________________
Phone: (________)_________________________________
Address: _________________________________________
_________________________________________________
Driver's License #
_________________________________________________
State License Issued:
_________________________________________________
Area of Damage:
_________________________________________________
Address: _________________________________________
Injured Person
Name: __________________________________________
Phone: (________)_________________________________
Address: _________________________________________
_________________________________________________
Age: _____________________________________________
Extent of Injury: ____________________________________
Damage to Other Property
Owner: __________________________________________
Phone: (________)_________________________________
Address: _________________________________________
________________________________________________
Nature of Damage:
______________________________________________
______________________________________________
Accident Facts
Date: ______________________________________________
Time: ______________________________________________
City: __________________________________________
Street: __________________________________________
Condition of Road: _________________________________
Weather: _________________________________________
Direction of your car: ________________________________
Speed of your car: __________________________________
Direction of other car:
_________________________________________________
Speed of other car:
_________________________________________________
Did the police take a report?:
_________________________________________________
Responding police department:
_________________________________________________
Case / Report Number:
_________________________________________________
Street: ___________________________________________
Condition of Road: _________________________________
Weather: _________________________________________
Direction of your car: ________________________________
Speed of your car: __________________________________
Direction of other car:
_________________________________________________
Speed of other car:
_________________________________________________
Case / Report Number:
_________________________________________________
Please give a brief description of how the accident occurred:
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
Witnesses
Name:
_______________________________________________
Phone: (________)
_______________________________________________
Address:
_______________________________________________
______________________________________________________________________________________________
Name:
_______________________________________________
Phone: (________)
_______________________________________________
Address:
_______________________________________________
___________________________________________________
Immediately report any accidents to your insurance company. If
you are not the owner of the car
you were driving at the time of the accident, report the accident
to both your insurance company
and to the owner’s insurance company. If you were driving a
company owned business vehicle,
report the accident promptly in accordance with your company’s
instructions. Make prompt
written report to authorities as required by law.