<?xml version="1.0" encoding="utf-8"?>
<InsuranceRequest xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema">
	<AffiliateInfo>
		<PartnerID>3</PartnerID>
		<Token>G15QncRptYzJftqUauVyodKvsoZWxArrfsgdetg</Token>
		<TrackingCampaign>MyCampaign</TrackingCampaign>
		<LeadSourceID>InHouse</LeadSourceID>
		<LeadIdToken>3DDAB3DF-978B-4E65-D2C6-79A3BC71D155</LeadIdToken>
		<ProductionEnvironment>true</ProductionEnvironment>
	</AffiliateInfo>
	<DistributionDirectives>
		<Cap>5</Cap>
		<DistributionCount>3</DistributionCount>
		<Excludes>
			<Exclude>
				<CarrierName>Independent</CarrierName>
				<LicenseNumber>4491903731590</LicenseNumber>
			</Exclude>
			<Exclude>
				<CarrierName>Allstate</CarrierName>
			</Exclude>
			<Exclude>
				<CarrierName>State Farm</CarrierName>
			</Exclude>
		</Excludes>
	</DistributionDirectives>
	<LeadTypeID>1</LeadTypeID>
	<ZipCode>43215</ZipCode>
	<AutoInsurance>
		<Vehicles>
			<Vehicle>
				<Id>1</Id>
				<Vin>1G1JF31W*K*******</Vin>
				<Year>1989</Year>
				<Make>CHEV</Make>
				<Model>CAVALIER Z24</Model>
				<SubModel>_</SubModel>
				<Owner>Leased</Owner>
				<Garage>Private</Garage>
				<PrimaryUse>Commute School</PrimaryUse>
				<OneWay>85</OneWay>
				<AnnualMileage>25000</AnnualMileage>
				<Salvaged>false</Salvaged>
				<Comprehensive>500</Comprehensive>
				<Collision>2500</Collision>
			</Vehicle>
			<Vehicle>
				<Id>2</Id>
				<Vin>1FTZF08W*X*******</Vin>
				<Year>1999</Year>
				<Make>FORD</Make>
				<Model>F150</Model>
				<SubModel>_</SubModel>
				<Owner>Owned</Owner>
				<Garage>Private</Garage>
				<PrimaryUse>Commute School</PrimaryUse>
				<OneWay>62</OneWay>
				<AnnualMileage>50000</AnnualMileage>
				<Salvaged>true</Salvaged>
				<Comprehensive>No Coverage</Comprehensive>
				<Collision>250</Collision>
			</Vehicle>
		</Vehicles>
		<Drivers>
			<Driver>
				<Id>1</Id>
				<FirstName>John</FirstName>
				<LastName>Doe</LastName>
				<Gender>Male</Gender>
				<Marital>Domestic Partner</Marital>
				<DOB>1992-07-25</DOB>
				<Relation>Self</Relation>
				<DLicenseState>CT</DLicenseState>
				<DLicenseStatus>Temporary</DLicenseStatus>
				<LicensedAge>17</LicensedAge>
				<VehicleId>1</VehicleId>
				<Filing>false</Filing>
				<Education>Doctorate Degree</Education>
				<Occupation>Self Employed</Occupation>
				<GoodStudent>false</GoodStudent>
				<Suspension>false</Suspension>
			</Driver>
			<Driver>
				<Id>2</Id>
				<FirstName>Jane</FirstName>
				<LastName>Doe</LastName>
				<Gender>Female</Gender>
				<Marital>Married</Marital>
				<DOB>1988-07-25</DOB>
				<Relation>Other</Relation>
				<DLicenseState>ND</DLicenseState>
				<DLicenseStatus>Probation</DLicenseStatus>
				<LicensedAge>18</LicensedAge>
				<VehicleId>2</VehicleId>
				<Filing>false</Filing>
				<Education>High School Diploma</Education>
				<Occupation>Homemaker</Occupation>
				<GoodStudent>false</GoodStudent>
				<Suspension>false</Suspension>
			</Driver>
		</Drivers>
		<Incidents>
			<Ticket>
				<DriverId>1</DriverId>
				<Date>2010-06-25</Date>
				<Description>Speeding</Description>
			</Ticket>
			<Ticket>
				<DriverId>1</DriverId>
				<Date>2010-10-30</Date>
				<Description>Child Seat</Description>
			</Ticket>
			<Ticket>
				<DriverId>2</DriverId>
				<Date>2011-02-09</Date>
				<Description>Other Ticket</Description>
			</Ticket>
			<Ticket>
				<DriverId>2</DriverId>
				<Date>2008-08-29</Date>
				<Description>Failure to Stop</Description>
			</Ticket>
			<Ticket>
				<DriverId>2</DriverId>
				<Date>2011-02-15</Date>
				<Description>Child Seat</Description>
			</Ticket>
			<Claim>
				<DriverId>2</DriverId>
				<Date>2010-06-26</Date>
				<Description>Vandalism Damage</Description>
				<PaidAmount>8300</PaidAmount>
			</Claim>
			<Claim>
				<DriverId>2</DriverId>
				<Date>2009-02-27</Date>
				<Description>Loss Claim Not Listed</Description>
				<PaidAmount>700</PaidAmount>
			</Claim>
			<Claim>
				<DriverId>2</DriverId>
				<Date>2009-04-24</Date>
				<Description>Vehicle Stolen</Description>
				<PaidAmount>6900</PaidAmount>
			</Claim>
			<Claim>
				<DriverId>2</DriverId>
				<Date>2010-06-06</Date>
				<Description>Loss Claim Not Listed</Description>
				<PaidAmount>8300</PaidAmount>
			</Claim>
		</Incidents>
		<ApplicantInfo>
			<Credit>Good</Credit>
			<Residence>Own</Residence>
		</ApplicantInfo>
		<CurrentInsurance>
			<CurrentlyInsured>false</CurrentlyInsured>
		</CurrentInsurance>
		<RequestedCoverage>Standard</RequestedCoverage>
	</AutoInsurance>
</InsuranceRequest>