# Limits and Coverages

**Automobile**

**Policy Number:** ISA H2556571A

## Policy Limits - Automobile Liability

| Coverage | Symbol | Limit |
|----------|--------|-------|
| Liability | 1      | 5,000,000 |
| Medical Payments | 2 | 5,000 |
| Personal Injury Protection | 5 | Stat & Reject |
| Additional Personal Injury Protection | N/A | Not Covered |
| Uninsured Motorist | 6 | Stat Min/Reject |
| Underinsured Motorist | 6 | Stat Min/Reject |

## Policy Form and Endorsements

- The policy forms and endorsements offered may be different than those requested.
- State mandatory endorsements will be attached to the policy in addition to those listed below.

| Title | Form # | Ed. | Restriction in Coverage from Prior Year | Comments |
|-------|--------|-----|--------------------------------------|-----------|
| BUSINESS AUTO | CA 00 01 | 10-13 | - | - |
| ADDITIONAL INSURED - DESIGNATED PERSONS OR ORGANIZATIONS | DA9U74c | 0316 | Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. | - |
| ADDITIONAL INSURED - LESSOR | CA2001 | 1120 | Additional Insured: Any Lessor whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss; Description of Leased Autos: All autos leased by you; Limit/Deductible: $5,000,000 / Excluded | - |
| AUTO MEDICAL PAYMENTS COVERAGE | CA9903 | 1013 | - | - |
| CONTRACTUAL LIABILITY COVERAGE | DA21916 | 0507 | - | - |
| DEFINITION OF BODILY INJURY | DA22185b | 0614 | - | - |
| DIRECT ACTION EXPENSES | ALL44289c | 1116 | - | - |
| DRIVE OTHER CAR COVERAGE - BROADENED COVERAGE FOR NAMED INDIVIDUALS | CA9910 | 1013 | Name of Individual: Any employee assigned a company vehicle holding a position of senior vice president or higher who is not an insured under a personal auto liability policy purchased by that employee or a "family member" Number of Individuals o; Name or Class of Individuals o; Liability Limit: 5,000,000; Medical Payments: Excluded; Comprehensive Deductible: Excluded; Collision Deductible: Excluded; UM Excluded; UIM Excluded | - |