# Chubb Global Casualty

## Limits and Coverages

**Automobile**

**Policy Number:** ISA H25579070

### Policy Limits - Automobile Liability

| Coverage | Symbol | Limit |
|----------|--------|-------|
| Liability | 1      | 5,000,000 |
| Medical Payments | 2 | 5,000 |
| Personal Injury Protection | 2 | 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 | 0307 | | |
| DEFINITION OF BODILY INJURY | DA22185b | 0614 | | |
| DIRECT ACTION EXPENSES | ALL44289e | 1116 | | |
| DRIVE OTHER CAR COVERAGE - BROADENED COVERAGE FOR NAMED INDIVIDUALS | CA9910 | 1013 | Limits and coverages [u/w input required]; 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: 0; Name or Class of Individuals: 0; Liability Limit: 5,000,000; Medical Payments Excluded; Comprehensive Deductible Excluded; | |

**INTERNA_05212023_William Overby**

**04/28/2023**

**Limits and Coverages Page 40 of 55**