# UNINSURED MOTORISTS INSURANCE

## COVERAGE PART

**For attachment to Policy No.:** [Policy Number]

**Schedule**

The insurance afforded is only with respect to the following coverage as indicated by specific premium charge. The limit of the company's liability shall be as stated herein, subject to all the terms of this policy having reference hereto.

| Coverage | Limits of Liability | Premium |
| --- | --- | --- |
| U. Uninsured Motorists | Thousand dollars each person | Thousand dollars each accident |
| Form numbers of endorsements attached at issue |  | Total Advance Premium: |

**Designated Insured**

- Any automobile owned by the named insured
- Any private passenger automobile leased to the named insured
- Any highway vehicle to which are attached dealer's license plates issued to the named insured
- Any highway vehicle designated in the declarations of the policy by the letters "UM" and a highway vehicle ownership of which is acquired during the policy period by the named insured as a replacement therefor
- Any mobile equipment owned or leased and by and registered in the name of the named insured

### Description of Insured Highway Vehicles (Check appropriate box)

- Any automobile owned by the named insured
- Any private passenger automobile leased to the named insured
- Any highway vehicle to which are attached dealer's license plates issued to the named insured
- Any highway vehicle designated in the declarations of the policy by the letters "UM" and a highway vehicle ownership of which is acquired during the policy period by the named insured as a replacement therefor
- Any mobile equipment owned or leased and by and registered in the name of the named insured

#### 1. COVERAGE — UNINSURED MOTORISTS (Damages for Bodily Injury)

The company will pay all sums which the insured or his legal representatives shall be legally entitled to recover as damages from the owner or operator of any uninsured highway vehicle because of bodily injury to such person or organization caused by accident and arising out of the ownership, maintenance, or use of such uninsured highway vehicle; provided, for the purposes of this coverage, "causation as to whom the insured or such representative shall be legally entitled to recover such damages, and if so the amount thereof shall be made by agreement between the insured or such representative and the company or, if they fail to agree, by arbitration.

No judgment against any person or organization shall be legally responsible for bodily injury liability under this coverage unless such judgment is based upon a finding that the cause of death or injury of such person or organization or the amount of damages to which the insured is legally entitled unless such judgment is obtained pursuant to an action prosecuted by the insured with the written consent of the company.

#### Exclusions

This insurance does not apply:

(a) To bodily injury to an insured with respect to which such insured, his legal representative or any person entitled to payment under this insurance shall, without the written consent of the company, settle with any person or organization who may be legally liable therefor;

(b) To bodily injury to an insured while occupying a highway vehicle other than an insured highway vehicle, except that, if the insured, any designated insured, any designated lessee, or any member residing in the same household as the insured is being transported in such vehicle through being struck by another vehicle;

(c) To bodily injury to an insured directly or indirectly to the benefit of any workman's compensation or disability benefits carrier or any person or organization qualifying as a self-insurance entity under a compensation or disability benefits law of any state or territory.

#### II. PERSONS ELIGIBLE FOR COVERAGE

Each of the following is an insured under this insurance to the extent set forth below:

(a) The insured named and any designated insured and, while residents of the United States, his spouse and children under 21 years of age;

(b) Any other person while occupying an insured highway vehicle, and

(c) Any person with respect to damages he is entitled to recover because of bodily injury to which this insurance applies sustained by an insured named (a) or (b) above.

The insurance applies separately with respect to each insured, except with respect to the limits of the company's liability.

#### III. LIMITS OF LIABILITY

Regardless of the number of persons or organizations who are insureds under this policy, 20 persons who sustain bodily injury, 12 claims made or suits brought on account of bodily injury, or 4 highway vehicles to which this policy applies.