DO NOT SIGN UNTIL YOU READ

Transcription

1 ARIZONA UNINSURED MOTORISTS COVERAGE AND UNDERINSURED MOTORISTS COVERAGE SELECTION/REJECTION TRUMBULL INSURANCE COMPANY HARTFORD ACCIDENT AND INDEMNITY COMPANY Name of Insured: Arizona law permits you to make certain decisions regarding UNinsured Motorists Coverage and UNDERinsured Motorists Coverage. This document describes these coverages and the options available. You should read this document carefully and contact us or your agent if you have any questions regarding UNinsured Motorists Coverage or UNDERinsured Motorists Coverage and your options with respect to these coverages. This document includes general descriptions of coverage. However, no coverage is provided by this document. You should read your policy and review your Declarations Page(s) and/or Schedule(s) for complete information on the coverages your policy provides. DO NOT SIGN UNTIL YOU READ You have a legal right to purchase both UNinsured and UNDERinsured Motorist coverages with the proposed automobile liability policy. THESE COVERAGES PROTECT YOU AND YOUR PASSENGERS. IN ADDITION, IF THE NAMED INSURED IS AN INDIVIDUAL YOUR FAMILY MEMBERS ARE PROTECTED. UNinsured motorist insurance provides protection for bodily injuries caused by a negligent motorist who has no insurance. UNDERinsured motorist coverage provides protection if the negligent motorist does not have enough liability insurance to pay for the injuries caused. For a more detailed explanation of these coverages, refer to your policy. Your policy provides UNinsured/UNDERinsured coverage in the same amount as the policy's Bodily Injury Liability Limit, unless you select a lower amount or no coverage, as stated in this notice. You have a right to purchase both UNinsured Motorist coverage and UNDERinsured Motorist coverage in any amount shown on the following list of Available Combined Single Limit up to your policy's bodily injury liability limit, or you may reject the coverage entirely. Neither limit may exceed your liability coverage limits for Bodily Injury. Your Bodily Injury Limit on the policy: 2013, The Hartford (Includes copyrighted material of Insurance Services Office with its permission.) Page 1 of 6

2 A. Mandatory Offer Of UNinsured Motorists Coverage Please indicate a choice from either 1., 2., or 3. below by initialing next to the appropriate item. 1. Selection Of UNinsured Motorists Coverage I select UNinsured Motorists Coverage at limits equal to the limits of my Liability Coverage. $ Premium 2. Rejection Of UNinsured Motorist Coverage I reject UNinsured Motorists Coverage. Page 2 of 6

3 3. Rejection Of UNinsured Motorists Coverage At Limits Equal To Liability Coverage Limits I reject UNinsured Motorists Coverage at limits equal to the limits of my Liability Coverage and I select the following lower limit: (Choose one): Available Combined Single Limits Premium Charge For Each Arizona Auto *Private Passenger *All Other $ 30,000 $25 $21 40,000 $28 $23 50,000 $30 $25 100,000 $38 $31 125,000 $40 $33 150,000 $42 $35 200,000 $46 $37 250,000 $48 $39 300,000 $50 $41 350,000 $52 $42 400,000 $54 $44 500,000 $56 $45 600,000 $58 $47 750,000 $60 $49 1,000,000 $62 $50 1,500,000 $65 $53 2,000,000 $66 $54 (Other) $ $ *If you select Uninsured Motorist Coverage equal to your policy Liability Insurance Limit, any change in your policy Liability Limits will result in a change to your Uninsured Motorist Coverage. Note: If you are an individual Named Insured, add $2 to each of the above per auto premium charges. If your policy is composite rated, the premium charges shown above are estimates only. Your actual premium charge for Uninsured Motorist Coverage will be calculated based upon the coverage limit you selected and the types of automobiles garaged in the various jurisdictions in which you do business and will be part of the composite rate shown in the policy. Page 3 of 6

4 B. Mandatory Offer Of UNDERinsured Motorists Coverage Please indicate a choice from either 1., 2., or 3. below by initialing next to the appropriate item. 1. Selection Of UNDERinsured Motorists Coverage I select UNDERinsured Motorists Coverage at limits equal to the limits of my Liability Coverage. 2. Rejection Of UNDERinsured Motorist Coverage I reject UNDERinsured Motorists Coverage. Page 4 of 6

5 3. Rejection Of UNDERinsured Motorists Coverage At Limits Equal To Liability Coverage Limits I reject UNDERinsured Motorists Coverage at limits equal to the limits of my Liability Coverage and I select the following lower limit: (Choose one): Available Combined Single Limits Premium Charge For Each Arizona Auto *Private Passenger *All Other $ 30,000 $26 $17 40,000 $33 $22 50,000 $39 $25 100,000 $64 $41 125,000 $75 $49 150,000 $84 $54 200,000 $100 $65 250,000 $111 $72 300,000 $120 $78 350,000 $129 $84 400,000 $136 $88 500,000 $148 $96 600,000 $157 $ ,000 $170 $110 1,000,000 $185 $120 1,500,000 $205 $133 2,000,000 $218 $142 (Other) $ $ *If you select Uninsured Motorist Coverage equal to your policy Liability Insurance Limit, any change in your policy Liability Limits will result in a change to your Uninsured Motorist Coverage. Note: If you are an individual Named Insured, add $2 to each of the above per auto premium charges. If your policy is composite rated, the premium charges shown above are estimates only. Your actual premium charge for Uninsured Motorist Coverage will be calculated based upon the coverage limit you selected and the types of automobiles garaged in the various jurisdictions in which you do business and will be part of the composite rate shown in the policy. Page 5 of 6

6 I understand and agree that selection of any of the above options applies to my liability insurance policy and future renewals or replacements of such policy that are issued at the same Bodily Injury Liability Limits. If I decide to select another option at some future time, I must let the Company know in writing. DO NOT SIGN UNTIL YOU READ Signed: (Named Insured) Date Page 6 of 6