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A8326E0710 Page 1 of 1
AMERICAN RELIABLE INSURANCE COMPANY
EXCESS UNINSURED MOTORISTS AND UNDERINSURED MOTORISTS
COVERAGE REJECTION
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy Number: Policy Effectiv
e Date:
Company: Producer:
Applicant/Named Insured:
Your state permits you to
make certain decisions regarding Uninsured Motorists Coverage and Underinsured Motorists
Coverage in umbrella and excess policies that provide excess limits to a motor vehicle liability policy. Please see the brief
descriptions below that these coverages provide.
You should read this document carefully and contact your agent, or us, if you have any questions regarding Uninsured
Motorists Coverage or Underinsured Motorists Coverage.
This document includes general descriptions of these coverages. 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 you are provided.
REJECTION OF UNINSURED MOTORISTS COVERAGE AND UNDERINSURED MOTORISTS COVERAGE
Uninsured Motorists Coverage provides insurance protection to an insured for compensatory damages which the insured
is legally entitled to recover from the owner or operator of an uninsured motor vehicle because of bodily injury caused by
an automobile accident. Also included are damages due to bodily injury that result from an automobile accident with a hit-
and-run vehicle whose owner or operator cannot be found.
Underinsured Motorists Coverage provides insurance protection to an insured for compensatory damages which the
insured is legally entitled to recover from the owner or operator of an underinsured vehicle because of bodily injury caused
by an automobile accident.
As a result, if your policy is an umbrella policy or an excess policy, you may reject Uninsured Motorists and Underinsured
Motorists Coverages in such policy by initialing and signing below. Rejection of such coverage by you shall constitute a
rejection of coverage by all insureds, and shall apply to all vehicles then and thereafter eligible to be covered under the
policy, and shall remain in effect upon policy amendment or renewal, unless you request such coverage in writing.
___________
___ I reject Uninsured Motorists and Underinsured Motorists Coverage.
(Initials)
________________________________________________________________ _____________________
Signature Of Applicant/Named Insured Date
