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N-2672 (1/11)
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FLORIDA
UNINSURED MOTORISTS COVERAGE SELECTION/REJECTION FORM
AND ANNUAL OPTIONS NOTICE
NORTHLAND INSURANCE COMPANY
YOU ARE ELECTING NOT TO PURCHASE CERTAIN VALUABLE COVERAGE WHICH
PROTECTS YOU AND YOUR FAMILY OR YOU ARE PURCHASING UNINSURED MOTORIST
LIMITS LESS THAN YOUR BODILY INJURY LIABILITY LIMITS WHEN YOU SIGN THIS FORM.
PLEASE READ CAREFULLY.
IF YOU ARE A NEW CUSTOMER OR APPLICANT,
Florida law requires that automobile liability policies be issued with
automatic
Uninsured Motorists Coverage at limits equal to the Bodily Injury Liability Coverage (split limits) or Combined
Single Limit for Liability Coverage in your policy,
unless
you select a lower limit offered by the company or reject
Uninsured Motorists Coverage entirely. If any named insured on the automobile liability policy is designated as an
individual, your automatic Uninsured Motorists Coverage will also be in the form of Stacked* coverage, unless you elect
otherwise on this form. For a non-individual named insured operating as a legal entity, your policy will include
Non-Stacked Uninsured Motorists Coverage, unless you reject Uninsured Motorists Coverage entirely.
IF YOU ARE A CURRENT POLICYHOLDER,
the Uninsured Motorists Coverage rejection or limits of your policy,
including the Stacked* or Non-Stacked form of coverage, will continue to apply
unless
you make a different election
below. If you change your policy's liability coverage limits for Bodily Injury Liability Coverage (split limits) or Combined
Single Limit for Liability Coverage, your Uninsured Motorists Coverage limits will equal the new liability coverage limit(s)
and if any named insured on the automobile liability policy is designated as an individual in the policy Declaration(s),
your Uninsured Motorists Coverage will also be in the form of Stacked* coverage,
unless
you elect otherwise on this
form. For a non-individual named insured operating as a legal entity, your policy will include Non-Stacked Uninsured
Motorists Coverage, unless you reject Uninsured Motorists Coverage entirely.
Florida law requires that we provide you notice of your Uninsured Motorists Coverage options at least annually.
Uninsured Motorists Coverage provides for payment of certain benefits for damages caused by owners or operators of
uninsured motor vehicles because of bodily injury or death resulting therefrom. Such benefits may include payments for
certain medical expenses, lost wages, and pain and suffering, subject to limitations and conditions contained in the
policy. For the purpose of this coverage, an uninsured motor vehicle may include a motor vehicle as to which the bodily
injury limits are less than your damages.
Non-Stacked is a limited type of Uninsured Motorists Coverage. Subject to the provisions of the policy, if injury occurs in
a covered vehicle owned or leased by you (or any family member who resides with you), under the Non-Stacked type of
coverage only the limits of coverage (if any) which apply to that vehicle are available under this policy. If an injury occurs
while occupying someone else's vehicle, or you are struck as a pedestrian, you are entitled to select the highest limits of
Uninsured Motorists Coverage available on any one vehicle for which you are a named insured, insured family member,
or insured resident of the named insured's household. This policy will not apply if you select the coverage available
under any other policy issued to you or the policy of any other family member who resides with you. For a named
insured designated as an individual, Non-Stacked Uninsured Motorists Coverage is available at a reduced rate when
compared to the Stacked* form of coverage. For a non-individual named insured operating as a legal entity, your policy
will include Non-Stacked Uninsured Motorists Coverage, unless you reject Uninsured Motorists Coverage entirely.
*Stacking of Uninsured Motorists Coverage is
not
available to a non-individual named insured operating as a legal
entity.
