Name
N-3641 (3/12)
Page 1 of 2
© 2012 The Travelers Indemnity Company. All rights reserved.
SUPPLEMENTARY COMMERCIAL AUTOMOBILE APPLICATION
NORTH CAROLINA
(To be completed and signed by the Named Insured
)
UNINSURED MOTORISTS COVERAGE
UNINSURED MOTORISTS COVERAGE INCLUDING UNDERINSURED
MOTORISTS COVERAGE
Uninsured Motorists Coverage
provides insurance protection to an insured that is legally entitled to recover damages
from the owner or operator of an uninsured motor vehicle because of bodily injury or property damage caused by an
automobile accident or for bodily injury damages that result from an automobile accident with a hit-and-run vehicle
whose owner or operator cannot be identified. Refer to your policy for the prevailing coverage provisions.
Uninsured Motorists Coverage
includes
Underinsured Motorists Coverage if
the limits of bodily injury liability
coverage on your policy exceed the minimum financial responsibility limits required by the North Carolina Motor
Vehicle Safety and Responsibility Act. Underinsured Motorists Coverage provides insurance protection to an insured
that is legally entitled to recover from the owner or operator of an underinsured motor vehicle because of bodily injury
caused by an automobile accident. An underinsured motor vehicle includes a motor vehicle for which the sum of all
bodily injury liability bonds or policies applicable at the time of the accident is less than the applicable limits of
underinsured motorist coverage for the vehicle involved in the accident and insured under the owner's policy. Refer to
your policy for the prevailing coverage provisions.
Unless you select other available coverage limits or certify exempt status,
your automobile liability policy will
automatically
include Uninsured Motorists Coverage and, if applicable, Underinsured Motorists Coverage in the amount
equal to the highest limit of bodily injury and property damage liability coverage for any one vehicle insured under the
policy; provided, however, that Uninsured Motorists Coverage, including Underinsured Motorists Coverage if applicable,
shall
not exceed
the maximum limits of one million dollars ($1,000,000) per person and one million dollars ($1,000,000)
per accident for bodily injury and one million dollars ($1,000,000) per accident for property damage or a Combined
Single Limit (CSL) of one million dollars ($1,000,000) per accident, regardless of whether the highest limits of bodily
injury or property damage liability coverage for any one vehicle insured under the policy exceeds these limits. The
Uninsured Motorists Coverage limits, including Underinsured Motorists Coverage if applicable, will be either split (each
person/each accident/each accident) or a Combined Single Limit (CSL), consistent with the liability limits on your
policy.
If this is a renewal
policy and your prior limits remain available, the coverage limits of your expiring policy will
apply for the renewal policy
unless
you select other available coverage limits or certify exempt status herein.
SELECTION OF LIMITS
My bodily injury liability coverage limits
exceed
the minimum financial responsibility limits required by the North
Carolina Motor Vehicle Safety and Responsibility Act and I select Uninsured Motorists Coverage including
Underinsured Motorists Coverage in limits which (i)
exceed
the minimum financial responsibility limits of $30,000
per person, $60,000 per accident for bodily injury and $25,000 for property damage and (ii) are
not greater than
one million dollars ($1,000,000) per person and one million dollars ($1,000,000) per accident for bodily injury and
not greater than
my policy property damage liability limit (subject to the maximum of one million ($1,000,000) for
property damage) or one million dollars ($1,000,000) per accident CSL for both bodily injury and property damage,
as follows:
Split Limits:
Bodily Injury _______________________; Property Damage ___________________.
OR
Combined Single Limit (CSL):
$ ___________________
