Seguro de Automóvil - ASPIRA...

Seguro de Automóvil

Folletos para los Participantes

Nationwide y el Marco Nationwide son marcas federales de servicio registradas de Nationwide Mutual Insurance Company.

Introducción para Adultos

Nationwide/ASPIRA Insurance Educative Initiative Folleto 1

Guía del Instructor


Folleto 1Listo...Prepárese...Conduzca: Lista de verificación

¿Sé lo que estoy haciendo?nn Tengo mi licenciann Tengo instrucciones de cómo llegar. He estudiado un mapa y tengo

conocimiento de hacia dónde me dirijo. Tengo un plan en caso de que me pierda.nn Mi automóvil está “preparado para la carretera.” He inspeccionado los

niveles de aceite, la presión de las llantas, los niveles de los líquidos, etc.•• Tengo los números de mi compañía de seguro, compañía de remolque, mi

licencia y la matrícula del automóvil están en el auto•• Sé como cambiar una llanta y puedo confrontar otros problemas imprevistos del

automóvilnn Tengo acceso a dinero en caso de que necesite hacer reparaciones de

emergenciann Sé como reducir las distracciones, conversaciones de los pasajeros, música,

teléfono celularnn Definitivamente sé que nunca se deben mezclar el alcohol, las drogas

con el volante

¿Puedo con el gasto?A continuación presentamos algunos gastos típicos asociados con la conducción de unautomóvil. ¿Tiene usted la capacidad de pagar estos gastos?nn Compra de un automóvil

•• Pago inicial o precio total de un automóvil más barato•• Pagos mensuales

nn Arrendamiento de un auto•• Pago inicial sobre el contrato•• Pagos mensuales del arriendo de un automóvil

nn Gasolinann Mantenimiento y reparaciones regularesnn Inspección y pruebas de emisiónnn Impuestos sobre la propiedadnn Placas y registronn Costos de estacionamiento (hogar, trabajo o escuela)nn Multas (exceso de velocidad o estacionamiento)

¿Tengo cobertura de seguro de automóvil?nn Estoy manejando el automóvil de un miembro de la familia

•• He sido añadido a la póliza de seguro de esta persona•• Necesito adquirir mi propia póliza de seguro

nn Estoy conduciendo mi propio auto•• Necesito adquirir mi propia póliza de seguro



Sugerencias de cómo ahorrar dinero en lacompra de seguro de automóvil:

n Agréguese al plan de sus padres (si tiene 25 años o menos y reside en el mismohogar). Si usted va a conducir un vehículo registrado a nombre de sus padres,pídales que consideren agregarlo a su plan. Usted ahorrará dinero si está deacuerdo en pagar los aumentos en sus primas y cualquier gasto (por ejemplo, siusted tiene un accidente o le dan una multa de tránsito).

n ¡Estudie! Muchas compañías ofrecen un descuento por buenas calificaciones. (Unpromedio de B o más).

n Mantenga un historial de conductor limpio. Cuando usted adquiere su licenciapor primera vez, “comienza en zero” en términos de su historial de conductor. Deahí en adelante, cada infracción o multa de tránsito — por exceso de velocidad oconducir de forma inapropiada — pueden aumentar su prima de seguro. Losaccidentes en los que usted resulta culpable pueden aumentarla aún más. Si hayalcohol o drogas involucrados o si usted comete infracciones repetidamente, puedeperder su cobertura o su licencia.

n Participe en talleres o clases para mejorar la forma de conducir: Si ustedrecibe una multa de tránsito o está involucrado en un accidente, algunas cortes detránsito pueden ofrecerle la opción de participar en un curso para mejorar su formade conducir, o de conductor defensivo para así eliminar la multa. Algunascompañías de seguros le ofrecen un descuento por completar el curso. Verifiquecon su compañía.

n Considere cómo la clase de automóvil que usted maneje afectará el costo. El segurode un auto deportivo, nuevo y de alto rendimiento es uno de los más costosos yaque las compañías de seguros han determinado que estos son más propensos aestar involucrados en accidentes. El seguro de un auto usado, más seguro y másconservador puede costar mucho menos. Ciertos elementos de seguridad, como elmecanismo anti-derrapante de frenos (“antilock”), bolsas de aire y sistemas dealarma pueden reducir su prima. Mantenga sus costos de seguro en mente cuandovaya a comprar un auto.

n Compare: Nosotros le ayudaremos a aprender cómo usar el Internet para obtenerel mejor precio de acuerdo a sus necesidades.




Folleto 2

Ejemplo de Cuenta de Seguro de Automóvil(Por favor, vea las hojas adjuntas)




Folleto 3

Términos de seguro que usted debe conocer

Ajustador de Persona que investiga los reclamos presentadas al seguro.Reclamos

Asegurado/a La(s) persona(s) asegurados o protegidos por una póliza Persona de seguros.

Asegurador Profesional de seguros que evalúa las solicitudes de seguro, (Underwriter) determina quién recibirá cobertura, y a qué costo. Esta

persona es un experto en la evaluación del riesgo.

Cobertura Protección que proporciona una póliza de seguro.

Cobertura adicional Seguro adicional para cubrir artículos no incluidos en una pólizabásica. Por ejemplo: Usted es dueño de una pieza de arte muycostosa. Su póliza de seguro básica solamente cubre hasta $5,000para el reemplazo de obras de arte. Usted decide pagar una prima adicional para cubrir el resto del valor; llamada flotante.

Cobertura aparte Cobertura que paga los daños a su automóvil no causados porde Colisión una Colisión (ejemplo: robo, incendio, vandalismo, granizo,

inundaciones, tormenta de viento).

Cobertura contra Paga los gastos de hospital y otros gastos médicos por dañosconductores no o lesiones a usted y a otros en su automóvil causados por unasegurados o con conductor no asegurado o con seguro insuficiente.seguro insuficiente

Cobertura de colisión Seguro que paga el daño a su automóvil cuando éste golpeapara automóvil a otro automóvil u objeto.

Cobertura de Paga las pérdidas de terceros causadas por una personaResponsabilidad asegurada sin intención o por negligencia.Civil (Automóvil)




Folleto 4

Cobertura de Es seguro de responsabilidad cubre daños a bienes de tercerosResponsabilidad o lesiones a terceros enforma accidental o por negligencia por(Propietario de parte del asegurado.Vivienda/Inquilino)

Compañía de Compañía que proporciona la cobertura de seguro y serviciosseguros bajo una póliza específica.

Costo de reemplazo El costo de reponer propiedad dañada o destruida sin deducción por depreciación del valor de la propiedad.

Cotización Estimado de la compañía de seguros de la prima que usted pagará por una póliza de seguro.

Culpabilidad Describe a la persona que es responsable legalmente o contribuye a la causa de un accidente o demanda, tal como un accidente automovilístico.

Deducible Cantidad que el asegurado acepta pagar de su bolsillo en caso de pérdida. La compañía de seguros paga sobre la base de exceso sobre el deducible en ciertas coberturas.

Depreciación Disminución del valor de propiedad debido al uso y deterioro,edad y otras causas.

Endoso Enmienda anexa a una póliza de seguro para modificar, restringir o ampliar la cobertura.

Exclusión Una cláusula en una póliza de seguro que elimina la coberturade ciertos riesgos, personas, clases de propiedad o zonas.

Límite (de seguro) Cantidad que una compañía de seguros pagará por una pérdida cubierta. Los límites están especificados en la página de Declaraciones y en los términos de la póliza.

Peligro Causas de pérdida bajo una póliza de seguro tales como fuego,tormenta de viento, explosión, vandalismo, etc.

Pérdida Daño o destrucción de algo de valor.

Póliza Un contrato legal del seguro que establece los derechos y obligaciones tanto del asegurado como de la compañía de seguros.

Prima Cantidad de dinero que cobra una compañía de seguro a cambio de proporcionar cobertura.

Propietario de Persona que es dueño/a de una póliza de seguro.póliza



Reclamo Un informe de pérdida enviada a la compañía de seguro.

Reporte de accidente Formulario que proporciona una lista de los detalles de un accidente para ser presentado a la compañía de seguros y a la policía.

Riesgo Probabilidad de pérdida económica.

Seguro Un sistema para hacer que las pérdidas económicas mayores sean más costeables mediante la agrupación del riesgo de muchos individuos y entidades de negocio y la transferencia de éste a una compañía de seguro u otro grupo mayor a cambio de una prima.

Valor real en El valor de su propiedad hoy menos uso y deterioro, edadefectivo y depreciación.





Solución a la Sopa de PalabrasAutomóvil:g. formulario de informe de accidentec. ajustador de reclamosh. deducibleb. depreciaciónd. estimadof. razón de gastosa. informe de vehículos de motorj. aseguradore. persona aseguradai. razón de pérdidaEjemplo de una Póliza de Automóvil

Cortesía de la Fundación para la Educación sobre Seguros


Folleto 5



Nombre Período de clase

Busque la palabra que se ajuste a cada descripción y escríbala; escriba la letraque le corresponda en la línea adyacente a la descripción apropiada.

1. Un formulario que se utiliza para registrar la a. ______________________información sobre un accidente

2. La persona directamente responsable de investigar b.______________________y procesar un reclamo cubierto por un seguro

3. Una porción de una pérdida cubierta que no paga c. ______________________el seguro: se resta de la cantidad que, de otra forma, el asegurado tendría que pagar

4 Pérdida en el valor de una propiedad como resultado d.______________________del desgaste, deterioro o cuando se convierte en obsoleta

5. Evaluación del costo de reparación de un vehículo: e.______________________puede ser hecha por un taller de hojalatería o unevaluador de daños físicos

6. El porcentaje de la prima que se utiliza para pagar f. ______________________los gastos de operación de la compañía de seguros.

7. Contiene una descripción de las infracciones de g.______________________tránsito por un auto en marcha y accidentes serios que ha tenido el conductor en el pasado

8. La persona que evalúa las solicitudes de seguros, que h.______________________determina cuales solicitantes son aceptados o rechazadosasí como cuanta cobertura está dispuesto el asegurador a ofrecer y a qué precio

9. Una persona, un negocio, u organización que i. ______________________ha adquirido un seguro

10. El porcentaje de las primas que se utiliza para pagar j. ______________________reclamaciones

Sopa depalabras



Ejemplo de una póliza(Por favor, vea las hojas adjuntas)


Folleto 6

Table Of ContentsPage

INSURING AGREEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D1DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D1INSURED PERSONS' DUTIES AFTER AN ACCIDENT OR LOSS . . . . . . . . . . D2TERRITORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D2COVERAGES:

Physical Damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P1ÄP6(damage to your auto)EF Comprehensive

CollisionTowing and Labor

Auto Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .L1ÄL4(for damage or injury to others caused by your auto)GH Property Damage and Bodily Injury

Medical Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .M1ÄM4(medical expenses payable regardless of fault)IJUninsured Motorists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U1ÄU5(for bodily injury caused by uninsured or underinsured motorists)KL

GENERAL POLICY CONDITIONS

How Your Policy May Be Changed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G1Optional Payment of Premium in Installments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G1Renewal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G1Non-Renewal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G1Cancellation During Policy Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G2Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G2If You Become Bankrupt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G2Unauthorized Use of Other Motor Vehicles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G3Fraud and Misrepresentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G3Suit Against Us . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G3Subrogation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G4Non-Sufficient Funds and Late Payment Charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G4Applicable Contract Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G4Representations and Warranties in the Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G4Interest Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G4

MUTUAL POLICY CONDITIONS

Nationwide Mutual Insurance CompanyNationwide Mutual Fire Insurance Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G5

V-034

_________________________________________________________________Nationwide Auto Policy

Insuring AgreementFor the policyholder's payment of premiums and fees in amounts we require and subject to allof the terms and conditions of this policy, we agree to provide the coverages the policyholder

has selected. These selections are shown in the enclosed Declarations, which are a part of thispolicy contract. The selected coverages in this policy apply only to occurrences while thepolicy is in force. Renewal premiums for terms of six months each must be paid in advance.

DefinitionsThis policy uses certain common words for easy reading. They are defined as follows:

1. ©POLICYHOLDER¬ means the first person named in the Declarations. The policyholder isthe named insured under this policy but does not include the policyholder's spouse. If thefirst named insured is an organization, that organization is the policyholder.

2. ©YOU¬ and ©YOUR¬ mean:

a) the policyholder and spouse, if resident of the same household, when the policyholder

is a natural person; or

b) the sole proprietor or majority shareholder of an organization, or general partner of afamily limited partnership, as shown in the Declarations, and spouse, if resident of thesame household, when the policyholder is an organization.

3. ©RELATIVE¬ means a natural person who regularly lives in your household and who isrelated to you by blood, marriage or adoption (including a ward or foster child). ©Relative¬includes such person, if under the age of 25 and unmarried, while living temporarily outsideyour household.

4. ©INSURED¬ means one who is described as entitled to protection under each coverage.

5. ©WE,¬ ©US,¬ ©OUR,¬ and ©THE COMPANY¬ mean or refer to the company issuing thepolicyÅNationwide Mutual Insurance Company, Nationwide Mutual Fire InsuranceCompany, Nationwide Property and Casualty Insurance Company, or Nationwide GeneralInsurance Company.

6. ©YOUR AUTO¬ means the vehicle(s) described in the Declarations.

7. ©MOTOR VEHICLE¬ means a land motor vehicle designed primarily to be driven on publicroads. This does not include vehicles operated on rails or crawler treads. Other motorizedvehicles designed for use mainly off public roads shall be included within the definition ofmotor vehicle while being driven on public roads.

8. ©PRIVATE PASSENGER AUTO¬ means a four-wheel:

a) automobile for private passenger use;

b) van; or

c) pick-up truck having either four or six wheels.

9. ©DEDUCTIBLE¬ means the amount of loss to be paid by the insured. We pay for coveredloss above the deductible amount shown in the Declarations.

10. ©OCCUPYING¬ means in, upon, entering, or alighting from.

11. ©BODILY INJURY¬ means:

a) physical injury;

b) sickness;

c) disease; or

d) resultant death;

of any person which results directly from a motor vehicle accident.

D1

_________________________________________________________________Nationwide Auto Policy

12. ©PROPERTY DAMAGE¬ means:

a) destruction of property;

b) damage or injury to it; and

c) loss of its use.

Other words are also defined. All defined words are in bold print.

Insured Persons' DutiesThe insured will:

1. give us or our agent prompt notice of all losses and provide written proof of claim if

required.

2. notify the police of all theft losses as soon as practicable.

3. promptly deliver to us all papers dealing with any claims or suits.

4. submit to examinations under oath as often as reasonably requested by us.

5. assist us and, if applicable, the defense counsel chosen for you by us, with any claim or

suit.

6. if injured, submit to examinations by company-selected physicians as often as the

company reasonably requires. The injured person must grant us authority, at our request,

to obtain copies of all wage and medical, dental or other health care provider records.

7. protect damaged property insured under this policy and make it available to us for

inspection before its repair or disposal.

8. provide all records and documents we reasonably request and permit us to make copies.

9. comply with and be bound by the terms, conditions and obligations of the policy.

TerritoryThe policy applies in Canada, the United States of America and its territories or possessions, or

between their ports. All coverages except Uninsured Motorists apply to occurrences in Mexico,

if within 50 miles of the United States boundary. We will base the amount of any

Comprehensive or Collision loss in Mexico on cost at the nearest United States point.

This policy does not apply in any territory except as stated in this provision.

NOTE: You will need to buy auto insurance from a Mexican insurance companyÅregardless of

coverage provided by this policyÅbefore driving in Mexico. Otherwise, you may be

subject to jail detention, auto impoundment, and other legal complications in case of an

accident.

D2

Physical Damage(damage to your auto)EF

ADDITIONAL DEFINITIONS APPLICABLE TO THESE COVERAGES

For purposes of these coverages only:

1. ©LOSS¬ means direct and accidental loss or damage to your auto. Your auto includes itsequipment.

2. ©EQUIPMENT¬ means anything usual and incidental to the use of a motor vehicle as amotor vehicle. Any type of trailer is not equipment.

Coverage Agreements

COMPREHENSIVE COVERAGE

1. We will pay for loss to your auto not caused by collision or upset. We will pay for the loss

less your deductible. Coverage is included for:

a) damage from contact with:

(1) animals; or

(2) falling or flying objects.

b) broken glass:

(1) even if caused by collision or upset; and

(2) if you do not have Collision coverage.

If your Comprehensive and Collision coverages have different deductibles, the smallerdeductible will apply to broken glass.

For damage to your auto's windshield, we may offer to have it repaired in lieu ofreplacement. We will not apply a deductible for the repair of the windshield. However,if the repair is not satisfactory, we will replace the windshield subject to your

deductible.

2. Also, if your auto has a loss under this coverage we will:

a) pay for resulting damage to your clothing and luggage or that of any relative.

Maximum payment is $200. We will pay for stolen clothing or luggage only if your auto

is stolen.

b) repay your travel costs after your auto is stolen. Maximum payment is $15 per day Ånot to exceed $450 per occurrence. These costs must be incurred within a certain time.It starts 48 hours after you report the theft to us and the police. It ends when your auto

is returned to you or a settlement is agreed to.

c) repay you for the cost of travel from where your auto was disabled to where you weregoing. Maximum payment is $10.

COLLISION COVERAGE

1. We will pay for loss to your auto caused by collision or upset. We will pay for the loss lessyour deductible. We will not subtract the deductible amount for broken glass if you havefull (no deductible) Comprehensive coverage in force.

2. Also if your auto has a loss under this coverage we will:

a) pay for resulting damage to your clothing and luggage or that of any relative.

Maximum payment is $200.

b) repay you for the travel cost to where you were going. Maximum payment is $10.

P1

_______________________________________________________________________Physical Damage

TOWING AND LABOR COSTS COVERAGE

We will pay towing and labor costs if your auto is disabled. We will pay only for labor costs at

the place where your auto is disabled. Our maximum payment per disablement is shown in the

Declarations.

Coverage Extensions

USE OF TRAILERS

The insurance on your auto covers a trailer used by you or a relative.

1. The trailer must be:

a) designed for use with a private passenger auto; and

b) used with a vehicle that is insured under these coverages.

2. The trailer must not be:

a) otherwise insured;

b) owned by you or a relative; or

c) used for business purposes with a vehicle that's not a private passenger auto.

3. The maximum amount payable is $500.

USE OF OTHER MOTOR VEHICLES

The insurance on your auto also covers other motor vehicles as follows:

1. A motor vehicle you do not own, while it is used in place of your auto for a short time.

Your auto must be out of use because of:

a) breakdown;

b) repair;

c) servicing; or

d) loss.

2. A four-wheel motor vehicle newly acquired by you. You must report the acquisition of the

vehicle to us during the first 30 days you own the vehicle. Also, if the newly acquired

vehicle does not replace your auto, all household vehicles owned by you must be insured

by us or a company affiliated with us for this extension of coverage to apply.

We provide this coverage only if you do not have other collectible insurance. You must pay

any added premium resulting from this coverage extension.

3. A private passenger auto owned by a non-member of your household and not covered in

item 1. of this section.

a) This applies only while such auto is operated by you or a relative.

b) We will not pay for loss:

(1) that results from the operation of an auto:

(a) repair shop;

(b) public garage or parking place;

(c) sales agency; or

(d) service or maintenance facility.

(2) involving a private passenger auto owned by an employer of an insured.

(3) involving a private passenger auto furnished or available to you or a relative for

regular use.

(4) to any rented motor vehicle.

4. A rented private passenger auto, including its loss of income.

a) This applies only:

(1) while such auto is rented by you or a relative;

P2

______________________________________________________________________ Physical Damage

(2) if such auto is rented from a rental company for less than 28 days; and

(3) for loss of income that is:

(a) verifiable by us; and

(b) owed to a rental company because:

(1) the rental company had a customer willing to rent a private passenger

auto; and

(2) there was no other vehicle available for rental in place of the damagedrented auto.

b) We will not pay for loss involving a private passenger auto rented or leased by anyonefor or on behalf of the employer of an insured.

Coverage ExclusionsWe will not pay for loss:

1. To more than one:

a) recording tape;

b) compact disc; or

c) other recording media.

2. To a container to be used for storing or carrying:

a) recording tapes;

b) compact discs; or

c) other recording media.

3. To any device which is a:

a) tape player;

b) compact disc player;

c) citizens band radio;

d) two-way mobile radio;

e) telephone; or

f) any other device which records, emits, amplifies, receives and/or transmits sound.

This exclusion (3.) does not apply if the device is a permanent part of your auto. Permanentpart means installed in a location used by an auto maker for such a device. If the device isnot covered, its antenna and other parts are not covered.

4. To scanning monitor receivers used for radar detection, or any other device designed todetect or deter the monitoring of speed.

5. To a camper or living quarters unit which can be mounted on or attached to a vehicle. We

will pay the loss if:

a) the unit is reported to us; and

b) the required premium is paid;

before the loss.

6. Caused by and limited to:

a) wear and tear;

b) freezing;

c) mechanical or electrical breakdown or failure.

This exclusion (6.) does not apply to Towing and Labor coverage.

7. To any motor vehicle while used:

a) to carry persons or property for a fee; or

b) for retail or wholesale delivery, including but not limited to pizza, magazine, newspaperand mail delivery.

This exclusion does not apply to motor vehicles used in shared-expense car pools.

P3

_______________________________________________________________________Physical Damage

8. To any motor vehicle due to an act of war.

9. To any motor vehicle which occurs:

a) while it is being used on a temporary or permanent basis, for the transportation of, or in

exchange for, any illegal substance, or in connection with any criminal trade or

transaction by:

(1) you;

(2) a relative; or

(3) anyone else with your knowledge or permission; or

b) due to confiscation of your auto by any law enforcement agency because of your

auto's use in such activities.

10. Caused intentionally by or at the direction of an insured, including willful acts the result of

which the insured knows or ought to know will follow from the insured's conduct.

11. To your auto while rented or leased to others.

12. To your auto while used in any competitive event, including but not limited to drag racing,

or in practice or preparation for such an event.

Limits and Conditions of Payment

ACTUAL CASH VALUE

The limit of our coverage is the actual cash value of your auto or its damaged parts at the time

of loss. To determine actual cash value, we will consider:

1. fair market value;

2. age; and

3. condition of the property;

at the time of loss. In addition to our payment of the loss, necessary and reasonable towing

and storage will be paid to protect the auto from further damage. Covered storage costs are

not to exceed four days of storage charges incurred prior to the date you report the loss to us.

LOSS SETTLEMENT

At our option, we may:

1. pay you directly for a loss;

2. pay to repair or replace your auto or its damaged parts with the parts furnished either by

original equipment manufacturers or non-original equipment manufacturers;

3. return stolen property at our expense and pay for any damage.

AMOUNTS PAYABLE FOR TOWING AND LABOR COSTS

The limit of our coverage for a loss is limited to the amount shown in the Declarations. Limits

apply as stated in the Declarations. Insuring more than one person or vehicle under this policy

does not increase our limits.

APPRAISAL

If you or we fail to agree on the amount of the loss, either can make a written demand for

appraisal of the loss. Each will select and pay a single, competent, disinterested appraiser,

notifying the other of the appraiser's identity within 20 days of the request for appraisal. As

soon as practical, but no later than 20 days after both you and we have named our appraiser,

the two appraisers will then select a competent, impartial appraiser who shall be the umpire.

If the two appraisers cannot agree on an umpire within 20 days after both appraisers have been

identified, you or we can petition a common pleas court judge of a court of competent

jurisdiction, in the county and state of the policyholder's address listed on the Declarations, to

P4

______________________________________________________________________ Physical Damage

appoint a competent, impartial umpire. Immediate, written notice of the petition must be given

to the other. A hearing must be held with the judge, in the presence of you and us, regarding

the selection of the umpire.

The appraisers will then state the actual cash value and the amount of the loss. If the

appraisers submit a written report of an agreement to us, the amount agreed upon will be the

amount payable for the loss. If the appraisers fail to agree within a reasonable time but no later

than 30 days after both appraisers have been identified, they will submit their differences to the

umpire. Neither you nor we, nor any representative of either, may discuss any aspect of the

claim with the umpire prior to the issuance of the umpire's written report. A written award

agreed upon and signed by any two of these three appraisers will set the amount payable for

the loss. The results of the appraisal shall be binding on both you and us.

All compensation, costs, fees or other expenses associated with or charged by the umpire will

be shared equally by you and us. Any compensation, costs, fees or other expenses associated

with that of an appraiser, expert witness or attorney will be borne and paid by the party who

hires them.

Neither we nor you waive any of the other rights, terms and conditions or obligations under this

policy by agreeing to an appraisal.

OTHER INSURANCE

If there is other insurance that covers any loss, we will pay only our share of the loss. Our

share is our proportion of the total insurance collectible for the loss. For loss to motor

vehicles other than your auto, we will pay only the insured loss not covered by other

insurance or self insurance.

Coverage Condition

AUTO RECOVERY

When an insured auto which has been stolen or abandoned is located, we have the right to take

it into our care and custody.

Loss Payable ClauseThis clause applies to the Comprehensive and Collision coverages provided by this policy. It

protects the lienholder named in the policy Declarations.

Payment for loss will be made according to the interest of the policyholder and lienholder. At

our option, payment may be made to both jointly, or to either separately. Either way, the

company will protect the interests of both.

Protection of the lienholder's financial interest will not be affected by any change in ownership

of the vehicle insured, nor by any act or omission by any person entitled to coverage under this

policy. However, protection under this clause does not apply:

a) in any case of conversion, embezzlement, secretion, or willful damaging or destruction,

of the vehicle committed by or at the direction of an insured.

b) to the loss of any motor vehicle while it is being used on a temporary or permanent

basis, for the transportation of, or in exchange for, any illegal substance, or in

connection with any criminal trade or transaction.

If the company cancels or refuses to renew the policy, the lienholder will receive notice at least

10 days before protection of its interest will end. The company will also notify the lienholder if

coverage under the policy is excluded for any named driver.

The lienholder shall notify the company upon learning of any change in ownership of the

vehicle.

P5

_______________________________________________________________________Physical Damage

To the extent of payment to the lienholder, the company will be entitled to the lienholder'srights of recovery. The company will do nothing to impair the right of the lienholder to recoverthe full amount of its claim.

AssignabilityNo interest or benefits in these coverages or cause of action against us arising out of thesecoverages can be transferred or assigned to another without our written consent. However, ifthe policyholder dies, the coverages will remain in force for the balance of the policy period forthe appointed legal representative or anyone having legal or proper temporary custody of yourauto until a legal representative is appointed.

P6

Auto Liability(for damage or injury to others caused by your auto)AB

Coverage AgreementPROPERTY DAMAGE AND BODILY INJURY LIABILITY COVERAGE

1. We will pay for damages for which you are legally liable as a result of an accident arisingout of the:

a) ownership;

b) maintenance or use; or

c) loading or unloading;

of your auto. A relative also has this protection. So does any person or organization whois liable for the use of your auto while used with your permission.

2. Damages must involve:

a) property damage; or

b) bodily injury.

3. We will pay such liability losses up to the limits stated in the Declarations. In addition tothese limits and as to any covered damages, we will:

a) defend at our expense, with attorneys of our choice, any suit against the insured. We

may settle or defend any claim or suit as we think proper.

b) pay:

(1) all expenses incurred by us; and

(2) all costs levied against the insured;

in any such suit.

c) pay premiums:

(1) of not more than $250 per insured for bail bonds required because of an accident ortraffic violation.

(2) for appeal bonds in defended suits and for bonds to release attached property. Theamount of such bonds shall not be more than the limits of liability shown in theDeclarations.

Although paying such premiums, we are not required to apply for or furnish any bonds.

d) pay post-judgment interest on all damages awarded. We will not pay interest that accruesafter such time as we have:

(1) paid;

(2) formally offered; or

(3) deposited in court;

the amount for which we were liable under this policy.

e) pay expenses incurred by an insured for emergency medical aid to others at the time ofaccident.

f) pay all reasonable expenses incurred by an insured at our request, but not more than$50 per day for loss of earnings.

4. After the limits of this coverage have been paid, we will not defend any suit or pay any claimor judgment.

L1

_________________________________________________________________________Auto Liability

Coverage ExtensionsUSE OF TRAILERS

1. This coverage applies to the use of a trailer by:

a) you;

b) a relative; or

c) someone else with your permission.



b) used with a vehicle that is insured under this coverage.

3. The trailer must not be used for business purposes with a vehicle that's not a private

passenger auto.

USE OF OTHER MOTOR VEHICLES

This coverage also applies to certain other motor vehicles as follows:

1. A motor vehicle you do not own, while it is used in place of your auto for a short time.

Your auto must be out of use because of:

a) breakdown; c) servicing; or

b) repair; d) loss.

2. A four-wheel motor vehicle newly acquired by you. This coverage applies only during the

first 30 days you own the vehicle unless it replaces your auto. If the newly acquired vehicle

does not replace your auto, all household vehicles owned by you must be insured by us or

a company affiliated with us for this extension of coverage to apply.

We provide this coverage only if you do not have other insurance. You must pay any

added premium resulting from this coverage extension.

3. A motor vehicle owned by a non-member of your household and not covered in item 1. of

this section.

a) This applies only while the vehicle is being operated by you or a relative. It protects

you or the relative as the operator, and any person or organization, except as noted

below in b), who does not own the vehicle but is legally responsible for its use.

b) This does not apply to losses involving a motor vehicle:

(1) used in the business or occupation of you or a relative except a private passenger

auto used by you, your chauffeur, or your household employee;

(2) owned, rented or leased by an employer of an insured;

(3) rented or leased by anyone for or on behalf of an employer of an insured; or

(4) furnished or available to you or a relative for regular use. Furnished for regular use

does not include a motor vehicle rented from a rental company for less than 28 days.

FINANCIAL RESPONSIBILITY

We will adjust this policy to comply:

1. With the financial responsibility law of any state or province which requires higher liability

limits than those provided by this policy.

2. With the kinds and limits of coverage required of non-residents by any compulsory motor

vehicle insurance law, or similar law.

However, any loss payment under this coverage will be made only over and above any other

collectible motor vehicle insurance. In no case will anyone be entitled to duplicate payments

for the same loss.

When we certify this policy as proof under any financial responsibility law, it will comply with the

law to the extent of the coverage required by the law. The insured agrees to reimburse us for

any payment which we would not have been obligated to make under the terms of this policy

except for the agreement outlined in this paragraph.

L2

_________________________________________________________________________ Auto Liability

Coverage ExclusionsThis coverage does not apply to:

1. Property damage or bodily injury caused intentionally by or at the direction of an insured,

including willful acts the result of which the insured knows or ought to know will follow fromthe insured's conduct.

2. Use of any motor vehicle:


b) for retail or wholesale delivery, including but not limited to pizza, magazine, newspaperand mail delivery.


3. a) Any person for any occurrence arising out of the operation of an auto:

(1) repair shop; (3) sales agency; or

(2) public garage or parking place; (4) service or maintenance facility.

b) However, this exclusion does not apply to:

(1) you;

(2) a relative; or

(3) a partner, employee, or agent of you or a relative;

with regard to the use of your auto.

4. Property damage caused by any insured:

a) to a motor vehicle that is owned or operated by, or in the custody of, that insured; or

b) to any other property that is owned by or in the custody of any insured or anyoneoccupying your auto. This exclusion does not apply to a:

(1) rented home; or

(2) rented private garage.

5. Bodily injury to any person eligible to receive any benefits required to be provided orvoluntarily provided by any insured under a:

a) workers' compensation;

b) unemployment compensation;

c) non-occupational or occupational disease;

d) disability benefits;

or any similar law.

6. Bodily injury to an employee of any insured while engaged in employment. However, itdoes cover an employee at your home who is not, or is not required to be, covered by anyworkers' compensation law.

7. The United States of America or any of its agencies. It also does not apply to any employeeof the United States of America or any of its agencies while such person is acting within thescope of his or her office or employment and the provisions of the Federal Tort Claims Actapply.

8. Any person protected under nuclear energy liability insurance. This exclusion applies evenif that insurance has been exhausted.

9. Punitive or exemplary damages, unless required or permitted by law.

10. Bodily injury or property damage arising out of the ownership, maintenance or use ofyour auto while rented or leased to others by any insured.

11. Bodily injury or property damage arising out of the ownership, maintenance or use ofyour auto while used in any competitive event, including but not limited to drag racing, orin practice or preparation for such an event.

L3

_________________________________________________________________________Auto Liability

Limits and Conditions of Payment

AMOUNTS PAYABLE FOR LIABILITY LOSSES

Our obligation to pay Property Damage or Bodily Injury Liability losses is limited to the amounts

per person and per occurrence stated in the Declarations. The following conditions apply to

these limits:

1. The limit shown:

a) for Property Damage Liability is for all property damage in one occurrence.

b) for Bodily Injury Liability for any one person applies to one person's bodily injury,

including death, and includes all claims resulting from or arising out of that one person's

bodily injury, including death. Any and all claims, including but not limited to any claim

for loss of consortium or injury to the relationship arising from this bodily injury, including

death, shall be included in this limit. This per person policy limit shall be enforceable

regardless of the number of insureds, claims made, vehicles or premiums shown in the

Declarations or policy, or vehicles involved in the accident.

c) for Bodily Injury Liability for each occurrence is, subject to the per person limit described

in paragraph b) above, the total limit of our liability for all covered damages when two or

more persons sustain bodily injury, including death, as a result of one occurrence. Any

and all claims, including but not limited to any claim for loss of consortium or injury to the

relationship arising from this bodily injury, including death, shall be included in this limit.

This per occurrence policy limit shall be enforceable regardless of the number of

insureds, claims made, vehicles or premiums shown in the Declarations or policy, or

vehicles involved in the accident.

2. Liability limits apply as stated in the Declarations. The insuring of more than one person or

vehicle under this policy does not increase our liability limits.

3. In any loss covered under items 2. and 3. of ©USE OF OTHER MOTOR VEHICLES,¬ the

highest liability limit applicable to any one vehicle on this policy will apply.

4. A motor vehicle and attached trailer are considered one vehicle for Auto Liability coverage.

OTHER INSURANCE

1. In any loss involving the use of your auto, we will be liable for only our share of the loss if

there is other collectible liability insurance. Our share is our proportion of the total

insurance limits for the loss.

2. For losses covered under ©USE OF OTHER MOTOR VEHICLES,¬ our coverage is excess

over any other collectible:

a) insurance;

b) self insurance;

c) proceeds from a governmental entity; or

d) sources of recovery.

If more than one policy issued by us or a company affiliated with us applies on an excess

basis to the same loss, we will pay only up to the highest limit of any one of them.

AssignabilityNo interest or benefits in this coverage or cause of action arising out of this coverage can be

transferred or assigned to another without our written consent. However, if the policyholderdies, the Liability coverage will remain in force for the balance of the policy period for the

appointed legal representative or anyone having legal or proper temporary custody of yourauto until a legal representative is appointed.

L4

Medical Payments(medical expenses payable regardless of fault)CD

ADDITIONAL DEFINITIONS APPLICABLE TO THIS COVERAGE

For purposes of this coverage only:

1. ©EXPERIMENTAL TREATMENT¬ means medical treatment that is experimental in naturewhich is not accepted as effective therapy by:

a) the state medical association or board;

b) an appropriate medical specialty board;

c) the American Medical Association;

d) the Surgeon General; or

e) the Federal Food and Drug Administration.

2. ©USUAL, CUSTOMARY AND REASONABLE CHARGES¬ means charges for services orsupplies covered under this policy, which are:

a) usual and customary in the place where provided; and

b) not more than what would have been charged if the injured person had no insurance;and

c) not Experimental Treatment.

3. ©MEDICALLY NECESSARY¬ means a service or procedure which is necessary, appropriateand consistent for the symptoms, diagnosis or treatment of a condition of injury or sicknesswithin generally accepted current standards of good medical practice. The fact that anyparticular doctor may prescribe, order, recommend, or approve a service or proceduredoes not, in itself, make the service or procedure medically necessary.

4. ©UTILIZATION MANAGEMENT OR REVIEW¬ means cost and utilization containmentactivities designed to determine usual, customary and reasonable charges for medically

necessary services provided to an insured. These activities include, but are not limited to,medical bill auditing and case management.

Coverage AgreementWe will pay usual, customary and reasonable charges:

1. for expenses incurred for:

a) medically necessary services; or

b) funeral costs;

due to accidental bodily injury suffered by you or a relative while occupying your auto.

2. incurred within one year after the accident.

3. up to the limit stated in the policy Declarations.

4. regardless of who is at fault in the accident.

We may apply utilization management or review to determine:

1. usual, customary and reasonable charges; and/or

2. medically necessary services.

M1

______________________________________________________________________Medical Payments

Coverage ExtensionsYOU AND A RELATIVE

In addition, you and a relative are covered:

1. While occupying a motor vehicle you do not own, while it is used in place of your auto fora short time. Your auto must be out of use because of:

a) breakdown;

b) repair;

c) servicing; or

d) loss.

2. While occupying a four-wheel motor vehicle newly acquired by you. This coverageapplies only during the first 30 days you own the vehicle, unless it replaces your auto. Ifthe newly acquired vehicle does not replace your auto, all household vehicles owned byyou must be insured by us or a company affiliated with us for this extension of coverage toapply.

3. While occupying any other motor vehicle not owned by you or a relative.

4. As pedestrians, if hit by any motor vehicle or trailer.

OTHER PERSONS

Persons other than you and a relative are protected under this coverage:

1. While occupying your auto when it is being used by:

a) you;

b) a relative; or

c) anyone else with your permission.

2. While occupying a motor vehicle you do not own, while it is used in place of your auto fora short time. Your auto must be out of use because of:

a) breakdown;

b) repair;

c) servicing; or

d) loss.

3. While occupying a four-wheel motor vehicle newly acquired by you. This coverageapplies only during the first 30 days you own the vehicle, unless it replaces your auto. Ifthe newly acquired vehicle does not replace your auto, all household vehicles owned byyou must be insured by us or a company affiliated with us for this extension of coverage toapply.

4. While occupying a motor vehicle that is owned by someone who is not a member of your

household.

a) This protection applies only when the vehicle is being operated by you or a relative.

b) This protection does not apply to:

(1) use of any vehicle in the business or occupation of you or a relative, except aprivate passenger auto used by:

(a) you;

(b) your chauffeur; or

(c) your household employee.

(2) use of a motor vehicle furnished to you or a relative for regular use.

ANY INSURED

The coverage limit will be increased 100 percent for an insured who is using an approvedmotor vehicle seat belt or child restraint system at the time of an accident.

M2

_____________________________________________________________________ Medical Payments

ADDED DEATH BENEFIT

We will pay a death benefit of $10,000 for any insured using an approved motor vehicle seat

belt or child restraint system at the time of the motor vehicle accident. Death must occur

within one year and as a direct result of the motor vehicle accident.

USE OF TRAILERS

1. This coverage applies to the use of a trailer by:

a) you;

b) a relative; or

c) someone else with your permission;

regardless of who owns it.



b) used with a vehicle that is insured under this coverage.

3. The trailer must not be used for business purposes with a vehicle that is not a private

passenger auto.

Coverage ExclusionsThis coverage does not apply to:

1. Use of any motor vehicle by an insured:


b) for retail or wholesale delivery, including but not limited to pizza, magazine, newspaper

and mail delivery.


2. a) Any person for any occurrence arising out of the operation of an auto:

(1) repair shop;

(2) public garage or parking place;

(3) sales agency; or

(4) service or maintenance facility.

b) However, this exclusion does not apply to the use of your auto by:

(1) you;

(2) a relative; or

(3) a partner, employee, or agent of you or a relative.

Limits and Conditions of PaymentBENEFITS PAYABLE

1. The amount payable under this coverage to or for one person in one accident is limited as

stated in the policy Declarations. Limits apply to each insured vehicle as stated in the

Declarations. The stated limit is not increased by the insuring of more than one person or

vehicle under this policy or any other policy issued by us.

2. In any loss covered under ©COVERAGE EXTENSIONS¬ and not involving your auto, the

highest liability limit applicable to any one vehicle in this policy will apply.

OTHER INSURANCE

We will pay only the insured benefit over and above the amount of other collectible auto Medical

Payments or Family Compensation insurance in any loss involving:

1. Use of a motor vehicle you do not own; or

2. Being hit by any motor vehicle or trailer.

M3

______________________________________________________________________Medical Payments

Regardless of the number of Nationwide policies or coverages that apply, the maximum AddedDeath Benefit payable, as a result of using an approved motor vehicle seat belt or childrestraint system, under all policies or coverages combined is $10,000.

DUPLICATE PAYMENT

We will make no duplicate payment to or for any insured for the same element of loss.

OTHER CLAIMS AND JUDGMENTS

Any loss payment under this coverage will apply toward payment of any claim or judgmentrelating to the same loss under the Bodily Injury Liability coverage of this policy. The company

will require written agreement to this condition before payment of a Medical Payments loss.

AssignabilityNo interest or benefits in this coverage or cause of action against us arising out of this coveragecan be transferred or assigned to another without our written consent. However, if thepolicyholder dies, the coverage will remain in force for the balance of the policy period forthose persons who were entitled to coverage at the time of death.

M4

Uninsured Motorists

(for bodily injury caused by uninsured or underinsured motorists)EFADDITIONAL DEFINITION APPLICABLE TO THIS COVERAGE

©UNINSURED MOTOR VEHICLE¬ Å See definition in ©COVERAGE AGREEMENT¬ section.

Coverage AgreementYOU AND A RELATIVE

We will pay compensatory damages, including derivative claims, that you or a relative arelegally entitled to recover from the owner or driver of an uninsured motor vehicle under the tortlaw of the state where the motor vehicle accident occurred, because of bodily injury sufferedby you or a relative and resulting from the motor vehicle accident. Damages must result froma motor vehicle accident arising out of the:

1. ownership;

2. maintenance; or

3. use;

of the uninsured motor vehicle.

OTHER PERSONS

We will also pay compensatory damages, including derivative claims, that other natural personsare legally entitled to recover from the owner or driver of an uninsured motor vehicle under thetort law of the state where the motor vehicle accident occurred and resulting from the motor

vehicle accident if such other persons suffer bodily injury while occupying:

1. Your auto.

2. A motor vehicle you do not own, while it is used in place of your auto for a short time.Your auto must be out of use because of:

a) breakdown;

b) repair;

c) servicing; or

d) loss.

3. A four-wheel motor vehicle newly acquired by you to which the Auto Liability coverage ofthis policy applies. This applies only during the first 30 days you own the vehicle, unless itreplaces your auto.

4. Any other motor vehicle while it is being driven by you or a relative. However, the vehiclemust not be:

a) owned by you or a relative; or

b) furnished or available for you or a relative for regular use.

Damages must result from a motor vehicle accident arising out of the:

1. ownership;

2. maintenance; or

3. use;

of the uninsured motor vehicle.

DEFAULT JUDGMENT AND INTERVENTION

We will not be bound by any default judgment ordered or obtained against the uninsuredmotorist unless you have our written consent to such judgment.

U1

____________________________________________________________________Uninsured Motorists

We reserve the right to intervene in an insured's suit against the uninsured motorist, including

but not limited to the protection of our subrogation rights and to contest any and all aspects of

the insured's claim or suit, including but not limited to fault, proximate cause, damages and/or

liability.

DEFINITION

1. An uninsured motor vehicle is:

a) one for which there is no bodily injury liability bond, insurance, or other security in

effect, applicable to the vehicle owner, operator, or any other liable person or

organization, at the time of the accident.

b) one which is underinsured. This is a motor vehicle for which bodily injury liability

coverage limits or other security or bonds are in effect; however, their total amount

available for payment is less than the limits of this coverage. See the Declarations for

those limits.

c) one for which the insuring company denies coverage or becomes insolvent.

d) one for which the identity of the owner and operator of the motor vehicle cannot be

determined, but independent corroborative evidence exists to prove that the bodily

injury, sickness, disease, or death of the insured was proximately caused by the

negligence or intentional actions of the unidentified operator of the motor vehicle. For

purposes of this section, the testimony of any insured seeking recovery from the

insurer shall not constitute independent corroborative evidence, unless the testimony is

supported by additional evidence.

An accident report must be made to the police within 24 hours of the accident. We

must have a sworn statement from anyone claiming coverage under this section within

30 days. The sworn statement must state that the insured has a legal action due to the

accident. It must also include facts to support the claim. We may inspect any vehicle

the insured was occupying at the time of the accident.

2. We will not consider as an uninsured motor vehicle:

a) a motor vehicle that is ©self-insured¬ under any law;

b) any motor vehicle owned by any political subdivision, unless the operator of the motor

vehicle and the political subdivision have immunity from liability for the accident under

Chapter 2744 of the Ohio Revised Code;

c) any vehicle in use as a residence or premises;

d) any equipment or vehicle designed for use mainly off public roads except while on

public roads;

e) any motor vehicle insured under the liability coverage of this policy; nor

f) any trolley, streetcar, trailer, railroad engine, railroad car, motorized bicycle, golf cart,

off-road recreational vehicle, snowmobile, fork lift, aircraft, watercraft, construction

equipment, farm tractor or other vehicle designed and principally used for agricultural

purposes, mobile home, vehicle traveling on treads or rails, or any similar vehicle.

Coverage ExclusionsA. This coverage does not apply to anyone for bodily injury or derivative claims:

1. While any insured is:

a) operating; or

b) occupying;

any motor vehicle without a reasonable belief that the insured is entitled to do so. An

insured whose license has been suspended, revoked or never issued, shall not be held

to have a reasonable belief that the insured is entitled to operate a motor vehicle.

2. If any insured seeking coverage settles, without our written consent, with a liable party.

U2

___________________________________________________________________ Uninsured Motorists

3. While any insured operates or occupies a motor vehicle:

a) owned by;

b) furnished to; or

c) available for the regular use of;

you or a relative, but not insured for Auto Liability coverage under this policy. It also

does not apply if any insured is hit by any such motor vehicle.

B. This coverage also does not apply to:

1. Punitive or exemplary damages. Punitive or exemplary damages also include any

damages awarded pursuant to statute in the form of double, treble or other multiple

damages in excess of compensatory damages.

2. Any claim by an insured arising out of bodily injury sustained by any person who is

not an insured under this policy.

Insured Persons' Duties1. The insured must:

a) submit written proof of the claim to us as soon as practicable. It must be under oath, if

required. It must include details of:

(1) the nature and extent of injuries;

(2) treatment; and

(3) any other facts which could affect the amount of payment.

b) provide all facts of the accident and the names of all witnesses.

c) answer questions under oath as often as we require.

d) be examined by doctors chosen by us as often as we require. At our request, the injured

person or his legal representative must promptly authorize us to:

(1) speak with any doctor, dentist, or other health care provider who has provided

treatment;

(2) read all medical history and reports of the injury;

(3) obtain copies of wage and medical reports and records; and

(4) obtain copies of all medical, dental, and other health care bills as they are incurred.

2. After we make payment under this coverage, we may require the insured to take legal

action against any liable party.

3. An insured may bring legal action against the other party for bodily injury. A copy of any

paper served in this action must be sent to us at once.

4. The insured must:

a) obtain our written consent to:

(1) settle any legal action brought against any liable party; or

(2) release any liable party.

b) preserve and protect our right to subrogate against any liable party.

Trust Agreement1. The following applies to the extent of any payment we make under this coverage. We will

have first right to any amount the insured receives from any liable party. The insured

must:

a) hold in trust for us his right to recover against any such party and execute a release and

trust agreement;

b) do whatever is proper to secure such rights, and do nothing to prejudice them;

c) furnish us all papers in any suit the insured files;

d) do whatever is necessary to recover for us payments made under this coverage; and

e) repay us out of any recovery for any payments we have made and any expenses we have

incurred in the action.

U3

____________________________________________________________________Uninsured Motorists

2. Our payment of a claim may result from the insolvency of an insurer. If so, we have the

right to recover from the insurer, but not its insured.

Limits and Conditions of PaymentAMOUNTS PAYABLE FOR UNINSURED MOTORISTS LOSSES

Our obligation to pay Uninsured MotoristsÅBodily Injury losses is limited to the amounts per

person and per occurrence stated in the policy Declarations. The following conditions apply to

these limits:

1. The limit shown:

a) for bodily injury for any one person applies to one person's bodily injury, including

death, and includes all claims resulting from or arising out of that one person's bodilyinjury, including death. Any and all claims, including but not limited to any claim for loss

of consortium or injury to the relationship arising from this bodily injury, including death,

shall be included in this limit. This per person policy limit shall be enforceable regardless

of the number of insureds, claims made, vehicles or premiums shown in the Declarations

or policy, or vehicles involved in the accident.

b) for bodily injury for each occurrence is, subject to the per person limit described in

paragraph a) above, the total limit of our liability for all covered damages when two or

more persons sustain bodily injury, including death, as a result of one occurrence. Any

and all claims, including any claim for loss of consortium or injury to the relationship

arising from this bodily injury, including death, shall be included in this limit. This per

occurrence policy limit shall be enforceable regardless of the number of insureds, claims

made, vehicles or premiums shown in the Declarations or policy, or vehicles involved in

the accident.

2. Coverage applies as stated in the Declarations. The insuring of more than one person or

vehicle under this policy does not increase our Uninsured Motorists payment limits. In no

event will any insured be entitled to more than the highest per person limit applicable under

this or any other policy issued by us or a company affiliated with us.

3. The limits of this coverage will be reduced by any amounts available for payment by or on

behalf of any liable parties for all claims, including claims for bodily injury, loss of

consortium, injury to the relationship, and any and all other claims.

4. Damages payable, if less than the limits of this coverage, will be reduced by any amounts

available for payment by or on behalf of any liable parties for all claims, including claims for

bodily injury, loss of consortium, injury to the relationship, and any and all other claims.

5. Any payment under this coverage to or for an insured will reduce the amount of damages

the insured may be entitled to recover under the Bodily Injury Liability coverage of this

policy.

6. No payment will be made until the limits of all other liability insurance and bonds that apply

have been exhausted by payments.

OTHER INSURANCE

1. If there is other insurance for bodily injury suffered by an insured while occupying a

motor vehicle other than your auto, our coverage is excess over any other collectible:

a) insurance;

b) self insurance;

c) proceeds from a governmental entity; or

d) sources of recovery other than workers' compensation benefits.

However, this insurance will apply only in the amount by which the limit of coverage under

this policy exceeds the total amount collectible from all of the above noted recovery

sources.

U4

___________________________________________________________________ Uninsured Motorists

2. If an insured other than you or a relative is a named insured or an insured household

member for uninsured motorists or underinsured motorists coverage under another policy,

our coverage is excess to any such coverage. Our coverage will apply only in the amount

by which the limit of coverage under this policy exceeds the limit of coverage of the policy

or policies under which such insured is a named insured or insured household member.

3. Except as stated above, if there is other insurance similar to this coverage under any other

policy, we will be liable for only our share of the loss. Our share is our proportion of the

total insurance limits for the loss.

4. In any event, if more than one policy applies, total limits applicable will be considered not to

exceed the highest limits amount of any one of them.

DUPLICATE PAYMENT

We will make no duplicate payment to or for any insured for the same element of loss.

AssignabilityNo interest or benefits in this coverage or cause of action against us arising out of this coverage

can be transferred or assigned to another without our written consent. However, if the

policyholder dies, the coverage will remain in force for the balance of the policy period for

those persons who were entitled to coverage at the time of death.

U5

General Policy ConditionsABWe, you, and anyone insured by this policy are bound by and must comply with all the terms,

conditions and obligations of the policy. The following are policy conditions:

1. HOW YOUR POLICY MAY BE CHANGED

a) Any terms of this policy which may be in conflict with statutes of the state in which the

policy is issued are hereby amended to conform.

b) Any insured will automatically have the benefit of any extension or broadening of

coverage in this policy, as of the effective date of the change, provided it does not

require more premium.

c) No other changes may be made in the terms of this policy except by endorsement or

policy revision.

d) The premium for each coverage is based on information in our possession. Any

change or correction in this information will allow us to make an adjustment of the

premium as of the date the change is effective.

e) The policyholder has a duty to notify us as soon as possible of any change which may

affect the premium or the risk under this policy. This includes, but is not limited to,

changes in:

(1) the principal garaging address of the insured vehicle(s), which must be reported to

us within 30 days of the date the address change becomes effective;

(2) drivers;

(3) use of the insured vehicle(s); or

(4) desired coverages, deductibles, or limits.

2. OPTIONAL PAYMENT OF PREMIUM IN INSTALLMENTS

The policyholder may pay the premium for this policy in installments, under terms and

conditions approved where required by the Department of Insurance. For each separate

installment payment there is an installment service charge. Your agent can provide more

information.

3. RENEWAL

This policy is written for a six-month policy period. We will renew it for successive policy

periods, subject to the following conditions:

a) Renewal will be in accordance with policy forms, rules, rates and rating plans in use by

us at the time.

b) All premiums or premium installment payments must be paid when due, whether

payable directly to us or through any premium finance plan.

c) Prior to the expiration of a policy term for which premium has been paid, we will mail a

notice to the policyholder for the premium required to renew or maintain the policy in

effect. We will mail this notice to the address last known to us.

4. NON-RENEWAL

a) At the end of each six-month period after the effective date of the policy, we will have

the right to refuse to renew the auto Property Damage Liability, Bodily Injury Liability,

Medical Payments, Family Compensation, and Uninsured Motorists coverages if we

have indicated our willingness to issue a new policy. This policy may be issued by

another company under the same ownership or management as our company. We will

have the right to refuse to renew any other coverage at the end of each six-month

period.

G1

________________________________________________________________General Policy Conditions

b) At the end of each 24-month period after the first effective date of the policy, we willhave the right to refuse to renew the auto Property Damage Liability, Bodily InjuryLiability, Medical Payments, Family Compensation, and Uninsured Motorists coverage.

c) If we elect not to renew under a) or b), we will mail or deliver written notice to thepolicyholder 30 days in advance of the date our action will take effect. Mailing of thisnotice to the last known address or delivery of it to the policyholder will be consideredproof of notice.

d) For non-payment of renewal premium, coverage will terminate at the end of the lastpolicy period for which premium was paid.

5. CANCELLATION DURING POLICY PERIOD

a) The policyholder may cancel this policy or any of its coverages orally or by mailingnotice to us of the future date of cancellation desired. We will calculate any returnedpremium according to the rules, rates, fees, and forms in effect and on file if required,for our use in your state.

b) Up to the time this policy or any coverage has been in effect 90 days, we have unlimitedright of cancellation. We may cancel by mailing notice to the policyholder 10 days inadvance of termination of coverage. While the date we mail this notice must be withinthe 90 days, the date of termination need not be.

c) After any coverage of this policy has been in force 90 days, our right to cancel suchcoverage during the policy period is limited.

(1) We may cancel:

(a) if all premiums or premium installment payments are not paid when due,whether payable directly to us or through any premium finance plan.

(b) if the policyholder or any insured principal driver loses the right to drivebecause of suspension, revocation, or expiration of driver's license.

(c) misrepresentation by the policyholder of any material fact in the procurementor renewal of the insurance or by you or a relative in the submission of claims.

(2) Loss of the right to drive by any insured other than the policyholder or a principaldriver will not affect our right to cancel your policy. By policy endorsement, however,we may:

(a) exclude such other insured from coverage under this policy while driving anymotor vehicle.

(b) exclude all Comprehensive or Collision coverages while such insured drivesany motor vehicle.

(3) We must mail or deliver notice to the policyholder 30 days in advance of the datecoverage is to be terminated, unless we are cancelling for nonpayment of premiums.To cancel for nonpayment we will mail or deliver notice to the policyholder 10 days inadvance of termination of coverage.

d) In any case of cancellation by us under items b) or c) above, our mailing of notice tothe policyholder's last known address will constitute proof of notice as of the date we

mail it. We will retain premium for days covered during the policy period.

e) Premium refund, if any due for Auto Liability or Uninsured Motorists coverages, or othersums we owe the policyholder under these coverages, will be tendered before the datecoverage is terminated. Any other premium refund that is due will be made as soon aspracticable. Mailing or delivery of our check will constitute tender of refund.

6. DIVIDENDS

The policyholder is entitled to any dividends which are declared by the Board of Directorsand are applicable to coverages in this policy.

7. IF YOU BECOME BANKRUPT

Bankruptcy or insolvency of any insured will not relieve us of any obligation under theterms of this policy.

G2

_______________________________________________________________ General Policy Conditions

8. UNAUTHORIZED USE OF OTHER MOTOR VEHICLES

Protection in this policy does not apply to other motor vehicles which any insured:

a) uses without a reasonable belief that the insured is entitled to do so.

b) has stolen.

c) knows to have been stolen.

An insured whose license has been suspended, revoked or never issued, shall not be held

to have a reasonable belief that the insured is entitled to operate a motor vehicle.

9. FRAUD AND MISREPRESENTATION

a) THIS POLICY WAS ISSUED IN RELIANCE ON THE INFORMATION YOU PROVIDED AT

THE TIME OF YOUR APPLICATION FOR INSURANCE COVERAGE. WE MAY VOID

THIS POLICY, DENY COVERAGE UNDER THIS POLICY, OR, AT OUR ELECTION,

ASSERT ANY OTHER REMEDY AVAILABLE UNDER APPLICABLE LAW, IF YOU, OR

ANY INSURED PERSON SEEKING COVERAGE UNDER THIS POLICY, KNOWINGLY,

OR UNKNOWINGLY CONCEALED, MISREPRESENTED OR OMITTED ANY MATERIAL

FACT OR ENGAGED IN FRAUDULENT CONDUCT AT THE TIME THE APPLICATION

WAS MADE OR AT ANY TIME DURING THE POLICY PERIOD.

b) WE MAY VOID THIS POLICY, DENY COVERAGE FOR AN ACCIDENT OR LOSS, OR AT

OUR ELECTION, ASSERT ANY OTHER REMEDY AVAILABLE UNDER APPLICABLE

LAW, IF ANY INSURED PERSON OR ANY OTHER PERSON SEEKING COVERAGE

UNDER THIS POLICY HAS KNOWINGLY OR UNKNOWINGLY CONCEALED OR

MISREPRESENTED ANY MATERIAL FACT OR ENGAGED IN FRAUDULENT CONDUCT

IN CONNECTION WITH THE FILING OR SETTLEMENT OF ANY CLAIM.

c) IF WE CERTIFY THIS POLICY AS PROOF OF FINANCIAL RESPONSIBILITY TO THE

REGISTRAR OF MOTOR VEHICLES OF THE STATE OF OHIO, AND WE VOID THIS

POLICY AB INITIO OR CANCEL IT FROM THE DATE OF INCEPTION, THAT ACTION

SHALL NOT AFFECT THE LIABILITY COVERAGE OF THIS POLICY UP TO THE

MINIMUM LIMITS REQUIRED BY THE FINANCIAL RESPONSIBILITY LAWS OF THE

STATE OF OHIO, UNTIL SUCH TIME AS WE NOTIFY THE REGISTRAR OF MOTOR

VEHICLES OF THE STATE OF OHIO THAT THE POLICY HAS BEEN CANCELLED. IF

AN ACCIDENT OCCURS OR A CLAIM IS MADE BEFORE WE NOTIFY THE REGISTRAR

OF MOTOR VEHICLES OF THE STATE OF OHIO OR THE POLICYHOLDER THAT THE

POLICY IS VOID AND/OR CANCELLED AND WE WOULD NOT HAVE BEEN

OBLIGATED TO MAKE ANY PAYMENT UNDER THE TERMS OF THE POLICY BUT FOR

THE PROOF OF FINANCIAL RESPONSIBILITY, THE POLICYHOLDER SHALL

RELMBURSE US FOR ANY AND ALL PAYMENTS MADE.

10. SUIT AGAINST US

No lawsuit may be filed against us by anyone claiming any of the coverages provided in

this policy until the said person has fully complied with all the terms and conditions of this

policy, including but not limited to the protection of our subrogation rights.

Subject to the preceding paragraph, under the Uninsured Motorists coverage of this policy,

any lawsuit must be filed against us:

a) within three (3) years from the date of the accident; or

b) within one (1) year after the Liability insurer for the owner or operator of the motor

vehicle liable to the insured has become the subject of insolvency proceedings in any

state;

whichever is later.

Under the Auto Liability coverages of this policy, no lawsuit may be filed against us until

judgment against an insured under this policy has been finally determined after trial. This

policy does not give anyone the right to make us a party to any lawsuit filed against an

insured under this policy.

G3

________________________________________________________________General Policy Conditions

11. SUBROGATION

We have the right of subrogation under the:

a) Physical Damage;

b) Auto Liability;

c) Medical Payments;

d) Family Compensation; and

e) Uninsured Motorists;

coverages in this policy and its endorsements. This means that after paying a loss to you

or others under this policy, we will have the insured's right to sue for or otherwise recover

such loss from anyone else who may be liable. Also, we may require reimbursement from

the insured out of any settlement or judgment that duplicates our payments. These

provisions will be applied in accordance with state law. Any insured will sign such papers,

and do whatever else is necessary, to transfer these rights to us, and will do nothing to

prejudice them.

12. NON-SUFFICIENT FUNDS AND LATE PAYMENT CHARGES

The company reserves the right to impose a fee for any premium payment that is unable to

be processed due to non-sufficient funds, or if there are non-sufficient funds in an account

that is being utilized for electronic funds transfer (EFT) payments, or if the premium is not

paid by the due date. This is under the terms and conditions approved where required by

the Department of Insurance.

13. APPLICABLE CONTRACT LAW

The contract law of the State of Ohio governs the interpretation of this contract.

14. REPRESENTATIONS AND WARRANTIES IN THE APPLICATION

The application for this policy is incorporated herein and made a part of this policy. When

we refer to the policy, we mean this document, the application, the Declarations page, and

the endorsements. The policyholder agrees that the statements in the Declarations and the

application for this policy are his or her agreements, representations and warranties. The

policyholder agrees that this policy is issued in reliance upon the truth of such

representations and warranties. If it is determined that any warranty made by the

policyholder is incorrect, this policy may be held void ab initio, or void back to the date of

inception, upon return of the policyholder's premium.

Warranties which, if incorrect, could void the policy from the beginning are:

(1) registered owner of the vehicle;

(2) all drivers and other operators in the household;

(3) use of the insured vehicle;

(4) make/model/year (identity) of the insured vehicle;

(5) correct address of the policyholder and correct garaging address;

(6) status of driver's license;

(7) prior motor vehicle accidents;

(8) prior claims involving loss to motor vehicles;

(9) existing damage to your auto.

15. INTEREST RATE

If a court determines that interest on judgment, decree, or order for the payment of money

is required by law on amounts due and payable under the policy to an insured, it will be

paid at the rate of two per cent per annum.

G4

_______________________________________________________________ General Policy Conditions

MUTUAL POLICY CONDITIONS

(Applicable only to policies issued by Nationwide Mutual Insurance CompanyÅNationwideMutual Fire Insurance Company.)

If this policy is issued by Nationwide Mutual Insurance Company or Nationwide Mutual FireInsurance Company, the policyholder is a member of the company issuing the policy whilethis or any other policy issued by one of these two companies is in force. While a member, thepolicyholder is entitled to one vote onlyÅregardless of the number of policies issued to thepolicyholderÅeither in person or by proxy at meetings of members of said company.

The annual meeting of members of Nationwide Mutual Insurance Company will be held at theHome Office at Columbus, Ohio, at 10 a.m. on the first Thursday of April. The annual meetingof members of Nationwide Mutual Fire Insurance Company will be held at the Home Office atColumbus, Ohio, at 9:30 a.m. on the first Thursday of April. If the Board of Directors of either ofthe above companies should elect to change the time or place of meeting, that company willmail notice of the change to the policyholder at the address last known to it. The company

will mail this notice at least 10 days in advance of the meeting date.

This policy is non-assessable, meaning that the policyholder is not subject to any assessmentbeyond the premiums the above companies require for each policy term.

IN WITNESS WHEREOF: Nationwide Mutual Insurance Company, Nationwide Mutual FireInsurance Company, Nationwide Property and Casualty Insurance Company, or NationwideGeneral Insurance Company, whichever is the issuing company as shown in the Declarations,has caused this policy to be signed by its President and Secretary, and countersigned as maybe required by a duly authorized representative of the company.

ABCDEFGH

Nationwide Mutual Insurance Company Ã Nationwide Mutual Fire Insurance Company

Nationwide Property and Casualty Insurance Company Ã Nationwide General Insurance Company

Home Office: Columbus, Ohio 43215-2220ABCDG5



Ejemplo de la página de declaración(Por favor, vea las hojas adjuntas)


Folleto 7



¿Qué cubre el seguro de automóvil?(del sitio de la red de Nationwide)

Quizás la razón primordial por la cual usted desea cobertura mediante el seguro deautomóvil sea la protección de su propiedad (automóvil, camión, van, etc.). Lacobertura de responsabilidad civil de automóvil puede protegerle en caso de que ustedcause daños a la propiedad de otro o daños corporales a otra persona sin intención.Algunos de los siguientes tipos de planes pueden ayudarle a proteger sus automóviles ysus pasajeros. Hasta los accidentes menores pueden causarle daños corporales a ustedy a los pasajeros en su vehículo.

Daños a su auton Cobertura aparte de Colisión: Paga los daños a su automóvil, menos el

deducible, causados por motivos diferentes a un accidente, tales como fuego, roboo rotura de vidrios

Por lo general paga eventos tales como daños sufridos por su vehículo aconsecuencia del contacto con aves o animales, objetos que caen o vuelan, robo,hurto, incendio, temporales de viento, granizo, agua, inundación, daños maliciosos,vandalismo, disturbios o conmoción civil, rotura de vidrios, explosión o terremoto.

n Cobertura de colisión: Paga los daños a su automóvil, menos el deducible, siusted choca contra otro auto u objeto y por volcadura.

n Cobertura de remolque y mano de obra: Paga una cantidad limitada por la manode obra para reparar su automóvil en el lugar en que se averió o el costo deremolcar su auto. Puede cubrir ayuda de 24 horas a través de un número deteléfono gratuito para problemas comunes, tales como: falta de gasolina, llantasponchadas, problemas de baterías, y llaves perdidas o que hayan quedadoencerradas dentro del auto.

Proporciona cobertura de gastos relacionados con remolque y mano de obra si suauto asegurado está averiado. Esta cobertura está sujeta a exclusiones, puede variardependiendo del estado y de la persona y está sujeta a un incremento de la prima.


Folleto 8

Daños y lesiones a otrosn Cobertura de responsabilidad civil por lesiones corporales: Paga cuando usted

es responsable por las lesiones corporales de otras personas y en ciertos casos, susgastos legales.

Por lo general, los límites de cobertura se indican con dos números, p. Ej. 100/300.El primer número es el límite por persona para lesiones, incluyendo la muerte, y elsegundo es el límite por accidente para dos o más personas que sufren lesionescorporales.

n Cobertura de responsabilidad civil por daños a bienes: Paga por reclamos siusted es responsable de daños al vehículo o a la propiedad de otros.

Lesiones en su automóviln Cobertura de gastos médicos: Paga por ciertos gastos médicos incurridos por

usted u otros cuando hay daño corporal mientras ocupan su automóvil,independientemente de quien tiene la culpa.

n Cobertura para conductores no asegurados o con seguro insuficiente: Pagapor gastos de hospital y otros gastos médicos por daños o lesiones a usted y otrosen su automóvil causados por un conductor no asegurado o con seguroinsuficiente.

n Protección contra lesiones personales (no-culpabilidad): Disponible enmuchos estados, los requisitos básicos bajo cada ley estatal sobre No-Culpabilidadestán disponibles, así como beneficios adicionales.





Si usted está involucrado en un accidente1. ¡Póngase en contacto con la policía!

•• Si usted resulta lesionado gravemente, el policía lo llevará a un hospital.•• Si no está herido de gravedad, considere una consulta con un doctor si tiene algún dolor

o se siente adolorido o si ha sufrido alguna clase de lesión en la cabeza o el cuello.•• No admita culpabilidad.

2. Llene el informe de accidente.3. Intercambie información de contacto y seguro con el otro conductor.4. Obtenga la información que necesitará para la reclamación, incluyendo:

la descripción de los vehículos y los daños específicos a cada uno, los nombres ydirecciones de todos los individuos involucrados o testigos del accidente;

5. Póngase en contacto con su compañía de seguros y dele su información depérdida / accidente. Tenga listo lo siguiente:•• Su nombre completo y dirección•• El número de su póliza•• Una descripción del accidente (¿Dónde?, ¿Cuándo?, ¿Cómo?)•• Nombres y direcciones de los testigos, conductores y personas lesionadas•• Información de pérdida general (¿qué propiedad resultó dañada?)•• Copias de los informes de la policía y del accidente y cualquier multa que

usted haya recibido6. Envíe prontamente a su compañía de seguros copias de cualquier carta,

avisos o documentos legales que usted reciba sobre el accidente. Puede serque tenga que ofrecer documentación como evidencia de pérdida Si usted recibiótratamiento por lesiones, puede ser que tenga que someter esa información también.

7. Usted puede reportar la reclamación en una de tres formas:•• Llamando al número gratuito en su tarjeta de seguro•• Llenando un formulario a través del Internet en el sitio en el Internet de su

compañía de seguros•• Comunicándose con su agente de seguros si tiene una oficina local

8. Su reclamación es manejada individualmente por un especialista enreclamaciones.

9. Un especialista en reclamaciones: •• Se pondrá en contacto con usted para verificar los datos en la reclamación•• Contestará cualquier pregunta que usted tenga•• Confirmará su cobertura•• Obtendrá documentos de reclamación e iniciará cualquier investigación necesaria

relacionada con la reclamación•• Establecerá la cantidad de los daños a ser pagados por el reclamo•• Autorizará pagos de acuerdo a las condiciones de la póliza


Folleto 9



Ejemplo de un Formulario de Reclamaciones (Por favor, vea las hojas adjuntas)


Folleto 10

SAMPLE Automobile Claim Form

CSR name CSR Ext

Called In By: Caller's Phone # _______-_______-_____________

PH's Name: Policy Number _____- ____- ____- _______________________ First Name Middle Initial Last Name Region State Prefix Six Digit Policy Number

PH Address PH Home Phone _______-________-_____________________

PH Business Phone _______-________-___________________

PH City State _______ ZIP______________________________ Alternate Phone:_____-_____-_____________ Cell Pager Other

PH County Email:

Was V1 Owner Injured ? oYes o No Extent of Injuries:_________________________________________________________oER oDr. oHosp oOther

No. Passengers In PH Vehicle? _______ All injured parties in PH vehicle other than the owner should be recorded on a Claimant Section

Date of Loss __________/ __________/ ________ Time of Loss AM PM

Loss Location/Cross Street:

City: State: Zip Code: County:

Number of Vehicles: Loss Description:

Police Rpt.?oYes o No oState oCounty oCity Report # ________ Violation? o PH o CLT Charged with? ____________________________________

Policyholder's Vehicle: Damage Collision o Comp(FTC) o V1 Driver Information (complete only if different from the person above) Year:______Make:_______________________ LF FE RF Flood Name:

Model________________ Fire Address:

Color ______________ LS Top RS Theft

Tag# ____________State________ Glass City: State: _______ Zip:________________

Driveable? o Yes o No LR RE RR Other --------------- Home Phone:

Seat Belts in Use? oYes oNo Air Bags Deploy? oYes o No Business Phone:

Where can Vehicle be seen? Alternate Phone:

Claimant Information

Claimant #1 Name _____________________________________ Claimant #2 Name ________________________________________ o Owner o Driver o Passenger o Owner o Driver o Passenger

Claimant Address ___________________________________________________ Claimant Address ___________________________________________________

_____________________________________________________ _____________________________________________________

Claimant City ______________________________________ Claimant City ______________________________________

Claimant State _______ ZIP _______________ County __________________ Claimant State _______ ZIP _______________ County __________________

Home Phone:______________________ Bus.Phone:_____________________ Home Phone:______________________ Bus.Phone:_____________________

Alternate Contact Info: _________________________________ Cell Pager Other Alternate Contact Info: _________________________________ Cell Pager Other

Injured? oNo oYes Extent of Injury ___________________________________ Injured? oNo oYes Extent of Injury ___________________________________

Hospital/Dr./Misc.__________________________________________________ Hospital/Dr./Misc.__________________________________________________

Claimant #1 Vehicle Information Damage Claimant #2 Vehicle Information Damage

Year:______Make:_______________________ LF FERF Year:______Make:_______________________ LF FE

RF

Model________________ Model________________

Color ______________ LS Top RS Color ______________ LS Top RS

Tag# ____________State________ Other ________________ Tag# ____________State________ Other ________________

Driveable? o Yes o No LRRE

RR Driveable? o Yes o No LR

RERR

Seat Belts in Use? oYes oNo Air Bags Deploy? oYes o No Seat Belts in Use? oYes oNo Air Bags Deploy? oYes o No

Driver's Name: Driver's Name:

Where can Vehicle be seen? Where can Vehicle be seen?

Witness/Comments:

Handwritten NOL.xls Revised 11/12/02

Copywrite 2003, Nationwide Mutual Insurance Company and its affiliates. May not be reproduced or duplicated without prior consent of Nationwide. For illustrative and instructional for ASPIRA use only.

Policy Information

Loss Information

Copywrite 2003, Nationwide Mutual Insurance Company and its affiliates. May not be reproduced or duplicated without prior consent of Nationwide. For illustrative and instructional for ASPIRA use only.



Ejemplo de una Solicitud de Seguro deAutomóvil(Por favor, vea las hojas adjuntas)


Folleto 11

Policy Number: 1 of 5

Automobile Insurance Application Nationwide Issuing Company

Policy Number: Effective: MM/DD/YYYY at XX:XX PM ET Expiration: MM/DD/YYYY Application Type: Personal Auto County: Territory: Fire/Tax Code: Named Insured: Home Phone: Secondary Phone: E-mail: Street: City: ST: ZIP:

DRIVER AND HOUSEHOLD INFORMATION Driver 1 Driver 2 Driver 3 Driver 4 Driver 5 Driver 6 Name Date Of Birth Gender Marital Social Security No. Driver License No. Licensed State Prior State If <3 Yrs. Relationship Occupation Resident Child Driver Type At Residence Street City State ZIP

Driver Discounts Good Student Safe Driver

Driver Surcharges Unverifiable License

YOUTHFUL HOUSEHOLD MEMBERS

Household Youth 1 Household Youth 2 Household Youth 3 Household Youth 4 Household Youth 5 Name Date Of Birth Gender

NON-LICENSED RESIDENTS Non-Licensed Resident 1 Non-Licensed Resident 2 Non-Licensed Resident 3 Non-Licensed Resident 4

Name Date Of Birth Gender Marital Relationship Reason Non-Licensed Driver Type

PRIOR AUTO INSURANCE HISTORY Previous Insurer Liability Limits Expiration Date Continuous Coverage

MM/DD/YYYY


VIOLATIONS, ACCIDENT, CLAIMS HISTORY Have you, any licensed driver in your household, or any operators of your vehicle(s) had any accidents (at-fault or not-at-fault), violations, or

filed any injury claims during the past five years (35 months in 4 states)? Name Occurence Date Conviction Date Description Violation/Accident Code

How many claims to an insurer have you or any operators of your vehicle(s) submitted in the last 35 months for comp/unattended collision losses (e.g. theft, vandalism, glass, etc.)? Does not include Towing & Labor.

VEHICLE AND COVERAGE INFORMATION Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Model Year Make Model Vehicle Identification Number Registered Owner(s) Product Type Sub Product Type Rate Symbol Existing Damage Description Cause Salvaged/Rebuilt Title Reason Customized Description Amount Symbol Stated Amount Inspection

Vehicle Level Coverages Bodily Injury Property Damage Personal Injury Protection Addl. Personal Injury Protection Comprehensive Collision Towing and Labor Loss Of Use Vehicle-Level Regulatory Fees Total Vehicle Premium

Trailer and Coverage Information Trailer Type Model Year Make Trailer ID Number Rate symbol Age Group Comprehensive Deductible/Premium Collision Deductible/Premium PE Limit/Premium Total Trailer Premium

POLICY LEVEL COVERAGES Uninsured Motorist BI Uninsured Motorist PD Policy Level Taxes/ Regulatory Fees Policy Level Premium

VEHICLE AND POLICY LEVEL DISCOUNTS Passive Restraint Homeowners Anti-Lock

VEHICLE AND POLICY LEVEL SURCHARGES Altered Vehicle (MI Only)


RATING VARIABLES

GENERAL INFORMATION

Has the named insured or spouse filed bankruptcy or had repossessions or unsatisfied judgments in the past five years? (non Class Plan M states) <Y/N> Does any driver reside in NJ, NY, MA, NM, or LA at any time during the year or are any of the vehicles principally garaged in any of these states? <Y/N> Have you, any member of your household, or any operators of your vehicles been convicted of a felony within the past ten years? <Y/N> Are there any vehicles in your household not insured with Nationwide? <Y/N>

If Yes: Model YR: Make: Model: Reason:

Since you have owned your vehicle(s), have you ever received payment from any insurance company for Diminution of Value due to damage to any of your vehicles (caused by you or someone else)? (GA Only) <Y/N>

If Yes: Vehicle: Payment Date: Amount: Is any vehicle garaged at an address other that the policy mailing address? <Y/N> If Yes: Vehicle #: Street: City: ST: ZIP: Terr:

FINANCIAL RESPONSIBILITY Name Filing Type Filing State Relationship to Applicant

THIRD PARTY INFORMATION Third Party Name Street/P.O. Box City ST ZIP Third Party Type

<Veh #> <Trailer #>

<Etc> <Etc>

COMPREHENSIVE FAMILY LIABILITY Farm Acreage Farm Income Additional Residences Limit of Liability CFL Premium

MISCELLANEOUS COVERAGE Name Coverage Premium

PAYMENT INFORMATION Total Vehicle Premiums: $ Applicable Fees/Taxes: $ Policy Coverage Premium: $ Installment Premium: $ Total Policy Premium: $ Amount Collected: $ Payment Plan: Installment Fees: $

PROXY GRANT (Where Applicable) In the event this application shall, at any time, result in the issuance to me of an insurance policy by Nationwide Mutual Insurance Company or any mutual insurance company affiliated with it (a Policy), I hereby appoint the Chairman of the Board of such mutual insurance company, with full power of substitution, to be my proxy, and such individual is authorized and empowered to vote for me on all matters presented for vote at any membership meeting of such company. This proxy shall continue in force for the full duration of the Policy and any renewal thereof, unless sooner revoked in writing. If I choose to revoke my proxy authorization, at any time, I can contact my agent or the Office of Secretary of the insurer to obtain a proxy revocation form.

NOTICE – AUTO LIABILITY COVERAGES Read your policy. The policy of insurance for which this application is being made, if issued, may be canceled without cause at the option of the insurer at any time in the first [xx] days during which it is in effect and at any time thereafter for reasons stated in the policy.


CLOSING STATEMENT I have received and read a copy of the “Nationwide Insurance Privacy Statement” as required by the Fair Credit Reporting Act. By submitting this application, I am applying for issuance of a policy of insurance and, at its expiration, for appropriate renewal policies issued by Nationwide Mutual Insurance Company and/or other members of the Nationwide group of insurance companies. I understand and agree that any information about me that is contained in, or that is obtained in connection with, this application or any policy issued to me may be used by any company within the Nationwide group to issue, review, and renew the insurance for which I am applying. I understand that misrepresentation of information on this application could void some or all of my coverages. I hereby authorize Nationwide Mutual Insurance Company and/or other members of the Nationwide group of insurance companies to obtain copies of consumer reports, to include but not limited to motor vehicle reports, consumer credit reports and/or credit scores, and claims loss history reports for use in rating and/or underwriting of my insurance. I understand that in obtaining these reports, a consumer reporting agency may be used. I hereby certify that the named drivers under this policy have authorized me to consent on their behalf for the insurer to obtain consumer reports for rating and/or underwriting. By submitting this application to Nationwide, I hereby attest and affirm that I have read and understand all of the questions posed and the answers provided herein are true and correct. I understand that these questions are being asked for the purpose(s) of providing me and my household with automobile insurance coverage and that my answers will be relied upon by Nationwide for that purpose. I further understand that before any coverage can or will be bound by Nationwide, I must comply with all of the following conditions precedent: 1) I must return this completed application to Nationwide or its agent (#1 omitted in Standard Auto Application, remaining numbers adjusted); 2) All vehicles to be insured on this policy requiring an inspection must have been provided to Nationwide for inspection within 72 hours of this application; 3) I must have paid the premium amount, in full, as indicated/requested by Nationwide and/or its agent. No coverage will be provided or bound by Nationwide until all conditions precedent are satisfied/completed. Should any part of the premium payment I pay to Nationwide be dishonored by any financial institution, for any reason, I understand that the policy will be considered as void from the inception and that it will be as if no policy ever existed. I also understand that it is my obligation and duty to notify Nationwide of any change in address or change in drivers or driver status within 30 days of such a change. I hereby acknowledge that all coverages, required and optional, available to me have been fully explained. I understand that the coverages and limits indicated on my application are those I have selected. I further understand and agree that the selected coverages and limits shall apply on all future renewals of the policy and on future policies issued to me because of a change in vehicle or coverage, unless I subsequently request a change, in writing if required. For the purpose of definitions in this application, "member of household" and "household member" include, but are not limited to individuals who reside in the same home, apartment, dwelling, premises and/or residence, whether or not said individuals be related by blood, adoption or marriage. Failure to disclose a driver or member of the household will be considered material misrepresentation and may constitute grounds for denial of coverage. <State mandated wording inserted here. Some states may require certain wording above be removed.>


Applicant must signify with their initials that the following statements are true and accurate as indicated on the application: Initials

Nonstandard Auto wording: All operators and drivers who may operate the vehicle(s) identified in this application or may have access to the vehicle(s) for the purpose of operating and/or driving the vehicle(s) and all persons residing at the address listed on this application and at the garaging address(es) of said vehicle(s), have been disclosed and listed on this application. Standard Auto wording: All operators and drivers who may operate the vehicle(s) identified in this application or may have access to the vehicle(s) for the purpose of operating and/or driving the vehicle(s) and all persons residing at the address listed on this application and at the garaging address(es) of said vehicle(s), have been disclosed and listed on this or another Nationwide application, with the exception of resident parents or grandparents insured with a company other than Nationwide.

I certify that I am the owner/lessee of the listed vehicle(s) and these vehicles are not owned or leased (fully or partially) by any other individuals, except as disclosed on this application.

I certify that I, any member of my household, or any operators of the vehicles listed on this application have not been convicted of an insurance related offense (not including accidents or moving violations).

MI Only: I certify that I, any member of my household, or any operators of the vehicles listed on this application have not been convicted of a felony resulting from the use of a motor vehicle.

Not applicable in MI True Group: I certify that the vehicles listed for coverage on this policy are not used for commercial use, the pick up and delivery of goods or people, which include but is not limited to pizza, mail, newspapers, taxi, debris/snow removal, for hire or fee.

I understand that vehicles not titled to the named insured or lessee as indicated on this application will be excluded from coverage to the extent as allowed by the auto insurance contract.

All existing damage to the vehicle(s) indicated on the application has been disclosed and listed on the application.

The garaging address for the vehicle(s) indicated on this application is the same as the residence address listed on this application (except where noted to be different on same application).

__________________________________ Date: ________________ Time: ________________ <<ET>> Signature of <<Applicant (Bold)>> __________________________________ Date: ________________ Time: ________________ <<ET>> Signature of Parent or Legal Guardian (if Applicant is under 18 years of age) __________________________________ Date: ________________ Time: ________________ <<ET>> Signature of <<Agent(Bold)>> <<Agent# (Bold)>>

<<Form Number, example: SA32001 7/03>>

Seguro de Automóvil - ASPIRA...

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