Commercial Consumer Information And Coverage Selection Form printable pdf download

_________________________________

Commercial Consumer Information And Coverage Selection Form

IMPORTANT NOTICE: This form is not your insurance policy.

This form is only a summary. It gives only general information about the basic coverages available

when you buy commercial motor vehicle insurance. The choices you make on this form decide the coverages

that apply to all insureds under your policy.

Your insurance policy contains all of the terms and details of the coverage you buy. Please read your policy.

If an insurer doesn’t offer all of the coverages you want to buy, selecting a coverage on this form won’t obligate the

insurer to provide you with that coverage.

Read This Form Completely Before Signing.

Bodily Injury and Property Damage Coverages

Mandatory Liability Coverages

Bodily Injury Coverage (split limits)

You must buy bodily injury coverage. Bodily injury coverage is a type of liability insurance. It pays for medical

expenses, lost wages, and pain and suffering that you cause (for which you are legally responsible or liable) to others due to

an automobile accident.

Bodily injury coverage does not pay for your medical expenses, lost wages, and pain and suffering from any

accident. To pay for your injuries and expenses you may buy medical payments coverage, uninsured motorist coverage, and

underinsured motorist coverage.

If you do not have any or enough bodily injury coverage and you cause an accident, a court may order you to

compensate the people you hurt in the accident. To decide how much bodily injury coverage you should buy, you must

decide (1) how much coverage you can afford to buy and (2) how much of your assets you would be willing to lose if you

cause a serious accident.

You must buy at least the minimum bodily injury liability limits, but you may buy coverage with higher limits. You

may buy bodily injury coverage with different limits for each vehicle covered by your policy. Due to the various financial

responsibility limits that apply to commercial vehicle risks, please consult with your insurance agent or advisor about the

minimum limits that apply to you.

Bodily Injury Coverage Selection. Initial your selection below. Please Note: Read your policy to learn the

specifics about what bodily injury coverage includes and what it doesn’t include.

____

I select the bodily injury liability limits of $_______________/$_________________.

____

I select bodily injury coverage but want higher liability limits of $_______________/$_________________.

____

I select bodily injury coverage with different limits for each of my vehicles as shown on my application.

____

Not offered by this insurer. You must buy this coverage from another insurer.

____

I reject bodily injury coverage and will buy this coverage from another insurer.

Commercial Consumer Information And Coverage Selection Form