515.A EXCLUSION OF NAMED DRIVER AND PARTIAL REJECTION OF COVERAGES
WARNING
READ THIS ENDORSEMENT CAREFULLY!
This acknowledgement and rejection is applicable to all renewals issued by us or any affiliated insurer.
However, we must provide a notice with each renewal as follows: "This policy contains a named driver exclusion."
You agree that none of the insurance coverages afforded by this policy shall apply while
_________________________________________________________________________________________
(The Excluded Driver[s])
is operating your covered auto or any other motor vehicle. You further agree that this endorsement will also serve as a rejection of Uninsured/Underinsured Motorists Coverage and Personal Injury Protection while your covered auto or any other motor vehicle is operated by the excluded driver.
Policy Number: _____________________
Acknowledged By: ____________________________________________
(Your Signature)
CM005 (2/00)