Free Appendix - District Court of Delaware - Delaware

..
Case 1:04-cv-01324-JJF-LPS Document 221-2 Filed 09/15/2006 Page 1 of 4

schedule of coerages. They apPly to each Insured vehlOle as Indicated. Property limits shown In the motorists ' financial responsibility laws of your state only for vehicles for whichYour and Damage and Bodily poley compiles with the Injury Liabilit coverages are provided.

superae any Decarations Issued earlier. Your poley provides the coerl'gee number beow. They identified by poley

TheM Decarations are a part of the poley named aboe and

NATIONWIDE AUTO POLICY DECLARATIONS
Page 1 of 2

Polley Numbe: DB Account Numbe Policyholder: 62 07 A 733616 (Nlmed Inlurld)
'''uld:
JUN 19, 2003

592993 THS

ROERTA L EAES

A &/OR

SEAFORD DE
19973- 8293

14908 CORD

ROAD

Policy Period From:
hal been the time the application for Insurance Is completed, or (2) 12:01paid as required. This poicy's paid and only for ben a. Initially efecive at (1 's later. Each renewal period beins and ends at m. on the firs day of the poicy period, whichever 12:01 a. m. standard time at the address of the named Insured stted herein. This poicy canr.es at 12:01 a.

JUN17 six

. 2003 to SEP 22 2003 month renewal periods If renewal but only If the required premium for thll1'rlod premiums have

m. at the address of the named Insured stated herein.

SELECTED AS S ARE SUBJECT TO THE EXCLUS IN THIS DECLARATIONS I ON A. 1: CASES YOUH N YOUR POll CY . IN 0\t: 11. ITA T l6Ns AND COD IT ONS OF COVERAE THE M I COVERAE I. Y BE LI M /TED TO MU L' LAW OF RESPOSIBILITY M I TSOR COVERAE REQ' RED BY THE DELAWARE F I THE DELAWARE MOTORISTS PROTECTION ACT. ONI THE NA DATE TH I S DECLARA T' ONS WAS ISSUED. THOSE L 1M' TS ARE:
DET A I LED

IMPORTANT MESSAGES: NOTICE: THE COVERAES YOU HAVE

AUTO L I AB I L I
NO- FAULT:
IT IS IMPORTAN

TY: $16, 000 PER PERS, $30. 000 $10 , 000 FOR PRPERTY DAMGEPER OCRRENE FOR BO I L Y 'NJURY $16 , 000 PER PERSON, $30. 000 PER OCRRENE FOR BO I L $10, 000 FOR DAME
Y INJURY TO PROPERTY OTHER THA A MOTOR VEH I CLE THAT YOU REA YOUR POLICY
CAREFULLY.

EFFEC f VE JUN 17,

2003

1999 FORD EXPLORER
1996 FORD

. ADED AD I T IONL PERSL

I NJURY

PROTECT' ON

ADED ADITIONL

RAER

PERSL INJURY
PREM I UM DET A' L

PROTECTION

SEE ENLOSED NOT I CE FOR

YOUR VEHICLE INFORlTION

STARS ON PAGE 2.

COPAEENS' VE
COLLISION
BOILY INJURY

1999 FO EXPLOR Cover.ge.
LIABILITY
L' TY

ID I1FM34EX79505
Limit, Of Liability ACTAL CASH VALUE lESS $ ACTUAL CASH VALUE lESS $ 100 250 50, 000 EA RENE 100 000 EA
Six Month

PRPERT DAME l lAB'

PROTECT I ON

AN DAME TO PROPERTY OTHER TH MOTOR VEH CLE AD I TI ONL PERL INJURY

PERSL INJURY

PROTECTION

300; 000 EA OCRRENE EE POLICY
270: 000 EACH ACC I DENT
85 000 EACH

PERSON

Premium 34. 70 85. 49.
111. 90 42. 80

PERS

ENRSEM 3016B'
TOTAL

32.
$ 356.

LIENLDER. W, LM, NaTON TRUST CO
V-0100-

liEN EXPIRES ON APR 15, 2008

1998 FO

RAN

Page 2 of 2
I D '1FTCR10A9TPBAR

g: ggg

g:

~~~~ ,,-.
Filed 09/15/2006 Page 2 of 4

Case 1:04-cv-01324-JJF-LPS

Document 221-2

Page 2 of 2

1998 FO
Coverege.
CQPREHENS I VE COLL IS ION

I D #1 FTCR1 OA9TPB8832

Limit. Of Llebllity
ACTUAL CAS H VALUE lESS $ 100 ACTUAL CASH VALUE LESS $ 250 60, OOOEA OCRRENCE
EE POL-ICY

Six Month

Prlmlum
31 .

BOILY INJURY LIABILITY

PROPERT DAME L I ASI L I TY
PROTECT ION

AD I T

AN DAME TO PRPERlY OTHER THA MOTOR VE I CLE
IONL

PERSL I NJURY

100 000 EA PERSON 300; 000 EA OCRRENCE

71. 49. 111. 90 42. 80

PROTECT I ON

PERSL INJURY
$ 86, 000

$ 270, 000 EACH ACC I DEN

ENDORSEMEN EACH PERSON

3016S"
TOTAL

32.
$ 338.

POLICY COVERAGES

Coverege.
UN I NSURED MOTOR I STS

Limit. Of Liability

BOILY INJURY
- PROPERTY DAMGE

Six Month Premium

$ 3

100, 000 EACH PERS
$250 DED
LESS
TOTAL

88. 88.

VEHICLE CLASSIFICATIONS
Premium ,. B..td

On:

USE OF VEH I CLE

RATED DRIVER

ADL T AGE 4 AGE PRINCIPAL PRINCIPAL 48 MARR I ED MARR I ED
APPL

FEMLE ADLT
MALE

PLEAURE PLEAURE
AIR BAG FULL .AIR

1999 FORD 1996 FORD

ED DISCNTS PASS I VE RESTRA I NT PASS I VE RESTRA I
MILEAE t.L T MILEAE ANNUALCAR I CAR LON TERM
ANNUAL
t.L T I

BAG FULL

SPECIAL RATING
RAT I NG SYIU:'

SAFE DR I

VER

LON TEAM

SAFE DR I VER

018.016 00

013.012 00

Polley Form & Endor..ment.:
Offlc. u..: E OG6707

V007D 3208

APR 22

, 2003 TERR:

NATlOMIDE WTUAL INSURAE COPAN Counterlgned At: WI LM I NGTON,
Illued By:

DEL.

012 $ 34.
Homl Office - COlumbu., Ohio
CULVER
By: 'M KE I TH

IMPORTANT PHONE NUMBERS Netlonwld. 24-Hour Clelm. Numbe: 1-80-421-3535
For QUESTIONS About Your Polley, Call Your NATIONWIDE AGENT: CULVER INS
AGENCY INC

For Heerlng Impaired: TT 1-80-a22-2421 302-629- 2510
Nationwide Rlglonel Offce: 352-377-8500

FRAME:

NATIONWIDE AUTO POLICY DECLARATIONS
These DeOlarallon

are II part of the oollev nAm9r1 IIhrwA Ann In..n+lflnM

" ""II

h,. ,,,

Page 1 of 3

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Case 1:04-cv-01324-JJF-LPS
COVERAGE AGREEMENT

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Document 221-2

Filed 09/15/2006

Page 3 of 4

Endorsement 30168

Additional PefsQnal lit jury Protection

(Delaware)
'i:

Please attach this import' anfi(t'ditiori toyour auto' policy.

Additional Personal Injury Protection ISSUbjecttoi lIterrnS ndp l1q!tlonsof th policy that apply to basic Personal Injury Protection (Noult),

t " Y!;. ::!ti S:;,

cept as changed by this endorsement.

Substitute Service Expenses, up to the limits of Additional Personal Injury Protection per person

This coverage takes up where basic Personi:iI lnjury Protection leaves off. The additional benefits apply when bodily injury is covered by the basic Delaware Personal Injury Protection of any policy, but covered expenses exceed the limits of the basic coverage required by!ay.. We wil pay for these expenses over and above all amounts that are paid or payable underffe basic coverage. We wil pay the additional benefits for Medical Expenses, Loss of Earnings, and

and per accident shown In the policy Declarations. Within these total limits, we will also pay additional Funeral Expenses up to $2 000. Time limitations within which expenses must be incurred are the same as for ba.sic benefits.
YOU AND A HOUSEHOLD MEMBER

You and a household member are covered for Additional Personal Injury protection:
1. while

occupying any motor vehicle; or

2. as a pedestrian If hit by any motor vehicle.

Additional Personal Injury Protection covering the other vehicle.
OTHER PERSONS Any other person Is covered:
1. while

However, If injured while occupying or hit by a motor vehicle other than your auto, this coverage wil apply only to the extent that limits under this covera.ge exceed those under any

occupying your auto anywhere this coverage Is In force; or

2. as a pedestrian , if such person is hit by your auto In Delaware.

COVERAGE EXCLUSIONS
We wil not payAdditlonal Personal Injury Protaction benefits for bodily injury:
1. to anyone whlie occupying, or as a pedeStrian- i(h

lsowned such person, but not Insured under this endorsernent. by

by,

motor- vehiclethat

2. to anyone whose conduct contributed -to his
3 . Involvlngtheuse ofa _motor
a fee.

convicted of drivng while under the Influ nCeofCtI9()holord ugs;,:

orherowii' bodiiy
CEl

iriji.ry, ifs'iich pEirson was

veh iClebYaninslJ

ryp
red as

Motor vehicfes used In shared-expense- can

poOls are no

J?!

r-'!.'

rtX. !()L

::::n

s for

LIMITS AND CONDITIONS OF PAYMENT
The Insuring of more than one person or motor vehicle under this coverage does not increase our liability to anyone person In anyone accident.

OTHER INSURANCE
The following provisions apply If you or a household member have AdditlonalPersonallnjury Protection as a named Insured or as a member of a household under any other policy. Whenany such Insurance applies to a loss: .
___m___

3016-

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Case 1:04-cv-01324-JJF-LPS

Document 221-2

Filed 09/15/2006

Page 4 of 4

ddltlonal leforrTore

PersOnallnjury Protectlon Is In a policyOr policies we have Issued,
than

thehlghe

2. and

other Additional Personal Injury leonlYfor ourproportlonal

benefit limits payable under any one policy. Protection Is In a polley or policies not Issued by us, share oft he

lNlUbe lIa

10ss. That sharewil be determined by
this and

, our, proportion of

coverage.
In )C' no

"t
tr1;j

the. total coverage

. limits provided under

the other

available

)nstanc
-BjE

wil

duplicate benefits i:: 1f:UD j:t ;'E; 2::

be collectible

:?f'Si

Thl endor

*jif

ntappliesas statedlnthepolicy
l1tISlssU d bythecO

l2::j

;;.z\t!

under this and other similar ' auto Insurance.
2!:
:JC:L -m

Declaratlons
clar
\Nl1ln l
tionsas

Thls:eh,99r
This

rnpanYsh

the Issuing company.

orsement supersedes any

priorendorse"1ent numbered 3016 or 3016A.

NATIONWIDE INSURANCE COMPANIES

Home Offce: Columbus , Ohio 43215- 2220

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