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<br />`~',ro.~.o PROTECTION AGAINST UNINSURED MOTORISTS INSURANCE
<br />L....... .._..
<br />Vlaslern Casualty and Suroty Company,
<br />Attached to and made a part of Policy No ................................................................................................................. of The and/or
<br />of Forl Scott, Kansas 66701. sYestern Fire Insurance Cc-pony,
<br />I ssucd lo ............................................................................................... .. ... ........... .... .. ............................................................... .. ..... .................................. ..~. ..
<br />Name of insmea Cnr Siaie ,.ntl Zin Cotle
<br />Endorsement Elte[live' ...................... ~-'~
<br />~,- ._ ;
<br />............
<br />Secretary V Authorized Represehtalive
<br />•II no date shown, This endorsement becomes elfectire concurrently with the elreclire date of the policy to which it is attached.
<br />tTHE INFORMATION A80VE IS REQUIRED ONLY WHEN THIS ENDORSEMENT IS ISSUED SUBSEQUENT TO PREPARATION OF POLICY)
<br />SCHEDULE
<br />The insurance zllortled is only with respell to the follo•eing Coverage as indicated by specilic premium charge. The limit of the company's liahility -r_ansl such
<br />Coverage shall he as stated herein, subject to all the terms of this policy having reference thereto.
<br />Coverage ~=~nn•LLq` _ Limits of Liahilily E _-. L-aq`_ Advance Premi_;I_
<br />U-Uninsured Motorists ~ _Ihpusand dollars each Derson_$- __ thousand dollars each accident $ _ S, ('rQ _ _ _ _
<br />Description of Insured Highway Vehicles IChecR appropr role box) Designated Insured:
<br />Any automohile owned by the named insured
<br />^ Any private passenger automohile owned by the named insured
<br />^ Any pickup, sedan delivery or panel type ov,ned Dy the named insured
<br />^ Any highway vehicle to which are attached dealer's license plates issued to the named insured
<br />^ Any highway vehicle designated in the declarations of the policy by the letters "UM" and a highway vehicle
<br />ownership o1 which is acquired during the policy penod by the named insured as a replacement Therefor
<br />^ Any mohile equipment ovrned or leased by and registered In the name of the named insured
<br />The company, in consideration of the Dayment of the premium and subject to all of the Drovisions of the policy not expressly modified herein, agree: with the
<br />named insured as follo•.vs:
<br />I. COVERAGE U-UNINSURED MDTDAISTS
<br />(Damages for Bodily Injury)
<br />The company will pay all sums which the insured or his legal representative shall be legally entitled to recover as damages Irom the owner or ops'ator nl an
<br />uninsured highway vehicle because of hodily injury sustained by the insured, caused by accident and arising out of the ownership, maintenance or c:e of such
<br />uninsured highway vehicle; provided, for the purposes of (his coverage, determination as to whether the insured or such representative is legally entitle: to recover
<br />such damages, and If so the amount thereof, shall be made by agreement between the insured or such representative and the company pr, if they fad to agree, b. arbitration.
<br />(TEXAS - in accordance with the arbitration Droves ron of this policy, or by judic gal de;erminalion.)
<br />No judgment against any person or organization alleged to he legally responsible tpr the hodily injury shall be conclusive, as between the insurer and the
<br />company, of the issues of liability of such person or organization or of the amount of damages to r:hich the insured is legally entitled unless such judgment is en-
<br />tered pursuant to an action prosecuted by the insured v: ith the written consent of the company.
<br />Exclusions
<br />This insurance does not apply:
<br />!al to hodily injury to an insured with respect to v,hich such insured, his legal representative or any person entitled to payment under this insurance shall, with-
<br />out written consent of the company, make any settlement with any person or organization •who may be legally Ilable therelor.
<br />(bl to hodily injury to an insured while occupying a highway vehicle lolher than an insured highway vehicle) o+rnzd by the named insured, any designa:=,d insured
<br />or any relative resident in the same household as the named or designated insured, or Through being slrucA by such vehicle, but (his exclusion d<i:, not apply
<br />to the narned insured or his relatives v:hile occupying or it struck by a highway vehicle o:•: red by a designated insured or his relatives;
<br />(d so as to inure directly or indirectly to the benefit of any wpiFmen's compensation or disabibty benefits ca; rier or any person or organization qualilylr: as a selh
<br />insurer under any wor6men's compensation or disability henelits law or any similar law.
<br />II. PERSONS INSURED
<br />Each of the lollowing is an insured under this insurance to the extent set forth below:
<br />(a) the named insured and any designated insured and, vrhile residents of the same household. the spouse and relat Ives of either;
<br />(bl any other person s•:hile occupying an insured highway vehicle, and
<br />Ic) any person, v,ith respect to damages he is entitled to recover because pl hodily injury to r.hich this insurance aDPlies sustained by an insured under lal:~ (bI above.
<br />The insurance applies separately with respect to each insured, except •:+ith respect to the limits of the company's liability.
<br />III. LIMITS DF LIABILITY
<br />Regardless of the numher o} insureds under the policy. the company's liahility is limited as lollows~
<br />(a) ifie limit of liability stated in the schedule as applicable to "each person" is the limit of the compan)s liahility for all damages because of bodily injury sus-
<br />tained by one person as the result of any one accident and, suhjecl to the above provision iespecl ing "each person," the limit of liability sts'ed in the
<br />schedule as applicable to "each accident" is the total limit of the company's liability Icr all damages hecause of hodily injury sustained by t+~ or more
<br />persons as the result of any one accident.
<br />Ibj Any amount payable under the teems of this insurance because of bodily injury sustzined in an accident by a person r:ho is an insured under ti ~s coverage
<br />shall be reduced by
<br />I]) all sums paid on account of such hodily injury by or on hehall of
<br />0) the o;vner or operator of the uninsured highway vehicle and
<br />(ii) Any other person or mganizal ion jointly or severally liable together vnlh such o~rner or operator for such hodily injury,
<br />including all sums paid under the hodily injury liability coverage of the policy, and
<br />121 the amount Daid acd the present value of ail amounts payzble on account of sudi hodily injury under any wo;Rmen's compensation law, disah~ ty benefits
<br />law or any similar law.
<br />Icy Any payment made under (his inswanre to or for any insured shall be applied in reductun of the amount of damages which he may be entitle: to recover
<br />Oom any Gee son or orgy mzation v, ho is an insured under the bodily injwy liability roverag~ of the policy.
<br />Idl The compzny shall not be obligated to pay under this insurance (hat pail of the damages r.hich the insured may be en;llled to recover Irom the ox ~ar or oper-
<br />ator of an uninsured highway vehicle v.hich represents expenses for medical sen•ices paid or pa}ahle under the medial pa, rents coverage of the :•:'icy.
<br />IV. POLICY PERIOD; TERRITORY
<br />Thic ;nananrn vnnliec only 1n arridonlc wh;rh nrr,.. dwlnn IFo nnnrv no•Ind and mdhin fha Ild/od Cl arse nl amn.:.a ;tr to„Ir n.:ov n. meemrinn. n, nv.M
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