Insurance Operator

INTERINSURANCE EXCHANGE of the Automobile Club

**84

Ed. 7-10

EXCLUSION OF DESIGNATED PERSON ENDORSEMENT

Effective 12:01 A.M. Pacific Standard Time

Forming a part of Policy No. issued by the INTERINSURANCE EXCHANGE OF THE AUTOMOBILE CLUB. Named Insured: Designated Person(s):

We will issue or continue this policy because you and we have agreed that coverage afforded by Part I (Liability), Part II

(Expenses for Medical Services), Part III (Physical Damage) and Part IV (Uninsured Motorist) of this policy for the use of or damage to any automobile insured shall not apply nor accrue to the benefit of you, any other person insured or any third party claimant while said automobile is being operated by a designated person. Under Part I (Liability), our obligation to defend shall not apply nor accrue to the benefit of you, any other person insured or any third party while any automobile is being operated by a designated person. We will defend you when all of the following apply to such designated person:

1. The designated person is a resident of the same household in which you reside. 2. As a result of operating your insured automobile, the designated person is jointly sued with you. 3. The designated person is an insured under a separate automobile liability policy issued to the designated person as a named insured, which does not provide a defense to you. This agreement will be in force as long as your policy remains in force and shall apply to any continuation, renewal or replacement of your policy by you or to reinstatement of your policy within 30 days of any lapse thereof. When uninsured motorist coverage bodily injury (Coverage F) is deleted with respect to one or more natural persons designated by name when operating a motor vehicle, California law requires the agreement to be in the following form:

“The California Insurance Code requires an insurer to provide uninsured motorist coverage in each bodily injury liability insurance policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the insurer and the applicant to delete the coverage completely or to delete the coverage when a motor vehicle is operated by a natural person or persons designated by name. Uninsured motorists coverage insures the insured, his or her heirs, or legal representatives for all sums within the limits established by law, which the person or persons are legally entitled to recover as damages for bodily injury, including any resulting sickness, disease, or death, to the insured from the owner or operator of an uninsured motor vehicle not owned or operated by the insured or a resident of the same household. An uninsured motor vehicle includes an underinsured motor vehicle as defined in subdivision (p) of Section 11580.2 of the Insurance Code*.”

*Subdivision (p) of Section 11580.2 of the Insurance Code defines an underinsured motor vehicle as one that is insured under a motor vehicle liability policy, or automobile liability insurance policy, self-insured, or for which a cash deposit or bond has been posted to satisfy a financial responsibility law, but insured for an amount that is less than the uninsured motorist limits carried on the motor vehicle of the injured person. All provisions of your policy not affected by this endorsement remain unchanged. By accepting this endorsement you declare that you have read the endorsement and understand it, that it represents a voluntary agreement between you and us, and that you agree to be bound by the limitations it imposes. Accepted Signature of Insured Date Hour

Print Name Here

ACSC Management Services, Inc.

ATTORNEY-IN-FACT

08/26/2016

CAA109259555

MILLER, SHELLY

WRIGHT, DAMIAN

DAMIAN WRIGHT

Electronically Signed 2016-08-25 16:04:11 UTC - 208.54.4.139 AssureSign® d5a37ff2-4c0f-45a4-a2a6-a66d010706c9

2016-08-25 09:04:17 (UTC-07:00)

DAMIAN WRIGHT

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