PERSONAL UMBRELLA LIABILITY DECLARATIONS PAGE

(July 2019)

Generally, insurers develop their own Declarations to meet their specific needs, including any requirements to conform with applicable state law. ISO provides advisory form DL DS 01, Personal Umbrella Liability Policy Declarations. If a company wishes to make use of it, the form would have to be independently filed. The form, which places the applicable policy number at the top of its page, includes space for

IDENTIFICATION INFORMATION

The name of the insurance carrier providing the coverage
The name of the producer

· Named insured (s)

· Mailing address. All correspondence from the insurance company will be mailed to this address so it must be accurate.

· Description of the Residence Premises. Assumed to be same location as mailing address. If that is not correct, the actual location must appear in this space.

· Policy Period

Insuring Agreement statement, obligating insurer to provide described coverage when required premium is paid.

POLICY LIMITS INFORMATION

· Personal Limit of Liability

· Checkbox, when marked, advising that personal injury coverage is subject to the Personal Injury Coverage Aggregate Limit of Liability. The actual limit then appears directly beneath

· Deductible

SCHEDULE OF UNDERLYING INSURANCE

· Name of Underlying Personal Liability Insurer, including policy number, limits, policy period and policy limits. Includes checkbox to indicate whether the coverage is subject to an annual aggregate limit and, if applicable, the aggregate limit amount.

· Name of Underlying Auto Liability Insurer, including policy number, policy period and Bodily Injury and Property Damage Limits (either split or combined).

· Name of Underlying Motorcycle Liability Insurer, including policy number, policy period and Bodily Injury and Property Damage Limits (either split or combined).

· Name of Underlying Watercraft Liability Insurer, including policy number, policy period and Per Accident Limit of Liability.

· Names of any Underlying Insurers providing other forms of liability, including policy numbers, policy periods, types of liability and respective limits

PREMIUM

· Premiums per coverage, vehicle and total policy premium.

· Coverage selected for each vehicle

FORMS AND ENDORSEMENTS

The numbers of the Forms and Endorsements that apply to the policy or coverage section at the time it is issued must be listed in order to incorporate them into the policy.

PREMIUM

· Policy Premium (net of endorsements)

· Endorsement Premium