Preview
FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023
EXHIBIT B
FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023
Erie
akinsurance®
Your Auto Policy Declarations (Amended)
Coverage provided by:
Erie Insurance Company
100 Erie Insurance Place Erie, PA 16530
www.erieinsurance.com Amendment Effective 09/20/2022
Named Insured Number Your ERIE Agent (NN2845) Agent Phone
Policy
HALEY M BAKER & Q07 5608536 SHUMWAY INSURANCE AGENCY INC (518)324-5300
JACK DOMINIE 345 CORNEUA ST STE 1
Policy Period
PO BOX 523 07/06/2022 to 07/06/2023 PLATTSBURGH, NY 12901
DANNEMORA, NY 12929-0523 NAIC Code http://www.shumwayins.com
26263
Total Annual Policy Premium: (This is not a bill. Your invoice will follow in a separate mailing.)
Youtpremiumislased on ood )river-rates.
Vehicles Covered: Vehicle Rating Information:
Vehicle VIN State Territory Use Annual miles
1. 2008 PONT G6 GT 1G2ZH57NX84131931 NY 72 To work < 6 up to 8,500
2. 2012 KIA SORENTO LX 5XYKTCA60CG266489 NY 72 To work < 6 up to 8,500
Driver Rating Information:
Drivers Included
Age Status Gender Vehicle
HALEY M BAKER 32 Single Female 1
JACK DOMINIE 54 Single Male 2
If a driver is not a resident relative as defined in your policy, coverages, benefits and rights may be limited. Refer to your policy and its
endorsements for terms, definitions, limitations, reductions, exclusions and conditions.
YOUR POLICY INCLUDES A DIMINISHING DEDUCTIBLE AND COVERAGE ENHANCEMENT THROUGH ERIE AUTO PLUS
Discounts that apply: Vehicle:
Antlel-eek-Brake-Discount/4-Wheel-- 1,.h= - s- --
¬ -r -
Anti-Theft Discount/Passive & Window Etching 1
Aof •Theft )kccnioi/P; been exhausted under all motor vehicle bodily injury
$50,000 to two or more persons injured as a liability insurance policies or bonds applicable at the
result of any one accident; and time of the accident in regard to any one person who
$50,000 per person for bodily injury resulting may be legally liable for the bodily injury sustained by
in death and, subject to the per person limit, the insured.
$100,000 to two or more persons for bodily 9. Release or Advance:
injury resulting in death as the result of any a. In accidents involving the insured and one or more
one accident. negligent parties, if such insured settles with any
AFYU01 3
FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023
such party for the available limit of the motor the Superintendent of Financial Services for this
vehicle bodily injury liability coverage of such purpose.
party, a release may be executed with such party b. If the maximum amount of SUM coverage
after thirty calendar days from our receipt of your provided by this endorsement equals the amount
written notice to us, unless within this time period of coverage required to be provided by New York
we agree to advance such settlement amounts to Insurance Law section 3420 (f)(1) and New York
the insured in return for the cooperation of the Vehicle and Traffic Law Article 6 or 8, then such
insured in our lawsuit on behalf of the insured· disagreement shall be settled by such arbitration
b. We shall have a right to the proceeds of any such procedures upon written demand of either the
lawsuit equal to the amount advanced to the insured or us.
insured and any additional amounts paid under this upon the award rendered
Judgment by the arbitrator
SUM coverage. Any excess above those amounts be entered in court jurisdiction
may any having thereof,
shall be paid to the insured· and any such insured and we each agree to be bound by
c. An insured shall not otherwise settle with any any award made by the arbitrator as to this SUM
negligent party, without our written consent, such coverage. For purposes of this Condition, the term
"insured"
that our rights would be impaired. includes any person authorized to act on
10. Non-Duplication: This SUM coverage shall not behalf of the insured.
duplicate any of the following: 12. Subrogation: If we make a payment under this SUM
workers' coverage, then we have the right to recover the amount
a. benefits payable under compensation or
other similar of the payment from any person legally responsible for
laws;
the bodily injury or loss of the person to whom, or for
b. non-occupational disability benefits under New
Workers' whose benefit, such payment was made to the extent of
York Compensation Law Article 9 or
the payment. The msured or any person acting on
other similar law· *
behalf of the insured must do whatever is necessary to
c. any amounts recovered or recoverable pursuant to transfer this right of recovery to us. Except as
New York Insurance Law Article 51 or any similar permitted by Condition 9, such person shall do nothing
motor vehicle insurance payable without regard to to prejudice this right.
fault '
13, Payment of Loss by Company: We shall pay any
d. any valid or collectible motor vehicle medical amount due under this SUM coverage to the insured or,
payments msurance; or at our option, to a person authorized by law to receive
e. any amounts recovered as bodily injury damages such payment or to a person legally entitled to recover
from sources other than motor vehicle bodily the damages which the payment represents.
injury liability insurance policies or bonds· 14. Action Against Company: No lawsuit shall lie against
11. Arbitration: us unless the insured or the insureds legal
a. If any insured makes a claim under this SUM representative has first fully complied with all the
coverage and we do not agree that such insured is terms of this SUM coverage.
legally entitled to recover damages from the owner 15. Survivor Rights: If you or your spouse, if a resident of
or operator of an uninsured motor vehicle because the same household, dies, this SUM endorsement shall
of bodily injury sustained by the insured, or we do cover:
not agree as to the amount of payment that may be a. the survivor as named insured;
owing under this SUM
coverage, then, at the
b. the decedent's legal representative as named
option, and upon written demand of such msured,
insured, but only while acting within the scope of
the matter or matters upon which such insured and
such representative's duties as such; and
we do not agree shall be settled by arbitration,
administered the American Arbitration c. any relative who was an insured at the time of
by
pursuant to procedures approved such death.
Association, by
AFYU01 4
FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023
ERIE INSURANCE GROUP AUTO
UF-0156 (Ed. 11/10)
CONSUMER INFORMATION REGARDING COVERAGE FOR RENTAL
VEHICLE REIMBURSEMENT/TRANSPORTATION EXPENSES
This notice is provided in accordance with the requirements of the New York Insurance Law Section 2610-a. In your Erie
policy, coverage for Rental Vehicle Reimbursement is referred to as Transportation Expenses Coverage.
COVERAGE FOR RENTAL VEHICLE RElMBURSEMENT - TRANSPORTATION EXPENSES
Rental Vehicle Reimbursement Coverage means coverage for the cost of renting a vehicle used as substitute transporta-
tion if your insured vehicle is damaged and is temporarily out of use due to a covered loss, until such vehicle is repaired
or declared a total loss. Under your Erie policy, this coverage is referred to as Transportation Expenses.
You have the right to choose a rental vehicle company or specific rental vehicle company location to utilize in the event
that:
I. an auto we insure is damaged and is temporarily out of use due to a covered loss, and
2. Transportation Expenses (Rental Vehicle Reimbursement) Coverage for the loss applies or has been pachased.
Please read your policy and its endorsements for details regarding coverage, exclusions or limitations cov-
including of
erage. In the case of any conflict between the infonnation in this notice and the policy, the policy language controls. If
you have any questions concerning Rental Vehicle Reimbursementf>ransportation Expenses Coverage, please contact your
Agent.
FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023
ERIE INSURANCE
PRIVATE PASSENGER AUTO
UF-2755 (Ed. 10/22)
Important Notice Regarding Changes To Your
New York Auto Insurance Policy
Please read your policy and its endorsements for details regarding coverage, including exclusions or limitations of coverage. in
the case of any conflict between the explanation in this notice and the policy, the policy language controls. Your payment of the
renewal premium for this policy sigmfes your understanding and acceptance of these changes. If you have specific questions
conceming these changes, contact your ERIE Agent.
POLICY CHANGE ENDORSEMENT
Enclosed with your renewal policy is a revised Policy Change Endorsement that amends your New York Auto Insurance Policy,
AP-NY (Ed. 10/15). Please review the following changes which may affect your coverage:
LIABILITY PROTECTION
DEFINITIONS
insure"
The definition of "owned auto we has been added to the Liability Protection section. With this revision, Liability
"trailer" "you" "trailer"
Protection is broadened to provide coverage for any own, even if that is not listed on the
"Declarations."
EXCLUSIONS - What We Do Not Cover
Exclusion 14. has been added:
"We"
do not cover:
"trailer" "trailer."
14. damage caused by any used as a residence, office, store, display or passenger
LIMIT OF PROTECTION
The second paragraph is changed to indicate that liability is provided on an unattached trailer subject to the limit of liability for
one auto.
PHYSICAL DAMAGE COVERAGES
ADDITIONAL PAYMENTS (No Deductible Applies)
The first paragraph has been revised to separately refer to Comprehensive Coverage and Collision Coverage in order to clarify the
intent on how these Additional Payments apply.
airbag"
Item 4. which referenced payment for "all expenses necessary to replace a deployed has been removed. Expenses necessary
to replace a deployed airbag will be paid under a covered Comprehensive or Collision loss.
Item 4. has been replaced with the following payment which broadens coverage to provide towing and labor if your trailer becomes
disabled while attached to a motor vehicle:
"We" "your" "trailer"
4. will pay reasonable towing and labor required because becomes disabled while attached to a "motor
vehicle."
Labor must be done at the site of the disablement.
Item 7. is broadened to indicate that we will pay for reasonable expenses for the cost incurred to replace a lost, stolen or disabled
key or electronic entry device for an auto we insure instead of up to $500:
"We"
7. will pay reasonable expenses for the cost incurred to replace a lost, stolen or disabled key or electronic entry device for
insure."
an "auto we
UF-2755 1
FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023
ERIE INSURANCE COMPANY
ERIE INSURANCE COMPANY OF NEW YORK
PRIVATE PASSENGER AUTO
UF-2974 (Ed. 12/19)
DISCOUNTS AVAILABLE ON YOUR NEW YORK AUTO POLICY
The Discounts which have been applied to your policy are indicated on your Declarations. You must notify your Agent if you
qualify for any of these discounts and they are not listed on your Declarations.
Erie Insurance Company of New York and are owned and
Accident Prevention Course - Available if the
used by the Named Insured or a relative who resides m the
principal operator of the vehicle has successfully completed
same household.
an Accident Prevention Course which has been approved
by the New York State Department of Motor Vehicles; and The discount may also apply if the Named Insured has
the Accident Prevention Course was NOT taken as a result unlimited personal use of a company-furnished private
of a court order; and a certificate is presented to The ERIE passenger auto even if that private passenger auto is not
signifying the course was successfully completed. insured by ERIE or titled to the Named Insured.
..
Age 55 Or Over - Available if you are age 55 or over as Discount- Available if you have a Family
Multi-Policy
of your policy effective date AND the principal driver of a Auto Policy and Home Protector or Mobile HomeProtector
private passenger auto listed on your Declarations. Policy with The ERIE. A discount is given on both the
, Family Auto Policy and the HomeProtector or Mobile
Anti-Lock Brakes Discount - Available for autos
HomeProtector Policy premiums.
equipped with anti-lock brakes on all four wheels.
Passive Restraint Discount - Available for autos
Anti-Theft Device Discount - Available for autos
equipped with factory-installed passive seat belts or
equipped with certam anti-theft devices.
airbags.
Claims/Violation Free Discount (Previously Safe - Available
- Pay Plan Discount if your policy premium
Driver Discount) Available if your policy has a good is paid under one of the following ERIE pay plans. The
claim/violation history. Variables that determine the
discount applied under Plan A is greater than the discount
discount may include the violation
percentage history of all applied under Plan B.
drivers on the policy, number of years the policy has been
in force and the claims experience of all drivers on the " Plan A- entire premium paid by policy effective date.
policy. " Plan B - one third of the premium paid by policy
College Student Discount - Available to reflect the effective date. One third of the premium paid within 30
limited use of an auto if a young, unmarried driver is a full. days after policy effective date. One third of the
time college premium paid within 60 days after policy effective
student; does not live at home; and does not
have a vehicle at school. date.
Daytime Lights - Available for autos To qualify for this discount, choose Plan A or Plan B prior
Running
equipped withfactory-installed daytime lights. to your policy effective date. If you choose one of these
running
payment plans during the policy period, the discount will
Driver Discount - Available for drivers
Training be applied at your next renewal. If you do not make
underage 21 who have successfully completed a driver payments in accordance with the terms of the pay plan you
training course which meets the standards of the New York selected, you may lose the pay plan discount and your
Department of Education or other educational agency. premium will be adjusted to reflect quarterly payments for
- Available the remainder of the policy period.
100% Farm Use Discount for autos used
in connection with the operation of a farm Reduced Usage Discount- Available for autos that are
exclusively
owned or rented by you. You must reside on the farm. The laid up for 90 days. This discount may not be available for
autos cannot be used regularly in connection with any other active members of the U.S. Military, Reserves, or National
business or occupation. If the fourth digit of the Rating Guard.
"F"
Class is the auto has received the Farm Discount.
Multi-Car Discount - Available if two or more private
passenger autos are insured by Erie Insurance Company or
UF-2974
FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023
Youthful Driver Longevity Discount (Erie Insurance of the discount is determined by the number of years the
- be available on a private passenger auto has been continuously in force.
Company) May policy
with an unmarried young driver classification. The amount
CUSTOMER INCENTIVES
Neither First Accident Forgiveness nor Feature Fifteen will affect our right to cancel or non-renew your policy should we decide
such action is necessary. For additional information on The ERIE's Defensive Driver Plan, First Accident Forgiveness or Feature
Fifteen, contact your Agent.
Feature Fifteen (Erie Insurance Company of New York policies written before 12/1/08 and all Erie Insurance Company
- If you have been insured on a voluntary Erie Auto Insurance Policy for 15 consecutive
policies) years, we will not apply a
Defensive Driver Plan surcharge for at-fault accidents presented on your policy. A policy lapse of 30 days or more is considered
an interruption of coverage and starts a new 15 year period. Violations subject to The ERIE's Defensive Driver Plan will
continue to result in a surcharge.
First Accident Forgiveness (Erie Insurance - ERIE will forgive the surcharge on the first at-fault accident
Company Only)
which is presented on your policy after the policy has been in force for three years. To qualify for this incentive, the policy must
be surchargeable accident free for those first three years. Should a surchargeable accident occur in those first three years, a
surcharge waiver will not be given on any future accidents.
For all policies eligible for First Accident
Forgiveness, only one accident will be forgiven per policy. The policy will not be
eligible for another surcharge waiver
in the event of a future accident, even if the driver responsible for the accident is removed
from the policy. If you have more than one auto policy with us, only one accident will be forgiven. In the event of another
surchargeable accident, the surcharge on the first accident will continue to be forgiven. However, the first accident will be
counted to determine the surcharge amount for a second or subsequent accident. Violations which are subject to The ERIE's
Defensive Driver Plan will continue to result in a surcharge.
If you have any questions about the Discounts, Defensive Driver Plan, Feature Fifteen or First Accident Forgiveness, please
contact your Agent.
VEHICLES WITHOUT LIABILITY PROTECTION
If you own a vehicle that is not insured for Liability Protection, you may not be fully protected in the event of a liability loss and
you are not protected against bodily injury or property damage liability claims made against you by third parties as a result of a
loss involving the particular auto without Liability Protection. In addition, Personal Injury Protection is not available to you
while you are operating the vehicle without Liability Protection.
If you have a vehicle that is not insured for Liability Protection, you should not allow that vehicle to be driven on public roads.
New York Financial Responsibility Law requires most registered vehicles, including cars with classic or antique license plates,
to meet certain financial security requirements. Purchasing Liability Protection from a licensed insurance company usually
satisfies these requirements. New York imposes penalties for the failure to maintain liability insurance on registered vehicles.
These penalties may include suspension of your vehicle registration, confiscation of your license plates and suspension of your
driver's license or operating privileges. In addition, some states have random verification programs in which they ask insurers to
verify that certain selected registered vehicles carry the required Liability Protection.
If your vehicle is unregistered, you should take care to ensure that it is not operated on the streets and highways of New York
unless and until it is registered and properly insured.
If you would like to purchase Liability Protection on a vehicle that currently does not have this coverage, please contact your
ERIE Agent.
2
UF-2974
FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023
ABBREVIATIONS USED ON YOUR DECLARATIONS FOR
ATTRIBUTES ASSIGNED TO SPECIFIC DRIVERS
AA3 - First chargeable accident in a three-year period, first CS11 - At-Fault paid Coll and PD claim between $500 and
year the surcharge is on policy $2000 with a BI paid claim between $0 and $500 in third
AA2 - First chargeable accident in a three-year period, year
second year the surcharge is on policy DS31 - At-Fault paid Coll and PD claim over $2000
AA1 - First chargeable accident in a three-year period, without
third year the surcharge is on policy a BI paid claim in first year
- Second chargeable accident in a three-year DS21 - At-Fault paid Coll and PD claim over $2000
AB3 period,
first year the surcharge is on policy without
AB2 - Second chargeable accident in a three-year period, a BI paid claim in second year
second year the surcharge is on policy DS11 - At-Fault paid Coll and PD claim over $2000
AB1 - Second chargeable accident in a three-year period, without
third year the surcharge is on policy a BI paid claim in third year
- Third chargeable DTD - Driver Discount
AC3 accident in a three-year period, Training
first year the surcharge is on policy ES31 - At-Fault paid Coll and PD claims between $500
AC2 - Third chargeable accident in a three-year period, and
second year the surcharge is on policy $2000 without a BI paid claim in the first year
AC1 - Third chargeable accident in a three-year period, ES21 - At-Fault paid Coll and PD claims between $500
third year the surcharge is on policy and
ACF - Accident/Chargeable Motor Vehicle Request $2000 without a BI paid claim in the second year
AFY - Accident Free Years ES11 - At-Fault paid Coll and PD claims between $500
APC - Accident Prevention Course and
$2000 without a BI paid claim in the third year
AS31 - At-Fault paid BI claim between $500 and $2000
FS31 - At-Fault paid Coll and PD claims over $2000
withor without a Coll and PD paid claim in first year
without a BI paid claim in the first year
AS21 - At-Fault paid BI claim between $500 and $2000
FS21 - At-Fault paid Coll and PD claims over $2000
withor without a Coll and PD paid claim in second year
without a BI paid claim in the second year
AS11 - At-Fault paid BI claim between $500 and $2000
FS11 - At-Fault paid Coll and PD claims over $2000
withor without a Coll and PD paid claim in third year
without a BI paid claim in the third year
BS31 - At-Fault paid BI claim over $2000 with or without
LSP - License Suspension
a Coll and PD paid claim in first year
MS31 - Major violation in first year
BS21 - At-Fault paid BI claim over $2000 with or without
MS21 - Major violation in second year
a Coll and PD paid claim in second year
MS11 - Major violation in third year
BS11 - At-Fault paid BI claim over $2000 with or without
a Colland PD paid claim in third year MVL - Moving Violation
CS31 - At-Fault paid Coll and PD claim between $500 and MVR - Motor Vehicle Request
paid claim MV1 - Hit and Run or Leaving the Scene of an Accident
$2000 with a BI between $0 and $500 in first
-
year MV2 Drag Racing on a Public Highway
CS21 - At-Fault paid Coll and PD claim between $500 and MV3 - under Suspension
Driving
$2000 with a BI paid claim between $0 and $500 in second MV4 - to Evade Arrest in a Car
Attempting
year MV5 - Assault with a Car
- a Car
MV6 Any Misdemeanor or Fel
Preview
FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023 EXHIBIT B FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023 Erie akinsurance® Your Auto Policy Declarations (Amended) Coverage provided by: Erie Insurance Company 100 Erie Insurance Place Erie, PA 16530 www.erieinsurance.com Amendment Effective 09/20/2022 Named Insured Number Your ERIE Agent (NN2845) Agent Phone Policy HALEY M BAKER & Q07 5608536 SHUMWAY INSURANCE AGENCY INC (518)324-5300 JACK DOMINIE 345 CORNEUA ST STE 1 Policy Period PO BOX 523 07/06/2022 to 07/06/2023 PLATTSBURGH, NY 12901 DANNEMORA, NY 12929-0523 NAIC Code http://www.shumwayins.com 26263 Total Annual Policy Premium: (This is not a bill. Your invoice will follow in a separate mailing.) Youtpremiumislased on ood )river-rates. Vehicles Covered: Vehicle Rating Information: Vehicle VIN State Territory Use Annual miles 1. 2008 PONT G6 GT 1G2ZH57NX84131931 NY 72 To work < 6 up to 8,500 2. 2012 KIA SORENTO LX 5XYKTCA60CG266489 NY 72 To work < 6 up to 8,500 Driver Rating Information: Drivers Included Age Status Gender Vehicle HALEY M BAKER 32 Single Female 1 JACK DOMINIE 54 Single Male 2 If a driver is not a resident relative as defined in your policy, coverages, benefits and rights may be limited. Refer to your policy and its endorsements for terms, definitions, limitations, reductions, exclusions and conditions. YOUR POLICY INCLUDES A DIMINISHING DEDUCTIBLE AND COVERAGE ENHANCEMENT THROUGH ERIE AUTO PLUS Discounts that apply: Vehicle: Antlel-eek-Brake-Discount/4-Wheel-- 1,.h= - s- -- ¬ -r - Anti-Theft Discount/Passive & Window Etching 1 Aof •Theft )kccnioi/P; been exhausted under all motor vehicle bodily injury $50,000 to two or more persons injured as a liability insurance policies or bonds applicable at the result of any one accident; and time of the accident in regard to any one person who $50,000 per person for bodily injury resulting may be legally liable for the bodily injury sustained by in death and, subject to the per person limit, the insured. $100,000 to two or more persons for bodily 9. Release or Advance: injury resulting in death as the result of any a. In accidents involving the insured and one or more one accident. negligent parties, if such insured settles with any AFYU01 3 FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023 such party for the available limit of the motor the Superintendent of Financial Services for this vehicle bodily injury liability coverage of such purpose. party, a release may be executed with such party b. If the maximum amount of SUM coverage after thirty calendar days from our receipt of your provided by this endorsement equals the amount written notice to us, unless within this time period of coverage required to be provided by New York we agree to advance such settlement amounts to Insurance Law section 3420 (f)(1) and New York the insured in return for the cooperation of the Vehicle and Traffic Law Article 6 or 8, then such insured in our lawsuit on behalf of the insured· disagreement shall be settled by such arbitration b. We shall have a right to the proceeds of any such procedures upon written demand of either the lawsuit equal to the amount advanced to the insured or us. insured and any additional amounts paid under this upon the award rendered Judgment by the arbitrator SUM coverage. Any excess above those amounts be entered in court jurisdiction may any having thereof, shall be paid to the insured· and any such insured and we each agree to be bound by c. An insured shall not otherwise settle with any any award made by the arbitrator as to this SUM negligent party, without our written consent, such coverage. For purposes of this Condition, the term "insured" that our rights would be impaired. includes any person authorized to act on 10. Non-Duplication: This SUM coverage shall not behalf of the insured. duplicate any of the following: 12. Subrogation: If we make a payment under this SUM workers' coverage, then we have the right to recover the amount a. benefits payable under compensation or other similar of the payment from any person legally responsible for laws; the bodily injury or loss of the person to whom, or for b. non-occupational disability benefits under New Workers' whose benefit, such payment was made to the extent of York Compensation Law Article 9 or the payment. The msured or any person acting on other similar law· * behalf of the insured must do whatever is necessary to c. any amounts recovered or recoverable pursuant to transfer this right of recovery to us. Except as New York Insurance Law Article 51 or any similar permitted by Condition 9, such person shall do nothing motor vehicle insurance payable without regard to to prejudice this right. fault ' 13, Payment of Loss by Company: We shall pay any d. any valid or collectible motor vehicle medical amount due under this SUM coverage to the insured or, payments msurance; or at our option, to a person authorized by law to receive e. any amounts recovered as bodily injury damages such payment or to a person legally entitled to recover from sources other than motor vehicle bodily the damages which the payment represents. injury liability insurance policies or bonds· 14. Action Against Company: No lawsuit shall lie against 11. Arbitration: us unless the insured or the insureds legal a. If any insured makes a claim under this SUM representative has first fully complied with all the coverage and we do not agree that such insured is terms of this SUM coverage. legally entitled to recover damages from the owner 15. Survivor Rights: If you or your spouse, if a resident of or operator of an uninsured motor vehicle because the same household, dies, this SUM endorsement shall of bodily injury sustained by the insured, or we do cover: not agree as to the amount of payment that may be a. the survivor as named insured; owing under this SUM coverage, then, at the b. the decedent's legal representative as named option, and upon written demand of such msured, insured, but only while acting within the scope of the matter or matters upon which such insured and such representative's duties as such; and we do not agree shall be settled by arbitration, administered the American Arbitration c. any relative who was an insured at the time of by pursuant to procedures approved such death. Association, by AFYU01 4 FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023 ERIE INSURANCE GROUP AUTO UF-0156 (Ed. 11/10) CONSUMER INFORMATION REGARDING COVERAGE FOR RENTAL VEHICLE REIMBURSEMENT/TRANSPORTATION EXPENSES This notice is provided in accordance with the requirements of the New York Insurance Law Section 2610-a. In your Erie policy, coverage for Rental Vehicle Reimbursement is referred to as Transportation Expenses Coverage. COVERAGE FOR RENTAL VEHICLE RElMBURSEMENT - TRANSPORTATION EXPENSES Rental Vehicle Reimbursement Coverage means coverage for the cost of renting a vehicle used as substitute transporta- tion if your insured vehicle is damaged and is temporarily out of use due to a covered loss, until such vehicle is repaired or declared a total loss. Under your Erie policy, this coverage is referred to as Transportation Expenses. You have the right to choose a rental vehicle company or specific rental vehicle company location to utilize in the event that: I. an auto we insure is damaged and is temporarily out of use due to a covered loss, and 2. Transportation Expenses (Rental Vehicle Reimbursement) Coverage for the loss applies or has been pachased. Please read your policy and its endorsements for details regarding coverage, exclusions or limitations cov- including of erage. In the case of any conflict between the infonnation in this notice and the policy, the policy language controls. If you have any questions concerning Rental Vehicle Reimbursementf>ransportation Expenses Coverage, please contact your Agent. FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023 ERIE INSURANCE PRIVATE PASSENGER AUTO UF-2755 (Ed. 10/22) Important Notice Regarding Changes To Your New York Auto Insurance Policy Please read your policy and its endorsements for details regarding coverage, including exclusions or limitations of coverage. in the case of any conflict between the explanation in this notice and the policy, the policy language controls. Your payment of the renewal premium for this policy sigmfes your understanding and acceptance of these changes. If you have specific questions conceming these changes, contact your ERIE Agent. POLICY CHANGE ENDORSEMENT Enclosed with your renewal policy is a revised Policy Change Endorsement that amends your New York Auto Insurance Policy, AP-NY (Ed. 10/15). Please review the following changes which may affect your coverage: LIABILITY PROTECTION DEFINITIONS insure" The definition of "owned auto we has been added to the Liability Protection section. With this revision, Liability "trailer" "you" "trailer" Protection is broadened to provide coverage for any own, even if that is not listed on the "Declarations." EXCLUSIONS - What We Do Not Cover Exclusion 14. has been added: "We" do not cover: "trailer" "trailer." 14. damage caused by any used as a residence, office, store, display or passenger LIMIT OF PROTECTION The second paragraph is changed to indicate that liability is provided on an unattached trailer subject to the limit of liability for one auto. PHYSICAL DAMAGE COVERAGES ADDITIONAL PAYMENTS (No Deductible Applies) The first paragraph has been revised to separately refer to Comprehensive Coverage and Collision Coverage in order to clarify the intent on how these Additional Payments apply. airbag" Item 4. which referenced payment for "all expenses necessary to replace a deployed has been removed. Expenses necessary to replace a deployed airbag will be paid under a covered Comprehensive or Collision loss. Item 4. has been replaced with the following payment which broadens coverage to provide towing and labor if your trailer becomes disabled while attached to a motor vehicle: "We" "your" "trailer" 4. will pay reasonable towing and labor required because becomes disabled while attached to a "motor vehicle." Labor must be done at the site of the disablement. Item 7. is broadened to indicate that we will pay for reasonable expenses for the cost incurred to replace a lost, stolen or disabled key or electronic entry device for an auto we insure instead of up to $500: "We" 7. will pay reasonable expenses for the cost incurred to replace a lost, stolen or disabled key or electronic entry device for insure." an "auto we UF-2755 1 FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023 ERIE INSURANCE COMPANY ERIE INSURANCE COMPANY OF NEW YORK PRIVATE PASSENGER AUTO UF-2974 (Ed. 12/19) DISCOUNTS AVAILABLE ON YOUR NEW YORK AUTO POLICY The Discounts which have been applied to your policy are indicated on your Declarations. You must notify your Agent if you qualify for any of these discounts and they are not listed on your Declarations. Erie Insurance Company of New York and are owned and Accident Prevention Course - Available if the used by the Named Insured or a relative who resides m the principal operator of the vehicle has successfully completed same household. an Accident Prevention Course which has been approved by the New York State Department of Motor Vehicles; and The discount may also apply if the Named Insured has the Accident Prevention Course was NOT taken as a result unlimited personal use of a company-furnished private of a court order; and a certificate is presented to The ERIE passenger auto even if that private passenger auto is not signifying the course was successfully completed. insured by ERIE or titled to the Named Insured. .. Age 55 Or Over - Available if you are age 55 or over as Discount- Available if you have a Family Multi-Policy of your policy effective date AND the principal driver of a Auto Policy and Home Protector or Mobile HomeProtector private passenger auto listed on your Declarations. Policy with The ERIE. A discount is given on both the , Family Auto Policy and the HomeProtector or Mobile Anti-Lock Brakes Discount - Available for autos HomeProtector Policy premiums. equipped with anti-lock brakes on all four wheels. Passive Restraint Discount - Available for autos Anti-Theft Device Discount - Available for autos equipped with factory-installed passive seat belts or equipped with certam anti-theft devices. airbags. Claims/Violation Free Discount (Previously Safe - Available - Pay Plan Discount if your policy premium Driver Discount) Available if your policy has a good is paid under one of the following ERIE pay plans. The claim/violation history. Variables that determine the discount applied under Plan A is greater than the discount discount may include the violation percentage history of all applied under Plan B. drivers on the policy, number of years the policy has been in force and the claims experience of all drivers on the " Plan A- entire premium paid by policy effective date. policy. " Plan B - one third of the premium paid by policy College Student Discount - Available to reflect the effective date. One third of the premium paid within 30 limited use of an auto if a young, unmarried driver is a full. days after policy effective date. One third of the time college premium paid within 60 days after policy effective student; does not live at home; and does not have a vehicle at school. date. Daytime Lights - Available for autos To qualify for this discount, choose Plan A or Plan B prior Running equipped withfactory-installed daytime lights. to your policy effective date. If you choose one of these running payment plans during the policy period, the discount will Driver Discount - Available for drivers Training be applied at your next renewal. If you do not make underage 21 who have successfully completed a driver payments in accordance with the terms of the pay plan you training course which meets the standards of the New York selected, you may lose the pay plan discount and your Department of Education or other educational agency. premium will be adjusted to reflect quarterly payments for - Available the remainder of the policy period. 100% Farm Use Discount for autos used in connection with the operation of a farm Reduced Usage Discount- Available for autos that are exclusively owned or rented by you. You must reside on the farm. The laid up for 90 days. This discount may not be available for autos cannot be used regularly in connection with any other active members of the U.S. Military, Reserves, or National business or occupation. If the fourth digit of the Rating Guard. "F" Class is the auto has received the Farm Discount. Multi-Car Discount - Available if two or more private passenger autos are insured by Erie Insurance Company or UF-2974 FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023 Youthful Driver Longevity Discount (Erie Insurance of the discount is determined by the number of years the - be available on a private passenger auto has been continuously in force. Company) May policy with an unmarried young driver classification. The amount CUSTOMER INCENTIVES Neither First Accident Forgiveness nor Feature Fifteen will affect our right to cancel or non-renew your policy should we decide such action is necessary. For additional information on The ERIE's Defensive Driver Plan, First Accident Forgiveness or Feature Fifteen, contact your Agent. Feature Fifteen (Erie Insurance Company of New York policies written before 12/1/08 and all Erie Insurance Company - If you have been insured on a voluntary Erie Auto Insurance Policy for 15 consecutive policies) years, we will not apply a Defensive Driver Plan surcharge for at-fault accidents presented on your policy. A policy lapse of 30 days or more is considered an interruption of coverage and starts a new 15 year period. Violations subject to The ERIE's Defensive Driver Plan will continue to result in a surcharge. First Accident Forgiveness (Erie Insurance - ERIE will forgive the surcharge on the first at-fault accident Company Only) which is presented on your policy after the policy has been in force for three years. To qualify for this incentive, the policy must be surchargeable accident free for those first three years. Should a surchargeable accident occur in those first three years, a surcharge waiver will not be given on any future accidents. For all policies eligible for First Accident Forgiveness, only one accident will be forgiven per policy. The policy will not be eligible for another surcharge waiver in the event of a future accident, even if the driver responsible for the accident is removed from the policy. If you have more than one auto policy with us, only one accident will be forgiven. In the event of another surchargeable accident, the surcharge on the first accident will continue to be forgiven. However, the first accident will be counted to determine the surcharge amount for a second or subsequent accident. Violations which are subject to The ERIE's Defensive Driver Plan will continue to result in a surcharge. If you have any questions about the Discounts, Defensive Driver Plan, Feature Fifteen or First Accident Forgiveness, please contact your Agent. VEHICLES WITHOUT LIABILITY PROTECTION If you own a vehicle that is not insured for Liability Protection, you may not be fully protected in the event of a liability loss and you are not protected against bodily injury or property damage liability claims made against you by third parties as a result of a loss involving the particular auto without Liability Protection. In addition, Personal Injury Protection is not available to you while you are operating the vehicle without Liability Protection. If you have a vehicle that is not insured for Liability Protection, you should not allow that vehicle to be driven on public roads. New York Financial Responsibility Law requires most registered vehicles, including cars with classic or antique license plates, to meet certain financial security requirements. Purchasing Liability Protection from a licensed insurance company usually satisfies these requirements. New York imposes penalties for the failure to maintain liability insurance on registered vehicles. These penalties may include suspension of your vehicle registration, confiscation of your license plates and suspension of your driver's license or operating privileges. In addition, some states have random verification programs in which they ask insurers to verify that certain selected registered vehicles carry the required Liability Protection. If your vehicle is unregistered, you should take care to ensure that it is not operated on the streets and highways of New York unless and until it is registered and properly insured. If you would like to purchase Liability Protection on a vehicle that currently does not have this coverage, please contact your ERIE Agent. 2 UF-2974 FILED: CLINTON COUNTY CLERK 03/16/2023 12:33 PM INDEX NO. 2023-00023161 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/16/2023 ABBREVIATIONS USED ON YOUR DECLARATIONS FOR ATTRIBUTES ASSIGNED TO SPECIFIC DRIVERS AA3 - First chargeable accident in a three-year period, first CS11 - At-Fault paid Coll and PD claim between $500 and year the surcharge is on policy $2000 with a BI paid claim between $0 and $500 in third AA2 - First chargeable accident in a three-year period, year second year the surcharge is on policy DS31 - At-Fault paid Coll and PD claim over $2000 AA1 - First chargeable accident in a three-year period, without third year the surcharge is on policy a BI paid claim in first year - Second chargeable accident in a three-year DS21 - At-Fault paid Coll and PD claim over $2000 AB3 period, first year the surcharge is on policy without AB2 - Second chargeable accident in a three-year period, a BI paid claim in second year second year the surcharge is on policy DS11 - At-Fault paid Coll and PD claim over $2000 AB1 - Second chargeable accident in a three-year period, without third year the surcharge is on policy a BI paid claim in third year - Third chargeable DTD - Driver Discount AC3 accident in a three-year period, Training first year the surcharge is on policy ES31 - At-Fault paid Coll and PD claims between $500 AC2 - Third chargeable accident in a three-year period, and second year the surcharge is on policy $2000 without a BI paid claim in the first year AC1 - Third chargeable accident in a three-year period, ES21 - At-Fault paid Coll and PD claims between $500 third year the surcharge is on policy and ACF - Accident/Chargeable Motor Vehicle Request $2000 without a BI paid claim in the second year AFY - Accident Free Years ES11 - At-Fault paid Coll and PD claims between $500 APC - Accident Prevention Course and $2000 without a BI paid claim in the third year AS31 - At-Fault paid BI claim between $500 and $2000 FS31 - At-Fault paid Coll and PD claims over $2000 withor without a Coll and PD paid claim in first year without a BI paid claim in the first year AS21 - At-Fault paid BI claim between $500 and $2000 FS21 - At-Fault paid Coll and PD claims over $2000 withor without a Coll and PD paid claim in second year without a BI paid claim in the second year AS11 - At-Fault paid BI claim between $500 and $2000 FS11 - At-Fault paid Coll and PD claims over $2000 withor without a Coll and PD paid claim in third year without a BI paid claim in the third year BS31 - At-Fault paid BI claim over $2000 with or without LSP - License Suspension a Coll and PD paid claim in first year MS31 - Major violation in first year BS21 - At-Fault paid BI claim over $2000 with or without MS21 - Major violation in second year a Coll and PD paid claim in second year MS11 - Major violation in third year BS11 - At-Fault paid BI claim over $2000 with or without a Colland PD paid claim in third year MVL - Moving Violation CS31 - At-Fault paid Coll and PD claim between $500 and MVR - Motor Vehicle Request paid claim MV1 - Hit and Run or Leaving the Scene of an Accident $2000 with a BI between $0 and $500 in first - year MV2 Drag Racing on a Public Highway CS21 - At-Fault paid Coll and PD claim between $500 and MV3 - under Suspension Driving $2000 with a BI paid claim between $0 and $500 in second MV4 - to Evade Arrest in a Car Attempting year MV5 - Assault with a Car - a Car MV6 Any Misdemeanor or Fel