FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`NYSCEF DOC. NO.
`4
`
`INDEX NO. 603245/2023
`INDEX NO. 603245/2023
`RECEIVED NYSCEF: 02/24/2023
`RECEIVED NYSCEF: 02/24/2023
`
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`
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`
`
`
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`
`
`EXHIBIT “B”
`EXHIBIT “B”
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`
`Certification
`
`As a duly authorized Nationwide Insurance associate entrusted with oversight of the system
`of record from which this copy was produced, based upon information and belief; certify
`under the penalty of perjury that this attached copy of the Declaration and or Policy pages on
`policy number was made at or near the time of certification, as part of
`5219J 185259
`regularly conducted business activities, and is a true and accurate copy of the official record
`kept as part of regular business activities.
`
`Signed By:
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`Prepared on September 2, 2021
`Page1cf 2
`
`Nationwide'
`is on yourside
`
`Your
`
`Revised
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`Policy
`
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`Your
`Nationwide
`Period:
`Policy
`Number:
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`
`separately.
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`Auto
`Policy
`4, 2021 - Aug
`Aug
`5219J
`185259
`
`4, 2022
`
`Dorlean
`Suitland
`
`Rd Apt
`
`Sezinior
`4248
`203
`Suitland,
`20746-2056
`
`MD
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`Declarations
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`Nationwide
`800-421-1444
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`Nationwide
`1.800.421.1444
`Nationwide.com
`1.800.421.3535
`1.800.622.2421
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`RECEIVED NYSCEF: 02/24/2023
`Prepared on Septernber 2, 2021
`Page 2 of 2
`
`INDEX NO. 603245/2023
`
`Nationwide.
`ison yourside
`
`Important
`
`Reminders
`
`from
`
`Nationwide
`
`[E
`
`A 2001
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`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`RECEIVED NYSCEF: 02/24/2023
`Page ' of 4
`Prepared on septernber 2, 2021
`Declarations
`
`Nationwide®
`is on yourside
`
`Your
`
`Policy
`
`INDEX NO. 603245/2023
`
`Insured):
`
`Nationwide
`Period:
`Policy
`Number:
`Policy
`
`Auto
`Policy
`- Aug
`4, 2021
`Aug
`5219J
`185259
`
`4. 2022
`
`(Named
`Dorlean
`Suitland
`
`Rd Apt
`
`Policyholder
`Sezinior
`4248
`203
`Suitland,
`20746-2056
`
`MD
`
`Keep
`
`these
`
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`
`for
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`your
`
`records.
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`General
`
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`
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`These
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`with
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`
`2, 2021
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`any
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`NAIC
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`#37877.
`
`Your
`
`is Nationwide
`
`Property
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`and
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`Casualty,
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`Changes
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`Effective
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`And
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`Rated
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`Driver(s)
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`Name
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`Ronise
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`Dorlean
`Dorlean
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`of Birth
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`11/14/91
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`07
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`16
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`Continued
`
`on
`
`the
`
`next
`
`page
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`RECEIVED NYSCEF: 02/24/2023
`Prepared on September 2. 2021
`Page 2 of 4
`Declarations
`
`INDEX NO. 603245/2023
`
`Nationwide®
`ison yourside
`
`Your
`
`Policy
`
`definitions
`coverage
`For
`visit Nationwide.com
`
`and descriptions.
`
`Insured
`
`Vehicle(s)
`
`and
`
`Schedule
`
`of Coverages
`
`Nationwide
`Period:
`Policy
`Number:
`Policy
`
`Auto
`Policy
`- Aug
`4, 2021
`Aug
`5219J
`185259
`
`4, 2022
`
`2019
`
`Toyo
`
`Rav4
`
`VIN
`
`2T3P1RFV2KCO60624
`
`Coverages
`Bodily
`Injury
`
`Liability
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`Property
`Personal
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`Damage
`Liability
`Protection
`Injury
`
`Uninsured
`
`Motorists
`
`Bodily
`
`Injury
`
`Uninsured
`
`Motorists
`
`Property
`
`Damage
`
`Damage
`
`To Your Auto
`
`Than Collision
`
`(Cornprehensive)
`
`of
`Limits
`100,000
`$
`$ 300,000
`25.000
`$
`
`Full
`
`Liability
`Each Person
`Each Occurrence
`Each Occurrence
`
`See Endorsement
`30,000
`Each Person
`60.000
`Each Occurrence
`See Endorsement
`25,000
`Each Occurrence
`See Endorsement
`Cash Value
`
`Less $
`
`$
`$
`
`$
`
`Actual
`
`Actual
`
`Cash Value
`
`Premium
`
`$
`
`$
`
`$
`
`$
`
`$
`
`1,000
`
`1.000
`
`Other
`Collision
`
`Custom
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`Equipment
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`A 5119 10 20
`
`2010
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`Ford
`
`Focus
`
`Ses
`
`VIN 1FAHP3GNXAW292844
`
`Coverages
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`Injury
`
`Liability
`
`Property
`Personal
`
`Damage
`Liability
`Protection
`Injury
`
`Uninsured
`
`Motorists
`
`Bodily
`
`Injury
`
`Uninsured
`
`Motorists
`
`Property
`
`Damage
`
`Endorsements
`Vehicle
`A 5119 10 20
`
`Less $
`
`$
`
`3,000
`
`of
`Limits
`100,000
`$
`$ 300.000
`25.000
`$
`
`Full
`
`Liability
`Each Person
`Each Occurrence
`Each Occurrence
`
`$
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`
`$
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`See Endorsement
`30,000
`Each Person
`60,000
`Each Occurrence
`See Endorsement
`Each Occurrence
`25,000
`See Endorsement
`
`Included
`
`Premium
`
`$
`
`$
`
`$
`
`$
`
`$
`
`$
`
`$
`
`Total
`
`for
`
`this
`
`Vehicle
`
`Total
`
`for
`
`this
`
`Vehicle
`
`Continued
`
`on
`
`the
`
`next
`
`page
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`
`Nationwide®
`ison yourside
`
`Your
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`Prepared on September 2, 2021
`Page 3 of 4
`Declarations
`
`Policy
`
`Nationwide
`Period:
`Policy
`Number:
`Policy
`
`Auto
`Policy
`4, 2021 - Aug
`Aug
`5219J
`185259
`
`4, 2022
`
`Form
`
`07
`
`04
`
`16
`
`18
`
`Policy
`A 4500
`A 4598
`A 5019
`18
`04
`A 5119 10 20
`A 5419
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`Your
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`Nationwide
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`Special
`
`of Columbia
`
`Provisions
`
`Uninsured
`
`Motorists
`
`Auto
`
`Policy
`Employees
`- Maryland
`Coverage
`
`Personal
`
`Injury
`
`Protection
`
`For Office
`08/04/21
`
`Use Only:
`210.88-
`
`$
`
`Terr:
`
`210
`
`Using
`
`Autos
`
`in Government
`
`Business
`
`- Maryland
`- Maryland
`Coverage
`
`Nationwide
`By:
`Issued
`How to Contact
`Us
`Your Nationwide
`Agent
`Nationwide
`Customer
`Internet
`24-Hour
`Hearing
`
`Claims
`Impaired
`
`Reporting
`(TTY)
`
`Solution
`
`O
`
`o
`
`Property
`
`and
`
`Casualty
`
`Sales Solutions
`
`Inc 800-421-1444
`
`Nationwide
`1.800.421.1444
`Nationwide.com
`1.800.421.3535
`1.800.622.2421
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`Preparedon September2,2021
`Page4 of 4
`
`N tiongide®
`
`This
`
`page
`
`intentionally
`
`blank
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`
`Your
`Nationwide®
`
`Auto
`
`Policy
`
`Nationwide®
`
`is on
`
`your
`
`side
`
`Nationwide Insurance Companies, Home Office: One Nationwide Plaza, Columbus, Ohio 43215-2220
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 A
`NYSCI EF DOC. NO.
`4
`NYSCEF DOC. NO. 4
`
`IND
`EX NO.
`603245/2023
`INDEX NO. 603245/2023
`
`
` EIVE iD
` EF’:
`
`02/24/2023
`RECEIVED NYSCEF: 02/24/2023
`
` NYSCI
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`Nationwide®
`
`Your
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`Nationwide
`Auto
`
`Policy
`
`is on your
`
`side
`
`AGREEMENT..............................................................................................................................................................3
`
`TABLEOF
`
`CONTENTS
`
`Page
`
`............................................................................................................................................................3
`
`PART
`
`.................................................................................................................5
`
`PART
`
`PART
`
`PART
`
`OF RECOVERY
`
`COVERAGE
`
`........................................................................................10
`
`MOTORISTS
`
`COVERAGE
`
`................................................................................13
`
`TO YOUR AUTO....................................................................13
`
`DEFINITIONS
`A -
`COVERAGE
`LIABILITY
`AGREEMENT
`INSURING
`SUPPLEMENTARY
`PAYMENTS
`EXCLUSIONS
`LIMIT OF LIABILITY
`COVERAGE
`OUTOF
`STATE
`FINANCIAL
`RESPONSIBILITY
`OTHERINSURANCE
`AND SOURCES
`B - MEDICAL
`PAYMENTS
`AGREEMENT
`INSURING
`EXCLUSIONS
`LIMIT OF LIABILITY
`OTHER
`INSURANCE
`C -
`UNINSURED
`D - COVERAGE
`FOR DAMAGE
`AGREEMENT
`INSURING
`TRANSPORTATION
`EXPENSES
`EXCLUSIONS
`LIMIT OF LIABILITY
`PAYMENT
`OF LOSS
`NO BENEFIT
`TO BAILEE
`OF RECOVERY
`OTHERSOURCES
`APPRAISAL
`PAYABLE
`LOSS
`E -
`DUTIES
`F - GENERAL
`PART
`PROVISIONS
`BANKRUPTCY........................................................................................................................................................20
`CHANGES
`................................................................................................................................................................20
`FRAUD
`AND MISREPRESENTATION............................................................................................................21
`LEGAL
`ACTION
`AGAINST
`US .........................................................................................................................21
`OUR RIGHT
`TO RECOVER
`PAYMENT.........................................................................................................22
`AND TERRITORY...............................................................................................................22
`POLICY
`PERIOD
`TERMINATION........................................................................................................................................................22
`ASSIGNABILITY
`.....................................................................................................................................................23
`TWO OR MORE AUTO POLICIES
`.................................................................................................................23
`PAYMENT
`OF PREMlUM
`OPTIONAL
`IN INSTALLMENTS...................................................................24
`RENEWAL................................................................................................................................................................24
`..............................................................................................................................................................24
`DIVIDENDS
`PAYMENT
`AND LATE
`FUNDS
`NON-SUFFICIENT
`CHARGES...........................................................24
`CONTRACT
`APPLICABLE
`LAW.....................................................................................................................24
`INTEREST
`RATE....................................................................................................................................................24
`AND INDIVIDUAL
`JOINT
`INTERESTS..........................................................................................................24
`................................................................................................................................................................24
`BENEFITS
`
`CLAUSE
`
`PART
`
`AFTER
`
`AN ACCIDENT
`
`OR LOSS
`
`..........................................................................20
`
`MUTUAL
`
`POLICY
`
`CONDITIONS.....................................................................................................................25
`
`A 4500
`07
`16
`N and Eagle and Nationwide
`the Nationwide
`Nationwide,
`Insurance Company. ©2015 Nationwide
`
`is on your
`
`side are service marks of Nationwide
`
`Mutual
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 A
`NYSCI EF DOC. NO.
`4
`NYSCEF DOC. NO. 4
`
`IND
`EX NO.
`603245/2023
`INDEX NO. 603245/2023
`
`
` EIVE iD
` EF’:
`
`02/24/2023
`RECEIVED NYSCEF: 02/24/2023
`
` NYSCI
`
`BLANK
`PAGE INTENTIONALLY
`LEFT
`THIS
`THIS PAGE INTENTIONALLY LEFT BLANK
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`Nationwide®
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`
`is on your
`
`side
`
`PERSONAL
`
`AUTO
`
`POLICY
`
`AGREEMENT
`
`In return
`terms
`
`of
`
`for
`this
`
`payment
`policy,
`
`of
`the
`we agree
`
`premium
`with
`
`you
`
`fees
`and
`as follows:
`
`in amounts
`
`we require
`
`and
`
`subject
`
`to
`
`all
`
`the
`
`DEFINITIONS
`
`A.
`
`Throughout
`
`The
`
`The
`
`"named
`
`spouse
`
`1.
`
`2.
`
`3.
`
`partner
`filed
`
`of
`and
`
`named
`the
`recognized
`
`this
`
`policy,
`insured"
`
`"you"
`
`"your"
`
`and
`
`refer
`
`to:
`
`shown
`
`in the
`
`Declarations;
`
`if a resident
`
`of
`
`the
`
`same
`
`household;
`by Civil
`state
`
`the
`
`or Registered
`Union
`of
`if a resident
`the
`
`or
`
`civil
`The
`Partnership
`4. A "Domestic
`If
`the
`spouse
`Partnership
`the
`policy
`considered
`
`or
`with
`period
`"you"
`
`partner".
`
`partner
`civil
`named
`the
`or prior
`to
`"your"
`and
`
`1.
`
`2.
`
`The
`
`end
`
`of 90
`
`days
`
`effective
`The
`or
`insured;
`
`date
`
`following
`of another
`
`3.
`
`The
`
`end
`"us"
`
`of
`
`and
`
`the
`"our"
`
`policy
`refer
`
`period.
`
`to
`
`the
`
`B.
`
`C.
`
`has
`
`entered
`who
`ceases
`insured
`inception
`the
`under
`this
`
`of
`policy
`spouse's
`
`the
`
`policy
`
`listing
`
`spouse
`
`or
`
`civil
`
`partner
`
`this
`
`insurance.
`
`auto,
`
`or
`
`van
`
`shall
`
`be
`
`deemed
`
`insured
`by
`
`Domestic
`same
`household;
`
`a Civil
`a resident
`the
`policy,
`until
`only
`civil
`
`partner's
`
`into
`be
`to
`this
`but
`
`or
`
`the
`
`or Registered
`Union
`Domestic
`of
`the
`same
`household
`during
`or
`civil
`partner
`will
`spouse
`be
`earlier
`of:
`the
`
`change
`
`of
`
`residency;
`as a named
`
`this
`policy,
`a person
`
`if
`
`providing
`Company
`passenger
`a private
`type
`leased:
`
`pickup
`
`"We",
`For
`to
`
`purposes
`be
`owned
`
`of
`by
`a written
`
`1. Under
`
`agreement
`
`to
`
`that
`
`2.
`
`For
`
`a continuous
`
`period
`
`of at
`
`least
`
`and
`
`person;
`6 months.
`
`Other
`
`words
`
`phrases
`
`are
`
`defined.
`
`and
`injury"
`
`"Bodily
`injury"
`
`means
`include
`not
`similar
`injury
`
`harm,
`bodily
`emotional
`unless
`
`are
`
`They
`sickness
`distress,
`the
`direct
`
`in quotation
`
`marks
`
`when
`
`used.
`
`death
`or disease,
`including
`mental
`anguish,
`humiliation,
`of bodily
`harm.
`result
`
`results.
`that
`"Bodily
`or
`mental
`distress
`
`D.
`
`E.
`
`F.
`
`does
`or any
`injury,
`"Business"
`includes
`member"
`
`"Family
`resident
`"Occupying"
`
`of
`
`your
`
`trade,
`means
`household.
`
`profession
`
`or occupation.
`
`a person
`This
`
`related
`includes
`
`you
`to
`a ward
`
`by
`or
`
`blood,
`foster
`
`marriage
`child.
`
`or adoption
`
`who
`
`is a
`
`G.
`
`H.
`
`I.
`
`1.
`
`In;
`2. Upon;
`3. Getting
`"Property
`property.
`"Trailer"
`
`means:
`
`or
`
`in, on,
`damage"
`
`out
`
`or off.
`
`means
`
`physical
`
`injury
`
`to,
`
`destruction
`
`of or
`
`loss
`
`of use
`
`of
`
`tangible
`
`means
`
`a vehicle
`
`designed
`
`to
`
`be
`
`pulled
`
`by
`
`a:
`
`1.
`
`Private
`
`passenger
`
`auto;
`
`or
`
`or
`
`2.
`
`Pickup
`It also means
`above.
`
`van.
`
`a farm
`
`wagon
`
`or
`
`farm
`
`implement
`
`while
`
`towed
`
`by
`
`a vehicle
`
`listed
`
`in 1. or 2.
`
`A 4500
`
`07
`
`16
`
`Page
`
`3 of
`
`27
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`Nationwide®
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`
`is on your
`
`side
`
`covered
`
`auto"
`
`means:
`
`shown
`
`in the
`
`Declarations.
`
`acquired
`
`auto".
`
`"Your
`1. Any
`vehicle
`2. A "newly
`"trailer"
`3. Any
`4. Any
`vehicle
`
`you
`"trailer"
`
`own.
`
`you
`in this
`
`not
`do
`definition
`
`own
`while
`which
`
`used
`is out
`
`as a temporary
`of normal
`use
`
`substitute
`because
`
`of
`
`for
`its:
`
`any
`
`other
`
`or
`described
`
`auto
`
`J.
`
`K.
`
`a.
`
`Breakdown;
`b. Repair;
`c.
`
`Servicing;
`or
`
`d.
`
`Loss;
`e. Destruction.
`
`This
`
`Provision
`
`acquired
`
`"Newly
`1.
`
`the
`
`or
`
`van,
`a Gross
`
`acquired
`"Newly
`of during
`owner
`a. A private
`passenger
`b. A pickup
`Has
`(1)
`
`(J.4.)
`auto":
`auto"
`
`does
`
`not
`
`apply
`
`to Coverage
`
`For Damage
`
`To Your
`
`Auto.
`
`means
`any
`period:
`policy
`
`of
`
`the
`
`following
`
`types
`
`of
`
`vehicles
`
`you
`
`become
`
`the
`
`auto;
`for which
`
`or
`
`no
`
`other
`
`insurance
`
`Vehicle
`
`Weight
`
`of 10,000
`
`Rating
`or
`transportation
`
`provides
`
`policy
`lbs.
`
`or
`
`of goods
`
`coverage,
`and
`
`less;
`and materials
`
`that:
`
`unless
`
`such
`
`(2)
`
`used
`
`for
`
`the
`
`delivery
`
`Is not
`is:
`use
`
`(a)
`
`(b)
`
`Incidental
`or equipment;
`For
`
`2. Coverage
`insure
`elapsed,
`request
`
`for
`a "newly
`any
`the
`
`farming
`a "newly
`acquired
`coverage
`coverage.
`
`"business"
`
`to
`
`your
`or
`
`of
`
`installing,
`
`maintaining
`
`or
`
`repairing
`
`furnishings
`
`or
`
`ranching.
`
`auto"
`
`acquired
`auto"
`after
`we provide
`
`is provided
`a specified
`for
`a "newly
`
`as described
`time
`period
`acquired
`
`below.
`described
`auto"
`will
`
`begin
`
`If you
`below
`at
`
`ask
`has
`the
`time
`
`us to
`
`you
`
`policy
`have
`
`Coverage
`except
`the
`broadest
`coverage
`on
`the
`Coverage
`begins
`to
`a "newly
`acquired
`apply
`ask
`you must
`Declarations,
`
`For Damage
`we now
`date
`you
`auto"
`
`To Your
`provide
`become
`which
`is in
`it within
`insure
`
`for
`
`the
`
`us to
`
`to
`
`in this
`For
`provided
`coverage
`any
`will
`acquired
`a "newly
`Auto,
`Declarations.
`shown
`in the
`vehicle
`any
`owner.
`for
`coverage
`this
`However,
`shown
`in the
`addition
`to
`vehicle
`any
`after
`owner.
`30
`days
`you
`become
`the
`auto"
`If a "newly
`provided
`
`a.
`
`auto"
`
`acquired
`for
`this
`
`vehicle
`
`replaces
`without
`
`b. Collision
`owner.
`
`for
`a "newly
`this
`coverage
`
`for
`
`Coverage
`However,
`after
`you
`applies
`broadest
`
`days
`30
`Coverage
`have
`the
`Declarations.
`
`(1)
`
`(2)
`
`a vehicle
`your
`having
`auto"
`
`acquired
`to
`
`shown
`ask
`to
`
`in the
`us to
`
`Declarations,
`it.
`insure
`
`coverage
`
`is
`
`begins
`you must
`
`on
`ask
`
`you
`date
`the
`us to
`insure
`
`become
`it within:
`
`the
`
`become
`to
`at
`least
`coverage
`
`the
`one
`we
`
`if
`the
`In this
`provide
`
`Declarations
`the
`case,
`for
`any
`
`that
`indicate
`acquired
`"newly
`shown
`in the
`auto
`
`Collision
`auto"
`
`will
`
`apply,
`owner
`auto.
`now
`
`Seven
`Collision
`requirement
`acquired
`
`after
`days
`Coverage
`and
`auto",
`
`become
`you
`applies
`to
`a loss
`occurred
`a Collision
`deductible
`
`at
`
`owner
`the
`least
`one
`before
`
`if
`Declarations
`the
`If you
`auto.
`comply
`you
`asked
`us to
`insure
`of $500
`will
`apply.
`
`not
`do
`with
`the
`
`that
`
`indicate
`the
`7-day
`"newly
`
`A 4500
`
`07
`
`16
`
`Page
`
`4 of
`
`27
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`Nationwide®
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`
`is on your
`
`side
`
`c. Other
`become
`within:
`
`Than
`the
`
`Collision
`owner.
`
`Coverage
`However,
`
`for
`for
`
`a "newly
`this
`coverage
`
`acquired
`to
`
`auto"
`
`apply,
`
`begins
`you must
`
`on
`ask
`
`date
`the
`us to
`
`you
`insure
`
`it
`
`after
`days
`Collision
`auto"
`
`30
`Than
`acquired
`shown
`
`in the
`
`become
`you
`Coverage
`will
`have
`Declarations.
`
`owner
`the
`to
`at
`applies
`the
`broadest
`
`if
`indicate
`Declarations
`the
`In this
`auto.
`one
`least
`case,
`we now
`coverage
`provide
`
`that
`the
`for
`
`Other
`"newly
`auto
`any
`
`after
`Seven
`days
`Collision
`Than
`Other
`requirement
`the
`7-day
`acquired
`auto",
`"newly
`partner"
`a person
`means
`resembles
`
`you
`
`relationship
`and:
`
`owner
`do
`Declarations
`the
`the
`become
`If you
`auto.
`one
`least
`to
`applies
`Coverage
`us to
`you
`asked
`before
`a loss
`occurred
`and
`an Other
`Than
`Collision
`of $500
`deductible
`a common
`such
`
`if
`at
`
`living
`a mutually
`
`with
`
`and
`
`you
`exclusive
`
`sharing
`partnership
`
`not
`
`that
`indicate
`with
`comply
`the
`insure
`will
`apply.
`
`domestic
`of a
`as that
`
`life
`
`(1)
`
`(2)
`
`L.
`
`"Domestic
`and
`whose
`marriage,
`1.
`
`Is at
`
`least
`
`18 years
`
`of age
`
`2.
`
`3.
`
`Is not
`
`Shares
`
`a "family
`with
`
`you
`
`member";
`financial
`
`capable
`
`of entering
`
`into
`
`a legal
`
`contract;
`
`and
`
`and
`
`interdependence
`
`and
`
`a common
`
`residence.
`
`Evidence
`
`of
`
`such
`
`includes,
`
`but
`
`is not
`
`limited
`
`to:
`
`Joint
`
`domestic
`
`for
`
`of
`
`the
`
`household;
`
`a.
`
`b.
`
`responsibility
`financial
`
`c.
`
`Having
`Documents
`address
`
`joint
`
`for
`
`such
`both
`
`obligations,
`as a driver's
`parties;
`
`the maintenance
`or assets;
`or bills
`
`resources,
`tax
`
`license,
`
`returns,
`
`mail
`
`receiving
`of domestic
`with
`an employer
`
`at
`
`the
`
`same
`
`address;
`person
`with
`that
`partnership
`or government
`entity.
`
`or
`
`showing
`
`a common
`
`or
`
`similar
`
`declaration
`
`about
`
`Both
`d.
`parties
`e. A declaration
`person
`that
`partner"
`A "domestic
`whether
`
`does
`expenses
`
`sharing
`network
`"Transportation
`passengers
`used
`to
`connect
`transportation
`prearranged
`testing"
`
`M.
`
`N.
`
`"Performance
`
`than
`more
`include
`not
`or one
`or not,
`equally
`platform"
`means
`drivers
`for
`
`with
`services
`
`an online-enabled
`vehicles
`using
`compensation.
`
`one
`who
`
`person,
`pays
`
`rent
`
`a roommate
`to
`the
`
`named
`
`or housemate
`insured.
`
`application
`the
`purpose
`
`for
`
`or digital
`of providing
`
`network
`
`is used
`
`to:
`
`or
`
`handling;
`
`is when
`a vehicle
`in speed,
`skills.
`
`driver
`
`issued
`driver
`
`does
`learner's
`training
`prevention,
`COVERAGE
`
`its performance
`
`1.
`
`2.
`
`Test
`
`Test
`
`or practice
`testing"
`
`PART
`
`LIABILITY
`AGREEMENT
`
`"Performance
`obtain
`a state
`not
`to
`apply
`vehicle
`accident
`A -
`INSURING
`A. We will
`becomes
`interest
`of
`liability
`claim
`or
`defense
`coverage
`
`not
`
`apply
`permit
`activities
`defensive
`
`student-driver
`activities
`to
`training
`license.
`or driver's
`"Performance
`to
`complete
`state-sanctioned
`or driver
`improvement.
`driving
`
`participated
`testing"
`also
`in motor
`
`courses
`
`in to
`does
`
`injury"
`
`damage"
`
`"insured"
`
`for which
`or
`any
`"property
`"bodily
`accident.
`of an auto
`prejudgment
`Damages
`include
`because
`"insured"
`our
`which
`exceed
`do
`not
`the
`against
`awarded
`We will
`as we consider
`or defend,
`settle
`appropriate,
`any
`we will
`all
`In addition
`our
`of
`damages.
`limit
`liability,
`pay
`for
`or defend
`when
`our
`of
`settle
`ends
`limit
`to
`duty
`liability
`of
`payment
`judgments
`settlements
`unless
`required
`by
`
`to
`
`or
`
`limit
`
`this
`by
`
`on
`
`for
`damages
`pay
`responsible
`legally
`covered
`damages
`for
`coverage.
`this
`for
`suit
`these
`asking
`we incur.
`Our
`costs
`been
`has
`exhausted
`
`A 4500
`
`07
`
`16
`
`Page
`
`5 of
`
`27
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`Nationwide®
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`
`is on your
`
`side
`
`law. We have
`damage"
`not
`
`no
`duty
`covered
`
`defend
`to
`under
`this
`
`suit
`any
`policy.
`
`or
`
`settle
`
`any
`
`claim
`
`for
`
`"bodily
`
`injury"
`
`or
`
`"property
`
`B.
`
`"Insured"
`
`as used
`or any
`1. You
`"trailer".
`
`"family
`
`Part means:
`in this
`member"
`
`for
`
`the
`
`ownership,
`
`maintenance
`
`or use
`
`of any
`
`auto
`
`or
`
`person
`
`2. Any
`"your
`3.
`For
`responsibility
`Part.
`this
`
`using
`covered
`for
`
`"your
`
`covered
`
`auto".
`
`person
`auto",
`any
`or omissions
`acts
`
`or organization
`with
`but
`only
`for whom coverage
`of a person
`
`respect
`is afforded
`
`to
`
`legal
`under
`
`or
`"trailer",
`but
`only
`member"
`
`"your
`than
`other
`covered
`auto",
`legal
`with
`to
`respect
`responsibility
`for whom coverage
`is afforded
`person
`or organization
`the
`does
`
`under
`not
`
`or
`
`any
`for
`
`other
`acts
`this
`own
`
`person
`of
`or omissions
`Part.
`Provision
`This
`or hire
`or
`the
`auto
`
`you
`
`or
`
`4.
`
`auto
`
`For
`any
`organization
`any
`"family
`applies
`(B.4.)
`"trailer".
`
`5.
`
`The
`
`only
`
`if
`
`are
`
`not
`
`States
`
`"insureds",
`of America
`
`following
`a.
`The United
`person
`b. Any
`operation
`Government.
`States
`Code
`the
`United
`be
`brought
`SUPPLEMENTARY
`We will
`pay
`1. Up
`to
`traffic
`covered
`
`under
`or any
`or
`to
`"property
`"bodily
`of
`as an employee
`person
`that
`of Section
`if
`provisions
`the
`only
`Claims
`as amended,
`require
`Act),
`person
`civil
`in any
`action
`that
`injury"
`or
`damage".
`"property
`
`policy:
`
`the
`
`Part A of
`of
`its agencies.
`injury"
`
`damage"
`
`the
`
`resulting
`States
`United
`of Title
`2679
`the
`Attorney
`or proceeding
`
`from
`
`the
`
`28, United
`General
`which
`
`of
`may
`
`with
`respect
`of an auto
`by
`This
`applies
`(Federal
`Tort
`States
`to
`defend
`for
`the
`"bodily
`PAYMENTS
`of an "insured":
`
`on
`
`behalf
`
`for
`the
`$250
`law violations.
`under
`this
`
`of bail
`accident
`
`bonds
`must
`
`required
`result
`
`because
`in "bodily
`
`of an accident,
`related
`including
`damage"
`injury"
`or
`"property
`
`cost
`The
`policy.
`
`2.
`
`Premiums
`
`on
`
`appeal
`
`bonds
`
`and
`
`bonds
`
`to
`
`3.
`
`Interest
`interest
`our
`limit
`
`4. Upon
`other
`
`accruing
`when
`ends
`of
`liability
`submission
`income,
`
`after
`a judgment
`we offer
`to
`pay
`for
`coverage.
`this
`
`in any
`release
`attachments
`suit we defend.
`in any
`of
`which
`the
`judgment
`
`is entered
`that
`part
`
`suit we defend.
`Our
`to
`pay
`does
`exceed
`
`duty
`not
`
`for
`because
`
`reimbursement,
`of attendance
`
`$250
`to
`up
`at hearings
`
`for
`
`a day
`or
`trials
`
`loss
`at our
`
`of earnings,
`request.
`
`but
`
`not
`
`5. Other
`
`reasonable
`
`expenses
`
`incurred
`
`at our
`
`request.
`
`These
`
`payments
`
`will
`
`not
`
`reduce
`
`the
`
`limit
`
`of
`
`liability.
`
`EXCLUSIONS
`A. We do
`1.
`For
`even
`
`not
`
`provide
`injury"
`
`"bodily
`if
`the
`
`resulting
`Is of different
`
`kind,
`quality
`a different
`by
`intended.
`damage"
`
`to
`
`damage"
`
`to
`
`a.
`
`b.
`
`Is sustained
`expected
`
`or
`
`2.
`
`3.
`
`For
`
`"property
`
`For
`
`"property
`a. Rented
`
`b. Used
`
`by;
`
`to;
`or
`
`A 4500
`
`07
`
`16
`
`Liability
`or
`
`Coverage
`
`for
`damage"
`injury"
`
`or
`
`"property
`"bodily
`
`any
`
`"insured":
`
`which
`"property
`than
`
`is expected
`damage":
`
`expected
`
`initially
`real
`or personal
`
`or degree
`
`person,
`
`entity,
`
`or
`
`intended
`
`an "insured"
`
`by
`
`or
`
`intended;
`than
`
`property,
`
`or
`
`initially
`
`property
`property:
`
`owned
`
`or being
`
`transported
`
`by
`
`that
`
`"insured".
`
`Page
`
`6 of
`
`27
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`Nationwide®
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`
`is on your
`
`side
`
`c.
`
`In the
`
`care
`
`of;
`
`that
`
`"insured".
`
`Exclusion
`
`(A.3.)
`
`does
`
`not
`
`apply
`
`to
`
`"property
`
`damage"
`
`to
`
`a residence
`
`or private
`
`This
`garage.
`
`injury"
`
`to
`
`of
`
`"insured"
`injury"
`
`an employee
`that
`to
`does
`not
`"bodily
`apply
`benefits,
`benefits,
`disability
`employee.
`that
`domestic
`
`for
`
`course
`the
`during
`a domestic
`to
`under
`or benefits
`
`of employment.
`employee
`unless
`similar
`laws
`are
`
`required
`
`For
`"bodily
`Exclusion
`This
`(A.4.)
`workers'
`compensation
`or available
`"insured's"
`
`4.
`
`5.
`
`used:
`
`a.
`
`liability
`
`arising
`
`out
`
`of
`
`the
`
`ownership
`
`or operation
`
`of a vehicle
`
`while
`
`for
`a fee
`a vehicle
`platform"
`
`compensation.
`or
`used
`is being
`as a driver,
`
`This
`any
`by
`whether
`
`includes
`"insured"
`
`or not
`
`is not
`but
`is logged
`who
`a passenger
`
`is
`
`For
`that
`it
`is being
`or property
`persons
`To
`carry
`of
`period
`time
`to
`limited
`any
`a "transportation
`network
`into
`"occupying"
`or
`the
`
`a regular
`b. On
`magazine,
`Exclusion
`the
`vehicle
`
`vehicle;
`for
`
`basis
`newspaper
`
`A.5.a.
`not
`does
`in the
`is used
`
`6. While
`
`employed
`
`or otherwise
`
`engaged
`
`a.
`
`Selling;
`b. Repairing;
`c.
`Servicing;
`d. Storing;
`e.
`
`or
`
`or wholesale
`retail
`delivery.
`and mail
`
`apply
`course
`
`to
`of
`
`vehicles
`volunteer
`
`delivery,
`
`including
`
`but
`
`not
`
`limited
`
`to
`
`pizza,
`
`in shared-expense
`used
`for
`work
`a tax-exempt
`"business"
`
`of:
`
`in the
`
`car
`pools
`organization.
`
`or while
`
`on
`does
`
`highways.
`to
`the
`
`road
`maintenance
`
`testing
`
`and
`or use
`
`of
`
`Parking;
`vehicles
`delivery.
`"your
`
`for
`designed
`Exclusion
`This
`auto"
`covered
`
`use mainly
`(A.6.)
`
`by:
`
`public
`not
`apply
`
`includes
`This
`ownership,
`
`member";
`
`or
`
`agent
`
`or employee
`
`a. You;
`b. Any
`"family
`c.
`business
`partner,
`Any
`or using
`7. Maintaining
`any
`"business"
`in any
`(other
`This
`
`while
`vehicle
`than
`farming
`
`not
`
`apply
`
`does
`
`of
`you
`"insured"
`
`or any
`"family
`is employed
`described
`
`not
`
`member".
`
`or otherwise
`in Exclusion
`
`engaged
`A.6.
`
`that
`or
`ranching)
`to the maintenance
`
`Exclusion
`
`(A.7.)
`passenger
`
`Private
`
`Pickup
`"Trailer"
`
`or
`
`van;
`used
`
`or
`
`with
`
`a.
`
`b.
`
`b.
`
`c.
`
`c.
`8. Using
`a. Without
`a reasonable
`"insured"
`
`a vehicle:
`
`The
`
`"insured"
`
`The
`"insured"
`
`has
`
`knows
`
`auto;
`
`a vehicle
`
`described
`
`in a. or b. above.
`
`belief
`
`of being
`
`entitled
`
`to
`
`do
`
`so;
`
`stolen;
`to
`
`or
`
`have
`
`been
`
`stolen.
`
`An
`motor
`
`shall
`if
`
`not
`that
`
`held
`be
`person's
`
`have
`to
`license
`
`vehicle
`
`This
`
`exclusion
`
`does
`
`not
`
`apply
`
`to
`
`the
`
`a. You;
`
`A 4500
`
`07
`
`16
`
`belief
`a reasonable
`been
`has
`suspended,
`covered
`
`of
`
`"your
`
`use
`
`or use
`
`of a:
`
`entitled
`or never
`
`to
`
`operate
`issued.
`
`a
`
`of being
`revoked,
`auto"
`by:
`
`Page
`
`7 of
`
`27
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`Nationwide®
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`
`is on your
`
`side
`
`member";
`
`or
`
`b. A "family
`c. A business
`For
`
`9.
`
`a.
`
`partner,
`injury"
`or
`
`under
`
`employee,
`
`"property
`a nuclear
`
`"bodily
`Is an insured
`
`or agent
`damage"
`
`of
`
`you
`
`for which
`
`or a "family
`"insured":
`that
`
`member".
`
`energy
`a nuclear
`of
`liability.
`
`liability
`
`policy;
`
`or
`
`energy
`
`liability
`
`policy
`
`but
`
`for
`
`its
`
`termination
`
`b. Would
`upon
`A nuclear
`successors:
`
`a. Nuclear
`
`an insured
`be
`exhaustion
`of
`
`under
`limit
`
`its
`
`energy
`
`liability
`
`policy
`
`is a policy
`
`issued
`
`by
`
`any
`
`of
`
`the
`
`following
`
`or
`
`their
`
`Liability
`
`Insurance
`
`Association;
`
`or
`
`b. Mutual
`
`c.
`
`Nuclear
`
`Energy
`Atomic
`
`Insurance
`injury"
`
`10. For
`"bodily
`provided
`a. Workers'
`b. Unemployment
`
`or
`
`voluntarily
`
`Liability
`Energy
`Association
`
`Underwriters;
`of Canada.
`
`to
`
`person
`any
`provided
`
`eligible
`by
`any
`
`receive
`to
`"insured"
`
`any
`under
`
`benefits
`a:
`
`required
`
`to
`
`be
`
`compensation;
`
`compensation;
`or occupational
`
`disease;
`
`c.
`
`Non-occupational
`
`d.
`Disability
`similar
`or any
`11. For
`use
`
`benefits;
`law.
`injury"
`"bodily
`of any motor
`a. While
`rented
`
`or
`"property
`vehicle:
`
`damage"
`
`arising
`
`out
`
`of
`
`the
`
`ownership,
`
`maintenance
`
`or
`
`or
`
`leased
`
`to
`
`others
`
`b.
`
`c.
`
`any
`
`If under
`type
`conditional
`sale,
`been
`transferred
`
`of
`conveyance
`for
`contract
`to
`others
`by
`
`sale,
`any
`
`including
`regardless
`own,
`or
`
`but
`
`limited
`not
`of whether
`
`a
`
`to
`title
`
`has
`
`terms
`
`"insured";
`any
`by
`of ownership
`or
`rent
`to
`"insured";
`under
`program
`such
`with
`"family
`
`vehicle
`used
`other
`
`sharing
`in connection
`than
`or any
`you
`
`the
`personal
`member".
`
`of a written
`vehicle
`sharing
`
`in a personal
`and
`being
`anyone
`by
`injury"
`
`sustained
`
`by:
`
`Enrolled
`agreement
`program
`
`12. For
`
`"bodily
`a. You;
`b.
`
`Any
`
`other
`
`"insured"
`
`person
`
`under
`
`the
`
`policy;
`
`c.
`
`d.
`
`Any
`
`person
`
`or member
`
`of
`
`member
`Any
`household
`
`of
`
`the
`that
`
`with
`
`family
`other
`
`family
`other
`
`your
`of any
`"insured".
`
`residing
`"insured"
`
`in the
`
`same
`
`household
`
`person
`
`residing
`
`in the
`
`with
`
`you;
`same
`
`or
`
`not
`
`provide
`
`Liability
`
`Coverage
`
`for
`
`the
`
`ownership,
`
`maintenance
`
`or use
`
`of:
`
`vehicle
`
`which:
`
`B. We do
`1. Any
`a. Has
`
`fewer
`
`than
`
`four
`
`b.
`
`Is designed
`
`This
`
`Exclusion
`
`a. While
`
`such
`
`mainly
`
`(B.1.)
`vehicle
`
`wheels;
`for
`use
`
`or
`
`off
`
`public
`
`roads.
`
`does
`
`not
`
`apply:
`
`is being
`
`used
`
`by
`
`an "insured"
`
`in a medical
`
`emergency;
`
`b.
`
`To
`
`any
`
`To
`
`any
`
`c.
`2. Any
`vehicle,
`a. Owned
`
`or
`
`"trailer";
`non-owned
`
`golf
`
`cart.
`
`other
`
`than
`
`"your
`
`covered
`
`auto",
`
`which
`
`is:
`
`by
`
`you;
`
`or
`
`A 4500
`
`07
`
`16
`
`Page
`
`8 of
`
`27
`
`

`

`FILED: NASSAU COUNTY CLERK 02/24/2023 08:28 AM
`NYSCEF DOC. NO. 4
`Nationwide®
`
`INDEX NO. 603245/2023
`
`RECEIVED NYSCEF: 02/24/2023
`
`is on your
`
`side
`
`Furnished
`
`b.
`3. Any
`vehicle,
`a. Owned
`
`b.
`
`Furnished
`
`or available
`
`for
`
`your
`
`regular
`
`use.
`
`other
`
`than
`
`"your
`
`covered
`
`auto",
`
`which
`
`is:
`
`by
`
`"family
`any
`or available
`
`member";
`for
`the
`
`or
`
`regular
`
`use
`
`of any
`to
`you
`
`"family
`while
`
`member".
`
`you
`
`are maintaining
`
`or
`
`Exclusion
`vehicle
`any
`a "family
`or available
`
`(B.3.)
`which
`
`does
`is:
`
`not
`
`apply
`
`member";
`for
`the
`
`or
`
`regular
`
`use
`
`of a "family
`
`member".
`
`However,
`"occupying"
`
`this
`
`a. Owned
`
`by
`
`Furnished
`
`vehicle:
`
`b.
`4. Any
`a. Used
`
`in an organized
`
`(1)
`
`(2)
`
`Racing
`Speed
`
`contest
`
`contest
`
`In practice
`
`(3)
`b. Used
`testing
`not
`
`C. We do
`1.
`For
`
`a.
`
`or prearranged
`or event;
`or event;
`or preparation
`testing"
`
`competitive
`
`event,
`
`including
`
`but
`
`not
`
`limited
`
`to:
`
`racing
`any
`on
`is done
`"insured"
`the
`
`or
`
`speed
`
`contest
`
`or event.
`
`a closed
`is not
`
`or a race
`road,
`competing.
`
`track,
`
`or a
`
`or
`
`for
`
`that
`where
`
`in "performance
`environment
`facility
`provide
`
`Liability
`
`Coverage:
`
`person's
`
`resulting
`the
`
`from
`
`the
`
`where
`or
`
`of property:
`
`handling
`it
`is accepted
`
`an "insured"
`
`by
`
`for movement
`
`any
`Before
`into
`
`liability
`is moved
`it
`"your
`or onto
`
`from
`covered
`
`place
`auto";
`
`b.
`
`After
`by
`
`is moved
`it
`an "insured".
`
`from
`
`"your
`
`covered
`
`auto"
`
`to
`
`the
`
`place
`
`where
`
`it
`
`is finally
`
`delivered
`
`any
`
`For
`device
`
`person's
`(other
`
`than
`
`liability
`a hand
`
`resulting
`truck)
`
`from
`not
`
`the movement
`"your
`attached
`to
`
`of property
`covered
`
`by
`auto".
`
`a mechanical
`
`For
`
`any
`
`of
`
`the
`
`following:
`
`2.
`
`3.
`
`a.
`
`Judgments;
`b. Costs;
`c.
`
`Attorney
`
`fees;
`
`or
`
`d.
`
`LIMIT
`
`A.
`
`Claims;
`an "insured"
`against
`OF LIABILITY
`of
`limit
`The
`our maximum
`or death,
`arising
`accident.
`Subject
`for
`Declarations
`all damages
`for
`
`liability
`limit
`out
`to
`each
`"bodily
`shown
`of
`liability
`is our maximum
`accident.
`
`limit
`The
`Liability
`auto
`
`for
`
`punitive
`
`or exemplary
`
`damages.
`
`shown
`of
`liability
`of
`"bodily
`limit
`this
`accident
`injury"
`
`in the
`Declarations
`all damages,
`for
`injury"
`sustained
`person,
`Injury
`from
`
`each
`for
`for
`Bodily
`resulting
`in the
`Declarations
`of
`for
`limit
`liability
`
`each
`for
`including
`by
`any
`the
`limit
`Liability
`one
`
`any
`each
`for
`"property
`
`for
`
`person
`Bodily
`for
`damages
`care,
`in any
`person
`one
`shown
`of
`liability
`is our maximum
`accident.
`auto
`
`Injury
`loss
`one
`in the
`limit
`
`is
`
`Liability
`of
`services
`auto
`
`of
`
`liability
`
`for
`
`accident
`damage"
`