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  • MBA Powersport Addendum P202132191003124913

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    zamo
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    This document provides an endorsement to an insurance policy to add additional insured coverage for a vehicle rental. It modifies the business auto coverage form to add Adolph Lombardi as an additional insured under the policy for a rental vehicle from Asheville Motorcycle Rentals LLC from October 4, 2019 to October 5, 2019. It also provides uninsured/underinsured motorist and other optional coverage to the additional insured if included in the policy. The additional insured and other authorized drivers listed on the rental agreement are insured under the policy's liability coverage for the covered rental vehicle during the endorsement dates.

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    MBA_Powersport_Addendum_P202132191003124913

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    This document provides an endorsement to an insurance policy to add additional insured coverage for a vehicle rental. It modifies the business auto coverage form to add Adolph Lombardi as an additional insured under the policy for a rental vehicle from Asheville Motorcycle Rentals LLC from October 4, 2019 to October 5, 2019. It also provides uninsured/underinsured motorist and other optional coverage to the additional insured if included in the policy. The additional insured and other authorized drivers listed on the rental agreement are insured under the policy's liability coverage for the covered rental vehicle during the endorsement dates.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    7 views2 pages

    MBA Powersport Addendum P202132191003124913

    Uploaded by

    zamo
    This document provides an endorsement to an insurance policy to add additional insured coverage for a vehicle rental. It modifies the business auto coverage form to add Adolph Lombardi as an additional insured under the policy for a rental vehicle from Asheville Motorcycle Rentals LLC from October 4, 2019 to October 5, 2019. It also provides uninsured/underinsured motorist and other optional coverage to the additional insured if included in the policy. The additional insured and other authorized drivers listed on the rental agreement are insured under the policy's liability coverage for the covered rental vehicle during the endorsement dates.

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    © All Rights Reserved
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    THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

    75006

    ADDITIONAL INSURED - RENTER


    This endorsement modifies coverage provided under the following:

    BUSINESS AUTO COVERAGE FORM

    This endorsement changes the policy only during the Endorsement Effective Dates/Times indicated below :

    Endorsement Effective Dates/Times

    Begin Date: 10/4/2019 at Time: 8:01AM


    End Date: 10/5/2019 at Time: 7:59AM
    Policy Number: 202132-3
    Named Insured: Asheville Motorcycle Rentals LLC
    Additional Insured: Adolph Lombardi

    1. The Additional Insured identified above has rented the covered "auto" or covered "consigned auto" identified
    below from the Named Insured pursuant to a rental agreement, and during the Endorsement Effective
    Dates/Times set forth above, the Additional Insured and any other person specifically identified as an
    additional driver on the rental agreement, is an " insured" under SECTION II - COVERED AUTOS LIABILITY
    COVERAGE with regard to the following covered "auto" or covered "consigned auto" only:
    Year: Per Rental Agreement
    Make: Per Rental Agreement
    VIN: Per Rental Agreement

    2. If the Policy identified above includes Uninsured Motorists Coverage, Underinsured Motorists Coverage,
    Medical Payments Coverage or Personal Injury Protection Coverage, such coverage will be provided to the
    Additional Insured identified above and any other person specifically identified as an additional driver on the
    rental agreement.

    3. "Consigned auto" means an "auto" consigned to the Named Insured by the owner of the "auto" pursuant to an
    agreement, written or otherwise, between the Named Insured and such owner whereby the owner authorizes
    the Named Insured to rent the "auto" to others.

    All other policy provisions apply.

    75006 (05/14) P202132191003124913


    Addendum Purchase Receipt

    Purchase Date: October 3, 2019

    Rental Operator: Asheville Motorcycle Rentals LLC


    Policy Number: 202132-3
    Addendum #: P202132191003124913
    Renter Name: Adolph Lombardi
    Effective Date: October 4, 2019
    Expiration Date: October 5, 2019

    Credit Card: American E - 2006


    Name on Card: Adolph Lombardi
    Billing Address: 3965 reynoldsnurg new albany road, New Albany, OH
    43054
    SLI Option was: Accepted
    Addendum Sub Total: $15.00
    SLI Total: $6.95
    Addendum Grand Total: $21.95

    Acceptance of Terms & Payment Information


    I agree to comply with the terms & conditions for this purchase as follows:

    This insurance is non-transferable and only provides coverage for the Authorized Driver. Authorized
    Drivers are those drivers identified on the front of the rental agreement as Renter and any Additional
    Drivers.
    I agree to pay the total amount according to the card issuer agreement.

    IMPORTANT NOTE
    The attached endorsement 75006 is your EVIDENCE OF INSURANCE. Present a copy of this ADDENDUM
    PURCHASE RECEIPT and the EVIDENCE OF INSURANCE to your rental operator when you take possession of
    your rental vehicle.
    If at any time you need to add or remove days from your trip, please contact your rental operator.

    Thank you for choosing MBA Insurance for your rental insurance needs.

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