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2 Your employee if the covered auto is owned by that employee or a member of his or her household. 3 Someone using a covered auto while he or she is working in a business of selling servicing repairing parking or storing autos unless that business is yours. 4 Anyone other than your employees partners if you are a partnership members if you are a limited liability company or a lessee or borrower or any of their employees while moving property to or from a covered auto. 5 A partner if you are a partnership or a member if you are a limited liability company for a covered auto owned by him or her or a member of his or her household. c. Anyone liable for the conduct of an insured described above but only to the extent of that liability. 2. Coverage Extensions a. Supplementary Payments We will pay for the insured 1 All expenses we incur. 2 Up to 2000 for cost of bail bonds including bonds for related traffic law violations required because of an accident we cover. We do not have to furnish these bonds. The cost of bonds to release attachments in any suit against the insured we defend but only for bond amounts within our Limit of Insurance. All reasonable expenses incurred by the insured at our request including actual loss of earnings up to 250 a day because of time off from work. All court costs taxed against the insured in any suit against the insured we defend. However these payments do not include attorneys fees or attorneys expenses taxed against the insured. All interest on the full amount of any judgment that accrues after entry of the judgment in any suit against the insured we defend but our duty to pay interest ends when we have paid offered to pay or deposited in court the part of the judgment that is within our Limit of Insurance. 3 4 5 6 These payments will not reduce the Limit of Insurance. b. Out of state Coverage Extensions While a covered auto is away from the state where it is licensed we will 1 Increase the Limit of Insurance for Covered Autos Liability Coverage to meet the limits specified by a compulsory or financial responsibility law of the jurisdiction where the covered auto is being used. This extension does not apply to the limit or limits specified by any law governing motor carriers of passengers or property. Provide the minimum amounts and types of other coverages such as no fault required of out of state vehicles by the jurisdiction where the covered auto is being used. We will not pay anyone more than once for the same elements of loss because of these extensions. B. Exclusions This insurance does not apply to any of the following 1. Expected Or Intended Injury Bodily injury or property damage expected or intended from the standpoint of the insured. 2. Contractual Liability assumed under any contract or agreement. But this exclusion does not apply to liability for damages a. Assumed in a contract or agreement that is an insured contract provided the bodily injury or property damage occurs subsequent to the execution of the contract or agreement or b. That the insured would have in the absence of the contract or agreement. 3. Workers Compensation Any obligation for which the insured or the insured s insurer may be held liable under any workers compensation disability benefits or unemployment compensation law or any similar law. 2 CA 00011013 Insurance Services Office Inc. 2011 Insured Copy Page 3 of 12 | 2 |
4. Employee Indemnification And Employer s Liability Bodily injury to a. An employee of the insured arising out of and in the course of 1 Employment by the insured or 2 Performing the duties related to the conduct of the insured s business or b. The spouse child parent brother or sister of that employee as a consequence of Paragraph a. above. This exclusion applies 1 Whether the insured may be liable as an employer or in any other capacity and 2 To any obligation to share damages with or repay someone else who must pay damages because of the injury. But this exclusion does not apply to bodily injury to domestic employees not entitled to workers compensation benefits or to liability assumed by the insured under an insured contract. For the purposes of the Coverage Form a domestic employee is a person engaged in household or domestic work performed principally in connection with a residence premises. 5. Fellow Employee Bodily injury to a. Any fellow employee of the insured arising out of and in the course of the fellow employee s employment or while performing duties related to the conduct of your business or b. The spouse child parent brother or sister of that fellow employee as a consequence of Paragraph a. above. 6. Care Custody Or Control Property damage to or covered pollution cost or expense involving property owned or transported by the insured or in the insured s care custody or control. But this exclusion does not apply to liability assumed under a sidetrack agreement. 7. Handling Of Property Bodily injury or property damage resulting from the handling of property a. Before it is moved from the place where it is accepted by the insured for movement into or onto the covered auto or b. After it is moved from the covered auto to the place where it is finally delivered by the insured. 8. Movement Of Property By Mechanical Device Bodily injury or property damage resulting from the movement of property by a mechanical device other than a hand truck unless the device is attached to the covered auto. 9. Operations Bodily injury or property damage arising out of the operation of a. Any equipment listed in Paragraphs 6.b. and 6.c. of the definiton of mobile equipment or b. Machinery or equipment that is on attached to or part of a land vehicle that would qualify under the definition of mobile equipment if it were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. 10. Completed Operations Bodily injury or property damage arising out of your work after that work has been completed or abandoned. In this exclusion your work means a. Work or operations performed by you or on your behalf and b. Materials parts or equipment furnished in connection with such work or operations. Your work includes warranties or representations made at any time with respect to the fitness quality durability or performance of any of the items included in Paragraph a. or b. above. Your work will be deemed completed at the earliest of the following times 1 When all of the work called for in your contract has been completed 2 When all of the work to be done at the site has been completed if your contract calls for work at more than one site or When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor working on the same project. Page 4 of 12 Insurance Services Office Inc. 2011 Insured Copy CA 00011013 | 2 |
Paragraphs b. and c. above of this exclusion do not apply to accidents that occur away from premises owned by or rented to an insured with respect to pollutants not in or upon a covered auto if a The pollutants or any property in which the pollutants are contained are upset overturned or damaged as a result of the maintenance or use of a covered auto and b The discharge dispersal seepage migration release or escape of the pollutants is caused directly by such upset overturn or damage. 12. War Bodily injury or property damage arising directly or indirectly out of a. War including undeclared or civil war b. Warlike action by a military force including action in hindering or defending against an actual or expected attack by any government sovereign or other authority using military personnel or other agents or c. Insurrection rebellion revolution usurped power or action taken by governmental authority in hindering or defending against any of these. 13. Racing Covered autos while used in any professional or organized racing or demolition contest or stunting activity or while practicing for such contest or activity. This insurance also does not apply while that covered auto is being prepared for such a contest or activity. C. Limit Of Insurance Regardless of the number of covered autos insureds premiums paid claims made or vehicles involved in the accident the most we will pay for the total of all damages and covered pollution cost or expense combined resulting from any one accident is the Limit Of Insurance for Covered Autos Liability Coverage shown in the Declarations. 1. Work that may need service maintenance correction repair or replacement but which is otherwise complete will be treated as completed. Pollution Bodily injury or property damage arising out of the actual alleged or threatened discharge dispersal seepage migration release or escape of pollutants a. That are or that are contained in any property that is 1 Being transported or towed by handled or handled for movement into onto or from the covered auto 2 Otherwise in the course of transit by or on behalf of the insured or 3 Being stored disposed of treated or processed in or upon the covered auto b. Before the pollutants or any property in which the pollutants are contained are moved from the place where they are accepted by the insured for movement into or onto the covered auto or c. After the pollutants or any property in which the pollutants are contained are moved from the covered auto to the place where they are finally delivered disposed of or abandoned by the insured. Paragraph a. above does not apply to fuels lubricants fluids exhaust gases or other similar pollutants that are needed for or result from the normal electrical hydraulic or mechanical functioning of the covered auto or its parts if 1 The pollutants escape seep migrate or are discharged dispersed or released directly from an auto part designed by its manufacturer to hold store receive or dispose of such pollutants and 2 The bodily injury property damage or covered pollution cost or expense does not arise out of the operation of any equipment listed in Paragraphs 6.b. and 6.c. of the definition of mobile equipment. CA 00011013 Insurance Services Office Inc. 2011 Insured Copy Page 5 of 12 | 2 |
3. Glass Breakage Hitting A Bird Or Animal Falling Objects Or Missiles If you carry Comprehensive Coverage for the damaged covered auto we will pay for the following under Comprehensive Coverage a. Glass breakage b. Loss caused by hitting a bird or animal and c. Loss caused by falling objects or missiles. However you have the option of having glass breakage caused by a covered auto s collision or overturn considered a loss under Collision Coverage. 4. Coverage Extensions a. Transportation Expenses We will pay up to 20 per day to a maximum of 600 for temporary transportation expense incurred by you because of the total theft of a covered auto of the private passenger type. We will pay only for those covered autos for which you carry either Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending regardless of the policy s expiration when the covered auto is returned to use or we pay for its loss. b. Loss Of Use Expenses For Hired Auto Physical Damage we will pay expenses for which an insured becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or agreement. We will pay for loss of use expenses if caused by 1 Other than collision only if the Declarations indicates that Comprehensive Coverage is provided for any covered auto 2 Specified Causes Of Loss only if the Declarations indicates that Specified Causes Of Loss Coverage is provided for any covered auto or All bodily injury property damage and covered pollution cost or expense resulting from continuous or repeated exposure to substantially the same conditions will be considered as resulting from one accident. No one will be entitled to receive duplicate payments for the same elements of loss under this Coverage Form and any Medical Payments Coverage endorsement Uninsured Motorists Coverage endorsement or Underinsured Motorists Coverage endorsement attached to this Coverage Part. SECTION Il PHYSICAL DAMAGE COVERAGE A. Coverage 1. We will pay for loss to a covered auto or its equipment under a. Comprehensive Coverage From any cause except 1 The covered auto s collision with another object or 2 The covered auto s overturn. b. Specified Causes Of Loss Coverage Caused by 1 Fire lightning or explosion 2 Theft 3 Windstorm hail or earthquake 4 Flood 5 Mischief or vandalism or 6 The sinking burning collision or derailment of any conveyance transporting the covered auto. c. Collision Coverage Caused by 1 The covered auto s collision with another object or 2 The covered auto s overturn. 2. Towing We will pay up to the limit shown in the Declarations for towing and labor costs incurred each time a covered auto of the private passenger type is disabled. However the labor must be performed at the place of disablement. Page 6 of 12 Insurance Services Office Inc. 2011 Insured Copy CA 00011013 | 2 |
3 Collision only if the Declarations indicates that Collision Coverage is provided for any covered auto. However the most we will pay for any expenses for loss of use is 20 per day to a maximum of 600. B. Exclusions 1. We will not pay for loss caused by or resulting from any of the following. Such loss is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. a. Nuclear Hazard 1 The explosion of any weapon employing atomic fission or fusion or 2 Nuclear reaction or radiation or radioactive contamination however caused. b. War Or tary Action 1 War including undeclared or civil war 2 Warlike action by a military force including action in hindering or defending against an actual or expected attack by any government sovereign or other authority using military personnel or other agents or 3 Insurrection rebellion revolution usurped power or action taken by governmental authority in hindering or defending against any of these. 2. We will not pay for loss to any covered auto while used in any professional or organized racing or demolition contest or stunting activity or while practicing for such contest or activity. We will also not pay for loss to any covered auto while that covered auto is being prepared for such a contest or activity. 3. We will not pay for loss due and confined to a. Wear and tear freezing mechanical or electrical breakdown. b. Blowouts punctures or other road damage to tires. This exclusion does not apply to such loss resulting from the total theft of a covered auto. 4. We will not pay for loss to any of the following a. Tapes records discs or other similar audio visual or data electronic devices designed for use with audio visual or data electronic equipment. b. Any device designed or used to detect speed measuring equipment such as radar or laser detectors and any jamming apparatus intended to elude or disrupt speed measuring equipment. c. Any electronic equipment without regard to whether this equipment is permanently installed that reproduces receives or transmits audio visual or data signals. d. Any accessories used with the electronic equipment described in Paragraph c. above. 5. Exclusions 4.c. and 4.d. do not apply to equipment designed to be operated solely by use of the power from the auto s electrical system that at the time of loss is a. Permanently installed in or upon the covered auto b. Removable from a housing unit which is permanently installed in or upon the covered auto c. An integral part of the same unit housing any electronic equipment described in Paragraphs a. and b. above or d. Necessary for the normal operation of the covered auto or the monitoring of the covered auto s operating system. 6. We will not pay for loss to a covered auto due to diminution in value. C. Limits Of Insurance 1. The most we will pay for a. Loss to any one covered auto is the lesser of 1 The actual cash value of the damaged or stolen property as of the time of the loss or 2 The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. b. All electronic equipment that reproduces receives or transmits audio visual or data signals in any one loss is 1000 if at the time of loss such electronic equipment is 1 Permanently installed in or upon the covered auto in a housing opening or other location that is not normally used by the auto manufacturer for the installation of such equipment CA 00011013 Insurance Services Office Inc. 2011 Insured Copy Page 7 of 12 | 2 |
2 Removable from a permanently installed housing unit as described in Paragraph b.1 above or 3 An integral part of such equipment as described in Paragraphs b.1 and b.2 above. 2. An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total loss. 3. If a repair or replacement results in better than like kind or quality we will not pay for the amount of the betterment. D. Deductible For each covered auto our obligation to pay for repair return or replace damaged or stolen property will be reduced by the applicable deductible shown in the Declarations. Any Comprehensive Coverage deductible shown in the Declarations does not apply to loss caused by fire or lightning. SECTION IV BUSINESS AUTO CONDITIONS The following conditions apply in addition to the Common Policy Conditions A. Loss Conditions 1. Appraisal For Physical Damage Loss If you and we disagree on the amount of loss either may demand an appraisal of the loss. In this event each party will select a competent appraiser. The two appraisers will select a competent and impartial umpire. The appraisers will state separately the actual cash value and amount of loss. If they fail to agree they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will a. Pay its chosen appraiser and b. Bear the other expenses of the appraisal and umpire equally. If we submit to an appraisal we will still retain our right to deny the claim. 2. Duties In The Event Of Accident Claim Suit Or Loss We have no duty to provide coverage under this policy unless there has been full compliance with the following duties a. In the event of accident claim suit or loss you must give us or our authorized representative prompt notice of the accident or loss. Include 1 How when and where the accident or loss occurred b. c. 2 The insured s name and address and 3 To the extent possible the names and addresses of any injured persons and witnesses. Additionally you and any other involved insured must 1 Assume no obligation make no payment or incur no expense without our consent except at the insured s own cost. 2 Immediately send us copies of any request demand order notice summons or legal paper received concerning the claim or suit. 3 Cooperate with us in the investigation or settlement of the claim or defense against the suit. Authorize us to obtain medical records or other pertinent information. 5 Submit to examination at our expense by physicians of our choice as often as we reasonably require. If there is loss to a covered auto or its equipment you must also do the following 1 Promptly notify the police if the covered auto or any of its equipment is stolen. 2 Take all reasonable steps to protect the covered auto from further damage. Also keep a record of your expenses for consideration in the settlement of the claim. Permit us to inspect the covered auto and records proving the loss before its repair or disposition. 4 Agree to examinations under oath at our request and give us a signed statement of your answers. 4 3 3. Legal Action Against Us No one may bring a legal action against us under this Coverage Form until a. b. There has been full compliance with all the terms of this Coverage Form and Under Covered Autos Liability Coverage we agree in writing that the insured has an obligation to pay or until the amount of that obligation has finally been determined by judgment after trial. No one has the right under this policy to bring us into an action to determine the insured s liability. Page 8 of 12 Insurance Services Office Inc. 2011 Insured Copy CA 00011013 | 2 |
5. Other Insurance a. For any covered auto you own this Coverage Form provides primary insurance. For any covered auto you do nt own the insurance provided by this Coverage Form is excess over any other collectible insurance. However while a covered auto which is a trailer is connected to another vehicle the Covered Autos Liability Coverage this Coverage Form provides for the trailer is 1 Excess while it is connected to a motor vehicle you do not own or 2 Primary while it is connected to a covered auto you own. b. For Hired Auto Physical Damage Coverage any covered auto you lease hire rent or borrow is deemed to be a covered auto you own. However any auto that is leased hired rented or borrowed with a driver is not a covered auto. c. Regardless of the provisions of Paragraph a. above this Coverage Form s Covered Autos Liability Coverage is primary for any liability assumed under an insured contract. d. When this Coverage Form and any other Coverage Form or policy covers on the same basis either excess or primary we will pay only our share. Our share is the proportion that the Limit of Insurance of our Coverage Form bears to the total of the limits of all the Coverage Forms and policies covering on the same basis. 6. Premium Audit a. The estimated premium for this Coverage Form is based on the exposures you told us you would have when this policy began. We will compute the final premium due when we determine your actual exposures. The estimated total premium will be credited against the final premium due and the first Named Insured will be billed for the balance if any. The due date for the final premium or retrospective premium is the date shown as the due date on the bill. If the estimated total premium exceeds the final premium due the first Named Insured will get a refund. b. If this policy is issued for more than one year the premium for this Coverage Form will be computed annually based on our rates or premiums in effect at the beginning of each year of the policy. 4. Loss Payment Physical Damage Coverages At our option we may a. Pay for repair or replace damaged or stolen property b. Return the stolen property at our expense. We will pay for any damage that results to the auto from the theft or c. Take all or any part of the damaged or stolen property at an agreed or appraised value. If we pay for the loss our payment will include the applicable sales tax for the damaged or stolen property. 5. Transfer Of Rights Of Recovery Against Others To Us If any person or organization to or for whom we make payment under this Coverage Form has rights to recover damages from another those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after accident or loss to impair them. B. General Conditions 1. Bankruptcy Bankruptcy or insolvency of the insured or the insured s estate will not relieve us of any obligations under this Coverage Form. 2. Concealment Misrepresentation Or Fraud This Coverage Form is void in any case of fraud by you at any time as it relates to this Coverage Form. It is also void if you or any other insured at any time intentionally conceals or misrepresents a material fact concerning a. This Coverage Form b. The covered auto c. Your interest in the covered auto or d. A claim under this Coverage Form. 3. Liberalization If we revise this Coverage Form to provide more coverage without additional premium charge your policy will automatically provide the additional coverage as of the day the revision is effective in your state. 4. No Benefit To Bailee Physical Damage Coverages We will not recognize any assignment or grant any coverage for the benefit of any person or organization holding storing or transporting property for a fee regardless of any other provision of this Coverage Form. CA 00011013 Insurance Servic Insurance Services Office Inc. 2011 Insured Copy Page 9 of 12 | 2 |
7. Policy Period Coverage Territory Under this Coverage Form we cover accidents and losses occurring a. During the policy period shown in the Declarations and b. Within the coverage territory. The coverage territory is 1 The United States of America 2 The territories and possessions of the United States of America 3 Puerto Rico 4 Canada and 5 Anywhere in the world if a covered auto of the private passenger type is leased hired rented or borrowed without a driver for a period of 30 days or less provided that the insured s responsibility to pay damages is determined in a suit on the merits in the United States of America the territories and possessions of the United States of America Puerto Rico or Canada or in a settlement we agree to. We also cover loss to or accidents involving a covered auto while being transported between any of these places. 8. Two Or More Coverage Forms Or Policies Issued By Us If this Coverage Form and any other Coverage Form or policy issued to you by us or any company affiliated with us applies to the same accident the aggregate maximum Limit of Insurance under all the Coverage Forms or policies shall not exceed the highest applicable Limit of Insurance under any one Coverage Form or policy. This condition does not apply to any Coverage Form or policy issued by us or an affiliated company specifically to apply as excess insurance over this Coverage Form. SECTION V DEFINITIONS A Accident includes continuous or repeated exposure to the same conditions resulting in bodily injury or property damage.. Auto means 1. A land motor vehicle trailer or semitrailer designed for travel on public roads or 2. Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However auto does not include mobile equipment.. Bodily injury means bodily injury sickness or disease sustained by a person including death resulting from any of these.. Covered pollution cost or expense means any cost or expense arising out of 1. Any request demand order or statutory or regulatory requirement that any insured or others test for monitor clean up remove contain treat detoxify or neutralize or in any way respond to or assess the effects of pollutants or 2. Any claim or suit by or on behalf of a governmental authority for damages because of testing for monitoring cleaning up removing containing treating detoxifying or neutralizing or in any way responding to or assessing the effects of pollutants. Covered pollution cost or expense does not include any cost or expense arising out of the actual alleged or threatened discharge dispersal seepage migration release or escape of pollutants a. That are or that are contained in any property that is 1 Being transported or towed by handled or handled for movement into onto or from the covered auto 2 Otherwise in the course of transit by or on behalf of the insured or 3 Being stored disposed of treated or processed in or upon the covered auto b. Before the pollutants or any property in which the pollutants are contained are moved from the place where they are accepted by the insured for movement into or onto the covered auto or c. After the pollutants or any property in which the pollutants are contained are moved from the covered auto to the place where they are finally delivered disposed of or abandoned by the insured. Page 10 of 12 Insurance Services Office Inc. 2011 Insured Copy CA 00011013 | 2 |
Paragraph a. above does not apply to fuels lubricants fluids exhaust gases or other similar pollutants that are needed for or result from the normal electrical hydraulic or mechanical functioning of the covered auto or its parts if 1 The pollutants escape seep migrate or are discharged dispersed or released directly from an auto part designed by its manufacturer to hold store receive or dispose of such pollutants and 2 The bodily injury property damage or covered pollution cost or expense does not arise out of the operation of any equipment listed in Paragraph 6.b. or 6.c. of the definition of mobile equipment. Paragraphs b. and c. above do not apply to accidents that occur away from premises owned by or rented to an insured with respect to pollutants not in or upon a covered auto if a The pollutants or any property in which the pollutants are contained are upset overturned or damaged as a result of the maintenance or use of a covered auto and b The discharge dispersal seepage migration release or escape of the pollutants is caused directly by such upset overturn or damage.. Diminution in value means the actual or perceived loss in market value or resale value which results from a direct and accidental loss.. Employee includes a leased worker. Employee does not include a temporary worker.. Insured means any person or organization qualifying as an insured in the Who Is An Insured provision of the applicable coverage. Except with respect to the Limit of Insurance the coverage afforded applies separately to each insured who is seeking coverage or against whom a claim or suit is brought.. Insured contract means 1. A lease of premises 2. A sidetrack agreement 3. Any easement or license agreement except in connection with construction or demolition operations on or within 50 feet of a railroad 4. An obligation as required by ordinance to indemnify a municipality except in connection with work for a municipality 5. That part of any other contract or agreement pertaining to your business including an indemnification of a municipality in connection with work performed for a municipality under which you assume the tort liability of another to pay for bodily injury or property damage to a third party or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement or 6. That part of any contract or agreement entered into as part of your business pertaining to the rental or lease by you or any of your employees of any auto. However such contract or agreement shall not be considered an insured contract to the extent that it obligates you or any of your employees to pay for property damage to any auto rented or leased by you or any of your employees. An insured contract does not include that part of any contract or agreement a. That indemnifies a railroad for bodily injury or property damage arising out of construction or demolition operations within 50 feet of any railroad property and affecting any railroad bridge or trestle tracks roadbeds tunnel underpass or crossing b. That pertains to the loan lease or rental of an auto to you or any of your employees if the auto is loaned leased or rented with a driver or c. That holds a person or organization engaged in the business of transporting property by auto for hire harmless for your use of a covered auto over a route or territory that person or organization is authorized to serve by public authority. I. Leased worker means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm to perform duties related to the conduct of your business. Leased worker does not include a temporary worker.. Loss means direct and accidental loss or damage. K. Mobile equipment means any of the following types of land vehicles including any attached machinery or equipment 1. Bulldozers farm machinery forklifts and other vehicles designed for use principally off public roads 2. Vehicles maintained for use solely on or next to premises you own or rent 3. Vehicles that travel on crawler treads CA 00011013 Insurance Services Office Inc. 2011 Insured Copy Page 11 of 12 | 2 |
4. Vehicles whether self propelled or not maintained primarily to provide mobility to permanently mounted a. Power cranes shovels loaders diggers or drills or b. Road construction or resurfacing equipment such as graders scrapers or rollers 5. Vehicles not described in Paragraph 1. 2. 3. or 4. above that are not self propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types a. Air compressors pumps and generators including spraying welding building cleaning geophysical exploration lighting and well servicing equipment or b. Cherry pickers and similar devices used to raise or lower workers or 6. Vehicles not described in Paragraph 1. 2. 3. or 4. above maintained primarily for purposes other than the transportation of persons or cargo. However self propelled vehicles with the following types of permanently attached equipment are not mobile equipment but will be considered autos a. Equipment designed primarily for 1 Snow removal 2 Road maintenance but not construction or resurfacing or 3 Street cleaning b. Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers and c. Air compressors pumps and generators including spraying welding building cleaning geophysical exploration lighting or well servicing equipment. However mobile equipment does not include land vehicles that are subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. Land vehicles subject to a compulsory or financial responsibility law or other motor vehicle insurance law are considered autos.. Pollutants means any solid liquid gaseous or thermal irritant or contaminant including smoke vapor soot fumes acids alkalis chemicals and waste. Waste includes materials to be recycled reconditioned or reclaimed.. Property damage means damage to or loss of use of tangible property.. Suit means a civil proceeding in which 1. Damages because of bodily injury or property damage or 2. A covered pollution cost or expense to which this insurance applies are alleged. Suit includes a. An arbitration proceeding in which such damages or covered pollution costs or expenses are claimed and to which the insured must submit or does submit with our consent or b. Any other alternative dispute resolution proceeding in which such damages or covered pollution costs or expenses are claimed and to which the insured submits with our consent.. Temporary worker means a person who is furnished to you to substitute for a permanent employee on leave or to meet seasonal or short term workload conditions.. Trailer includes semitrailer. Page 12 of 12 Insurance Services Office Inc. 2011 Insured Copy CA 00011013 | 2 |
COMMERCIAL AUTO CA 011009 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MICHIGAN CHANGES For a covered auto licensed or principally garaged in or auto dealer operations conducted in Michigan this endorsement modifies insurance provided under the following AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement the provisions of the Coverage Form apply unless modified by the endorsement. A. Changes In Covered Autos Lial 1. lity Coverage For a covered auto subject to the Michigan no fault law Covered Autos Liability Coverage does not apply to property damage to a motor vehicle caused by an accident occurring in Michigan.. Paragraph 2.b.4 of the Who Is An Insured Provision in the Auto Dealers Coverage Form is replaced by the following 4 Your customers. However those customers are insureds up to the compulsory or financial responsibility law limits where the covered auto is principally garaged.. The Expected Or Intended Injury Exclusion is replaced by the following Expected Or Intended Injury Bodily injury or property damage expected or intended from the standpoint of the insured. However this exclusion does not apply for coverage up to the minimum limit specified by the Michigan Financial Responsibility Act.. The Racing Exclusion is replaced by the following Racing Covered autos while used in any professional or organized racing or demolition contest or stunting activity or while practicing for such contest or activity. This insurance also does not apply while that covered auto is being prepared for such a contest or activity. However this exclusion does not apply for coverage up to the minimum limit specified by the Michigan Financial Responsibility Act. B. Changes In Physical Damage Coverage Any Physical Damage Coverage and any Rental Reimbursement Coverage provided by the Policy do not apply to the extent that Property Protection Coverage benefits are available as required by Michigan law. C. Changes In Conditions 1. The Duties In The Event Of Accident Claim Suit Or Loss Condition in the Business Auto and Motor Carrier Coverage Forms and the Duties In The Event Of Accident Claim Offense Suit Loss Or Acts Errors Or Omissions Condition in the Auto Dealers Coverage Form are amended to a. Revise Paragraph a. to allow you or anyone on your behalf to provide the notice necessary to satisfy this condition. b. Add the following paragraph Failure to give any notice required by this Condition within the time period specified shall not invalidate any claim made by you if it shall be shown not to have been reasonably possible to give notice within the prescribed time period and that notice was given as soon as was reasonably possible. However this exclusion does not apply for coverage up to the minimum limit specified by the Michigan Financial Responsibility Act. B. Changes In Physical Damage Coverage Any Physical Damage Coverage and any Rental Reimbursement Coverage provided by the Policy do not apply to the extent that Property Protection Coverage benefits are available as required by Michigan law. C. Changes In Conditions 1. The Duties In The Event Of Accident Claim Suit Or Loss Condition in the Business Auto and Motor Carrier Coverage Forms and the Duties In The Event Of Accident Claim Offense Suit Loss Or Acts Errors Or Omissions Condition in the Auto Dealers Coverage Form are amended to a. Revise Paragraph a. to allow you or anyone on your behalf to provide the notice necessary to satisfy this condition. b. Add the following paragraph Failure to give any notice required by this Condition within the time period specified shall not invalidate any claim made by you if it shall be shown not to have been reasonably possible to give notice within the prescribed time period and that notice was given as soon as was reasonably possible. CA 011009 16 Insurance Services Office Inc. 2016 Insured Copy Page 1 of 2 | 2 |
2. The Concealment Misrepresentation Or Fraud Condition is replaced by the following Concealment Misrepresentation Or Fraud We do not provide coverage in any case of fraud by you at any time as it relates to this Coverage Form. We also do not provide coverage if you or any other insured at any time intentionally conceals or misrepresents a material fact concerning a. This Coverage Form b. The covered auto c. Your interest in the covered auto or d. A claim under this Coverage Form. Page 2 of 2 Insurance Services Office Inc. 2016 Insured Copy CA 011009 16 | 2 |
COMMERCIAL AUTO CA 021707 17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MICHIGAN CHANGES CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement the provisions of the Coverage Form apply unless modified by the endorsement. If you are an individual and the covered auto you own is of the private passenger type and the Policy covers fewer than five autos the Cancellation Common Policy Condition does not apply to that auto. The following condition applies instead Ending This Policy A. Cancellation 1. You may cancel the Policy by giving us notice of cancellation. 2. When this Policy is in effect less than 55 days and is not a renewal or continuation policy we may cancel for any reason by mailing or delivering to you within this period written notice of cancellation at least 20 days before the effective date of cancellation. If we cancel for nonpayment of premium we will mail or deliver notice to you at least 10 days before the effective date of cancellation. 3. When this Policy is in effect 55 days or more or is a renewal or continuation policy we may cancel only for one or more of the reasons listed below. If we cancel for nonpayment of premium we will mail you at least 10 days notice. If we cancel for any other reason we will mail you at least 30 days notice. a. Nonpayment of premium. b. The named insured or any other operator who either resides in the same household or customarily operates an auto has had his or her driver s license suspended during the policy period and the revocation or suspension has become final. c. If during the first 55 days after the original issue date of the Policy the risk is unacceptable to us. But if this Policy has been written for a period of more than a year or without a fixed expiration date we may cancel at an anniversary of its original effective date for any reason. If we cancel we will mail or deliver to you at least 30 days written notice.. Notice of cancellation will state the effective date of cancellation.. If this Policy is cancelled we will send you any pro rata premium refund due. The minimum earned premium shall not be less than the pro rata premium for the expired time or 25.00 whichever is greater. The cancellation will be effective even if we have not made or offered a refund. B. Nonrenewal 1. If we decide not to renew or continue this Policy we will mail or deliver to you written notice at least 30 days before the end of the policy period. If we offer to renew or continue and you do not accept this Policy will terminate at the end of the current policy period. Failure to pay the required renewal or continuation premium when due shall mean that you have not accepted our offer.. If we fail to mail or deliver proper notice of nonrenewal and you obtain other insurance this Policy will end on the effective date of that insurance. c. If during the first 55 days after the original issue date of the Policy the risk is unacceptable to us. But if this Policy has been written for a period of more than a year or without a fixed expiration date we may cancel at an anniversary of its original effective date for any reason. If we cancel we will mail or deliver to you at least 30 days written notice.. Notice of cancellation will state the effective date of cancellation.. If this Policy is cancelled we will send you any pro rata premium refund due. The minimum earned premium shall not be less than the pro rata premium for the expired time or 25.00 whichever is greater. The cancellation will be effective even if we have not made or offered a refund. B. Nonrenewal 1. If we decide not to renew or continue this Policy we will mail or deliver to you written notice at least 30 days before the end of the policy period. If we offer to renew or continue and you do not accept this Policy will terminate at the end of the current policy period. Failure to pay the required renewal or continuation premium when due shall mean that you have not accepted our offer.. If we fail to mail or deliver proper notice of nonrenewal and you obtain other insurance this Policy will end on the effective date of that insurance. CA 02170717 Insurance Services Office Inc. 2016 Insured Copy Page 1 of 2 | 2 |
C. Mailing Of Notices We will mail by certified mail our notice of cancellation to your last mailing address known to us except that if the Policy is in effect less than 55 days or is a renewal policy or is cancelled for nonpayment of premium we will mail you notice by regular mail. If notice is mailed proof of mailing will be sufficient proof of notice. For all other private passenger types the Cancellation Common Policy Condition does not apply to Covered Autos Liability Coverage on a covered auto of the private passenger type. The following condition applies instead Ending This Policy A. Cancellation 1. You may cancel the Policy by giving us notice of cancellation. 2. When this Policy is in effect less than 55 days and is not a renewal or continuation policy we may cancel for any reason by mailing or delivering to you within this period written notice of cancellation at least 20 days before the effective date of cancellation. If we cancel for nonpayment of premium we will mail or deliver notice to you at least 10 days before the effective date of cancellation. 3. When this Policy is in effect 55 days or more or is a renewal or continuation policy we may cancel only for one or more of the reasons listed below. If we cancel for nonpayment of premium we will mail you at least 10 days notice. If we cancel for any other reason we will mail you at least 20 days notice. a. Nonpayment of premium. b. The named insured or any other operator who either resides in the same household or customarily operates an auto has had his or her driver s license suspended during the policy period and the revocation or suspension has become final. c. If during the first 55 days after the original issue date of the Policy the risk is unacceptable to us. But if this Policy has been written for a period of more than a year or without a fixed expiration date we may cancel at an anniversary of its original effective date for any reason. If we cancel we will mail or deliver to you at least 20 days written notice. 4. Notice of cancellation will state the effective date of cancellation. 5. If this Policy is cancelled we will send the first Named Insured any pro rata premium refund due. The minimum earned premium shall not be less than the pro rata premium for the expired time or 25.00 whichever is greater. The cancellation will be effective even if we have not made or offered a refund. B. Nonrenewal 1. If we decide not to renew or continue this Policy we will mail or deliver to you written notice at least 20 days before the end of the policy period. If we offer to renew or continue and you do not accept this Policy will terminate at the end of the current policy period. Failure to pay the required renewal or continuation premium when due shall mean that you have not accepted our offer. 2. If we fail to mail or deliver proper notice of nonrenewal and you obtain other insurance this Policy will end on the effective date of that insurance. C. Mailing Of Notices We will mail by certified mail our notice of cancellation to your last mailing address known to us except that if the Policy is in effect less than 55 days or is a renewal policy or is cancelled for nonpayment of premium we will mail you notice by regular mail. If notice is mailed proof of mailing will be sufficient proof of notice. Page 2 of 2 Insurance Services Office Inc. 2016 Insured Copy CA 02170717 | 2 |
POLICY NUMBER CPP144139A POLICY NUMBER CPP144139A COMMERCIAL AUTO CA 21311013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MICHIGAN UNINSURED MOTORISTS COVERAGE For a covered auto licensed or principally garaged in or auto dealer operations conducted in Michigan this endorsement modifies insurance provided under the following AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured Endorsement Effective Date SCHEDULE Limit Of Insurance 1000000 Each Accident Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Coverage b. A tentative settlement has been made 1. We will pay all sums the insured is legally between an insured and the Insurer of a entitled to recover as compensatory damages vehcle desc fbe.d in Paragraph b Of the from the owner or driver of an uninsured motor definition of uninsured motor vehicle and vehicle. The damages must result from bodily we injury sustained by the insured caused by an 1 Have been given prompt written notice accident. The owner s or driver s liability for of such tentative settlement and these damages must result from the ownership maintenance or use of the amount equal to the tentative settlement uninsured motor vehicle. within 30 days after receipt of 2. With respect to damages resulting from an notification. accident with a vehicle described in 3. Any judgment for damages arising out of a Paragraph b of the definition of uninsured suit brought without our written consent is not motor vehicle we will pay under this coverage binding on us. only if Paragraph a. or b. below applies... B. Who Is An Insured a. The limit of any applicable liability bonds or.. policies has been exhausted by payment of If the Named Insured is designated in the judgments or settlements or Declarations as 1. An individual then the following are insureds a. The Named Insured and any family members. 2 Advance payment to the insured in an tive Nata bay all sums the insured is legally recover as compensatory damages owner or driver of an uninsured motor The damages must result from bodily stained by the insured caused by an. The owner s or driver s liability for amages must result from the b maintenance or use of the d motor vehicle. pect to damages resulting from an with a vehicle described in h b. of the definition of uninsured icle we will pay under this coverage ragraph a. or b. below applies CA 21311013 Insurance Services Office Inc. 2012 Insured Copy Page 1 of 4 | 2 |
b. Anyone else occupying a covered auto or a temporary substitute for a covered auto. The covered auto must be out of service because of its breakdown repair servicing loss or destruction. c. Anyone for damages he or she is entitled to recover because of bodily injury sustained by another insured. 2. A partnership limited liability company corporation or any other form of organization then the following are insureds a. Anyone occupying a covered auto or a temporary substitute for a covered auto. The covered auto must be out of service because of its breakdown repair servicing loss or destruction. b. Anyone for damages he or she is entitled to recover because of bodily injury sustained by another insured. C. Exclusions This insurance does not apply to any of the following 1. Any claim settled without our consent. However this exclusion does not apply to a settlement made with the insurer of a vehicle described in Paragraph b. of the definition of uninsured motor vehicle in accordance with the procedures described in Paragraph A.2.b. 2. The direct or indirect benefit of any insurer or self insurer under any workers compensation disability benefits or similar law. 3. Bodily injury sustained by a. An individual Named Insured while occupying or when struck by any vehicle owned by that Named Insured that is not a covered auto for Uninsured Motorists Coverage under this Coverage Form b. Any family member while occupying or when struck by any vehicle owned by that family member that is not a covered auto for Uninsured Motorists Coverage under this Coverage Form or c. Any family member while occupying or when struck by any vehicle owned by the Named Insured that is insured for Uninsured Motorists Coverage on a primary basis under any other Coverage Form or policy. 4. Anyone using a vehicle without a reasonable belief that the person is entitled to do so. 5. Punitive or exemplary damages. 6. Bodily injury arising directly or indirectly out of a. War including undeclared or civil war b. Warlike action by a military force including action in hindering or defending against an actual or expected attack by any government sovereign or other authority using military personnel or other agents or c. Insurrection rebellion revolution usurped power or action taken by governmental authority in hindering or defending against any of these. D. Limit Of Insurance 1. Regardless of the number of covered autos insureds premiums paid claims made or vehicles involved in the accident the most we will pay for all damages resulting from any one accident is the Limit Of Insurance for Uninsured Motorists Coverage shown in the Schedule or Declarations. 2. No one will be entitled to receive duplicate payments for the same elements of loss under this Coverage Form any Liability Coverage form or any Medical Payments Coverage endorsement attached to this Coverage Part. We will not make a duplicate payment under this coverage for any element of loss for which payment has been made by or for anyone who is legally responsible. We will not pay for any element of loss if a person is entitled to receive payment for the same element of loss under any workers compensation disability benefits or similar law. E. Changes In Conditions The Conditions are changed for Uninsured Motorists Coverage as follows 1. Other Insurance in the Auto Dealers and Business Auto Coverage Forms and Other Insurance Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form are replaced by the following If there is other applicable insurance available under one or more policies or provisions of coverage a. The maximum recovery under all Coverage Forms or policies combined may equal but not exceed the highest applicable limit for any one vehicle under any Coverage Form or policy providing coverage on either a primary or excess basis. Page 2 of 4 Insurance Services Office Inc. 2012 Insured Copy CA 21311013 | 2 |
b. Any insurance we provide with respect to a vehicle the Named Insured does not own shall be excess over any other collectible uninsured motorists insurance providing coverage on a primary basis.. If the coverage under this Coverage Form is provided 1 On a primary basis we will pay only our share of the loss that must be paid under insurance providing coverage on a primary basis. Our share is the proportion that our limit of liability bears to the total of all applicable limits of liability for coverage on a primary basis. 2 On an excess basis we will pay only our share of the loss that must be paid under insurance providing coverage on an excess basis. Our share is the proportion that our limit of liability bears to the total of all applicable limits of liability for coverage on an excess basis. 2. Duties In The Event Of Accident Claim Suit Or Loss in the Business Auto and Motor Carrier Coverage Forms and Duties In The Event Of Accident Claim Offense Suit Loss Or Acts Errors Or Omissions in the Auto Dealers Coverage Form are changed by adding the following a. b. Promptly notify the police if a hit and run driver is involved. Promptly send us copies of the legal papers if a suit is brought.. A person seeking coverage from an insurer owner or operator of a vehicle described in Paragraph b. of the definition of uninsured motor vehicle must also promptly notify us in writing of a tentative settlement between the insured and the insurer of the vehicle described in Paragraph b. of the definition of uninsured motor vehicle and allow us to advance payment to that insured in an amount equal to the tentative settlement within 30 days after receipt of notification to preserve our rights against the insurer owner or operator of such vehicle described in Paragraph b. of the definiton of uninsured motor vehicle. 3. The Legal Action Against Us Provision is replaced by the following Legal Action Against Us a. No one may bring a legal action against us under this Coverage Form until there has been full compliance with all the terms of this Coverage Form. b. Any legal action against us under this Coverage Form must be brought within three years after the date of the accident. However this Paragraph 3.b. does not apply to an insured if within three years after the date of the accident 1 We and the insured agree to arbitration in accordance with this endorsement or 2 The insured has filed an action for bodily injury against the owner or operator of a vehicle described in Paragraph b. of the definiton of uninsured motor vehicle and such action is a Filed in a court of competent jurisdiction and b Not barred by the applicable statute of limitations. In the event that the three year time limitation identified in this condition does not apply the applicable state statute of limitations will govern legal action against us under this Coverage Form.. Transfer Of Rights Of Recovery Against Others To Us is changed by adding the following If we make any payment and the insured recovers from another party the insured shall hold the proceeds in trust for us and pay us back the amount we have paid. Our rights do not apply under this provision with respect to damages caused by an accident with a vehicle described in Paragraph b. of the definition of uninsured motor vehicle if we a. Have been given prompt written notice of a tentative settlement between an insured and the insurer of a vehicle described in Paragraph b. of the definition of uninsured motor vehicle and b. Fail to advance payment to the insured in an amount equal to the tentative settlement within 30 days after receipt of notification. If we advance payment to the insured in an amount equal to the tentative settlement within 30 days after receipt of notification a. That payment will be separate from any amount the insured is entitled to recover under the provisions of Uninsured Motorists Coverage and b. We also have a right to recover the advance payment. CA 21311013 Insurance Services Office Inc. 2012 Insured Copy Page 3 of 4 | 2 |
5. The following condition is added Arbitration a. If we and an insured disagree whether the insured is legally entitted to recover damages from the owner or driver of an uninsured motor vehicle or do not agree as to the amount of damages that are recoverable by that insured then the matter may be arbitrated. However disputes concerning coverage under this endorsement may not be arbitrated. Both parties must agree to arbitration. If so agreed each party will select an arbitrator. The two arbitrators will select a third. If they can not agree within 30 days either may request that selection be made by a judge of a court having jurisdiction. Each party will pay the expenses it incurs and bear the expenses of the third arbitrator equally. b. Unless both parties agree otherwise arbitration will take place in the county in which the insured lives. Local rules of law as to arbitration procedure and evidence will apply. A decision agreed to by two of the arbitrators will be binding. F. Additional Definitions As used in this endorsement 1. Family member means a person related to an individual Named Insured by blood marriage or adoption who is a resident of such Named Insured s household including a ward or foster child. 2. Occupying means in upon getting in on out or off. 3. Uninsured motor vehicle means a land motor vehicle or trailer a. For which no liability bond or policy at the time of an accident provides at least the amounts required by the applicable law where a covered auto is principally garaged b. That is an underinsured motor vehicle. An underinsured motor vehicle is a land motor vehicle or trailer for which the sum of all liability bonds or policies at the time of an accident provides at least the amounts required by the applicable law where a covered auto is principally garaged but that sum is less than the Limit of Insurance of this coverage c. For which an insuring or bonding company denies coverage or is or becomes insolvent or d. Thatis a hit and run vehicle and neither the driver nor owner can be identified. The vehicle must hit or cause an object to hit an insured a covered auto or a vehicle an insured is occupying. If there is no direct physical contact with the hit and run vehicle the facts of the accident must be corroborated by competent evidence other than the testimony of any person having a claim under this or any similar insurance as the result of such accident. However uninsured motor vehicle does not include any vehicle a. Owned or operated by a self insurer under any applicable motor vehicle law except a self insurer who is or becomes insolvent and can not provide the amounts required by that motor vehicle law b. Owned by a governmental unit or agency or c. Designed for use mainly off public roads while not on public roads. Page 4 of 4 Insurance Services Office Inc. 2012 Insured Copy CA 21311013 | 2 |
POLICY NUMBER CPP144139A POLICY NUMBER CPP144139A COMMERCIAL AUTO CA 222007 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MICHIGAN PERSONAL INJURY PROTECTION For a covered auto licensed or principally garaged in or auto dealer operations conducted in Michigan this endorsement modifies insurance provided under the following AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the Policy effective on the inception date of the Policy unless another date is indicated below. Named Insured QUALITY ROASTING LLC Endorsement Effective Date 09242020 SCHEDULE Coverage Limit Of Insurance Medical Expenses Unlimited Per Person Funeral Expenses Up To 1750 Per Person Work Loss Up To 5718 For Any 30 day Period Replacement Services 20 Per Day Maximum Survivors Loss Benefits Consisting Of Income Loss Up To 5718 For Any 30 day Period Subject To A Benefits And Replacement Services 20 Per Day Maximum For Replacement Services Or whatever maximum amount is established by the Michigan Insurance Commissioner for accidents occurring on or after the date of the change in maximum. CA 222007 20 Insurance Services Office Inc. 2020 Insured Copy Page 10of 7 | 2 |
The following option applies as indicated in the Declarations or by an X in the box below Excess Attendant Care Excess Attendant Care Coverage Limit Per Person Per Accident If you are an individual the following options apply as indicated in the Declarations or by an X in the box below Rejection Of Medical Expenses Medical Expenses Coverage Does Not Apply To You Or Any Family Member Qualified Health Coverage Applicable To The 250000 Limit For Medical Expenses Qualified Health Coverage Applies To Individuals If listed below or in the Declarations coverage for medical expenses is excluded for the following persons Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Coverage 4. Replacement Services We will pay Personal Injury Protection benefits to or for an insured who sustains bodily injury caused by an accident and resulting from the ownership maintenance or use of an auto as an auto. These benefits are subject to the provisions of Chapter 31 of the Michigan Insurance Code. Personal Injury Protection benefits consist of the following benefits 1. Medical Expenses Reasonable and necessary medical expenses for an insured s care recovery or rehabilitation. Charges for a hospital room are limited to those customary for a semiprivate room unless special or intensive care is required. This includes attendant care. 2. Funeral Expenses Reasonable funeral and burial expenses. 3. Work Loss Up to 85 of an insured s actual loss of income from work. We will pay a higher percentage if the insured gives us reasonable proof that net income is more than 85 of gross income. The most we will pay in any 30 day period for this benefit is the amount shown in the Schedule or Declarations unless another amount is established by law. Any income an insured earns during the 30 day period is included in determining the income benefit we will pay. This benefit is payable for loss sustained during the three years after the accident. It does not apply after an insured dies. We will prorate this benefit for any period less than 30 days. Reasonable expenses for obtaining services to replace those an insured would normally have performed without pay for himself or herself or dependents. This benefit is payable for loss sustained during the three years after the accident. It does not apply after an insured dies. 5. Survivors loss benefits consisting of a. Income Loss The contributions a deceased insured s spouse and dependents would have received as dependents if the insured had not died as a result of the accident. b. Replacement Services Reasonable expenses for obtaining services to replace those a deceased insured would have performed without pay for his or her spouse and dependents. The most we will pay in any 30 day period for the total of survivors loss benefits is the amount shown in the Schedule unless another amount is established by law. Any income an insured earns during the 30 day period is included in determining the income benefits we will pay. These benefits are payable during the three years after the accident but do not apply to any loss or expense incurred after an insured dies. We will prorate these benefits for any period of less than 30 days. ily Member 1ses Page 2 of 7 Insurance Services Office Inc. 2020 Insured Copy CA 222007 20 | 2 |
Survivors loss benefits are payable during the three years after the accident. A deceased insured s spouse must have either resided with or been dependent on the insured at the time of death. The benefits cease for a spouse at remarriage or death. Any other dependent qualifies for benefits if at the time of the insured s death the person is under age 18 physically or mentally unable to earn a living or a full time student. B. Who Is An Insured 1. You or any family member. 2. Anyone else who sustains bodily injury who is a resident of Michigan and is entitled to Michigan no fault benefits as a Named Insured Named Insured s spouse or family member under another policy a. While occupying a covered auto or b. While occupying any other auto operated by you or a family member if that auto is a covered auto under the Policy s Covered Autos Liability Coverage. 3. Anyone else who sustains bodily injury while occupying a motorcycle if the accident involves an auto. C. Exclusions 1. We will not pay Personal Injury Protection benefits for bodily injury a. To anyone causing intentional bodily injury to himself herself or anyone else. b. To anyone willingly operating or willingly using an auto he or she has taken unlawfully and that person knew or should have known that the auto was taken unlawfully. c. To anyone not occupying an auto if the accident takes place outside Michigan. This exclusion does not apply to you or any family member. d. To you while occupying or struck by any auto owned or registered by you which is not a covered auto. e. To the owner or registrant of an auto for which the coverage required by the Michigan no fault law is not in effect. f. To a Named Insured s spouse or any family member entitled to Michigan no fault benefits as a Named Insured under another policy providing similar coverage except while occupying a motorcycle. g. To anyone while occupying or struck by an auto other than a covered auto operated by you or a family member if the owner or registrant has the required Michigan no fault coverage. This exclusion does not apply to you or any family member. h. To anyone while occupying an auto located for use as a residence or premises. i. To anyone while occupying a public auto other than a covered auto for which the required Michigan no fault coverage is in effect. This exclusion does not apply to bodily injury to you or a family member while a passenger in a 1 School bus 2 Certified common carrier 3 Bus operated under a government sponsored transportation program 4 Bus operated by or servicing a nonprofit organization 5 Bus operated by a watercraft bicycle or horse livery used only to transport passengers to or from a destination point 6 Taxicab 7 Transportation network company vehicle or 8 Motor vehicle insured under a policy for which the individual Named Insured has elected not to maintain personal injury protection coverage or to which an exclusion related to qualified health coverage applies under such policy. To you or any family member while occupying an auto which is owned or registered by your or any family member s employer and for which the required Michigan no fault coverage is in effect. To anyone while occupying an auto for which the owner or registrant is not required to provide Michigan no fault benefits and which is operated by you or a family member outside Michigan. This exclusion does not apply to you or a family member nor does it apply under medical or funeral expense benefits. CA 222007 20 Insurance Services Office Inc. 2020 Insured Copy Page 3 of 7 | 2 |
B To any person resulting from the ownership operation maintenance or use of a parked auto. This exclusion does not apply if 1 The auto was parked in such a way as to cause unreasonable risk of the bodily injury or 2 The bodily injury results from physical contact with a Equipment permanently mounted on the auto while the equipment is being used or b Property being lifted onto or lowered from the auto or 3 The bodily injury is sustained while occupying the auto. However Exceptions 2 and 3 to this exclusion do not apply to any employee who has Michigan workers disability compensation benefits available and who sustains bodily injury in the course of employment while loading unloading or doing mechanical work on an auto unless the injury arises from the use or operation of another vehicle. To you or any family member while occupying a motorcycle if the owner registrant or operator of the auto involved in the accident has the required Michigan no fault coverage. Avrising directly or indirectly out of 1 War including undeclared or civil war 2 Warlike action by a military force including action in hindering or defending against an actual or expected attack by any government sovereign or other authority using military personnel or other agents or Insurrection rebellion revolution usurped power or action taken by governmental authority in hindering or defending against any of these. 3. Sustained by anyone who is not a resident of Michigan unless at the time of the accident such person is the owner of a motor vehicle which is registered in Michigan and to which the security required under the Michigan Insurance Code is in effect. 2. We do not provide Personal Injury Protection Coverage for medical expenses for an individual Named Insured if a. Rejection Of Medical Expenses is indicated in the Schedule or in the Declarations and b. That individual Named Insured has signed a form rejecting coverage for medical expenses. 3. We do not provide Personal Injury Protection Coverage for medical expenses for an individual Named Insured if a. Such Named Insured is covered under qualified health coverage as defined in Paragraph F.4.a. of the Definitions section b. Qualified health coverage is indicated in the Schedule or in the Declarations and c. The Schedule or the Declarations indicates that coverage for medical expenses is excluded for such individual Named Insured. 4. We do not provide Personal Injury Protection Coverage for medical expenses for an individual Named Insured s spouse or any family member if a. Such person is covered under qualified health coverage as defined in Paragraph F.4.a. or F.4.b. of the Definitions section b. Qualified health coverage is indicated in the Schedule or in the Declarations and c. The Schedule or the Declarations indicates that coverage for medical expenses is excluded for such person. D. Limit Of Insurance 1. Regardless of the number of covered autos insureds premiums paid claims made vehicles involved in the accident or insurers providing no fault benefits the most we will pay for bodily injury for each insured injured in any one accident are the amounts shown in the Schedule.. Any amount payable under this insurance shall be reduced by any benefits paid payable or required to be provided by state or federal law except any benefits paid payable or required to be provided by Medicare provided a. The benefits serve the same purpose as personal injury protection benefits and Page 4 of 7 Insurance Services Office Inc. 2020 Insured Copy CA 222007 20 | 2 |
b. The benefits are provided or required to be provided as the result of the same accident for which this insurance is payable. However this insurance shall not be reduced if any amount of workers compensation benefits that are required to be provided are not available to the insured. 3. Any amount payable under this insurance shall be reduced by any deductible you elect. However the deductible applies only to you and any family member. The following provision is added Excess Attendant Care If Excess Attendant Care is indicated in the Schedule or in the Declarations we will pay up to the limit shown in the Schedule or in the Declarations. The Excess Attendant Care Coverage limit shown in the Schedule or in the Declarations is in additon to the Limit Of Insurance shown in the Schedule or in the Declarations for medical expenses. E. Changes In Conditions 1. Transfer Of Rights Of Recovery Against Others To Us is replaced by the following Transfer Of Rights Of Recovery Against Others To Us If any person or organization to or for whom we make payment under this Coverage Form has rights to recover damages from another and that other person is an uninsured motorist those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after accident or loss to impair them. 2. Duties In The Event Of Accident Claim Suit Or Loss in the Business Auto and Motor Carrier Coverage Forms and Duties In The Event Of Accident Claim Offense Suit Loss Or Acts Errors Or Omissions in the Auto Dealers Coverage Form are amended by the addition of the following If requested by us the insured shall furnish a sworn statement of earnings since the accident and for a reasonable time prior to the accident. 3. Legal Action Against Us is amended by the addition of the following No claimant may bring a legal action for Personal Injury Protection benefits against us more than a year after the accident. There are two exceptions. The action may be brought if we have been given notice within a year after the accident or have made a payment of benefits. In these cases a claimant may bring the action within a year after the most recent allowable expense work loss or survivor s loss has been incurred. The commencement of an action and the recovery of benefits is tolled from the date of a specific claim for payment of personal injury protection benefits until the date we formally deny the claim. Such tolling does not apply if the person claiming the benefits fails to pursue the claim with reasonable diligence. However the claimant may not recover benefits for any part of a loss incurred more than a year before the action was brought. 4. Other Insurance in the Auto Dealers and Business Auto Coverage Forms and Other Insurance Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form are amended by adding the following a. If Medical Expenses are payable under two or more policies benefits are only payable up to an aggregate coverage limit that equals the highest available coverage limit under any one of the policies. b. If an insured is a Named Insured under this Policy and that insured is insured as a spouse or as a family member under another policy providing similar coverage Medical Expenses benefits for such named insured are only payable up to the Limit Of Insurance shown in the Schedule or in the Declarations for each person under this Policy. CA 222007 20 Insurance Services Office Inc. 2020 Insured Copy Page 5 of 7 | 2 |
5. The following conditions are added Reimbursement And Trust If we make any payment and the insured recovers from another party the insured shall hold the proceeds in trust for us and pay us back the amount we have paid. This requirement is subject to any applicable limitations of Michigan law. Coordination And Nonduplication a. If an insured is entitled to Personal Injury Protection benefits under more than one policy the maximum recovery under all policies shall not exceed the amount payable under the Policy providing the highest dollar limit. b. No person may recover duplicate benefits for the same expenses or loss. c. An insured who sustains bodily injury resulting from an accident which shows evidence of the involvement of an auto while an operator or passenger of a motorcycle shall claim insurance benefits in the following order of priority 1 The insurer of the owner or registrant of the auto involved in the accident. 2 The insurer of the operator of the auto involved in the accident. 3 The auto insurer of the operator of the motorcycle involved in the accident. 4 The auto insurer of the owner or registrant of the motorcycle involved in the accident. If personal injury protection benefits are payable under two or more policies in the same order of priority the benefits are only payable up to an aggregate coverage limit that equals the highest available coverage limit under any one of the policies. Premium Recomputation Chapter 31 of the Michigan Insurance Code places certain limitations on a person s right to sue for damages. The premium for the Policy reflects these limitations. If a court from which there is no appeal declares any of these limitations unenforceable we will have the right to recompute the premium. The rates we use to recompute the premium will be subject to review by the Commissioner of Insurance. If you choose to delete any coverage as the result of the court s decision we will compute any refund of premium on a pro rata basis. Qualified Health Coverage Ineligibility The individual Named Insured shall notify us when qualified health coverage has been terminated for you or any family member if the Schedule or the Declarations indicates that coverage for medical expenses is excluded for you or any family member. In such case the individual Named Insured shall obtain coverage for personal injury protection benefits within 30 days after the effective date of the termination of qualified health coverage. If it is determined that a. The individual Named Insured who is listed as excluded from coverage for medical expenses in the Schedule or in the Declarations did not have qualified health coverage as defined in Paragraph F.4.a. of the Definitions section or b. The individual Named Insured s spouse or any family member who is listed as excluded from coverage for medical expenses in the Schedule or in the Declarations did not have qualified health coverage as defined in Paragraph F.4.a. or F.4.b. of the Definitions section in effect at the time an accident occurred which resulted in bodily injury to that individual Named Insured individual Named Insured s spouse or family member after the 30 day period in which the qualified health coverage has elapsed and the individual Named Insured did not obtain personal injury protection coverage within such period such injured person is not entitted to medical expenses benefits under this Policy. F. Additional Definitions As used in this endorsement 1. Auto means a motor vehicle or trailer operated or designed for use on public roads but does not include a vehicle operated by muscular power a vehicle with fewer than three wheels a motorcycle or a farm tractor or other implement of husbandry which is not subject to the registration requirements of the Michigan Vehicle Code. This definition replaces the definition in the Policy. 2. Family member means a person related to you by blood marriage or adoption who is a resident of your household including a ward or foster child. 3. Occupying means in upon getting in on out or off. Page 6 of 7 Insurance Services Office Inc. 2020 Insured Copy CA 222007 20 | 2 |
4. Qualified health coverage means either of the following a. Other health or accident coverage in which 1 Such coverage does not exclude or limit coverage for bodily injury sustained in an auto accident and 2 The annual deductible for such coverage is 6000 or less per individual or the amount as annually adjusted by the Director of the Department of Insurance and Financial Services or b. Coverage provided under Parts A and B of Medicare. CA 222007 20 Insurance Services Office Inc. 2020 Insured Copy Page 7 of 7 | 2 |
COMMERCIAL AUTO CA 22241013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MICHIGAN PROPERTY PROTECTION COVERAGE For a covered auto licensed or principally garaged in or auto dealer operations conducted in Michigan this endorsement modifies insurance provided under the following AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement the provisions of the Coverage Form apply unless modified by the endorsement. A. Coverage 6. Property damage to any property while a We will pay for property damage caused by an accident and resulting from the ownership covered auto is located for use as a residence or premises. maintenance or use of a covered auto as an 7. Property damage to property as a result of an auto. A covered auto under this coverage accident involving an auto not owned by includes an auto operated by but not owned by you or any family member. This exclusion you or any family member to which the Covered applies only to the extent that the security Autos Liability Coverage of the policy applies. This required by the Michigan no fault law has been coverage is subject to Chapter 31 of the Michigan provided by or for the owner. Insurance Code and applies only to an accident 8. Property damage to any property you accept which happens in Michigan. for transportation as a motor carrier as that. Exclusions term is defined in Chapter 475 of the Michigan o. Compiled Laws. However this exclusion This insurance does not apply to applies only to the extent that the property is 1. Property damage to property owned by you covered or would be covered except for a or any family member if you or any family deductible by a certificate of insurance or member was the owner operator or registrant other security you have on file with any of an auto involved in the accident which regulatory authority. caused the property damage.. 9. Property damage to property that occurs 2. Property damage to any covered auto or its within the course of the business of repairing contents. servicing or otherwise maintaining motor 3. Property damage to any auto which is not a vehicles. covered auto or to its contents. However this 10. Property damage arising directly or indirectly exclusion does not apply to the auto or its contents if the auto was parked in such a way as not to cause unreasonable risk of the property damage. 4. Property damage to the property of anyone while using a covered auto without your out of a. War including undeclared or civil war b. Warlike action by a military force including action in hindering or defending against an actual or expected attack by any consent unless that person reasonably government sovereign or other authority believed he or she was entitled to use the using military personnel or other agents or auto. c. Insurrection rebellion revolution usurped 5. Property damage caused intentionally by any claimant. power or action taken by governmental authority in hindering or defending against any of these. 10.. Property damage to any property while a covered auto is located for use as a residence or premises. Property damage to property as a result of an accident involving an auto not owned by you or any family member. This exclusion applies only to the extent that the security required by the Michigan no fault law has been provided by or for the owner.. Property damage to any property you accept for transportation as a motor carrier as that term is defined in Chapter 475 of the Michigan Compiled Laws. However this exclusion applies only to the extent that the property is covered or would be covered except for a deductible by a certificate of insurance or other security you have on file with any regulatory authority.. Property damage to property that occurs within the course of the business of repairing servicing or otherwise maintaining motor vehicles. Property damage arising directly or indirectly out of a. War including undeclared or civil war b. Warlike action by a military force including action in hindering or defending against an actual or expected attack by any government sovereign or other authority using military personnel or other agents or c. Insurrection rebellion revolution usurped power or action taken by governmental authority in hindering or defending against any of these. CA 22241013 Insurance Services Office Inc. 2012 Insured Copy Page 1 of 2 | 2 |
C. Limit Of Insurance 1. Regardless of the number of covered autos premiums paid claims made vehicles involved in the accident or insurers providing property protection insurance the most we will pay for all property damage resulting from any one accident is 1000000. However the amount we pay will be limited to the lesser of reasonable repair costs or replacement costs minus depreciation and the value of any loss of use. 2. Any amount we would otherwise pay for property damage will be reduced by any deductible shown in the Declarations prior to the application of our Limit of Insurance. To settle any claim we will pay all or any part of the deductible shown. If this happens you must reimburse us for the deductible or the part of the deductible we have paid. D. Changes In Conditions The Conditions are changed for Property Protection Coverage as follows 1. Transfer Of Rights Of Recovery Against Others To Us does not apply. 2. Legal Action Against Us is amended by the addition of the following No action to recover property protection insurance may be brought against us more than a year after the accident. 3. The following conditions are added Reimbursement And Trust If we make any payment to a claimant who recovers from a party legally responsible for property damage the claimant shall hold the proceeds in trust for us and pay us back the amount we have paid. This requirement is subject to any applicable limitations of Michigan law. Nonduplication We will not pay duplicate benefits for the same expenses or loss. Claimants Notice To Us A claimant must promptly notify us of an accident and must tell us how when and where the accident happened. E. Additional Definitions As used in this endorsement 1. Auto means a motor vehicle or trailer operated or designed for use on public roads but does not include a vehicle operated by muscular power a vehicle with fewer than three wheels a motorcycle or a farm tractor or other implement of husbandry which is not subject to the registration requirements of the Michigan Vehicle Code. 2. Family member means a person related to you by blood marriage or adoption who is a resident of your household including a ward or foster child. 3. Occupying means in upon getting in on out or off. 4. Property damage means damage to tangible property including the loss of use of such tangible property. Page 2 of 2 Insurance Services Office Inc. 2012 Insured Copy CA 22241013 | 2 |
COMMERCIAL AUTO CA 23841013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF TERRORISM This endorsement modifies insurance provided under the following AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SINGLE INTEREST AUTOMOBILE PHYSICAL DAMAGE INSURANCE POLICY With respect to coverage provided by this endorsement the provisions of the Coverage Form apply unless modified by the endorsement. A. The following definitions are added and apply under this endorsement wherever the term terrorism or the phrase any injury damage loss or expense is enclosed in quotation marks 1. Terrorism means activities against persons organizations or property of any nature a. That involve the following or preparation for the following 1 Use or threat of force or violence or 2 Commission or threat of a dangerous act or 3 Commission or threat of an act that interferes with or disrupts an electronic communication information or mechanical system and b. When one or both of the following apply 1 The effect is to intimidate or coerce a government or the civilian population or any segment thereof or to disrupt any segment of the economy or It appears that the intent is to intimidate or coerce a government or to further political ideological religious social or economic objectives or to express or express opposition to a philosophy or ideology. 2 2. Any injury damage loss or expense means any injury damage loss or expense covered under any Coverage Form or Policy to which this endorsement is applicable and includes but is not limited to bodily injury property damage personal and advertising injury loss loss of use rental reimbursement after loss or covered pollution cost or expense as may be defined under this Coverage Form Policy or any applicable endorsement. B. Except with respect to Physical Coverage Trailer Interchange Garagekeepers Coverage Garagekeepers Coverage Customers Sound Receiving Equipment or the Single Interest Automobile Physical Damage Insurance Policy the following exclusion is added Exclusion Of Terrorism Damage Coverage We will not pay for any injury damage loss or expense caused directly or indirectly by terrorism including action in hindering or defending against an actual or expected incident of terrorism. Any injury damage loss or expense is excluded regardless of any other cause or event that contributes concurrently or in any sequence to such injury damage loss or expense. But this exclusion applies only when one or more of the following are attributed to an incident of terrorism 1. The terrorism is carried out by means of the dispersal or application of radioactive material or through the use of a nuclear weapon or device that involves or produces a nuclear reaction nuclear radiation or radioactive contamination or CA 23841013 Insurance Services Office Inc. 2013 Insured Copy Page 10of 3 | 2 |
C. With respect to Physical Damage Coverage Trailer Interchange Coverage Garagekeepers Coverage Garagekeepers Coverage Customers Sound Receiving Equipment or the Single Interest Automobile Physical Damage Insurance Policy the following exclusion is added Exclusion Of Terrorism We will not pay for any loss loss of use or rental reimbursement after loss caused directly or indirectly by terrorism including action in hindering or defending against an actual or expected incident of terrorism. But this exclusion applies only when one or more of the following are attributed to an incident of terrorism 1. The terrorism is carried out by means of the dispersal or application of radioactive material or through the use of a nuclear weapon or device that involves or produces a nuclear reaction nuclear radiation or radioactive contamination or 2. Radioactive material is released and it appears that one purpose of the terrorism was to release such material or 3. The terrorism is carried out by means of the dispersal or application of pathogenic or poisonous biological or chemical materials or 4. Pathogenic or poisonous biological or chemical materials are released and it appears that one purpose of the terrorism was to release such materials or 5. The total of insured damage to all types of property exceeds 25000000. In determining whether the 25000000 threshold is exceeded we will include all insured damage sustained by property of all persons and entities affected by the terrorism and business interruption losses sustained by owners or occupants of the damaged property. For the purpose of this provision insured damage means damage that is covered by any insurance plus damage that would be covered by any insurance but for the application of any terrorism exclusions. Multiple incidents of terrorism which occur within a 72 hour period and appear to be carried out in concert or to have a related purpose or common leadership will be deemed to be one incident for the purpose of determining whether the threshold in Paragraph C.5. is exceeded. 2. Radioactive material is released and it appears that one purpose of the terrorism was to release such material or 3. The terrorism is carried out by means of the dispersal or application of pathogenic or poisonous biological or chemical materials or 4. Pathogenic or poisonous biological or chemical materials are released and it appears that one purpose of the terrorism was to release such materials or 5. The total of insured damage to all types of property exceeds 25000000. In determining whether the 25000000 threshold is exceeded we will include all insured damage sustained by property of all persons and entities affected by the terrorism and business interruption losses sustained by owners or occupants of the damaged property. For the purpose of this provision insured damage means damage that is covered by any insurance plus damage that would be covered by any insurance but for the application of any terrorism exclusions or 6. Fifty or more persons sustain death or serious physical injury. For the purposes of this provision serious physical injury means a. Physical injury that involves a substantial risk of death or b. Protracted and obvious physical disfigurement or c. Protracted loss of or impairment of the function of a bodily member or organ. Multiple incidents of terrorism which occur within a 72 hour period and appear to be carried out in concert or to have a related purpose or common leadership will be deemed to be one incident for the purpose of determining whether the thresholds in Paragraphs B.5. and B.6. are exceeded. With respect to this exclusion Paragraphs B.5. and B.6. describe the thresholds used to measure the magnitude of an incident of terrorism and the circumstances in which the threshold will apply for the purpose of determining whether this exclusion will apply to that incident. When the exclusion applies to an incident of terrorism there is no coverage under this Coverage Form Policy or any applicable endorsement. Page 2 of 3 Insurance Services Office Inc. 2013 Insured Copy CA 23841013 | 2 |
With respect to this exclusion Paragraph C.5. describes the threshold used to measure the magnitude of an incident of terrorism and the circumstances in which the threshold will apply for the purpose of determining whether this exclusion will apply to that incident. When the exclusion applies to an incident of terrorism there is no coverage under this Coverage Form Policy or any applicable endorsement. D. In the event of any incident of terrorism that is not subject to the exclusion in Paragraph B. or C. coverage does not apply to any injury damage loss or expense that is otherwise excluded under this Coverage Form Policy or any applicable endorsement. CA 23841013 Insurance Services Office Inc. 2013 Insured Copy Page 3 of 3 | 2 |
COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OCCURRENCE DEDUCTIBLE ENDORSEMENT This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM SCHEDULE Commercial General Liability Policy Business Auto Policy Commercial Output Program Property Policy The following is added to the Deductible provisions Deductible Applying To Loss Under More Than One Coverage If an occurrence gives rise to a loss under more than one coverage in any policy issued by us and shown in the Schedule of this endorsement only one deductible shall apply to all damages arising from such an occurrence. In determining which deductible applies we will use the largest of the deductibles applying to the loss for any coverage provided by the applicable policies issued by us and shown in the Schedule of this endorsement. Our Right To Reimbursement To settle any claim or suit we will pay all or any part of any deductible. You must reimburse us for the deductible or the part of the deductible we paid. ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. Copyright 2013 Nationwide Agribusiness Insurance Company. All rights reserved CCAB169 1013 Page 1 of 1 Insured Copy | 2 |
COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NEW VEHICLE REPLACEMENT COST This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement the provisions of the Coverage Form apply unless modi fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured QUALITY ROASTING LLC Endorsement Effective Date 09242020 The following is added to paragraph C. Limit Of Insurance of SECTION Il PHYSICAL DAMAGE COVERAGE 1. The provisions of subparagraphs 1. and 3. of paragraph C. Limit Of Insurance do not apply to a covered auto of the private passenger type or a vehicle with a gross vehicle weight of 20000 pounds or less which is a new vehicle. In the event of a total loss to your new vehicle to which this coverage applies we will pay at your option a. The verifiable new vehicle purchase price you paid for your damaged vehicle not including any insurance or warranties purchased b. Ifitis available the purchase price as negotiated by us of a new vehicle of the same make model and equipment or the most similar model available not including any furnishings parts or equipment not installed by the manufacturer or manufacturer s dealership or c. The market value of your damaged vehicle not including any furnishings parts or equipment not installed by the manufacturer or manufacturer s dealership. We will not pay for initiation or set up costs associated with loans or leases. In this endorsement a new vehicle means an auto of which you are the original owner that has not been previously titled and which you purchased less than 365 days before the date of the loss. ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. CCAB241 0213 Page 1 of 1 Includes copyrighted material of Insurance Services Office Inc. with its permission Insured Copy | 2 |
COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLLUTION MODIFICATION ENDORSEMENT This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM A. POLLUTION CLARIFICATION The following is added to 11. Pollution of Paragraph B. Exclusions under SECTION Il COVERED AUTOS LIABILITY or to any amendment to or replacement thereof This exclusion applies even if the pollutants have a function in your business operations premises site or location. B. The definition of Pollutants under SECTION V DEFINITIONS is deleted and replaced by L. Pollutants mean a. Any organic or inorganic substance or material that is a solid liquid gaseous or thermal irritant or contaminant including but not limited to smoke vapor soot dust fumes acids alkalis chemicals fibers particles sludge by products biofuels herbicides pesticides insecticides fertilizers and all other similar chemicals and waste. b. Waste includes but is not limited to 1 materials that have been or are to be recycled reconditioned or reclaimed or 2 the excrement of livestock poultry or other animals. c. Pollutants also include gasoline diesel fuel all other petroleum products and their derivatives. ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. Includes copyrighted material of Insurance Services Office Inc. with its permission CCAB251 1013 Page 1 of 1 CCAB251 1013 Page 1 of 1 Insured Copy | 2 |
COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF BODILY INJURY DEFINITION This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM The definition of bodily injury under SECTION V DEFINITIONS is deleted and replaced by C. Bodily injury means bodily injury sickness or disease sustained by a person including death resulting from any of these at any time. Bodily injury includes mental anguish or other mental injury resulting from bodily injury. ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. Includes copyrighted material of Insurance Services Office Inc. with ts permission. CCAB283 0317 Page 1 of 1 Insured Copy | 2 |
Date 10082019 Policy Number 686 24 15 DANIEL CONDON 0075 0075 Underwriter Name Underwriter Region Underwriter Branch Underwriter Telephone Operator Name Operator Telephone Issuing Division Policy Effective Date Transaction Type Set Copy Name Broker Email Address JHAMIE CAPARAS 0055 09302019 REN ELECTRONIC COPY mmartinglockton.com EPS TRACKING1D UUF95021000110082019 POLICY NUMBER 006862415 TABLE EFFECTIVE DATE 09302019 TABLE WRITTEN DATE 09062019 DocuCorp International eUPS | 2 |
DANIEL CONDON CHICAGO 500 W. Madison Street Suite 3000 Chicago ILLINOIS 60661 Re EAGLE TRANSPORT CORPORATION PRODUCER IS 0036877 LOCKTON COMPANIES LLC b4k W. 47TH STREET SUITE 900 KANSAS CITY MO 64112 686 24 15 PRODUCER COV LTR | 2 |
AIG Insurance 877 To Serve 867 3783 Email toserveAIG.com 10082019 MATT MARTING LOCKTON COMPANIES LLC 444 W. 47TH STREET SUITE 900 KANSAS CITY MO 64112 Re INSURED NAME EAGLE TRANSPORT CORPORATION Policy No. GL 686 24 15 Effective Date 09302019 Dear MATT MARTING Enclosed please find the following document New Policy Thank you for your binder. Enclosed please find the original and broker copies of the policy issued to the above named insured. Renewal Thank you for your renewal binder. Enclosed please find the original and broker copies of the policy issued to the above named insured. Endorsements No. and Type of Change Enclosed please find the original and one copy of the change endorsements as requested. The enclosed documents provide a complete and accurate representation of the coverages agreed to under the terms and conditions set out in the binder or change request document. Upon your review please contact your underwriter promptly with any questions or concerns. We appreciate your business and strive to makeyour satisfaction our 1 priority. | 2 |
POLICYHOLDER NOTICE Thank you for purchasing insurance from a member company of American International Group Inc. AIG. The AIG member companies generally pay compensation to brokers and independent agents and may have paid compensation in connection with your policy. You can review and obtain information about the nature and range of compensation paid by AIG member companies to brokers and independent agents in the United States by visiting our website at www.aig.comproducercompensation or by calling 1 800 706 3102. 91222 916 | 2 |
Ry of No I 2 Feney o 61 288 24 15 al of No. 1929282 CG DS 011 oo 6L 24 15 Coverage is provided by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA a capital stock company 175 Water Street New York NY 10038 212 458 5000 COMMERCIAL GENERAL LIABILITY DECLARATIONS CG DS 011001 NAMED INSURED MAILING ADDRESS EAGLE TRANSPORT CORPORATION 300 S. WESLEYAN BLVD 200 ROCKY MOUNT NC 27804 4215 PRODUCER S NAME MAILING ADDRESS LOCKTON COMPANIES LLC 4hk W. 47TH STREET SUITE 900 KANSAS CITY MO 64112 POLICY PERIOD From 09302019 to 09302020 at 1201 A.M. Standard Time at your mailing address shown above. FORM OF BUSINESS X CORPORATION PARTNERSHIP O LIMITED LIABILITY COMPANY INDIVIDUAL O OTHER BUSINESS DESCRIPTION TRANSPORT SERVICES LOCATION OF ALL PREMISES YOU OWN RENT OR OCCUPY ON FILE WITH COMPANY IN RETURN FOR THE PAYMENT OF THE PREMIUM AND SUBJECT TO ALL THE TERMS OF THIS POLICY WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. POLICY PREMIUM 114455 PREMIUM SHOWN IS PAYABLE 114 455 at inception. This policy is subject to annual audit Premium for Certified Acts of Terrorism Coverage Under Terrorism Risk Insurance Act 2002 as amended by the Terrorism Risk Insurance Program Reauthorization Act 2015 Not Applicable Coverage Rejected By Insured SCHEDULE OF STATE TAXES FEES AND SURCHARGES IF APPLICABLE State Taxes Fees and Surcharges shown are in addition to the above referenced Policy Premium. ENDORSEMENTS ATTACHED TO THIS POLICY SEE ATTACHED FORMS SCHEDULE THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS IF APPLICABLE TOGETHER WITH THE COMMON POLICY CONDITIONS COVERAGE FORMS AND ENDORSEMENTS IF ANY ISSUED TO FORM A PART THEREOF COMPLETE THE ABOVE NUMBERED POLICY. Date Issued 10082019 93837 1206 CGDS011001 Includes copyrighted material of Insurance Services Office Inc. with its permission ISO Properties Inc. 2000 Page1 of 2 | 2 |
LIMITS OF INSURANCE EACH OCCURRENCE LIMIT DAMAGE TO PREMISES RENTED TO YOU LIMIT MEDICAL EXPENSE LIMIT PERSONAL ADVERTISING INJURY LIMIT GENERAL AGGREGATE LIMIT PRODUCTS COMPLETED OPERATIONS AGGREGATE LIMIT 2000000 100000 10000 2000000 2000000 2000000 Any one premise Any one person Any one person or organization RETROACTIVE DATE CG 00 02 ONLY THIS INSURANCE DOES NOT APPLY TO BODILY INJURY PROPERTY DAMAGE OR PERSONAL AND ADVER TISING INJURY WHICH OCCURS BEFORE THE RETROACTIVE DATE IF ANY SHOWN BELOW. RETROACTIVE DATE NONE ENTER DATE OR NONE IF NO RETROACTIVE DATE APPLIES. CLASSIFICATION AND PREMIUM RATE ADVANCE PREMIUM CODE PREMIUM prem Prod comp Prem Prod comp CLASSIFICATION NO. BASE Ops Ops Ops Ops SEE COMPOSITE RATE ENDORSEMENT A AREA Total 1144565 cHwvozo Gl OTHER Ul TOTAL COST DMISSIONS OTAL OPERATING EXPENSES AYROLL ROSS SALES NITS EACH OuU LIMIT 93837 1206 CGDS011001 Includes copyrighted material of Insurance Services Office Inc. with its permission ISO Properties Inc. 2000 Page2 of 2 | 2 |
IN WITNESS WHEREOF the Insurer has caused this Policy to be signed by its President Secretary and Authorized Representative. Secretary NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA gm.w President NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA This Policy shall not be valid unless signed below at the time of issuance by an authorized representative of the insurer. Authorized Representative SIGNUJ | 2 |
FORMS SCHEDULE EFFECTIVE DATE 09302019 NAM ED INSURED EAGLE TRANSPORT CORPORATION POLICY NO GL 686 24 15 CGO001 0413 COMM GENERAL LIABILITY COVERAGE FORM G0224 1093 EARLIER NOTICE OF CANC G2001 0413 PRIMARY AND NONCONTRIBUTORY G2010 0413 OWNERS LESSEES CONTR LIAB CG2011 0413 MANAGERS LESSORS OF PREMISES G2015 0413 ADDITIONAL INSURED VENDORS G2026 0413 DESGNTD PERS ORG G2033 0413 ADDITIONAL INSRD 62107 0514 EXCL ACC DISCL CONF PERS LMTD BI NOT INC G2147 1207 EMPL. RELATED PRACTICES EXCL. G2155 0999 TOTAL POLL EXCL WITH A HOSTILE FIRE G2266 1185 MISDELIVERY OF LIQUID PROD COV G2404 0509 WAIVER OF TRANS RIGHTS OF RECOV G2427 0413 LIMITED CONTRACTUAL LIAB RAILROADS IL0017 1198 COMMON POLICY CONDITIONS IL0021 0908 NUCLEAR ENERGY LIAB EXCL BROAD FORM IL0269 0908 NC CHANGES CANCELLATION NONRENEWAL 58332 0807 TOTAL LEAD EXCLUSION 61944 0914 BROAD FORM NAMED INSURED 62132 1008 UNINTENTIONAL ERRORS AND OMISSIONS 62898 0712 RADIOACTIVE MATTER EXCLUSION 64004 0712 ERISA EXCLUSION 65329 0901 DELN OF CONTRL LIAB EXCL COV B 74447 0901 PERSONAL INJURY DEFINITION EXTENSION 81461 0804 LARGE RISK RATING PLAN ENDT 81462 0403 EXTENSION SCHEDULE OF THE LARGE RISK 82540 0712 ASBESTOS AND SILICA EXCL ENDT 89644 0613 ECONOMICS SANCTIONS ENDORSEMENT 94356 1016 DEDUCTIBLE COVERAGE ENDT FORM A 95284 0807 COVG FOR EMPL RELATING TO CO EMPL INJ 115924 1013 INDIANA AMENDATORYDEFIN OF POLLU 118951 0115 TERRORISM EXCL CERTIFIED ACTS 119483 0816 COMPOSITE RATING PLAN ENDORSEMENT | 2 |
POLICY NUMBER GL 686 24 15 POLICY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY CG 00010413 COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights duties and what is and is not covered. Throughout this policy the words you and your refer to the Named Insured shown in the Decla rations and any other person or organization quali fying as a Named Insured under this policy. The words we us and our refer to the company providing this insurance. The word insured means any person or organi zation qualifying as such under Section Il Who Is An Insured. Other words and phrases that appear in quotation marks have special meaning. Refer to Section V Definitions. SECTION COVERAGES COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY 1. Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as damages because of bodily injury or property damage to which this insurance applies. We will have the right and duty to defend the insured against any suit seeking those damages. However we will have no duty to defend the insured against any suit seeking damages for bodily injury or property damage to which this insurance does not apply. We may at our discretion investigate any occurrence and settle any claim or suit that may result. But 1 The amount we will pay for damages is limited as described in Section lll Limits Of Insurance and 2 Our right and duty to defend ends when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverages A or B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments Coverages A and B. b. This insurance applies to bodily injury and property damage only if 1 The bodily injury or property damage is caused by an occurrence that takes c. place in the coverage territory 2 The bodily injury or property damage occurs during the policy period and 3 Prior to the policy period no insured listed under Paragraph 1. of Section Il Who Is An Insured and no employee authorized by you to give or receive notice of an occurrence or claim knew that the bodily injury or property damage had occurred in whole or in part. If such a listed insured or authorized employee knew prior to the policy period that the bodily injury or pro perty damage occurred then any conti nuation change or resumption of such bodily injury or property damage during or after the policy period will be deemed to have been known prior to the policy period. Bodily injury or property damage which occurs during the policy period and was not prior to the policy period known to have occurred by any insured listed under Paragraph 1. of Section Il Who Is An Insured or any employee authorized by you to give or receive notice of an occurrence or claim includes any continuation change or resumption of that bodily injury or property damage after the end of the policy period.. Bodily injury or property damage will be deemed to have been known to have occurred at the earliest time when any insured listed under Paragraph 1. of Section Il Who Is An Insured or any employee authorized by you to give or receive notice of an occurrence or claim 1 Reports all or any part of the bodily injury or property damage to us or any other insurer 2Receives a written or verbal demand or claim for damages because of the bodily injury or property damage or 3 Becomes aware by any other means that bodily injury or property damage has occurred or has begun to occur.. Damages because of bodily injury include damages claimed by any person Insurance Services Office Inc. 2012 Page 1 of 16 m CG 00010413 | 0 |
or organization for care loss of services or death resulting at any time from the bodily injury. 2. Exclusions This insurance does not apply to a. Expected Or Intended Injury Bodily injury or property damage ex pected or intended from the standpoint of the insured. This exclusion does not apply to bodily injury resulting from the use of reasonable force to protect persons or property. b. Contractual Liability Bodily injury or property damage for which the insured is obligated to pay dama ges by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages 1 That the insured would have in the ab sence of the contract or agreement or 2 Assumed in a contract or agreement that is an insured contract provided the bodily injury or property damage occurs subsequent to the execution of the contract or agreement. Solely for the purposes of liability assumed in an insured contract reasonable attorneys fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of bodily injury or property damage provided a Liability to such party for or for the cost of that party s defense has also been assumed in the same insured contract and b Such attorneys fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. c. Liquor Liability Bodily injury or property damage for which any insured may be held liable by reason of 1 Causing or contributing to the intoxication of any person 2 The furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol or 3 Any statute ordinance or regulation relating to the sale gift distribution or use of alcoholic beverages. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in a The supervision hiring employment training or monitoring of others by that insured or b Providing or failing to provide trans portation with respect to any person that may be under the influence of al cohol if the occurrence which caused the bodily injury or property damage involved that which is described in Paragraph 1 2 or 3 above. However this exclusion applies only if you are in the business of manufacturing distri buting selling serving or furnishing al coholic beverages. For the purposes of this exclusion permitting a person to bring al coholic beverages on your premises for consumption on your premises whether or not a fee is charged or a license is required for such activity is not by itself considered the business of selling serving or furnishing alcoholic beverages.. Workers Compensation And Similar Laws Any obligation of the insured under a workers compensation disability benefits or unemployment compensation law or any similar law.. Employer s Liability Bodily injury to 1 An employee of the insured arising out of and in the course of a Employment by the insured or b Performing duties related to the con duct of the insured s business or 2 The spouse child parent brother or sister of that employee as a con sequence of Paragraph 1 above. This exclusion applies whether the insured may be liable as an employer or in any other capacity and to any obligation to share damages with or repay someone else who must pay damages because of the injury. This exclusion does not apply to liability assumed by the insured under an insured contract. Insurance Services Office Inc. 2012 CG00010413 O Page 2 of 16 | 1 |
contractors or subcontractors working directly or indirectly on any insured s behalf are performing operations if the pollutants are brought on or to the premises site or location in connec tion with such operations by such insured contractor or subcontractor. However this subparagraph does not apply to i Bodily of fuels lubricants or other opera ting fluids which are needed to perform the normal electrical hydraulic or mechanical functions necessary for the operation of mobile equipment or its parts if such fuels lubricants or other operating fluids escape from a vehicle part designed to hold store or receive them. This exception does not apply if the bodily injury or property damage a rises out of the intentional dis charge dispersal or release of the fuels lubricants or other operating fluids or if such fuels lubricants or other operating fluids are brought on or to the premises site or location with the intent that they be discharged dispersed or released as part of the operations being performed by such insured contractor or subcontractor ii Bodily injury or property damage sustained within a building and caused by the release of gases fumes or vapors from materials brought into that building in connection with operations being performed by you or on your behalf by a contractor or subcont ractor or iiiBodily injury or property damage arising out of heat smoke or fumes from a hostile fire. e At or from any premises site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured s behalf are performing operations if the operations are to test for monitor clean up remove contain treat de toxify or neutralize or in any way res pond to or assess the effects of pollutants. f. Pollution 1 Bodily injury or property damage arising out of the actual alleged or threatened discharge dispersal seepage migration release or escape of pollutants a At or from any premises site or location which is or was at any time owned or occupied by or rented or loaned to any insured. However this subparagraph does not apply to i Bodily injury if sustained within a building and caused by smoke fumes vapor or soot produced by or originating from equipment that is used to heat cool or dehumidify the building or equipment that is used to heat water for personal use by the building s occupants or their guests Bodily injury or property damage for which you may be held liable if you are a contractor and the owner or lessee of such premises site or location has been added to your policy as an addi tional insured with respect to your ongoing operations performed for that additional insured at that premises site or location and such premises site or location is not and never was owned or occupied by or rented or loaned to any insured other than that additional insured or Bodily injury or property damage arising out of heat smoke or fumes from a hostile fire b At or from any premises site or location which is or was at any time used by or for any insured or others for the handling storage disposal processing or treatment of waste c Which are or were at any time transported handled stored treated disposed of or processed as waste by or for i Any insured or i Any person or organization for whom you may be legally respon sible or d At or from any premises site or location on which any insured or any Insurance Services Office Inc. 2012 Page 3 of 16 m CG 00010413 | 1 |
Page 4 of 16 2 Any loss cost or expense arising out of any a Request demand order or statutory or regulatory requirement that any insured or others test for monitor clean up remove contain treat de toxify or neutralize or in any way res pond to or assess the effects of pollutants or b Claim or suit by or on behalf of a governmental authority for damages because of testing for monitoring cleaning up removing containing treating detoxifying or neutralizing or in any way responding to or asses sing the effects of pollutants. However this paragraph does not apply to liability for damages because of pro perty damage that the insured would have in the absence of such request de mand order or statutory or regulatory requirement or such claim or suit by or on behalf of a governmental authority. g. Aircraft Auto Or Watercraft Bodily injury or property damage arising out of the ownership maintenance use or entrustment to others of any aircraft auto or watercraft owned or operated by or rented or loaned to any insured. Use includes operation and loading or unloading. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision hiring employment training or monitoring of others by that insured if the occurrence which caused the bodily injury or property damage involved the ownership main tenance use or entrustment to others of any aircraft auto or watercraft that is owned or operated by or rented or loaned to any insured. This exclusion does not apply to 1 A watercraft while ashore on premises you own or rent 2 A watercraft you do not own that is a Less than 26 feet long and b Not being used to carry persons or property for a charge 3 Parking an auto on or on the ways next to premises you own or rent pro vided the auto is not owned by or rented or loaned to you or the insured 4 Liability assumed under any insured contract for the ownership maintenance or use of aircraft or watercraft or 5 Bodily injury sing out of a The opera equipment t of a land under the d ment if it v pulsory or 1 or other mc where it is raged or b The operatic or equipmer or f.3 of equipment. h. Mobile Equipment Bodily injury or out of 1 The transportat by an auto rented or loane 2 The use of I while in practic pared for any demolition or s i. War Bodily injury or ever caused aris out of 1 War including 2 Warlike action cluding action against an actt any governmer thority using n agents or 3 Insurrection re ped power or mental authorit against any of j. Damage To Proper Property damage 1 Property you including any c by you or any or entity for hancement res such property prevention of mage to anothe 2 Premises you s if the propert any part of tho 3 Property loanec Insurance Services Office Inc. 2012 5 Bodily injury or property damage ari sing out of a The operation of machinery or equipment that is attached to or part of a land vehicle that would qualify under the definition of mobile equip ment if it were not subject to a com pulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally ga raged or b The operation of any of the machinery or equipment listed in Paragraph f.2 or f.3 of the definition of mobile equipment. h. Mobile Equipment Bodily injury or property damage arising out of 1 The transportation of mobile equipment by an auto owned or operated by or rented or loaned to any insured or 2The use of mobile equipment in or while in practice for or while being pre pared for any prearranged racing speed demolition or stunting activity. i. War Bodily injury or property damage how ever caused arising directly or indirectly out of 1 War including undeclared or civil war 2 Warlike action by a military force in cluding action in hindering or defending against an actual or expected attack by any government sovereign or other au thority using military personnel or other agents or 3 Insurrection rebellion revolution usur ped power or action taken by govern mental authority in hindering or defending against any of these. j. Damage To Property Property damage to 1 Property you own rent or occupy including any costs or expenses incurred by you or any other person organization or entity for repair replacement en hancement restoration or maintenance of such property for any reason including prevention of injury to a person or da mage to another s property 2 Premises you sell give away or abandon if the property damage arises out of any part of those premises 3 Property loaned to you CG00010413 O | 1 |
4 Personal property in the care custody or control of the insured 5 That particular part of real property on which you or any contractors or subcont ractors working directly or indirectly on your behalf are performing operations if the property damage arises out of those operations or 6 That particular part of any property that must be restored repaired or replaced because your work was incorrectly performed on it. Paragraphs 1 3 and 4 of this exclusion do not apply to property damage other than damage by fire to premises including the contents of such premises rented to you for a period of seven or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Sectionlll Limits Of Insurance. Paragraph 2 of this exclusion does not apply if the premises are your work and were never occupied rented or held for rental by you. Paragraphs 3 4 5 and 6 of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph 6 of this exclusion does not apply to property damage included in the products completed operations hazard.. Damage To Your Product Property damage to your product arising out of it or any part of it. Damage To Your Work Property damage to your work arising out of it or any part of it and included in the products completed operations hazard. This exclusion does not apply if the da maged work or the work out of which the damage arises was performed on your behalf by a subcontractor.. Damage To Impaired Property Or Property Not Physically Injured Property damage to impaired property or property that has not been physically in jured arising out of 1 A defect deficiency inadequacy or dan gerous condition in your product or your work or 2A delay or failure by you or anyone acting on your behalf to perform a cont ract or agreement in accordance with its terms. This exclusion does not apply to the loss of use of other property arising out of sudden and accidental physical injury to your product or your work after it has been put to its intended use.. Recall Of Products Work Or Impaired Property Damages claimed for any loss cost or expense incurred by you or others for the loss of use withdrawal recall inspection repair replacement adjustment removal or disposal of 1 Your product 2 Your work or 3 Impaired property if such product work or property is with drawn or recalled from the market or from use by any person or organization because of a known or suspected defect deficiency inadequacy or dangerous condition in it.. Personal And Advertising Injury Bodily injury arising out of personal and advertising injury.. Electronic Data Damages arising out of the loss of loss of use of damage to corruption of inability to access or inability to manipulate electronic data. However this exclusion does not apply to liability for damages because of bodily in jury. As used in this exclusion electronic data means information facts or programs stored as or on created or used on or transmitted to or from computer software including sys tems and applications software hard or floppy disks CD ROMs tapes drives cells data processing devices or any other media which are used with electronically controlled equipment.. Recording And Di ution Of Material Or Information In Violation Of Law Bodily injury or property damage arising directly or indirectly out of any action or omission that violates or is alleged to vio late 1 The Telephone Consumer Protection Act TCPA including any amendment of or addition to such law 2 The CAN SPAM Act of 2003 including any amendment of or addition to such law Insurance Services Office Inc. 2012 Page 5 of 16 m CG 00010413 | 1 |
3 The Fair Credit Reporting Act FCRA and any amendment of or addition to such law including the Fair and Accurate Credit Transactions Act FACTA or 4 Any federal state or local statute ordinance or regulation other than the TCPA CAN SPAM Act of 2003 or FCRA and their amendments and additions that addresses prohibits or limits the printing dissemination disposal collec ting recording sending transmitting communicating or distribution of material or information. Exclusions c. through n. do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section Il Limits Of Insurance. COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY 1. Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as damages because of personal and advertising injury to which this insurance applies. We will have the right and duty to defend the insured against any suit seeking those damages. However we will have no duty to defend the insured against any suit seeking damages for personal and advertising injury to which this insurance does not apply. We may at our discretion investigate any offense and settle any claim or suit that may result. But 1 The amount we will pay for damages is limited as described in Section lll Limits Of Insurance and 2 Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverages A or B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments Coverages A and B. b. This insurance applies to personal and advertising injury caused by an offense arising out of your business but only if the offense was committed in the coverage territory during the policy period. 2. Exclusions This insurance does not apply to. Knowing Violation Of Rights Of Another Personal and advertising injury caused by or at the direction of the insured with the knowledge that the act would violate the rights of another and would inflict personal and advertising injury.. Material Published With Knowledge Of Falsity Personal and advertising injury arising out of oral or written publication in any manner of material if done by or at the direction of the insured with knowledge of its falsity.. Material Published Prior To Policy Period Personal and advertising injury arising out of oral or written publication in any manner of material whose first publication took place before the beginning of the policy period.. Criminal Acts. Contractual Lial Personal and advertising injury arising out of a criminal act committed by or at the direction of the insured. y Personal and advertising injury for which the insured has assumed liability in a cont ract or agreement. This exclusion does not apply to liability for damages that the in sured would have in the absence of the contract or agreement. Breach Of Contract Personal and advertising injury arising out of a breach of contract except an implied contract to use another s advertising idea in your advertisement.. Quality Or Performance Of Goods Failure To Conform To Statements Personal and advertising injury arising out of the failure of goods products or services to conform with any statement of quality or performance made in your advertisement.. Wrong Description Of Prices Personal and advertising injury arising out of the wrong description of the price of goods products or services stated in your advertisement. Infringement Of Copyright Patent Trade mark Or Trade Secret Personal and advertising injury arising out of the infringement of copyright patent trademark trade secret or other intellectual property rights. Under this exclusion such other intellectual property rights do not include the use of another s advertising idea in your advertisement. Insurance Services Office Inc. 2012 CG00010413 O Page 6 of 16 | 1 |
However this exclusion does not apply to infringement in your advertisement of copyright trade dress or slogan. Insureds In Media And Internet Type Businesses Personal and advertising injury committed by an insured whose business is 1 Advertising broadcasting publishing or telecasting 2 Designing or determining content of web sites for others or 3An Internet search access content or service provider. However this exclusion does not apply to Paragraphs 14.a. b. and c. of personal and advertising injury under the Definitions section. For the purposes of this exclusion the placing of frames borders or links or advertising for you or others anywhere on the Internet is not by itself considered the business of advertising broadcasting publishing or telecasting.. Electronic Chatrooms Or Bulletin Boards Personal and advertising injury arising out of an electronic chatroom or bulletin board the insured hosts owns or over which the insured exercises control. Unauthorized Use Of Another s Name Or Product Personal and advertising injury arising out of the unauthorized use of another s name or product in your e mail address domain name or metatag or any other similar tactics to mislead another s potential customers.. Pollution Personal and advertising injury arising out of the actual alleged or threatened dis charge dispersal seepage migration re lease or escape of pollutants at any time.. Pollution related Any loss cost or expense arising out of any 1 Request demand order or statutory or regulatory requirement that any insured or others test for monitor clean up re move contain treat detoxify or neutra lize or in any way respond to or assess the effects of pollutants or 2Claim or suit by or on behalf of a governmental authority for damages be. Recording And Di cause of testing for monitoring cleaning up removing containing treating de toxifying or neutralizing or in any way responding to or assessing the effects of pollutants. o. War Personal and advertising injury however caused arising directly or indirectly out of 1 War including undeclared or civil war 2 Warlike action by a military force in cluding action in hindering or defending against an actual or expected attack by any government sovereign or other authority using military personnel or other agents or 3 Insurrection rebellion revolution usur ped power or action taken by govern mental authority in hindering or defending against any of these. ution Of Material Or Information In Violation Of Law Personal and advertising injury arising directly or indirectly out of any action or omission that violates or is alleged to vio late 1 The Telephone Consumer Protection Act TCPA including any amendment of or addition to such law 2 The CAN SPAM Act of 2003 including any amendment of or addition to such law 3The Fair Credit Reporting Act FCRA and any amendment of or addition to such law including the Fair and Accurate Credit Transactions Act FACTA or 4 Any federal state or local statute ordinance or regulation other than the TCPA CAN SPAM Act of 2003 or FCRA and their amendments and additions that addresses prohibits or limits the printing dissemination disposal collec ting recording sending transmitting communicating or distribution of material or information. COVERAGE C MEDICAL PAYMENTS 1. Insuring Agreement a. We will pay medical expenses as described below for bodily injury caused by an acci dent 1 On premises you own or rent Insurance Services Office Inc. 2012 Page 7 of 16 m CG 00010413 | 1 |
2On ways next to premises you own or rent or 3 Because of your operations provided that a The accident takes place in the cove rage territory and during the policy period b The expenses are incurred and re ported to us within one year of the date of the accident and c The injured person submits to exa mination at our expense by physi cians of our choice as often as we reasonably require. b. We will make these payments regardless of fault. These payments will not exceed the applicable limit of insurance. We will pay reasonable expenses for 1 First aid administered at the time of an accident 2 Necessary medical surgical X ray and dental services including prosthetic de vices and 3 Necessary ambulance hospital profes sional nursing and funeral services. 2. Exclusions We will not pay expenses for bodily injury a. Any Insured To any insured except volunteer workers. b. Hired Person To a person hired to do work for or on be half of any insured or a tenant of any in sured. c. Injury On Normally Occupied Premises To a person injured on that part of premises you own or rent that the person normally occupies. d. Workers Compensation And Similar Laws To a person whether or not an employee of any insured if benefits for the bodily injury are payable or must be provided under a workers compensation or disability benefits law or a similar law. e. Athletics Activiti To a person injured while practicing ins tructing or participating in any physical exercises or games sports or athletic con tests. es f. Products Completed Operations Hazard Included within the products completed operations hazard. g. Coverage A Exclusions Excluded under Coverage A. SUPPLEMENTARY PAYMENTS COVERAGES A AND B 1. We will pay with respect to any claim we investigate or settle or any suit against an insured we defend a. All expenses we incur. b. Up to 250 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. c. The cost of bonds to release attachments but only for bond amounts within the applicable limit of insurance. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or suit including actual loss of earnings up to 250 a day because of time off from work. e. All court costs taxed against the insured in the suit. However these payments do not include attorneys fees or attorneys ex penses taxed against the insured. f. Prejudgment interest awarded against the insured on that part of the judgment we pay. If we make an offer to pay the applicable limit of insurance we will not pay any prejudgment interest based on that period of time after the offer. g. All interest on the full amount of any judgment that accrues after entry of the judgment and before we have paid offered to pay or deposited in court the part of the judgment that is within the applicable limit of insurance. These payments will not reduce the limits of insurance.. If we defend an insured against a suit and an indemnitee of the insured is also named as a party to the suit we will defend that in demnitee if all of the following conditions are met Insurance Services Office Inc. 2012 CG00010413 O Page 8 of 16 | 1 |
damages for bodily injury and property damage and will not reduce the limits of insurance. Our obligation to defend an insured s indemnitee and to pay for attorneys fees and necessary litigation expenses as Supplementary Payments ends when we have used up the applicable limit of insurance in the payment of judgments or settlements or the conditions set forth above or the terms of the agreement described in Paragraph f. above are no longer met. SECTION Il WHO IS AN INSURED 1. If you are designated in the Declarations as a. An individual you and your spouse are in sureds but only with respect to the conduct of a business of which you are the sole owner. b. A partnership or joint venture you are an insured. Your members your partners and their spouses are also insureds but only with respect to the conduct of your business. c. A limited liability company you are an insured. Your members are also insureds but only with respect to the conduct of your business. Your managers are insureds but only with respect to their duties as your managers. d. An organization other than a partnership joint venture or limited liability company you are an insured. Your executive officers and directors are insureds but only with respect to their duties as your officers or directors. Your stockholders are also insureds but only with respect to their liability as stock holders. e. A trust you are an insured. Your trustees are also insureds but only with respect to their duties as trustees. 2. Each of the following is also an insured a. Your volunteer workers only while per forming duties related to the conduct of your business or your employees other than either your executive officers if you are an organization other than a partnership joint venture or limited liability company or your managers if you are a limited liability company but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However none of these employees or volunteer workers are in sureds for a. The suit against the indemnitee seeks damages for which the insured has assumed the liability of the indemnitee in a contract or agreement that is an insured contract b. This insurance applies to such liability assumed by the insured c. The obligation to defend or the cost of the defense of that indemnitee has also been assumed by the insured in the same insured contract d. The allegations in the suit and the information we know about the occur rence are such that no conflict appears to exist between the interests of the insured and the interests of the indemnitee e. The indemnitee and the insured ask us to conduct and control the defense of that indemnitee against such suit and agree that we can assign the same counsel to defend the insured and the indemnitee and f. The indemnitee 1 Agrees in writing to a Cooperate with us in the investi gation settlement or defense of the suit b Immediately send us copies of any demands notices summonses or legal papers received in connection with the suit c Notify any other insurer whose coverage is available to the in demnitee and d Cooperate with us with respect to coordinating other applicable insu rance available to the indemnitee and 2 Provides us with written authorization to a Obtain records and other information related to the suit and b Conduct and control the defense of the indemnitee in such suit. So long as the above conditions are met attorneys fees incurred by us in the defense of that indemnitee necessary litigation expenses incurred by wus and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Notwithstanding the provisions of Paragraph 2.b.2 of Section Coverage A Bodily Injury And Property Damage Liability such payments will not be deemed to be Insurance Services Office Inc. 2012 Page 9 of 16 m CG 00010413 | 1 |
1 Bodily injury or personal and adver tising injury a To you to your partners or members if you are a partnership or joint venture to your members if you are a limited liability company to a coemployee while in the course of his or her employment or performing duties related to the conduct of your business or to your other volunteer workers while performing duties related to the conduct of your busi ness b To the spouse child parent brother or sister of that coemployee or volunteer worker as a consequence of Paragraph 1a above c For which there is any obligation to share damages with or repay some one else who must pay damages because of the injury described in Paragraph 1a or b above or d Arising out of his or her providing or failing to provide professional health care services. 2 Property damage to property a Owned occupied or used by b Rented to in the care custody or control of or over which physical control is being exercised for any pur pose by you any of your employees volunteer workers any partner or member if you are a partnership or joint venture or any member if you are a limited liability company. b. Any person other than your employee or volunteer worker or any organization while acting as your real estate manager. c. Any person or organization having proper temporary custody of your property if you die but only 1 With respect to liability arising out of the maintenance or use of that property and 2 Until your legal representative has been appointed. d. Your legal representative if you die but only with respect to duties as such. That representative will have all your rights and duties under this Coverage Part. 3. Any organization you newly acquire or form other than a partnership joint venture or limited liability company and over which you maintain ownership or majority interest will qualify as a Named Insured if there is no other similar insurance available to that organization. How ever a. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period whichever is earlier b. Coverage A does not apply to bodily injury or property damage that occurred before you acquired or formed the organization and c. Coverage B does not apply to personal and advertising injury arising out of an offense committed before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any current or past partnership joint venture or limited liability com pany that is not shown as a Named Insured in the Declarations. SECTION Ill LIMITS OF INSURANCE 1. The Limits of Insurance shown in the Decla rations and the rules below fix the most we will pay regardless of the number of a. Insureds b. Claims made or suits brought or c. Persons or organizations making claims or bringing suits. 2. The General Aggregate Limit is the most we will pay for the sum of a. Medical expenses under Coverage C b. Damages wunder Coverage A except damages because of bodily injury or pro perty damage included in the pro ducts completed operations hazard and c. Damages under Coverage B. 3. The Products Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of bodily injury and property damage included in the pro ducts completed operations hazard. 4. Subject to Paragraph 2. above the Personal And Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all personal and ad vertising injury sustained by any one person or organization. o iding or health tody or physical ny pur s m T T Insurance Services Office Inc. 2012 CG00010413 O Page 10 of 16 | 1 |
5. Subject to Paragraph 2. or 3. above whichever applies the Each Occurrence Limit is the most we will pay for the sum of a. Damages under Coverage A and b. Medical expenses under Coverage C because of all bodily injury and property damage arising out of any one occurrence. 6. Subject to Paragraph 5. above the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of property damage to any one premises while rented to you or in the case of damage by fire while rented to you or temporarily occu pied by you with permission of the owner. 7. Subject to Paragraph 5. above the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of bodily injury sustained by any one person. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months starting with the beginning of the policy period shown in the Declarations unless the policy period is extended after issuance for an additional period of less than 12 months. In that case the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS 1. Bankruptcy Bankruptcy or insolvency of the insured or of the insured s estate will not relieve us of our obligations under this Coverage Part. 2. Duties In The Event Of Occurrence Offense Claim Or Suit a. You must see to it that we are notified as soon as practicable of an occurrence or an offense which may result in a claim. To the extent possible notice should include 1 How when and where the occurrence or offense took place 2 The names and addresses of any injured persons and witnesses and 3 The nature and location of any injury or damage arising out of the occurrence or offense. b. If a claim is made or suit is brought against any insured you must 1 Immediately record the specifics of the claim or suit and the date received and 2 Notify us as soon as practicable. You must see to it that we receive written notice of the claim or suit as soon as practicable. c. You and any other involved insured must 1 Immediately send us copies of any demands notices summonses or legal papers received in connection with the claim or suit 2 Authorize us to obtain records and other information 3 Cooperate with us in the investigation or settlement of the claim or defense a gainst the suit and 4 Assist us upon our request in the en forcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will except at that insured s own cost voluntarily make a payment assume any obligation or incur any expense other than for first aid without our consent. 3. Legal Action Against Us No person or organization has a right under this Coverage Part a. To join us as a party or otherwise bring us into a suit asking for damages from an in sured or b. To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us the insured and the claimant or the claimant s legal representative.. Other Insurance If other valid and collectible insurance is avai lable to the insured for a loss we cover under Coverages A or B of this Coverage Part our obligations are limited as follows a. Primary Insurance This insurance is primary except when Para graph b. below applies. If this insurance is ses of determining the Limits of OMMERCIAL GENERAL LIABILITY r insolvency of the insured or of estate will not relieve us of our der this Coverage Part. e Event Of Occurrence Offense see to it that we are notified as acticable of an occurrence or an hich may result in a claim. To the sible notice should include vhen and where the occurrence 1se took place mes and addresses of any injured s and witheccaa and o o e Insurance Services Office Inc. 2012 Page 110f 16 O CG 00010413 | 1 |
primary our obligations are not affected un less any of the other insurance is also primary. Then we will share with all that other insurance by the method described in Paragraph c. below.. Excess Insurance 1 This insurance is excess over a Any of the other insurance whether primary excess contingent or on any other basis i That is Fire Extended Coverage Builder s Risk Installation Risk or similar coverage for your work ii That is Fire insurance for premises rented to you or temporarily occu pied by you with permission of the owner i That is insurance purchased by you to cover your liability as a tenant for property damage to premises rented to you or tempo rarily occupied by you with per mission of the owner or ivIf the loss arises out of the main tenance or use of aircraft autos or watercraft to the extent not subject to Exclusion g. of Section Coverage A Bodily Injury And Property Damage Liability. b Any other primary insurance available to you covering liability for damages arising out of the premises or opera tions or the products and completed operations for which you have been added as an additional insured. 2 When this insurance is excess we will have no duty under Coverages A or B to defend the insured against any suit if any other insurer has a duty to defend the insured against that suit. If no other insurer defends we will undertake to do so but we will be entitled to the insured s rights against all those other insurers. 3 When this insurance is excess over other insurance we will pay only our share of the amount of the loss if any that exceeds the sum of a The total amount that all such other insurance would pay for the loss in the absence of this insurance and b The total of all deductible and self insured amounts under all that other insurance. 4 We will share the remaining loss if any with any other insurance that is not described in this Excess Insurance pro vision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part.. Method Of Sharing If all of the other insurance permits contri bution by equal shares we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains whichever comes first. If any of the other insurance does not permit contribution by equal shares we will contri bute by limits. Under this method each insurer s share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 5. Premium Audit We will compute all premiums for this Coverage Part in accordance with our rules and rates.. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium we will return the excess to the first Named Insured.. The first Named Insured must keep records of the information we need for premium computation and send us copies at such times as we may request. 6. Representations By accepting this policy you agree b. The statements in the Declarations are accu rate and complete Those statements are based presentations you made to us and upon re. We have issued this policy in reliance upon your representations. 7. Separation Of Insureds Except with respect to the Limits of Insurance and any rights or duties specifically assigned in Insurance Services Office Inc. 2012 CG00010413 O Page 12 of 16 | 1 |
this Coverage Part to the first Named Insured this insurance applies a. As if each Named Insured were the only Named Insured and b. Separately to each insured against whom claim is made or suit is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part those rights are transferred to us. The insured must do nothing after loss to impair them. At our request the insured will bring suit or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part we will mail or deliver to the first Named In sured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed proof of mailing will be suffi cient proof of notice. SECTION V DEFINITIONS 1. Advertisement means a notice that is broad cast or published to the general public or speci fic market segments about your goods pro ducts or services for the purpose of attracting customers or supporters. For the purposes of this definition a. Notices that are published include material placed on the Internet or on similar elec tronic means of communication and b. Regarding web sites only that part of a web site that is about your goods products or services for the purposes of attracting custo mers or supporters is considered an adver tisement. 2. Auto means a. A land motor vehicle trailer or semitrailer designed for travel on public roads including any attached machinery or equipment or b. Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However auto does not include mobile equipment. 3. Bodily injury means bodily injury sickness or disease sustained by a person including death resulting from any of these at any time.. Coverage territory means a. The United States of America including its territories and possessions Puerto Rico and Canada b. International waters or airspace but only if the injury or damage occurs in the course of travel or transportation between any places included in Paragraph a. above or c. All other parts of the world if the injury or damage arises out of 1 Goods or products made or sold by you in the territory described in Paragraph a. above 2 The activities of a person whose home is in the territory described in Paragraph a. above but is away for a short time on your business or 3 Personal and advertising injury offenses that take place through the Internet or similar electronic means of communi cation provided the insured s responsibility to pay damages is determined in a suit on the me rits in the territory described in Paragraph a. above or in a settlement we agree to.. Employee includes a leased worker. Employee does not include a temporary worker.. Executive officer means a person holding any of the officer positions created by your charter constitution bylaws or any other similar governing document.. Hostile fire means one which becomes un controllable or breaks out from where it was in tended to be.. Impaired property means tangible property that other than your product or your worl can not be used or is less useful because a. It incorporates your product or your work that is known or thought to be defec tive deficient inadequate or dangerous or b. You have failed to fulfill the terms of a cont ract or agreement if such property can be restored to use by the repair replacement adjustment or removal of your product or your work or your fulfilling the terms of the contract or agreement.. Insured contract means a. A contract for a lease of premises. However that portion of the contract for a lease of premises that indemnifies any person or sured were the only sured against whom is brought. covery Against Others o recover all or part of e made under this hts are transferred to nothing after loss to uest the insured will hose rights to us and w this Coverage Part o the first Named In arations written notice s than 30 days before f mailing will be suffi notice that is broad eneral public or speci Insurance Services Office Inc. 2012 Page 130f 16 O CG 00010413 | 1 |
organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an insured contract. A sidetrack agreement Any easement or license agreement except in connection with construction or demo lition operations on or within 50 feet of a railroad. An obligation as required by ordinance to indemnify a municipality except in connec tion with work for a municipality An elevator maintenance agreement That part of any other contract or agreement pertaining to your business including an indemnification of a municipality in connec tion with work performed for a municipality under which you assume the tort liability of another party to pay for bodily injury or property damage to a third person or organization. Tort liability means a liability that would be imposed by law in the ab sence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement 1 That indemnifies a railroad for bodily injury or property damage arising out of construction or demolition operations within 50 feet of any railroad property and affecting any railroad bridge or trestle tracks road beds tunnel under pass or crossing 2 That indemnifies an architect engineer or surveyor for injury or damage arising out of a Preparing approving or failing to pre pare or approve maps shop drawings opinions reports surveys field orders change orders or drawings and specifications or b Giving directions or instructions or failing to give them if that is the primary cause of the injury or damage or 3Under which the insured if an architect engineer or surveyor assumes liability for an injury or damage arising out of the insured s rendering or failure to render professional services including those listed in 2 above and supervisory ins pection architectural or engineering acti vities. 10. Leased worker means a person leased to you 1 by a labor leasing firm under an agreement between you and the labor leasing firm to per form duties related to the conduct of your business. Leased worker does not include a temporary worker.. Loading or unloading means the handling of property a. After it is moved from the place where it is accepted for movement into or onto an aircraft watercraft or auto b. While it is in or on an aircraft watercraft or or c. While it is being moved from an aircraft watercraft or auto to the place where it is finally delivered but loading or unloading does not include the movement of property by means of a mecha nical device other than a hand truck that is not attached to the aircraft watercraft or auto. 12. Mobile equipment means any of the following types of land vehicles including any attached machinery or equipment a. Bulldozers farm machinery forklifts and other vehicles designed for use principally off public roads b. Vehicles maintained for use solely on or next to premises you own or rent c. Vehicles that travel on crawler treads d. Vehicles whether self propelled or not maintained primarily to provide mobility to permanently mounted 1 Power cranes shovels loaders diggers or drills or 2Road construction or resurfacing equip ment such as graders scrapers or rollers e. Vehicles not described in Paragraph a. b. c. or d. above that are not self propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types 1 Air compressors pumps and generators including spraying welding building cleaning geophysical exploration lighting and well servicing equipment or 2 Cherry pickers and similar devices used to raise or lower workers f. Vehicles not described in Paragraph a. b. c. or d. above maintained primarily for pur poses other than the transportation of persons or cargo. Insurance Services Office Inc. 2012 CG00010413 O Page 14 of 16 | 1 |
to be recycled reconditioned or reclaimed. 16. Products completed operations hazard b. Includes all bodily injury and property damage occurring away from premises you own or rent and arising out of your pro duct or your work except 1 Products that are still in your physical possession or 2 Work that has not yet been completed or abandoned. However your work will be deemed completed at the earliest of the following times a When all of the work called for in your contract has been completed. b When all of the work to be done at the job site has been completed if your contract calls for work at more than one job site. c When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or sub contractor working on the same pro ject. Work that may need service main tenance correction repair or replace ment but which is otherwise complete will be treated as completed. Does not include bodily injury or property damage arising out of 1 The transportation of property unless the injury or damage arises out of a condition in or on a vehicle not owned or operated by you and that condition was created by the loading or unloading of that vehicle by any insured 2 The existence of tools uninstalled equip ment or abandoned or unused materials or 3 Products or operations for which the classification listed in the Declarations or in a policy Schedule states that pro ducts completed operations are subject to the General Aggregate Limit. 17. Property damage means Physical injury to tangible property including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it or. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the occurrence that caused it. However self propelled vehicles with the following types of permanently attached equipment are not mobile equipment but will be considered autos 1 Equipment designed primarily for a Snow removal b Road maintenance but not construc tion or resurfacing or c Street cleaning 2Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers and 3 Air compressors pumps and generators including spraying welding building cleaning geophysical exploration lighting and well servicing equipment. However mobile equipment does not include any land vehicles that are subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. Land vehicles subject to a compulsory or financial responsi bility law or other motor vehicle insurance law are considered autos. 13. Occurrence means an accident including continuous or repeated exposure to substan tially the same general harmful conditions. 14. Personal and advertising injury means injury including consequential bodily injury arising out of one or more of the following offenses a. False arrest detention or imprisonment b. Malicious prosecution c. The wrongful eviction from wrongful entry into or invasion of the right of private occupancy of a room dwelling or premises that a person occupies committed by or on behalf of its owner landlord or lessor d. Oral or written publication in any manner of material that slanders or libels a person or organization or disparages a person s or organization s goods products or services e. Oral or written publication in any manner of material that violates a person s right of privacy f. The use of another s advertising idea in your advertisement or g. Infringing upon another s copyright trade dress or slogan in your advertisement. 15. Pollutants mean any solid liquid gaseous or thermal irritant or contaminant including smoke vapor soot fumes acids alkalis chemicals and waste. Waste includes materials Insurance Services Office Inc. 2012 Page 150f 16 O CG 00010413 | 1 |
property manufactured sold handled distributed or disposed of by a You b Others trading under your name or c A person or organization whose busi ness or assets you have acquired and 2 Containers other than vehicles materials parts or equipment furnished in connection with such goods or products. b. Includes 1 Warranties or representations made at any time with respect to the fitness quality durability performance or use of your product and 2 The providing of or failure to provide warnings or instructions. c. Does not include vending machines or other property rented to or located for the use of others but not sold. 22.Your work a. Means 1 Work or operations performed by you or on your behalf and 2 Materials parts or equipment furnished in connection with such work or operations. b. Includes 1 Warranties or representations made at any time with respect to the fitness quality durability performance or use of your work and 2 The providing of or failure to provide warnings or instructions. For the purposes of this insurance electronic data is not tangible property. As used in this definition electronic data means information facts or programs stored as or on created or used on or transmitted to or from computer software including systems and applications software hard or floppy disks CD ROMs tapes drives cells data processing devices or any other media which are used with electronically controlled equipment. 18.Suit means a civil proceeding in which damages because of bodily injury property damage or personal and advertising injury to which this insurance applies are alleged. Suit includes a. An arbitration proceeding in which such damages are claimed and to which the in sured must submit or does submit with our consent or b. Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent. 19. Temporary worker means a person who is furnished to you to substitute for a permanent employee on leave or to meet seasonal or short term workload conditions. 20. Volunteer worker means a person who is not your employee and who donates his or her work and acts at the direction of and within the scope of duties determined by you and is not paid a fee salary or other compensation by you or anyone else for their work performed for you. 21. Your product a. Means 1 Any goods or products other than real Insurance Services Office Inc. 2012 CG00010413 O Page 16 of 16 | 1 |
CY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY CG 02 24 1093 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER GL 686 24 15 EARLIER NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Number of Days Notice 30 If no entry appears above information required to complete this Schedule will be shown in the Declarations as applicable to this endorsement. For any statutorily permitted reason other than nonpazment of premium the number of days required for notice of cancellation as provided in paragraph 2. of either the CANCELLATION Common Policy Condition or as amended by an applicable state cancellation endorsement is increased to the number of days shown in the Schedule above. Page 1of 1 O CG 02 24 1093 Copyright Insurance Services Office Inc. 1992 | 2 |
POLICY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY CG 20010413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART POLICY NUMBER GL 686 24 15 policy provided that 1 The additional insured is a Named Insured under such other insurance and 2 You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribu tion from any other insurance available to the additional insured. The following is added to the Other Insurance Condition and supersedes any provision to the contrary Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your Insurance Services Office Inc. 2012 Page 1of 1 CG 20010413 | 2 |
POLICY NUMBER GL 686 24 15 POLICY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY CG 20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organizations Locations Of Covered Operations ANY PERSON OR ORGANIZATION WHOM YOU PER THE CONTRACT OR AGREEMENT. BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. Information required to complete this Schedule if not shown above will be shown in the Declarations. that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds the following additional exclusions apply This insurance does not apply to bodily injury or property damage occurring after 1. All work including materials parts or equipment furnished in connection with such work on the project other than service maintenance or repairs to be performed by or on behalf of the additional insureds at the location of the covered operations has been completed or 2. That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. A. Section Il Who Is An Insured is amended to include as an additional insured the persons or organizations shown in the Schedule but only with respect to liability for bodily injury property damage or personal and advertising injury caused in whole or in part by 1. Your acts or omissions or 2. The acts or omissions of those acting on your behalf in the performance of your ongoing operations for the additional insureds at the locations designated above. However 1. The insurance afforded to such additional insured only applies to the extent permitted by law and 2. If coverage provided to the additional insured is required by a contract or agreement the insurance afforded to such additional insured will not be broader than CG 201004 13 Page10f2 O Insurance Services Office Inc. 2012 | 2 |
C. With respect to the insurance afforded to these additional insureds the following is added to Section Il Limits Of Insurance If coverage provided to the additional insured is required by a contract or agreement the most we will pay on behalf of the additional insured is the amount of insurance 1. Required by the contract or agreement or 2. Available under the applicable Limits of Insurance shown in the Declarations whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 CG 20100413 0 Insurance Services Office Inc. 2012 | 2 |
COMMERCIAL GENERAL LIABILITY POLICY NUMBER GL 686 24 15 CG 20110413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises Part Leased To You ANY PREMISES OR PART THEREOF LEASED TO YOU. Name Of Persons Or Organizations Additional Insured ANY PERSON OR ORGANIZATION FROM WHOM YOU LEASE PREMISES OR WHO MANAGES PREMISES YOU OWN AND TO WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED UNDER THIS POLICY AS A RESULT OF ANY LEASE OR MANAGEMENT AGREEMENT YOU ENTER INTO WITH SUCH PARTIES. Additional Premium INCLUDED Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Section Il Who Is An Insured is amended to Schedule and subject to the following additional include as an additional insured the persons or exclusions organizations shown in the Schedule but only This insurance does not apply to with respect to liability arising out of the ownership maintenance or use of that part of the premises leased to you and shown in the 1. Any occurrence which takes place after you cease to be a tenant in that premises. CG 20110413 Insurance Services Office Inc. 2012 Page 1 of 2 POLICY NUMBER GL 686 24 15 ANY PREMISES OR PART THEREOF LEASED TO YOU. ANY PERSON OR ORGANIZATION FROM WHOM YOU LEASE PREMISES OR WHO MANAGES PREMISES YOU OWN AND TO WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED UNDER THIS POLICY AS A RESULT OF ANY LEASE OR MANAGEMENT AGREEMENT YOU ENTER INTO WITH SUCH PARTIES. | 2 |
2. Structural alterations new construction or demolition operations performed by or on behalf of the persons or organizations shown in the Schedule. However 1. The insurance afforded to such additional in sured only applies to the extent permitted by law and 2. If coverage provided to the additional in sured is required by a contract or ag reement the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds the following is added to Section Il Limits Of Insurance If coverage provided to the additional insured is required by a contract or agreement the most we will pay on behalf of the additional insured is the amount of insurance 1. Required by the contract or agreement or 2. Available under the applicable Limits of Insurance shown in the Declarations whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Insurance Services Office Inc. 2012 CG 20110413 Page 2 of 2 | 2 |
POLICY NUMBER GL 686 24 15 POLICY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY CG 20150413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED VENDORS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organizations Vendor Your Products ANY PERSON OR ORGANIZATION WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. PER THE CONTRACT OR AGREEMENT Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Section Il Who Is An Insured is amended to include as an additional insured any persons or organizations referred to throughout this endorsement as vendor shown in the Schedule but only with respect to bodily injury or property damage arising out of your products shown in the Schedule which are distributed or sold in the regular course of the vendor s business. However 1. The insurance afforded to such vendor only applies to the extent permitted by law and 2. If coverage provided to the vendor is required by a contract or agreement the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor. B. With respect to the insurance afforded to these vendors the following additional exclusions apply 1. The insurance afforded the vendor does not apply to CG 20 1504 13 Insurance Services Office Inc. 2012 Bodily injury or property damage for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement. Any express warranty unauthorized by you. Any physical or chemical change in the product made intentionally by the vendor. Repackaging except when unpacked solely for the purpose of inspection demonstration testing or the substitution of parts under instructions from the manufacturer and then repackaged in the original container. Any failure to make such inspections adjustments tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the distribution or sale of the products Page 1 of 2 ARGV VI VIR ent Ty st Ve ECOME OBLIGATED TO INCLUDE AS AN DDITIONAL INSURED AS A RESULT OF ANY ONTRACT OR AGREEMENT YOU HAVE NTERED INTO. CG 20 1504 13 | 2 |
f. Demonstration installation servicing or repair operations except such operations performed at the vendor s premises in connection with the sale of the product g. Products which after distribution or sale by you have been labeled or relabeled or used as a container part or ingredient of any other thing or substance by or for the vendor or h. Bodily injury or property damage ng out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However this exclusion does not apply to 1 The exceptions contained in Sub paragraphs d. or f. or 2 Such inspections adjustments tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization from whom you have acquired such products or any ingredient part or container entering into accom panying or containing such products. C. With respect to the insurance afforded to these vendors the following is added to Section Il Limits Of Insurance If coverage provided to the vendor is required by a contract or agreement the most we will pay on behalf of the vendor is the amount of insurance 1. Required by the contract or agreement or 2. Available under the applicable Limits of Insurance shown in the Declarations whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 Insurance Services Office Inc. 2012 CG 20 15 04 13 m | 2 |
POLICY NUMBER GL 686 24 15 POLICY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organizations ANY PERSON OR ORGANIZATION WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Section Il Who Is An Insured is amended to include as an additional insured the persons or organizations shown in the Schedule but only with respect to liability for bodily injury property damage or personal and advertising injury caused in whole or in part by your acts or omissions or the acts or omissions of those acting on your behalf 1. In the performance of your operations or ongoing 2. In connection with your premises owned by or rented to you. However 1. The insurance afforded to such additional insured only applies to the extent permitted by law and 2. If coverage provided to the additional insured is required by a contract or agreement the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds the following is added to Section Il Limits Of Insurance If coverage provided to the additional insured is required by a contract or agreement the most we will pay on behalf of the additional insured is the amount of insurance 1. Required by the contract or agreement or 2. Available under the applicable Limits of Insurance shown in the Declarations whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT You HAVE ENTERED INTO. CG 20 26 04 13 Insurance Services Office Inc. 2012 Page 1 of 1 | 2 |
POLICY NUMBER GL 686 24 15 OLICY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY CG 20 3304 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS LESSEES OR CONTRACTORS AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section Il Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an addi tional insured only with respect to liability for bodily injury property damage or personal and advertising injury caused in whole or in part by 1. Your acts or omissions or 2. The acts or omissions of those acting on your behalf in the performance of your ongoing operations for the additional insured. However the insurance afforded to such additional insured 1. Only applies to the extent permitted by law and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person s or organization s status as an addi tional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds the following additional ex clusions apply This insurance does not apply to 1. Bodily injury property damage or personal and advertising injury arising out of the rendering of or the failure to render any professional architectural engineering or surveying services including a. The prey drav fielc and b. Sup engl This exclu any insure doing in 1 training or if the occ jury or which cal injury in to rende engineerin 2. Bodily occurril a. All equi sucl serv perf add covi or b. Tha the to orgz con perf part. With respe additional Section Il The most insured is a. The preparing approving or failing to prepare or approve maps shop drawings opinions reports surveys field orders change orders or drawings and specifications or b. Supervisory inspection architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrong doing in the supervision hiring employment training or monitoring of others by that insured if the occurrence which caused the bodily in jury or property damage or the offense which caused the personal and advertising injury involved the rendering of or the failure to render any professional architectural engineering or surveying services. 2. Bodily injury or property damage occurring after a. All work including materials parts or equipment furnished in connection with such work on the project other than service maintenance or repairs to be performed by or on behalf of the additional insureds at the location of the covered operations has been completed or b. That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds the following is added to Section Il Limits Of Insurance The most we will pay on behalf of the additional insured is the amount of insurance CG 20330413 Insurance Services Office Inc. 2012 Page10f2 O | 2 |
Insurance shown in the Declarations whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.. Required by the contract or agreement you have entered into with the additional insured or. Available under the applicable Limits of Insurance Services Office Inc. 2012 CG20330413 O Page 2 of 2 | 2 |
POLICY NUMBER GL 686 24 15 POLICY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY CG 2107 05 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION AND DATA RELATED LIABILITY LIMITED BODILY INJURY EXCEPTION NOT INCLUDED This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Exclusion 2.p. of Section Coverage A transmitted to or from computer soft Bodily Injury And Property Damage Liability is replaced by the following 2. Exclusions This insurance does not apply to p. Access Or Disclosure Of Confidential Or Personal Information And Data related Liability Damages arising out of 1 Any access to or disclosure of any person s or organization s confidential or personal information including pat ents trade secrets processing meth ods customer lists financial informa tion credit card information health information or any other type of non public information or 2 The loss of loss of use of damage to corruption of inability to access or inability to manipulate electronic data. This exclusion applies even if damages are claimed for notification costs credit monitoring expenses forensic expenses public relations expenses or any other loss cost or expense incurred by you or others arising out of that which is des cribed in Paragraph 1 or 2 above. As used in this exclusion electronic data means information facts or programs stored as or on created or used on or ware including systems and appli cations software hard or floppy disks CD ROMs tapes drives cells data processing devices or any other media which are used with electronically controlled equipment. B. The following is added to Paragraph 2. Exclusions of Section Coverage B Personal And Advertising Injury Liability 2. Exclusions This insurance does not apply to Access Or Disclosure Of Confidential Or Personal Information Personal and advertising injury arising out of any access to or disclosure of any person s or organization s confidential or personal information including patents trade secrets processing methods customer lists financial information credit card in formation health information or any other type of nonpublic information. This exclusion applies even if damages are claimed for notification costs credit moni toring expenses forensic expenses public relations expenses or any other loss cost or expense incurred by you or others arising out of any access to or disclosure of any person s or organization s confidential or personal information. transmitted to or from computer soft ware including systems and appli cations software hard or floppy disks CD ROMs tapes drives cells data processing devices or any other media which are used with electronically controlled equipment. B. The following is added to Paragraph 2. Exclusions of Section Coverage B Personal And Advertising Injury Liability 2. Exclusions This insurance does not apply to Access Or Disclosure Of Confidential Or Personal Information Personal and advertising injury arising out of any access to or disclosure of any person s or organization s confidential or personal information including patents trade secrets processing methods customer lists financial information credit card in formation health information or any other type of nonpublic information. This exclusion applies even if damages are claimed for notification costs credit moni toring expenses forensic expenses public relations expenses or any other loss cost or expense incurred by you or others arising out of any access to or disclosure of any person s or organization s confidential or personal information. CG 21 07 05 14 Insurance Services Office Inc. 2013 Page 1 of 1 | 2 |
POLICY NUMBER GL 686 24 15 POLICY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY CG 2147 1207 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYMENT RELATED PRACTICES EXCLUSION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following exclusion is added to Paragraph 2. Exclusions of Section Coverage A Bodily Injury And Property Damage Liability This insurance does not apply to Bodily injury to 1 A person arising out of any a Refusal to employ that person b Termination of that person s employ ment or c Employment related practices policies acts or omissions such as coercion demotion evaluation reassignment dis cipline defamation harassment humilia tion discrimination or malicious prosecu tion directed at that person or 2 The spouse child parent brother or sister of that person as a consequence of bodily injury to that person at whom any of the employment related practices described in Paragraphs a b or c above is direct ed. This exclusion applies 1 Whether the injury causing event described in Paragraphs a b or c above occurs before employment during employment or after employment of that person Whether the insured may be liable as an employer or in any other capacity and 2 3 To any obligation to share damages with or repay someone else who must pay damages because of the injury. B. The following exclusion is added to Paragraph 2. Exclusions of Section Coverage B Personal And Advertising Injury Liability This insurance does not apply to Personal and advertising injury to 1 A person arising out of any a Refusal to employ that person b Termination of that person s employ ment or c Employment related practices policies acts or omissions such as coercion de motion evaluation reassignment dis cipline defamation harassment humilia tion discrimination or malicious prosecu tion directed at that person or 2 The spouse child parent brother or sister of that person as a consequence of per sonal and advertising injury to that person at whom any of the employment related practices described in Paragraphs a b or c above is directed. This exclusion applies 1 Whether the injury causing event described in Paragraphs a b or c above occurs before employment during employment or after employment of that person Whether the insured may be liable as an employer or in any other capacity and 2 3 To any obligation to share damages with or repay someone else who must pay damages because of the injury. IS0 Properties Inc. 2006 Page 1 of 1 m CG 2147 1207 | 2 |
POLICY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY CG 21 55 09 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOTAL POLLUTION EXCLUSION WITH A HOSTILE FIRE EXCEPTION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART Exclusion f. under Paragraph 2. Exclusions of Sec tion Coverage A Bodily Injury And Property Damage Liability is replaced by the following This insurance does not apply to f. Pollution 1 Bodily injury or property damage which would not have occurred in whole or part but for the actual alleged or threatened discharge dispersal seepage migration release or escape of pollut ants at any time. This exclusion does not apply to bodily injury or property damage arising out of heat smoke or fumes from a hostile fire unless that hostile fire occurred or originated a At any premises site or location which is or was at any time used by or for any insured or others for the handling storage disposal processing or treatment of waste or b At any premises site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured s behalf are performing operations to test for monitor clean up remove contain treat detoxify neutralize or in any way respond to or assess the effects of pollutants. 2 Any loss cost or expense arising out of any a Request demand order or statutory or b regulatory requirement that any insured or others test for monitor clean up remove contain treat detoxify or neutralize or in any way respond to or assess the effects of pollutants or Claim or suit by or on behalf of a governmental authority for damages because of testing for monitoring cleaning up removing containing treating detoxifying or neutralizing or in any way responding to or assessing the effects of pollutants. CG 21 55 09 99 Copyright Insurance Services Office Inc. 1998 Page 1 of 1 | 2 |
POLICY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MISDELIVERY OF LIQUID PRODUCTS COVERAGE This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART. Exclusion g. of COVERAGE A Section I does not apply to bodllv injury or property dam age arising out o 1.The delivery of any liquid product into a wrong receptacle or to a wrong address or 2.The erroneous delivery of one liquid product for another by an auto if the bodily injury or property damage oc curs after such operations have been completed or abandoned at the site of such delivery. Operations which may require further service maintenance correction repair or replacement of performance at the wrong address or be cause of any error defect or deficiency but which are otherwise completed will be deemed completed. Copyright Insurance Services Office Inc. 1984 Page 1 of 1 CG 2266 1185 | 2 |
POLICY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization PNC BANK NATIONAL ASSOCIATION 4720 PIEDMONT ROW DRIVE SUITE 300 CHARLOTTE NC 28210 Information required to complete this Schedule if not shown above will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Sec tion IV Conditions We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing opera tions or your work done under a contract with that person or organization and included in the products completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. POLICY NUMBER GL 686 24 15 NC BANK NATIONAL ASSOCIATION 720 PIEDMONT ROW DRIVE SUITE 300 HARLOTTE NC 28210 CG 24 04 05 09 Insurance Services Office Inc. 2008 Page 1of1 O | 2 |
POLICY NUMBER GL 686 24 15 CY NUMBER GL 686 24 15 COMMERCIAL GENERAL LIABILITY CG 24 27 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED CONTRACTUAL LIABILITY RAILROADS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Scheduled Railroad ANY RAILROAD OR GANIZATIONWHOM HAS GRANTED YOU AN EASEMENT FOR ANY AGREEMENT YOU HAVE ENTERED INTO. Designated Job Site JOB SITE TO PERMIT YOU TO PERFORM WORK AS A RESULT OF ANY CONTRACT OR Information required to complete this Schedule if not shown above will be shown in the Declarations. With respect to operations performed for or affecting a Scheduled Railroad at a Designated Job Site the definition of insured contract in the Definitions section is replaced by the following 9. Insured contract means a. A contract for a lease of premises. However that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an insured contract b. A sidetrack agreement c. Any easement or license agreement d. An obligation as required by ordinance to indemnify a municipality except in connection with work for a municipality e. An elevator maintenance agreement f. That part of any other contract or agreement pertaining to your business including an in demnification of a municipality in connection with work performed for a municipality under which you assume the tort liability of another party to pay for bodily injury or property damage to a third person or organization provided the bodily injury or property damage is caused in whole or in part by you or those acting on your behalf. However such part of a contract or agree ment shall only be considered an insured contract to the extent your assumption of the tort liability is permitted by law. Tort liability means a liability that would be im posed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement 1 That indemnifies an architect engineer or surveyor for injury or damage arising out of a Preparing approving or failing to pre pare or approve maps shop drawings opinions reports surveys field orders change orders or drawings and specifications or b Giving directions or instructions or failing to give them if that is the primary cause of the injury or damage 2 Under which the insured if an architect engineer or surveyor assumes liability for an injury or damage arising out of the in sured s rendering or failure to render pro fessional services including those listed in Paragraph 1 above and supervisory inspection architectural or engineering activities. GRANTED YOU AN EASEMENT FOR ANY With respect to operations performed for or affecting a Scheduled Railroad at a Designated Job Site the definition of insured contract in the Definitions section is replaced by the following 9. Insured contract means a. A contract for a lease of premises. However that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an insured contract b. A sidetrack agreement c. Any easement or license agreement d. An obligation as required by ordinance to indemnify a municipality except in connection with work for a municipality e. An elevator maintenance agreement f. That part of any other contract or agreement pertaining to your business including an in demnification of a municipality in connection with work performed for a municipality under which you assume the tort liability of another party to pay for bodily injury or property damage to a third person or organization provided the bodily injury or property damage is caused in whole or in CG 24 27 04 13 Insurance Services Office Inc. 2012 Page 1of 1 O | 2 |
POLICY NUMBER GL 686 24 15 IL00 17 11 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation D. 1. 6. The first Named Insured shownin the Decla rations may cancel this policy by mailing or delivering to us advance written notice of cancellation. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least a. 10days beforetheeffective date of can cellation if we cancel for nonpaymentof premium or b. 30days before the effectivedate of can cellation if we cancel for any other reason. We willmail or deliver our notice to the first Named Insured s lastmailing address known to us. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. If this policy is cancelled we willsend the first Named Insured any premium refund due. If we cancel the refund will be pro rata. If the first Named Insured cancels the refund may be less than pro rata. The cancellationwill be effective even if we have not made or offered a refund. If notice is mailed proof of mailing will be sufficient proof of notice. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy s terms can be amended or waived only by endorsement issued by us and made a part of this policy. Examination Of Your Books And Records We may examine and audit your books and rec ords as theyrelate to this policy at any time dur ing the policy period and up to three years afterward. Inspections And Surveys 1. We have the right to a. Make inspections and surveys at any time b. Give you reports on the conditions we find and c. Recommend changes. 2. We are not obligated to make any inspec tions surveys reports or recommenda tions and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions a. Are safe or healthful or b. Comply withlaws regulations codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us but also to any rating ad visory rate service or similar organization which makes insurance inspections surveys reports or recommendations. 4. Paragraph 2. of this conditiondoes not apply to any inspections surveys reports or re commendations we may make relative tocer tification under state or municipal statutes ordinances or regulations of boilers pres sure vessels or elevators. Premiums The first Named Insured shown in the Decla rations 1. Is responsible for the payment of all pre miums and 2. Will be the payee forany return premiums we pay. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual Named Insured. If you die your rights and duties will be trans ferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL00 17 11 98 IL00 17 11 98 Copyright Insurance Services Office Inc. 1998 Page 1of 1 O | 2 |
POLICY NUMBER GL 686 24 15 IL 00 21 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT Broad Form This endorsement modifies insurance provided under the following COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY 1. The insurance does not apply A. Under any Liability Coverage to bodily in jury or property damage 1 With respect to which an insured under the policy is also an insured under a nu clear energy liability policy issued by Nu clear Energy Liability Insurance Associa tion Mutual Atomic Energy Liability Underwriters Nuclear Insurance Associa tion of Canada or any of their succes sors or would be an insured under any such policy but for its termination upon exhaustion of its limit of liability or Resulting from the hazardous proper ties of nuclear material and with re spect to which a any person or organi zation is required to maintain financial protection pursuant to the Atomic Energy Act of 1954 or any law amendatory thereof or b the insured is or had this policy not been issued would be en titled to indemnity from the United States of America or any agency thereof under any agreement entered into by the United States of America or any agency there of with any person or organization. 2 B. Under any Medical Payments coverage to expenses incurred with respect to bodily in jury resulting from the hazardous proper ties of nuclear material and arising out of the operation of a nuclear facility by any person or organization. C. Under any Liability Coverage to bodily in jury or property damage resulting from hazardous properties of nuclear material if 1 The nuclear material a is at any nu clear facility owned by or operated by or on behalf of an insured or b has been discharged or dispersed therefrom 2 The nuclear material is contained in spent fuel or waste at any time pos sessed handled used processed stored transported or disposed of by or on behalf of an insured or The bodily injury or property damage arises out of the furnishing by an in sured of services materials parts or equipment in connection with the plan ning construction maintenance opera tion or use of any nuclear facility but if such facility is located within the United States of America its territories or pos sessions or Canada this exclusion 3 ap plies only to property damage to such nuclear facility and any property there at. 3. As used in this endorsement Hazardous properties includes radioactive toxic or explosive properties. Nuclear material means source material special nuclear material or by product mate rial. Source material special nuclear material and by product material have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. Spent fuel means any fuel element or fuel component solid or liquid which has been used or exposed to radiation in a nuclear reac tor. S0 Properties Inc. 2007 Page 1 of 2 m IL 00 21 09 08 | 2 |
Waste means any waste material a contain ing by product material other than the tailings or wastes produced by the extraction or con centration of uranium or thorium from any ore processed primarily for its source material content and b resulting from the operation by any person or organization of any nuclear fa cility included under the first two paragraphs of the definition of nuclear facility. Nuclear facility means a Any nuclear reactor b Any equipment or device designed or c used for 1 separating the isotopes of uranium or plutonium 2 processing or utilizing spent fuel or 3 handling processing or packaging waste Any equipment or device used for the processing fabricating or alloying of special nuclear material if at any time the total amount of such material in the custody of the insured at the premises where such equipment or device is lo cated consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof or more than 250 grams of uranium 235 d Any structure basin excavation prem ises or place prepared or used for the storage or disposal of waste and includes the site on which any of the fore going is located all operations conducted on such site and all premises used for such opera tions. Nuclear reactor means any apparatus de signed or used to sustain nuclear fission in a self supporting chain reaction or to contain a critical mass of fissionable material. Property damage includes all forms of radio active contamination of property. S0 Properties Inc. 2007 ILO0 210908 O Page 2 of 2 | 2 |
POLICY NUMBER GL 686 24 15 POLICY NUMBER GL 686 24 15 IL 02 69 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NORTH CAROLINA CHANGES CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following CAPITAL ASSETS PROGRAM OUTPUT POLICY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraph 2. of the Cancellation Common Poli claim under this policy cy Condition is replaced by the following 2. Cancellation Requirements a. Policies In Effect Less Than 60 Days If this policy has been in effect for less than 60 days we may cancel this policy by mailing or delivering to the first Named Insured written notice of cancella tion at least 1 15 days before the effective date of cancellation if we cancel for nonpay ment of premium or 2 30 days before the effective date of cancellation if we cancel for any other reason. b. Policies In Effect More Than 60 Days If this policy has been in effect for 60 days or more or is a renewal of a policy we issued we may cancel this policy pri or to the 1 Expiration of the policy term or 2 Anniversary date stated in the policy only for one or more of the following reasons a Nonpayment of premium b An act or omission by the insured or his or her representative that constitutes material misrepresenta tion or nondisclosure of a material fact in obtaining this policy con tinuing this policy or presenting a c d e f g h 0 Increased hazard or material change in the risk assumed that could not have been reasonably contemplated by the parties at the time of assumption of the risk Substantial breach of contractual duties conditions or warranties that materially affects the insurabil ity of the risk A fraudulent act against us by the insured or his or her representative that materially affects the insurabil ity of the risk Willful failure by the insured or his or her representative to institute reasonable loss control measures that materially affect the insurabil ity of the risk after written notice by us Loss of facultative reinsurance or loss of or substantial changes in applicable reinsurance as provided in G.S. 58 41 30 Conviction of the insured of a crime arising out of acts that mate rially affect the insurability of the risk A determination by the Commis sioner of Insurance that the contin uation of the policy would place us in violation of the laws of North Carolina or IL 02 69 09 08 IS0 Properties Inc. 2007 Page10f2 O | 2 |
You fail to meet the requirements contained in our corporate charter articles of incorporation or by laws when we are a company organized for the sole purpose of providing members of an organization with insurance coverage in North Carolina. We will mail or deliver written notice of cancellation to the first Named Insured at least i 15 days before the effective date of cancellation if we cancel for nonpayment of premium or i 30 days before the effective date of cancellation if we cancel for any other reason. c. Cancellation for nonpayment of premium will not become effective if you pay the premium amount due before the effective date of cancellation. d. We may also cancel this policy for any reason not stated above provided we ob tain your prior written consent. B. The following provisions are added and super sede any other provisions to the contrary 1. Nonrenewal a. If we elect not to renew this policy we will mail or deliver to the first Named In sured shown in the Declarations written notice of nonrenewal at least 45 days pri or to the 1 Expiration of the policy if this policy has been written for one year or less or 2 Anniversary date of the policy if this policy has been written for more than one year or for an indefinite term. b. We need not mail or deliver the notice of nonrenewal if you have 1 Insured property covered under this policy under any other insurance poli cy 2 Accepted replacement coverage or 3 Requested or agreed to nonrenewal of this policy. c. If notice is mailed proof of mailing will be sufficient proof of notice. 2. The written notice of cancellation or nonre newal will a. Be mailed or delivered to the first Named Insured and any designated mortgagee or loss payee at their addresses shown in the policy or if not indicated in the poli cy at their last known addresses and b. State the reason or reasons for cancella tion or nonrenewal. Page 2 of 2 IS0 Properties Inc. 2007 IL 02 69 08 | 2 |
ENDORSEMENT This endorsement effective 1201 A.M. 09302019 forms a part of 686 24 15 policy No. GL issued to EAGLE TRANSPORT CORPORATION by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOTAL LEAD EXCLUSION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL UMBRELLA LIABILITY This insurance does not apply to any bodily injury property damage personal and advertising injury or any other loss cost or expense arising out of the presence ingestion inhalation or absorption of or exposure to lead in any form or products containing lead. 72 AutHorized Representative or Countersignature in States Where Applicable 58332 0807 Includes copyrighted material of Insurance Services Office Inc. with its permission Page 1 of 1 | 2 |
ENDORSEMENT This endorsement effective 1201 A.M.09302019 forms a part of policy No. GL 686 24 15 issued to EAGLE TRANSPORT CORPORATION by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROAD FORM NAMED INSURED This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM Policy Declarations Named Insured is revised to include Named Insured means the person or organization first named as the Named Insured on the Declarations Page of this policy the First Named Insured. Named Insured also includes 1 any other person or organization named as a Named Insured on the Declarations Page 2 any subsidiary associated affiliated allied or acquired company or corporation including subsidiaries thereof of which any insured named as the Named Insured on the Declarations Page has more than 50 ownership interest in or exercises management or financial control over at the inception date of this policy provided such subsidiary associated affiliated allied or acquired company or corporation and their operations have been declared to us prior to the inception date of this policy. All other terms and conditions remain unchanged. Vs AUTHORIZED REPRESENTATIVE Page 1 of 1 Includes copyrighted information of Insurance Services Office Inc. with its permission. 61944 914 | 2 |
ENDORSEMENT This endorsement effective 1201 A.M. 09302019 forms a part of 686 24 15 policy No. GL issued to EAGLE TRANSPORT CORPORATION by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UNINTENTIONAL ERRORS AND OMISSIONS ENDORSEMENT This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM Section IV Commercial General Liability Conditions 6. Representations is amended by adding d. The unintentional failure by you or any Insured to provide accurate and complete representations as of the inception of the policy will not prejudice the coverages afforded by this policy. Applicable Page 1 of 1 62132 1008 | 2 |
ENDORSEMENT This endorsement effective 1201 A.M. 09302019 forms a part of policy No. GL 686 24 15 issued to EAGLE TRANSPORT CORPORATION by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RADIOACTIVE MATTER EXCLUSION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM Section I. Coverages Coverage A. Bodily Injury and Property Damage Liability 2. Exclusions is amended to add Bodily injury or property damage arising out of the actual alleged or threatened exposure of persons or property to any radioactive matter or any form of radiation. Section I. Coverages Coverage B. Personal and Advertising Liability 2. Exclusions is amended to add Personal and advertising injury arising out of the actual alleged or threatened exposure of persons or property to any radioactive matter or any form of radiation. Autl d Representative 62898 0712 Includes copyrighted material of Insurance Services Office Inc. with its permission. Page 1 of 1 | 2 |
ENDORSEMENT This endorsement effective 1201 A.M. 09302019 forms a part of policy No. GL 686 24 15 issued to EAGLE TRANSPORT CORPORATION by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ERISA EXCLUSION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM Section I. Coverages Coverage A. Bodily Injury and Property Damage Liability 2. Exclusions is amended to add Bodily injury or property damage arising out of any obligation you incur under the Employee Retirement Income Security Act of 1974 Public Law 93 406 any law amendatory thereof or any regulation pertaining thereto. Section. Coverages Coverage B. Personal and Advertising Liability 2. Exclusions is amended to add Personal and advertising injury arising out of any obligation you incur under the Employee Retirement Income Security Act of 1974 Public Law 93 406 any law amendatory thereof or any regulation pertaining thereto. Ause ntative 64004 0712 Includes copyrighted material of Insurance Services Office Inc. with its permission. Page 1 of 1 | 2 |
ENDORSEMENT This endorsement effective 1201 A.M. 09302019 forms a part of 686 24 15 policy No. GL issued to EAGLE TRANSPORT CORPORATION by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DELETION OF CONTRACTUAL LIABILITY EXCLUSION COVERAGE B This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM Section Coverages Coverage B. Personal and Advertising Injury Liability 2. Exclusions e is deleted in its entirety. Auth d Representative or Countersignature in States Where Applicable 65329 901 | 2 |
ENDORSEMENT This endorsement effective 1201 A.M. 09302019 forms a part of 686 24 15 policy No. GL issued to EAGLE TRANSPORT CORPORATION by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PERSONAL INJURY DEFINITION EXTENSION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART Section V Definitions 14. Personal injury and Advertising injury is amended to read 14. Personal injury and advertising injury means injury including consequential bodily injury humiliation mental anguish or shock arising out of one or more of the following offenses a. False arrest detention or imprisonment Malicious prosecution The wrongful eviction from wrongful entry into or invasion of the right of private occupancy of a room dwelling or premises that a person occupies by or on behalf of its owner landlord or lessor Oral or written publication of material in any manner that slanders or libels a person or organization or disparages a person s or organization s goods products or services or Oral or written publication in any manner of material that violates a person s right of privacy. The use of another s advertising idea in your advertisement or Infringing upon another s copyright trade dress or slogan in your advertise ment. Auth d Representative or Countersignature in States Where Applicable 74447 901 | 2 |
LARGE RISK RATING PLAN ENDORSEMENT PLAN TYPE ONE YEAR This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. The following attaching clause needs to be completed only when this endorsement is issued subsequent to the preparation of the policy. This Endorsement effective 1201 AM 09302019 forms a part of Policy Number GL 6862415 Issued to EAGLE TRANSPORT CORPORATION By National Union Fire Insurance Company of Pittsburgh Pa. PART I. GENERAL TERMS and CONDITIONS This endorsement determines the Final Premium for the insurance provided during the Rating Period by this policy any other policy described in this endorsement in Section 1 of PART II and the renewals and replacements of each the policies. The Rating Period begins and ends at 1201 AM on the respective dates shown in Section 1 of PART II. If the Plan Type of this endorsement states Construction Project this endorsement applies only to and for the duration of the construction project described in Section 1 of PART II. The rates and the basis types described in PART Il will remain fixed for the duration of the Rating Period except if applicable Section 7 Claims Service Charges on Fee Basis Section 8 Taxes Assessments and Surcharges and any applicable items set forth in Section 11 Exceptions. These exceptions will be subject to change at each anniversary of the beginning of the Rating Period. Section 1. Premium Calculation The Final Premium for the policies will be the sum of the total Subject Premium and the total Non Subject Premium. The way that the total Subject Premium will be determined is described below and is shown in Section 9 Item A of PART II. The way that the total Non Subject Premium will be determined is described below and is shown in Section 9 Item B of PART Il A. Total Subject Premium The total Subject Premium for the policies will be determined separately by state and kind of insurance. For each state and kind of insurance the Subject Premium shall be the sum of Subject Losses and the Charges for the Insurance Charge Expenses and Profit divided by the Tax Assessment Divisor as determined below. 1. Subject Losses The first part of the Subject Premium will be the sum of all Subject Losses under any applicable terms of the policies described in Section 1 of PART Il and as identified in Section 5 Item A of PART II. 2. Charges for Insurance Charge Expenses and Profit The second part of the Subject Premium will be the component parts of the Subject Premium other than Subject Losses that are identified as line items in Section 9 Item A of PART Il. The entire estimated amount of each such charge can be found in Section 9 Item A of PART Il subject to any applicable Minimum Premium shown for it. We will apportion the entire amount of each such charge to each kind of insurance and state covered under the policies in proportion to the respective Standard Premium of each except that a. Charges for claims service expenses will be allocated in proportion to respective Subject Losses and b. Charges for administrative expenses and profit for the kinds of insurance in the states described in Section 2 of PART Il will be the difference between i. the Final Premium for such kinds of insurance and states determined as provided for in the policy other than by this Endorsement and ii. the sum of Subject Losses all other charges for the Insurance Charge Expenses and Profit included in this item 2 taxes and assessments determined through the application of the Tax Assessment Divisor and Non Subject Premiums for such states. 3. Tax Assessment Divisor One 1.000 less the Tax Assessment Rate as shown in Section 9 Item A of PART Il The rate is calculated as indicated in Section 8 of PART Il B. Total Non Subject Premium The part of the Final Premium for the kinds or layers of insurance described in Section 9 Item B of PART Il will be calculated as shown therein. If no Basis of premium determination for Non Subject Premium is shown in Section 9 Item B of PART II the Non Subject Premium will be determined as set forth in the policy under which such insurance is provided. Form No. 81461 804 Copyright 2004 American International Group Inc. Page 1 of 15 ooz oosoz 0570539 | 2 |
LARGE RISK RATING PLAN ENDORSEMENT Section 2. Schedule of Premium Adjustments A. The estimated Final Premium is shown in Section 9 Item C of PART Il. We will recalculate the estimated Fina Premium as soon as practicable after the First Valuation Date shown in Section 5 of PART Il. We will recalculate the estimated Final Premium annually thereafter until you and we agree in writing that no more recalculations will be done. B. Additional premium due us or return premium due you resulting from the calculation or recalculation of the Final Premium will be payable in its entirety promptly unless otherwise specified in a premium finance agreement between you and us. Section 3. Expected Total Cost In addition to Final Premium you may be liable under the terms of the policies for reimbursements of certain losses and Allocated Loss Adjustment Expenses we pay subject to any Minimum Cost and Maximum Cost as described below and surcharges. Our estimated amounts for such additional costs if any are shown in Section 9 Item C of PART II. A. Minimum Cost If a Minimum Cost is applicable that amount is the minimum you must pay for the Subject Premium and if applicable Non Subject Premium Reimbursable Losses Deductible Losses Self Insured Losses and ALAE itemized in Section 6 Item A. c. of PART Il. Component items not itemized in Section 6 Item A. c. of Part Il are not included in the Minimum Cost. If an Adjustment Rate and a Basis of Adjustment are shown in Section 6 Item A. a. of PART Il the Minimum Cost will be determined by multiplying the Adjustment Rate by the actual Basis of Adjustment as determined by our final audit of your books and records. B. Maximum Cost If a Maximum Cost is applicable that amount is the maximum you must pay for Subject Premium and if applicable Non Subject Premium Reimbursable Losses Deductible Losses Self Insured Losses and ALAE itemized in Section 6 Item B. c. of PART Il. Component items not itemized in Section 6 Item B. c. of Part Il are not included in the Maximum Cost. If an Adjustment Rate and a Basis of Adjustment are shown in Section 6 Item B. a. of PART Il the Maximum Cost will be determined by multiplying the Adjustment Rate by the actual Basis of Adjustment as determined by our final audit of your books and records. Section 4. Definitions A. Aggregate Stop Amount means the maximum amount of benefits damages and ALAE payable by you for losses under the policies described in Section of PART Il subject to any Aggregate Stop Limit. B. Aggregate Stop Limit means the maximum amount of benefits damages and ALAE above the Aggregate Stop Amount that we will not require you to reimburse us for under any Loss Reimbursement or Deductible terms of the policies described in Section of PART II. C. Allocated Loss Adjustment Expenses or ALAE will include all fees for service of process and court costs and court expenses pre and post judgement interest attorneys fees cost of undercover operative and detective services costs of employing experts costs for legal transcripts copies of any public records and costs of depositions and court reported or recorded statements costs and expenses of subrogation and any similar fee cost or expense reasonably chargeable to the investigation negotiation settlement or defense of a loss or a claim or suit against you or to the protection and perfection of your or our subrogation rights. ALAE will not include loss adjustment expenses explicitly included in the premium calculation formula of Section 1 Paragraph A Item 2 of this PART or otherwise explicitly included in the rating values shown in PART II nor the salary employee benefits or overhead of any of our employees nor the fees of any attorney who is our employee or under our permanent retainer nor the fees of any attorney we retain to provide counsel to us about our obligations if any under any policy issued by us or our affiliated companies with respect to a claim or suit against you. ALAE Option selected and shown in Section 3 of PART Il is described below. a. Option A Subject Loss includes all or a part of all ALAE such that the Subject Loss will not exceed the applicable Retained Amount. b. Option B Subject Loss includes 100 of all ALAE. c. Option C Subject Loss includes all or a part of ALAE calculated according to the following formula i. if we incur NO obligation under the policies to pay damages benefits or indemnity resulting from a claim Subject Loss under that claim will include all ALAE up to the applicable Retained Amount and a percentage of all ALAE in excess thereof. That percentage is shown in Section 3 of PART Il under Option C Excess or Form No. 81461 804 Copyright 2004 American International Group Inc. Page 2 of 15 Y 0910612019 005102 9570339 | 2 |
LARGE RISK RATING PLAN ENDORSEMENT ii. if we DO incur an obligation to pay damages benefits or indemnity under the policies because of a claim Subject Loss under that claim will include all ALAE incurred under that claim multiplied by the amount of our obligation to pay damages or benefits up to the applicable Retained Amount divided by the total amount of our obligation to pay damages or benefits. d. Option D Subject Loss includes none of the ALAE. o Basis will have the meanings shown in Section 10 of PART Il E. Deductible Loss means any amount that you must reimburse us under a Deductible Endorsement of the policies described in Section of PART II. F. Final Premium means the premium for the insurance afforded under the policies described in Section 1 of PART Iland others as may be added by endorsement thereto upon its final recalculation according to the terms of the policies and this endorsement. Prior to such final recalculation the premium for such insurance is only the estimated premium. G. Incurred Loss means the total amount we have paid and have reserved for payment as damages or benefits because of an occurrence accident claim or suit and all the Allocated Loss Adjustment Expenses we incur in connection therewith under a policy described in PART I including reserves for occurrences accidents claims or suits that have happened but have not been reported to us and for statistically expected loss development on claims that have been reported to us. H. Minimum Cost means the minimum amount payable by you for the Schedule of Subject Premium and Reimbursable Losses and Deductible Losses and Self Insured Losses and ALAE if applicable described in Section 6 of PART II. I Maximum Cost means the maximum amount payable by you for the Schedule of Subject Premium and Reimbursable Losses and Deductible Losses and Self Insured Losses and ALAE if applicable described in Section 6 of PART II. Non Subject Premium means the premium not subject to the premium calculation of this endorsement. K. Reimbursable Loss means any amount that you must reimburse us under a Loss Reimbursement Endorsement of the policies described in Section of Part II. L. Retained Amount means 1. the amount that is specified as your Self Insured Retention or as the Loss Reimbursement amount or Deductible amount applicable to an ncurred Loss in the applicable policy or 2. if the foregoing does not apply the largest part of any damages or benefits paid or payable under a policy because of any single accident occurrence claim or suit that we will include in the computation of the Subject Premium. Such amount is shown in Section 4 of PART Il for each type of insurance afforded under the policies described in Section 1 of PART Il M. Self Insured Loss or SIR means any loss you incur under a Self Insured Retention of the policies described in Section of PART Il N. Standard Premium means the premium as calculated according to the terms of each applicable policy without application of this Endorsement subject to the following 1. For Workers Compensation and Employers Liability Insurance Standard Premium means the premium determined on the basis of our rates as approved by regulatory authority the remuneration of your employees in the coverage period your Experience Modifications and Schedule Modifications Loss Constant and Minimum Premiums. Determination of Standard Premium will exclude a. any discount that recognizes any reduction in our expense ratio based on premium size or other factors or b. any discount for a Loss Reimbursement or Deductible. c. Expense Constant. 2. For all other insurance Standard Premium is the premium as calculated according to the terms of each applicable policy for insurance within the Retained Amounts but without the application of this Endorsement and without reduction for a. any discount that recognizes any reduction in our expense ratio based on premium size or other factors or b. any discount for a Loss Reimbursement or Deductible. Form No. 81461 804 Copyright 2004 American International Group Inc. Page 3of 15 ooz oosoz 0570539 | 2 |
LARGE RISK RATING PLAN ENDORSEMENT 0. Subject Loss means the entire Incurred Loss including any reimbursable or deductible portion of it up to the sum of 1. the damages or benefits we must pay or have paid up to the Retained Amount and 2. all or a part of the Allocated Loss Adjustment Expenses we incur in accordance with the ALAE Option shown in Section 3 of PART Il and defined in Item C of this section. P. Subject Premium means the premium subject to retrospective adjustment on the basis described in Section 1 Paragraph A of this PART I. Section 5. Exceptions and Changes All exceptions and changes if any to the provisions of PART PART Il or PART Il of this endorsement are set forth in Section 11 of PART Il or in a written addendum hereto. Form No. 81461 804 Copyright 2004 American International Group Inc. Page 4 of 15 Y 0910612019 005102 9570339 | 2 |
LARGE RISK RATING PLAN ENDORSEMENT PART Il. SCHEDULE of POLICIES and RATING VALUES Section 1. APPLICATION of this Endorsement RATING PERIOD This Endorsement applies to the period beginning 09302019 and ending 09302020. The Basis of Premium Subject Losses Self Insured Losses Minimum Cost Maximum Cost Minimum Premiums and Estimated Premiums shown in Section 5 Section 6 Section 7 and Section 9 of this PART Il are estimated amounts for the first year of the Rating Period or X the entire Rating Period. POLICIES X This Endorsement applies to the policies described below and to their replacements and renewals effective during the Rating Period or This Endorsement applies to the policies described below and to their replacements and renewals and all subcontractor policies issued under a Construction Project. The Construction Project is described as follows a. Workers Compensation and Employers Liability Insurance policies WC 017515768 WC 017515769 WC 017515770 WC 017515771. b. Commercial General Liability Insurance policies GL 6862415. c. Automobile Liability Insurance policies CA 4993239 CA 4993240. d. Other Insurance policies described Section 2. Premiums for insurance on risks in states described below will be determined in accordance with the terms of the applicable policy other than this endorsement. Kinds of Insurance States wc FLFL Section 3. Allocated Loss Adjustment Expenses Options ALAE Option If ALAE Option C enter ALAE Option A enter Excess Applies to B C or D as applicable A 0 CA 4993239 CA 4993240 GL 6862415 WC 017515768 WC 017515769 WC 017515770 WC 017515771. POLICIES Form No. 81461 804 Copyright 2004 American International Group Inc. Page 5 of 15 Y 0910612019 005102 9570339 | 2 |
LARGE RISK RATING PLAN ENDORSEMENT Section 4. Retained Amounts applicable to all insureds or X refer to Extension Schedule Kind of Insurance Retained Applicable to Limitations or Amount Descriptions Workers Compensation Workers Compensation and Employers Liability See Schedule Each Accident or each under State Law Insured States Person for Disease Workers Compensation and Employers Liability See Schedule Each Accident or each under Federal Law Insured States Person for Disease Workers Compensation and Employers Liability See Schedule Each Accident or each Self Insured States Person for Disease Employers Liability Monopolistic States Each Accident or each Person for Disease Each Accident or each Person for Disease Commercial General Liability Premises Operations Personal and Advertising 100.000 Each Occurrence Injury Medical Payments or Damage to Property Liability Products or Completed Operations Liability 100000 Each Occurrence Other Liquor Liability 0 Each Common Cause Other Owners And Contractors Protective o0 Each Occurrence Liability Other Railroad Protective Liability 0 Each Occurrence Commercial Automobile Lial UM UIM and PIP No Fault if any y including Automobile Liability 0 Each Accident Garage Liability 0 Each Accident Each Accident Other Motor Carrier Truckers Liability See Schedule Any one Accident or Loss Combined Kinds Retention Each Occurrence Section 5. Forecast of Subject Losses We have shown our forecast of your Subject Losses below. a. Reimbursable and deductible portion of covered ncurred Losses except amounts insured under 3962416 Deductible Liability Protection policies if any subject to this Endorsement b. All other covered Subject Losses including amounts insured under Deductible Liability 292760 Protection policies if any subject to this Endorsement First Loss Valuation Date 03312021 and annually thereafter until all claims are closed or mutually agreed upon as to value. Section 6. Minimum Cost and Maximum Cost The Minimum Cost and Maximum Cost if any will be applied as explained below. Form No. 81461 804 Copyright 2004 American International Group Inc. Page 6 of 15 ooz oosoz 0570539 ich Occurrence ich Occurrence urrence ich Accident ich Accident ich Accident rrence | 2 |
LARGE RISK RATING PLAN ENDORSEMENT Item A. Minimum Cost applicable or X not applicable Line of Insurance Minimum Cost adjustable on the Basis and rate shown below 0 Basis of Adjustment Per 0 Estimated Basis amount 1 Adjustment Rate 0.0000 Self Insured Losses you incur to which no insurance under the policies described in Section 1 of this PART Il applies will NOT be included in determining whether or when the Minimum Cost has been reached except as described herein Exceptions Our forecast of your Self Insured Losses included in paragraph a. above 0 The following Minimum Cost itemization schedule applies Item B. Maximum Cost applicable or X not applicable Line of Insurance The Maximum Cost will not be less than the estimated amount shown below unless otherwise set forth in Section 11 of PART Two. a. Maximum Cost adjustable on the Basis and rate shown below 0 Basis of Adjustment Per 0 Estimated Basis amount 1 Adjustment Rate 0.0000 b. Self Insured Losses you incur to which no insurance under the policies described in Section 1 of this PART Il applies will NOT be included in determining whether or when the Maximum Cost has been reached except as described herein Exceptions Our forecast of your Self Insured Losses included in paragraph a. above 0 The following Maximum Cost itemization schedule applies Form No. 81461 804 Copyright 2004 American International Group Inc. Page 7 of 15 Y 0910612019 005102 9570339 | 2 |
LARGE RISK RATING PLAN ENDORSEMENT Section 7. Claims Service Charges X Charge shown in Section 9 Item A Subject Premium of PART Il or fee schedule described below. The Claims Service Provider is AIG Claims Inc. FEE SCHEDULE X If Xed here the following fee schedule applies Claims Services Fee Schedule Rates per Claimant Type of Claim Rate per Claimant Estimated No. of Estimated Fee Claimants Workers Comp Medical 165.00 44 7260 Indemnity 0.00 0 California 1650.00 0 0 Texas 1550.00 5 7750 AOS 1350.00 13 17550 Surcharge Claims 0.00 0 Other 65.00 1 65 General Liability Bodily Injury 1250.00 3 3750 Property Damage 800.00 4 3200 Other 70.00 1 70 Product Liability Bodily Injury 0.00 0 0 Property Damage 2000.00 0 0 Other 0.00 0 Automobile Liability Bodily Injury 1050.00 88 92400 Property Damage 650.00 132 85800 Physical Damage 500.00 0 Other 65.00 1 65 Incident Reports 0.00 0 Int. to Designated States 0.00 0 Other 0.00 0 General Liability Premises Medical Only 200.00 0 Employers Liability 2050.00 0 0 Estimated Total Rate per Claimant Fee 217910 1250.00 800.00 70.00 3750 3200 70 0.00 2000.00 0.00 0 0 0 1050.00 650.00 500.00 65.00 0.00 0.00 0.00 92400 85800 0 65 0 0 0 Form No. 81461 804 Copyright 2004 American International Group Inc. Page 8 of 15 Y 0910612019 005102 9570339 | 2 |
LARGE RISK RATING PLAN ENDORSEMENT X If Xed here the following fee schedule applies Additional Service Fees Details Additional Service Fees Item Count Rate ltem Estimated Fee Quarterly Loss Report 0 0.00 0 Subcontractor Interoffice Supervision 0 0.00 0 Magnetic Tape Fee 0 0.00 0 Subrogation 0 0.00 0 Appraisals 0 0.00 0 TPA Expenses 0 0.00 0 GAB Expenses 0 0.00 0 Cash Management Account Services 0 0.00 0 Claim File Reviews 0 0.00 0 Contingency Recovery Fees 0 0.00 0 Incoming Quality Control 0 0.00 0 Legal Cost Control 0 0.00 0 Location Visits 0 0.00 0 Semiannual Client Meetings 0 0.00 0 RMIS Reports 0 0.00 0 Customized Account Servicing 0 0.00 0 Structured Settlement Program 0 0.00 0 Reporting 0 0.00 0 Conversion 0 0.00 0 Minimum Adjusting Fee 0 0.00 0 Intellirisk Charges 0 0.00 0 Administration Fee 1 21791.00 21791 Estimated Additional Services Fee 21791 Tail Fees Details Tail Fees Item Count Rate ltem Estimated Fee Workers Comp Med. Only 0 0.00 0 Workers Comp. Indemnity 0 0.00 0 General Liability 0 0.00 0 Products Liability 0 0.00 0 Auto Liability 0 0.00 0 Maintenance 0.00 0 Estimated Tail Fee 0 or Interoffice Supervision pe Fee es es lement Account Services eviews Recovery Fees iality Control ontrol its Client Meetings ts Account Servicing Settlement Program Jjusting Fee arges Indemnity y Form No. 81461 804 Copyright 2004 American International Group Inc. Page 9 of 15 Y 0910612019 005102 9570339 | 2 |
LARGE RISK RATING PLAN ENDORSEMENT If Xed here the following fee schedules applies Fee Schedule Time and Expenses Type of Charge Rate Per Est. Units Estimated Fee Investigating Service by Employed Staff Hour Adjuster Hour General Adjuster Hour Executive General Adjuster Hour Heavy Equipment Appraiser Hour Auto Damage Appraiser Hour Property Damage Appraiser Hour Supervisor Hour Examiner Hour Account Manager Hour Subcontracted Investigations And Appraisals Hour Clerical and Statistical Processing Hour Other Expenses including Telephone Minute Postage Express Mail Cost Auto Mileage Rental Tolls Parking Mile Photocopies Copy Photography Photo Public Transportation Cost Overhead Flat Services Outside of USA Estimated Total Time and Expense 0 Estimated Total Claims Service Expenses 239701 uster eneral Adjuster oment Appraiser ge Appraiser mage Appraiser anager vestigations And Appraisals stical Processing including xpress Mail je Rental Tolls Parking y sportation Form No. 81461 804 Copyright 2004 American International Group Inc. Page 10 of 15 Y 0910612019 005102 9570339 | 2 |
LARGE RISK RATING PLAN ENDORSEMENT Section 8. Taxes and Assessments The taxes and assessments determined by the method indicated by the box Xd below shall apply in determining the Final Premium earned under the policies described in Section 1 of Part Il during the first annual term of this endorsement. If the Rating Period under this endorsement is longer than 1 year we will provide you written notice of the applicable taxes and assessments for the subsequent term of the Rating Period not less than thirty 30 days prior to each anniversary of this endorsement. X Item A. Fixed Rates The Average Rates for taxes and assessments are shown in Item A. of Section 9 of PART Il. The Average Rates will be fixed and applied without change in determining the Fina Premiums earned under the policies described in Section of PART Il during the first annual period of this Endorsement. Item B. Rates to be Recalculated The Average Rates for taxes and assessments are shown in Item A. of Section 9 of Part Il. The Average Rates will be recalculated to determine the Final Premium under the policies described in Section of PART II based on the rates shown in the chart below. Form No. 81461 804 Copyright 2004 American International Group Inc. Page 11 of 15 Y 0910612019 005102 9570339 | 2 |
LARGE RISK RATING PLAN ENDORSEMENT Section 9. The Rating Values and Amounts Basis shown below apply as the Final Premium of the If the Rating Period exceeds one year and if the estimated Basis of Premium Minimum Premiums and Estimated Premiums shown below apply only to the first year on or about each anniversary of the beginning of the Rating Period we will issue an extension of this Section to show the rating values and amounts for each subsequent year of the Rating Period. Item A. Subject Premium part of Final Premium Line Items Rates Per Basis Types Estimated Minimum Estimated Basis Premium Premium Expected Primary Losses 0.0000 1 Ultimate Losses o 0 292760 Claims Service Fees 0.0000 1 Contract of 239701 239701 Total Taxes and Assessments 0.0664 100 Payroll Excl. Mono. FL 45378000 0 30141 AL GL WC Expenses 0.2728 100 Payroll Excl. Mono. FL 45378000 123785 123785 Subtotal 686387 Taxes Assessments 0.0000 or Taxes Assessments Divisor 0.0000 0 Estimated Total Subject Premiums 686387 Item B. Non Subject Premiums part of Final Premium Coverage Description Rates Per Basis Types Estimated Minimum Estimated Basis Premium Premium Excess PremiumALThe Entire 3666.8193 1 Power Units Vehicles 487 1736554 1736554 Contract Excess PremiumWCThe Entire 0.6728 100 WC Payroll 63405001 426568 426568 Contract Excess PremiumGLThe Entire 0.7138 1000 Sales 150000000 107077 107077 Contract Excess PremiumALAuto Virginia 3565.8235 1 Power Units Vehicles 51 181857 181857 Non LRRP WCWC Non LRRP 0.0000 1 Audited Earned Premium 0 0 177195 Estimated Total Non Subject Premiums 2629251 Item C. Summary of Expected Total Cost Estimated Final Premium Part A. plus Part B 3315638 Expected Reimbursable Losses and Deductible Losses and Self Insured Losses and ALAE if applicable 3962416 Minimum Cost from Section 6. If not applicable show 0 0 Maximum Cost from Section 6. If not applicable show 0 0 Surcharges 0.0000 1 Audited Earned Premium 0 0 62189 EXPECTED TOTAL COST 7340243 Form No. 81461 804 Copyright 2004 American International Group Inc. Page 12 of 15 Y 0910612019 005102 9570339 | 2 |
LARGE RISK RATING PLAN ENDORSEMENT Section 10. Basis of Premium Payroll means all of the money or the substitute for money earned during the terms of the policies described in Section 1 of this PART Il by you if you are the proprietor of the insured business by all partners or joint venturers if you are a partnership or joint venture by all members if you are a limited liability company and by all employees including temporary employees and workers leased by you from any employee leasing organization for their services to you during the policy period subject to limitations set forth in the New York Workers Compensation Rating Bureau s manual rules if applicable. Sales means the gross amount of money you or others trading in your name have charged for all goods and services you or they have sold or distributed during the terms of the policies described in Section 1 of this PART Il including charges for delivery installation service and repair and including taxes other than taxes which you or such others collect as a separate item and remit directly to a government division. Receipts means the gross amount of money you have charged others for work that you your partners your employees your contractors and subcontractors at all levels have performed during the terms of the policies described in Section 1 of this PART Il including taxes other than taxes which you or such others collect as a separate item and remit directly to a government division. Cost means the total cost to you for all work performed for you during the terms of the policies described in Section 1 of this PART Il by independent contractors and their subcontractors at all levels including the cost of all labor materials equipment and supplies furnished used or delivered for use in the execution of such work whether furnished by the owner by contractors or subcontractors at any level including but not limited to all fees allowances bonuses and commissions either made paid or due as well as taxes other than taxes which you collect as a separate item and remit directly to a government division. Units means the number of items of the type specified in this endorsement. Units that you hold for use in your business will mean the sum of their number at the inception of the terms of the policies described in Section 1 of this PART Il plus their number at their expiration or termination times 50 of the fraction of a full year that such policies were in force. Units that you sell to others whether for your own account or the account of another means the total number of such units that you sell during the term of such policies. Indemnitymeans the total amount we have paid and have reserved for payment as Workers Compensation Losses benefits other than Medical benefits under a policy described in this PART II including reserves for accidents or illness that have happened but have not been reported to us and for statistically expected loss development on claims that have been reported to us. U ltimatemeans the Forecast of Subject Losses in Final Premium from Part Il Section 5.b. Losses Other Other Section 11. Exceptions PART I. GENERAL TERMS and CONDITIONS Section 1. Premium Calculation A. Total Subject Premium 1. is amended to read Subject Losses The first part of the Subject Premium will be the sum of all Subject Losses under any applicable terms of the policies described in Section 1 of PART Il and as identified in Section 5 Item b. of PART II. PART I. GENERAL TERMS AND CONDITIONS Section 4. Definitions C. Allocated Loss Adjustment Expense is amended to include the following additional wording Medical Management Fees which may include medical bill audit fees utilization management fees network access fees case management fees and any other costs associated with medical management services. Sales Receipts Cost Units Form No. 81461 804 Copyright 2004 American International Group Inc. Page 13 of 15 Y 0910612019 005102 9570339 | 2 |
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