text stringlengths 1 8.07k | labels int64 0 2 |
|---|---|
D. LEGAL COSTS 1. We will pay with respect to any Suit brought against you by a Covered Person as a direct result of a Kidnap Extortion or Wrongful Detention occurring during the Policy Period those sums that you become legally obligated to pay as damages as a result of a judgment or settlement with our prior approval of such a Suit. 2. We will have the right to investigate negotiate or settle any such claim or Suit or to take over the conduct of the defense thereof and you will cooperate with us to these ends pursuant to Section VII subsection C of this Policy. E. MEDICAL DEATH OR DISMEMBERMENT As aresult of a Covered Event 1. we will reimburse you for reasonable and customary medically necessary hospital surgical and other medical and dental expenses incurred by a Covered Persons andor paid by you within twenty four 24 months following either the release of such Covered Persons or the last reasonably credible Extortion threat occurring during the Policy Period including a. any reasonable and customary medically necessary costs for care by a neurologist psychologist or psychiatrist and expense of confinement for such care and b. cosmetic surgery which is required to correct any permanent disfigurement sustained by a Covered Persons directly as a result of a Covered Event. Reasonable and customary charges are those that are the same as or compare fairly with charges made for similar services or supplies to individuals with similar medical or dental conditions in the same geographic area in which the Covered Persons resides 2. If a Covered Persons loses his her life or suffers any Bodily Injury we will pay the following percentages of the benefit amounts listed in the Declarations Loss of Life 100 of Benefit Complete physical severance of the hand or foot 100 of Benefit Irrecoverable loss of sight of an eye Total permanent paralysis or Total permanent disability of any limb Loss of any finger or 50 of Benefit Complete physical severance of one half or more of atoe nose ear or genitalia No more than 100 of the amounts stated in the Declarations for Medical Death or Dismemberment will be paid for Bodily Injury to any one Covered Person. F. INCIDENT RESPONSE We will reimburse you for 1. reasonable and customary fees and expenses of security consultants provided by us or other independent security consultants retained by you for the exclusive function of responding to a Covered Event provided that we have given our prior consent to the use of such other independent security consultants and IT7037 version date 07 2012 Page 2 of 13 2012 K4F 2122016 | 2 |
2. any other reasonable and customary fees and expenses of other specialist consultants retained by you for the exclusive function of responding to a Covered Event including but not limited to public relations consultants or private investigation consultants provided we have given our prior consent to the use of such specialist consultant. DEFINITIONS The following words when used in this Coverage Form have these meanings A. G. Application means all applications including any attachments thereto and all other information and materials submitted by you or on your behalf to us in connection with our underwriting this Policy or any policy of which this Policy is a renewal replacement or which it succeeds in time. Bodily Injury means death of or physical injury to a Covered Persons sustained as a direct and sole result of a Covered Event. Covered Event means those events shown in Section COVERED EVENT or a series of connected acts thereof. If it is evident from the demands or the making of such demands that Kidnaps andor Extortions andor Detentions are or were carried out in furtherance of one another they shall be deemed to be connected and to constitute a single Covered Event. In no event shall we have any liability nor shall there be any coverage under this Coverage Form with respect to a series of Kidnaps andor Extortions andor Detentions the first of which commenced before the Policy Period of this Policy. Covered Loss means any Expense payment cost benefit or other covered expenditure as described under this Coverage Form sustained directly as a result of a Covered Event. Covered Persons means 1. directors officers and employees of the Named Insured and any Subsidiary. 2. a spouse or domestic partner child including step adopted foster spouse of married child or child s domestic partner parent including step or in law sibling including step half foster adopted or in law niece nephew aunt uncle lineal ancestor or descendant or spouse or domestic partner of a lineal ancestor or descendant of a persons named in paragraph 1 above 3. any person visiting the home of or normally domiciled in the home of a persons named in paragraph 1 above and any person or customer of yours while on your Property or while traveling with any persons named in paragraph 1 above and 4. any persons authorized by you or by a Covered Person to deliver the Extortion Ransom Monies. Employee Compensation means the total gross salary including bonuses commissions welfare and benefits contributions and any other contributions and allowances contractually due to a a Covered Person b an individual newly hired to conduct the specific duties of the Covered Person while the Covered Person is the victim of a Kidnap or a Wrongful Detention andor c an individual who leaves his her employment in order to assist in the negotiation of the release of the Covered Person and who has been specifically designated by you to so assist. Expense means as a direct result of a Covered Event only the following a. reasonable payment by you to an Informant who contributes to the resolution of the Covered Event IT7037 version date 07 2012 Page 3 0f 13 2012 K4F 2122016 | 2 |
reasonable and customary loan costs incurred by you from a financial institution for obtaining money to be used for Extortion Ransom Monies payments reasonable and customary travel and accommodation costs incurred by you or a Covered Persons as follows i. directly related to the resolution of a Covered Event ii. for a Covered Person who is the victim of a Kidnap or Wrongful Detention to join his her immediate family upon his her release and the travel accommodation costs including lodging and meals of a newly hired individual to replace the Covered Person who is a victim of a Kidnap or Wrongful Detention. These costs will apply only once per Covered Persons and replacement persons andor to evacuate a Covered Person andor his or her spouse andor children living in the same household as the Covered Person who is the victim of a Kidnap or Wrongful Detention Employee Compensation paid by you i. up to thirty 30 days after the release of the Covered Persons from a Kidnap or Wrongful Detention or ii. up to discovery of the death of the Covered Persons or iii. up to one hundred twenty 120 days after we receive the last reasonably credible evidence that the Covered Persons is still alive or iv. up to sixty 60 months after the date of the Kidnap or Wrongful Detention if the victim has not been released Personal Financial Loss suffered by a Covered Persons reasonable and necessary fees and expenses of a qualified interpreter retained directly to assist you in resolving a Covered Event reasonable and necessary expenses of independent forensic analysts engaged by you increased costs of security resulting directly from Kidnap or Extortion threats including but not limited to hiring of security guards hiring of armored vehicles and overtime pay to existing security staff for a period of up to ninety 90 consecutive days provided that the security consultant has specifically recommended such security measures job retraining costs for a Kidnap or Wrongful Detention victim including but not limited to the salary of the Kidnap or Wrongful Detention victim while being retrained and costs of external training courses reasonable rest and recovery expenses including travel lodging meals and recreation for a Covered Persons who is a victim of a Kidnap or Wrongful Detention with his her spouse andor children for a period not exceeding thirty 30 consecutive days and incurred by you within six 6 months following the conclusion of the Covered Event provided however that we will pay no more than 100000 for all victims and family members for any one Covered Event and other reasonable and customary expenses incurred by you directly related to negotiating the release of a Covered Person. IT7037 version date 07 2012 Page 4 of 13 2012 K4F 2122016 | 2 |
H. Extortion means a threat or series of threats to Kidnap cause Bodily Injury Property Damage or Product Adulteration or disclose your Proprietary Information including any personal private or confidential information about you or a Covered Persons for the purpose of demanding Extortion Ransom Monies as a condition not to carry out such threat. Extortion Ransom Monies means consideration for the return of a Kidnap victim or consideration to terminate or end an Extortion paid to a persons believed to be responsible for the Kidnap or Extortion including but not limited to cash securities marketable goods or services property or monetary instruments. Informant means any person other than the Covered Persons providing information not otherwise obtainable solely in return for compensation. Kidnap means the illegal abduction and holding hostage of one or more Covered Persons for the purpose of demanding Extortion Ransom Monies as a condition of release. A Kidnap in which more than one Covered Persons is abducted will be considered a single Kidnap. Named Insured means the organization named in the Declarations. Personal Financial Loss means financial loss suffered by a Covered Persons solely and directly as the result of the physical inability of a Covered Persons to attend to personal financial matters while a victim and as a direct result of a Covered Event. Policy Period means the time period stated in the Declarations of this Policy. Product Adulteration means the intentional act of contaminating polluting or rendering harmful or unfit for their intended use products or goods manufactured handled or distributed by you or publicity implying or stating the same. Property means any building and contents or equipment fixed or mobile owned or leased by you as a place to conduct business or a residence occupied by any director officer or employee and for which you or the Covered Persons is legally liable. Property Damage means physical loss of or damage to tangible Property or electronic data including the corruption or modification of data or denial of access to computer or network services. Proprietary Information means any information which you maintain as a trade secret and includes methods processes devices and techniques particular to the conduct of your business. Subsidiary means any entity in which the Named Insured 1. owns interests representing 50 or more of the voting appointment or designation power for the selection of a majority of the board of directors if such entity is a corporation the management committee members if such entity is a joint venture the members of the management board if such entity is a limited liability company or the general partners of a partnership or 2. has the right pursuant to written contract or the by laws charter operating agreement or similar documents of an entity to elect appoint or designate a majority of the board of directors if such entity is a corporation the management committee members if such entity is a joint venture the members of the management board if such entity is a limited liability company or the general partners of a partnership. Suit means a civil lawsuit or arbitration arising from a Covered Event provided that such proceeding is brought within twelve 12 months after the release or death of a kidnapped or detained Covered Persons or the last reasonably credible Extortion threat occurring during the Policy Period but in no event longer than sixty 60 months after the inception of the Kidnap Extortion or Wrongful Detention. IT7037 version date 07 2012 Page 5 of 13 2012 K4F 2122016 | 2 |
u. V. Wrongful Detention means the arbitrary or capricious act of confining or detaining a Covered Persons against his her will for whatever reason whether by local governmental authorities or those purporting to act on behalf of local governmental authorities or by those acting or purporting to act on behalf of any insurgent party organization or group. A Wrongful Detention in which more than one Covered Persons is detained will be considered a single Wrongful Detention. Throughout this Coverage Form the terms you and your mean the persons people or organizations including any Subsidiaries shown as the Named Insured in the Declarations. Besides you there may be other people insured under certain parts of the Coverage Form. We us and our mean the insurance company issuing the Policy. IV. EXCLUSIONS This Coverage Form does not apply to any loss cost damage injury liability obligation or expense resulting directly or indirectly from A. E. Any fraudulent illegal or dishonest act committed by you a Covered Persons or any person you authorize to have custody of Extortion Ransom Monies or Monies or property surrendered away from the Property in any face to face encounter involving the use or threat of force or violence unless surrendered by a person in possession of such monies at the time of such surrender for the sole purpose of conveying it to pay an Extortion or demand for Extortion Ransom Monies previously communicated to you or to the Covered Person or. Monies or property surrendered on the Property unless brought onto the Property after receipt of the Extortion or demand for Extortion Ransom Monies for the purpose of paying such demand or Regarding Wrongful Detention only 1. A Covered Persons in direct employment of a government military intelligence or law enforcement agency or 2. Any violation by you or a Covered Persons of the laws of the country of residence or where a Covered Persons is traveling. This would include a failure by you or a Covered Persons to maintain all legally required travel documents. However this exclusion will not apply to any detention resulting from allegations that are deliberately false fraudulent and malicious and made solely to achieve a political propaganda andor coercive effect upon or at the expense of you or a Covered Persons. You agree to reimburse us for any payments made hereunder by us which are ultimately determined not to be covered because of the application of this exclusion. Fines penalties punitive or exemplary damages or the multiple part of multiplied damages. V. LIMITS OF LIABILITY NON ACCUMULATION OF LIABILITY A. For each Covered Loss the maximum limit and aggregate limit of our liability hereunder will not exceed the corresponding amounts set forth in the Declarations by reason of any Covered Event except as stated herein regardless of the number of Covered Persons under the Coverage Form. All Covered Losses arising from a Covered Event will be deemed to have been incurred during the Policy Period in which the Covered Event commenced. Regardless of the number of years this Coverage Form continues in force and of the number of premiums which will be payable or paid or of any other circumstances whatsoever our liability under this Coverage Form with respect to any Covered Losses will not be cumulative from year to year or Policy Period to Policy Period. When there is more than one Covered Person the aggregate Limit IT7037 version date 07 2012 Page 6 of 13 2012 K4F 2122016 | 2 |
of Liability under this Coverage Form for Covered Losses sustained by any or all of them will not exceed the amount for which we would be liable if all such Covered Losses were sustained by any one of them. VI. CONDITIONS PRECEDENT TO OUR LIABILITY In the event of a Covered Event A. You must provide us or any of our authorized agents as soon as practicable with written and oral notice containing particulars sufficient to identify you and also reasonably obtainable information with respect to the time place and circumstances of the Covered Event and the names and addresses of the victims and of available witnesses. B. You also must provide us with periodic and timely updates along with detailed reports of all significant events relating to the Covered Event. C. You must investigate all reasonably obtainable information and determine whether a Covered Event has actually occurred and is not a hoax prior to any liability attaching under this Coverage Form. D. Prior to the payment of any Extortion Ransom Monies Expenses you first must have approved payment of such Extortion Ransom Monies. VIl. GENERAL POLICY CONDITIONS As respects to this Coverage Form the following General Policy Conditions supersede and replace those stated in the Common Policy Conditions of this Policy. A. APPRAISAL If we can not agree with you on the amount of the Covered Loss either of us can demand that the following procedure be used to determine the amount. 1. You or we will request in writing that the dispute be submitted to appraisal within sixty 60 days from the time we receive your proof of Covered Loss. Each of us will then select an appraiser and notify the other of that choice within twenty 20 days of the initial request. 2. The appraisers will select an impartial umpire. If they can not agree on an umpire within fifteen 15 days either you or we can ask that an umpire be appointed by a judge of the court in the jurisdiction in which the appraisal is pending. 3. The appraisers will appraise each item of Covered Loss. If they can not agree they will submit any differences to the umpire. An agreement in writing by any two of these three will determine the amount of the Covered Loss. Each appraiser will be paid by the party selecting that appraiser. Other expenses of the appraisal and the compensation of the umpire will be paid equally by you and us. B. ASSIGNMENT Assignment of interest under this Coverage Form will not bind us until our consent is endorsed hereon. C. ASSISTANCE AND COOPERATION 1. If claim is made or Suit is brought against you as set forth in Section I COVERED LOSS subsection D LEGAL COSTS you will immediately forward to us every demand notice summons or other process received by you or your representative. You will also IT7037 version date 07 2012 Page 7 of 13 2012 K4F 2122016 | 2 |
a. Not admit liability in any such Suit and b. Cooperate with us in conducting the defense of any such Suit. We will have the right but not the duty to investigate negotiate or settle any such Suit or to take over the conduct of the defense thereof and you will cooperate with us to these ends. 2. You and any other Covered Persons will cooperate with us and upon our request assist in making settlements in the conduct of Suits and in enforcing any right of contribution or indemnity against any person or organization who may be liable to you because of injury or damage with respect to which insurance is afforded under this Coverage Form and you will attend hearings and trials and assist in securing and giving evidence and obtaining the attendance of witnesses. You or any other Covered Persons will not except at your own cost voluntarily make payment assume any obligation or incur any expense other than for first aid to others at the time of a Covered Event. D. AUTHORIZATION By acceptance of this Coverage Form the Named Insured agrees to act on behalf of any of its Subsidiaries with respect to the giving and receiving of any return premiums that may become due under this Coverage Form the acceptance of endorsements and the giving or receiving of any other notice provided for in this Coverage Form and these Subsidiaries agree that the Named Insured will act on their behalf. E. BANKRUPTCY AND INSOLVENCY Bankruptcy or insolvency of the insured or of the insured s estate will not relieve us of our obligations under this Coverage Form. F. CANCELLATION a. The first Named Insured shown in the Declarations first Named Insured may cancel this Coverage Form by mailing or delivering to us advance written notice of cancellation. b. We may cancel this Coverage Form by mailing or delivering to the first Named Insured written notice of cancellation at least 1 10 days before the effective date of cancellation if we cancel for nonpayment of premium. 2 90 days before the effective date of cancellation if we cancel for any other reason. c. We will mail or deliver our notice to the first Named Insured s last mailing address known to us. d. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. e. If we cancel this Coverage Form we will send the first Named Insured any premium refund due. The refund will be pro rata. The cancellation will be effective even if we have not made or offered arefund.. If the first Named Insured cancels this Coverage Form we will send the first Named Insured any premium refund due. The refund may be less than pro rata and will be calculated using the customary standard short rate scale or the cancellation tables promulgated under the laws of the state shown in the first Named Insured s mailing address on the Declarations whichever is more beneficial to the first Named Insured. The cancellation will be effective even if we have not made or offered a refund. g. If notice is mailed proof of mailing will be sufficient proof of notice. IT7037 version date 07 2012 Page 8 of 13 2012 K4F 2122016 | 2 |
G. CHANGES Notices to any agent or knowledge possessed by any agent or by any other person will not effect a waliver or change in any part of this Coverage Form or stop us from asserting any right under the terms of this Coverage Form nor will the terms of this Coverage Form be waived or changed except by endorsement issued to form a part of this Coverage Form. H. CONCEALMENT MISREPRESENTATION AND FRAUD This Coverage Form is void if 1. you have concealed or misrepresented any material fact or circumstance in the procurement of or concerning this insurance including within the Application or 2. you make any attempt to defraud us either before or after a Covered Loss or 3. you have concealed or misrepresented any material fact or circumstance in connection with any claim. I. CONFIDENTIALITY You and all Covered Persons insured under this Coverage Form will make all reasonable efforts not to disclose the existence of this insurance. J. CONSOLIDATION MERGER If during the Policy Period the Named Insured acquires voting securities in another organization or creates another organization which as a result of such acquisition or creation becomes a Subsidiary or acquires any organization by merger into or consolidation with the Named Insured then subject to the terms and conditions of this Policy such organization and its Covered Persons shall be covered under this Policy but only with respect to Covered Events taking place after such acquisition or creation. If the total assets of such acquired or created organization as reflected in the then most recent consolidated financial statements of the organization exceed 10 of the total assets of the Named Insured and the Subsidiaries as reflected in the then most recent consolidated financial statements of the Named Insured coverage shall be provided for such acquired or created organization and its Covered Persons for a period of 30 days after the effective date of such acquisition or creation or until the end of the Policy Period whichever is earlier so long as the Named Insured gives written notice of such acquisition or creation to us prior to the end of the Policy Period. Coverage otherwise afforded under this paragraph for such acquired or created organization and its Covered Persons shall terminate 30 days after the effective date of such acquisition or creation or at the end of the Policy Period whichever is earlier unless the Named Insured agrees to and pays any additional premium required by us and agrees to any additional terms and conditions of this Policy as required by us. In no event however shall we have any liability nor shall there be any coverage under this Policy with respect such acquired or created organization and its Covered Persons arising out of a Covered Event or a threat of a Covered Event which commenced prior to the acquisition or creation of the organization. K. CURRENCY OF COVERED LOSSES PAYMENT If your Covered Loss involves currency other than the currency of the United States of America we will not reimburse or pay you for more than the United States dollar equivalent of the foreign currency IT7037 version date 07 2012 Page 9 of 13 2012 K4F 2122016 | 2 |
based on the rate of exchange published in the Wall Street Journal on the date that the Covered Loss was incurred. DEDUCTIBLE If a deductible is shown in the Declarations we subtract the amount of the deductible from the amount of your Covered Loss. The deductible applies separately for each Covered Loss. We will only pay for a Covered Loss when it is in excess of the deductible amount.. DUE DILIGENCE You and all Covered Persons will exercise due diligence in doing all things to avoid or reduce any Covered Loss under this Coverage Form.. EXAMINATION OF YOUR BOOKS AND RECORDS We may examine and audit your books and records as they relate to this Coverage Form at any time during the policy period and up to three years afterward.. EXAMINATION UNDER OATH As often as may be reasonably required you or any other Covered Persons will submit to examinations under oath by any person named by us and as often as may be reasonably required you or any other Covered Persons will produce for examination all books of account vouchers bills invoices schedules accounting information and any documentation relating to your Covered Loss or certified copies thereof if originals be lost at such reasonable time and place as may be designated by us or our representative and will permit extracts and copies thereof to be made. INSPECTIONS AND SURVEYS We have the right but are not obligated to a. Make inspections and surveys at any time b. Give you reports on the conditions we find and c. Recommend changes. Any inspections surveys reports or recommendations 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 with laws regulations codes or standards. This condition applies not only to us but also to any rating advisory rate service or similar organization which makes insurance inspections surveys reports or recommendations.. LEGAL ACTION AGAINST US You or any other Covered Persons may not bring any legal action against us involving a Covered Loss unless and until 1. You have complied with the all of the terms of this Coverage Form and any other applicable terms conditions limitations and exclusions of this Policy IT7037 version date 07 2012 Page 10 of 13 2012 K4F 2122016 | 2 |
2. ninety 90 days after you have notified us of the existence of a Covered Event and 3. brought within two 2 years from the date you reported the Covered Event to us. If any limitation is prohibited by law such limitation is amended so as to equal the minimum period of limitation provided by such law. R. LIBERALIZATION If we adopt any revision that would broaden the coverage under this Coverage Form without additional premium within 45 days prior to or during the policy period the broadened coverage will immediately apply to this policy. S. OTHER INSURANCE The insurance afforded by this Coverage Form is primary insurance except when stated to apply in excess of or contingent upon the absence of other insurance. When this insurance is primary and you or any other Covered Persons have other insurance which is stated to be applicable to the loss on an excess or contingent basis the amount of our liability under this Coverage Form will not be reduced by the existence of such other insurance. When both this insurance and other insurance apply to the Covered Loss on the same basis whether primary excess or contingent we will not be liable under this Policy for a greater proportion of the loss than that stated in the applicable contribution provision below. 1. Contribution by Equal Shares. If all of such other applicable insurance provides for contribution by equal shares we will not be liable for a greater proportion of such Covered Loss than would be payable if each insurer contributes an equal share until the share of each insurer equals the lowest applicable limit of liability under any one policy or the full amount of the Covered Loss is paid and with respect to any amount of Covered Loss not so paid the remaining insurers then continue to contribute equal shares of the remaining amount of the loss until each such insurer has paid its limit in full or the Covered Loss is paid. 2. Contribution by Limits. If any of such other insurance does not provide for contribution by equal shares we will not be liable for a greater proportion of such Covered Loss than the applicable limit of liability under this Policy for such Covered Loss bears to the total applicable limit of liability of all applicable insurance against such Covered Loss. T. PREMIUMS a. The first Named Insured shown in the Declarations 1 Is responsible for the payment of all premiums and 2 Will be the payee for any return premiums we pay. b. The premium shown in the Declarations was computed based on rates in effect at the time the policy was issued. On each renewal continuation or anniversary of the effective date of this policy we will compute the premium in accordance with our rates and rules then in effect. c. With our consent you may continue this policy in force by paying a continuation premium for each successive one year period. The premium must be 1 Paid in accordance with our payment terms 2 Determined in accordance with Paragraph b. above. IT7037 version date 07 2012 Page 11 of 13 2012 K4F 2122016 | 2 |
Our forms then in effect will apply. If you do not pay the continuation premium this policy will expire on the first anniversary date that we have not received the premium. d. Undeclared exposures or change in your business operation acquisition or use of locations may occur during the policy period that are not shown in the Declarations. If so we may require an additional premium. That premium will be determined in accordance with our rates and rules then in effect.. RECOVERIES In the event of any payment under this Coverage Form all recoveries less the actual cost to us of recovery will be distributed first to us for all amounts paid by us under this Coverage Form and then to you to the extent there are any remaining monies from such recoveries. SEVERABILITY CONSTRUCTION AND CONFORMANCE TO STATUTE 1. If any provision contained in this Coverage Form is for any reason held to be invalid illegal or unenforceable in any respect it is hereby deemed to be severed and to have no effect on any other valid legal and enforceable provisions of this Coverage Form. 2. If any provision contained in this Coverage Form is for any reason held to be invalid illegal or unenforceable it will be construed by limiting it so as to be valid legal and enforceable to the extent of compatible with applicable law. 3. Any provisions of this Coverage Form which are in conflict with the statutes or regulations of the state or country wherein the policy is issued are hereby amended to conform to such statutes or regulations.. SOLE AGENT If more than one person or organization is insured under this Coverage Form the first one named in the Declarations first Named Insured will act on behalf of all others. TERRITORY This Policy applies to Covered Events occurring anywhere within the Territory shown in the declarations unless specifically limited by endorsement or restricted by law. TRADE OR ECONOMIC SANCTIONS OR OTHER LAWS This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance including but not limited to the payment of claims. TRANSFER OF YOUR RIGHTS OF RECOVERY AGAINST OTHERS TO US You must transfer to us all your rights of recovery against any person or organization for any Covered Loss you sustained and for which we have paid or settled. You and each Covered Person also must do everything necessary to secure those rights and do nothing after a Covered Loss to impair them. AA.UNINTENTIONAL ERRORS OR OMISSIONS Your unintentional failure or omission to disclose all hazards existing as of the inception date of this Coverage Form shall not prejudice coverage afforded by this Coverage Form. IT7037 version date 07 2012 Page 12 of 13 2012 K4F 2122016 | 2 |
BB.WHEN WE DO NOT RENEW If we decide not to renew this Coverage Form we will mail or deliver to the first Named Insured shown in the Declarations written notice of the non renewal not less than 90 days before the expiration date. If notice is mailed proof of mailing will be sufficient proof of notice. CC.WHEN YOUR COVERAGE BEGINS Your coverage under this Coverage Form will begin and end at 1201 a.m. standard time at the address of the Named Insured and on the dates shown in the Declarations. However if this Coverage Form replaces other coverage that ends on the same day this policy begins this policy will not take effect until the other coverage ends. IT7037 version date 07 2012 Page 13 of 13 2012 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 001 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY BROAD NAMED INSURED This endorsement modifies coverage under the following INTERNATIONAL ADVANTAGE COMMERCIAL INSURANCE POLICY It is agreed that the Named Insured is amended to include the following The Named Insured shown on the declarations and all subsidiary affiliated associated and allied companies entities divisions corporations firms or individuals joint ventures or other interests which exist now or may hereafter exist in which the Named Insureds have 50 or more controlling interest or coming under their active control or for which the Insured has the responsibility of placing insurance but solely as respects the interests of the Named Insureds as their respective rights and interests may appear. Al other terms and conditions of this policy remain unchanged. K4F 2122016 IT7101 version date 09 2011 Page 1 of 1 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 002 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY THE ACE GPSSGLOBAL PROGRAM SOLUTIONS ENDORSEMENT Non Admitted Included LD34280 1011 Modifies coverage provided under the following if box is marked X COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM CLAIMS MADE X CONTINGENT AUTO LIABILITY COVERAGE FORM EMPLOYEE BENEFITS LIABILITY ENDORSEMENT x EMPLOYERS RESPONSIBILITY COVERAGES Endorsement No. Endorsement No. All other terms and conditions of this policy remain unchanged. IT7325 version date 05 2012 Page 1 of 1 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
ACE GPSSGLOBAL PROGRAM SOLUTIONS ENDORSEMENT Non Admitted Included Named Insured Endorsement Number East West Copolymer Rubber LLC 003 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Gompany ACE AMERICAN INSURANCE COMPANY Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This policy is amended as follows FOREIGN ENTITY LOSS PROVISIONS A. Insuring Agreement 1. This endorsement applies only when a foreign occurrence arising out of the premises products or operations of a foreign entity causes injury or damage of a type covered under this policy. In that case rather than directly pay on behalf of a foreign entity we will indemnify the first named insured for the foreign loss caused by a foreign occurrence in accordance with this endorsement. 2. Nothing in this endorsement is intended to nor does it extend coverage beyond the terms conditions exclusions and other limitations of this policy.. Who Is An Insured When this endorsement applies the WHO IS AN INSURED provisions are amended to provide that the foreign entity is not an insured on whose behalf we have a direct duty to pay settlements or judgments or a duty to defend under this policy.. Defense and Supplementary Payments When this endorsement applies rather than directly defend a foreign entity we will indemnify the first named insured for defense costs incurred in defending a suit brought against a foreign entity provided that the first named insured complies with the Additional Conditions shown below and other policy terms conditions and limitations. Limits of Insurance The insurance provided by this endorsement is subject to all applicable limits of insurance limits of liability deductibles and self insured retentions if any shown in the Declarations of or elsewhere in this policy including any aggregates and sub limits collectively limits. Any foreign loss for which we pay indemnity will erode and be counted against such limits. Such limits apply on the same basis per occurrence per claim per accident per offense etc. with respect to the first named insured as would apply if the foreign entity was an insured under this policy. K4F 2122016 LD34280 1011 Page 1 of 4 ACE Group Holdings Inc. All Rights Reserved. | 2 |
Notwithstanding the foregoing if allocated loss adjustment expense is payable under the applicable coverage coverage part or coverage form of this policy in addition to the applicable limit of insurance or liability then amounts incurred for allocated loss adjustment expense by the foreign entity which are subject to the terms of A. Insuring Agreement of this endorsement will not be included in the applicable limit of insurance or liability. E. Additional Conditions When this endorsement applies the following conditions apply in addition to the conditions and limitations provided elsewhere in this policy. 1. Claims Made Reported Coverage if applicable Any requirements in this policy that a claim be first made or deemed made during the policy period or any discovery or extended reporting period will also apply to all claims made against a foreign entity for which the first named insured seeks indemnification. Any provisions regarding notice of circumstances which may become a claim under this policy will apply to circumstances known or which reasonably should have been known by the first named insured. 2. Additional Duties Of The First Named Insured a. With respect to a foreign occurrence which may result in a claim under this endorsement the first named insured assumes the duty to notify us and must notify us in accordance with the standards shown in the applicable coverage form coverage part or endorsement. b. The first named insured will when directed by us 1 retain in its own name but at our expense a loss adjusting expert loss adjuster authorized in the jurisdiction or country in which the foreign loss occurred and approved by us 2 where permitted by applicable law grant us the full right to collaborate with such loss adjuster 3 grant us full access to any records produced by such loss adjuster and 4 obtain the right to control the investigation adjustment defense and settlement of the foreign loss using experts approved by us including access to books records bills invoices vouchers and other information. 3. Payment As Discharge Of Liability With respect to any foreign loss payment to the first named insured will to the extent of such payment and in all circumstances discharge us from any liability or alleged liability to any other person or entity whether or not named as an insured in this policy. 4. Truthfulness and Accuracy of Information When this endorsement applies a. The first named insured will make a good faith effort to provide truthful and accurate information to us with respect to a foreign entity foreign occurrence claim suit or foreign loss. K4F 2122016 LD34280 1011 Page 2 of 4 ACE Group Holdings Inc. All Rights Reserved. | 2 |
b. The first named insured will not at any time intentionally conceal or misrepresent facts concerning this policy including the risk to be insured a foreign entity a foreign loss claim or suit or a foreign occurrence. Additional Definitions The following definitions apply to this endorsement in addition to definitions set forth elsewhere in this policy 1. Allocated loss adjustment expense means any a. Expenses costs and interest provided for under this policy that responds to a loss claim suit or demand and Other expenses costs or interest incurred in connection with the investigation administration adjustment settlement or defense of any loss claim suit or demand arising under this policy that we directly allocate to a particular claim whether or not a payment indemnifying the claimants is made by any person or entity. Such expenses will include subrogation all court costs fees and expenses fees for service of process fees and expenses to attorneys for legal services the cost of services of undercover operations and detectives fees to obtain medical cost containment services the cost of employing experts for the purpose of preparing maps photographs diagrams or chemical or physical analysis or for expert advice or opinion the cost of obtaining copies of any public records and the cost of obtaining depositions and court reporters or recorded statements. However allocated loss adjustment expense does not include 1. 2 the salaries of the employees of any foreign entity or of the first named insured fees expenses and interest for legal services not provided to or for the benefit of the first named insured and amounts otherwise reimbursed to the first named insured or foreign entity. First named insured means the first Named Insured shown in the Declarations. Foreign entity means a person entity or organization whose principal place of business statutory domicile or residence is located in a country where we are not permitted to provide insurance without a license. Country includes any political jurisdiction that independently regulates the licensing of insurance companies. Foreign loss means a. Damages benefits or other amounts for which coverage is provided under this policy that a foreign entity has incurred or becomes legally obligated to pay because of injury damage loss or liability to which this insurance would apply if the first named insured were directly liable for such amounts because of acts errors or omissions of the first named insured and b. Any reasonable and necessary expenses or costs incurred by a foreign entity to which this insurance would apply if we defended the claim or suit which have not been paid indemnified or reimbursed under any other insurance. Foreign occurrence means an occurrence offense accident act error omission wrongful act as any of these terms may be defined in this policy which may result in a foreign loss. K4F 2122016 LD34280 1011 Page 3 of 4 ACE Group Holdings Inc. All Rights Reserved. | 2 |
6. License or Licensed means with respect to any country permitted in accordance with applicable law to conduct the business of insurance in such country. All other terms and conditions of this policy remain unchanged. Authorized Representative K4F 2122016 LD34280 1011 Page 4 of 4 ACE Group Holdings Inc. All Rights Reserved. | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 004 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY MINIMUM EARNED PREMIUM ENDORSEMENT This endorsement modifies coverage under the following INTERNATIONAL ADVANTAGE COMMERCIAL INSURANCE POLICY COMMON POLICY CONDITIONS It is agreed that The COMMON POLICY CONDITIONS are amended at section 10. Premiums by adding the following The minimum premium for this insurance is 2500 and shall be considered fully earned as of the inception date of this policy When Coverage Begins in the POLICY PERIOD item of the GENERAL DECLARATIONS. Al other terms and conditions of this policy remain unchanged. IT7955 version date 03 2014 Page 1 of 1 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 005 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY ADDITIONAL INSURED BY CONTRACT This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization As required by contract WHO IS AN INSURED Section Il is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. All other terms and conditions of this policy remain unchanged. K4F 2122016 IT7133 version date 02 2011 Page 1 of 1 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 006 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY EXCLUSION WAR OR TERRORISM This endorsement modifies coverage under the following It is agreed COMMERCIAL GENERAL LIABILITY COVERAGE FORM EMPLOYEE BENEFITS LIABILITY COVERAGE FORM that 1. SECTION COVERAGES COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY 2. Excl usions for Coverage A of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended by deleting paragraph i. War and replacing it with the following War or Terrorism Bodily injury or property damage arising 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 3 Insurrection rebellion revolution usurped power or action taken by governmental authority in hindering or defending against any of these or 4 Terrorism including any action taken in hindering or defending against an actual or expected incident of terrorism regardless of any other cause or event that contributes concurrently or in any sequence to the injury or damage. We will have no duty of any kind with respect to any such loss demand claim or suit. SECTION COVERAGES COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY 2. Exclusions for Coverage B of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended by deleting paragraph p. War and replacing it with the following p. War or Terrorism Personal and advertising injury arising directly or indirectly out of IT7828 version date 08 2010 Page 1 0f 3 K4F 2122016 | 2 |
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 3 Insurrection rebellion revolution usurped power or action taken by governmental authority in hindering or defending against any of these or 4 Terrorism including any action taken in hindering or defending against an actual or expected incident of terrorism regardless of any other cause or event that contributes concurrently or in any sequence to the injury or damage. We will have no duty of any kind with respect to any such loss demand claim or suit. 3. Section A of the EMPLOYEE BENEFITS LIABILITY COVERAGE FORM is amended by adding the following under 2. Exclusions This insurance does not apply to War or Terrorism Any claim arising 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 3 Insurrection rebellion revolution usurped power or action taken by governmental authority in hindering or defending against any of these or 4 Terrorism including any action taken in hindering or defending against an actual or expected incident of terrorism regardless of any other cause or event that contributes concurrently or in any sequence to the injury or damage. We will have no duty of any kind with respect to any such loss demand claim or suit. 4. The following definition is added to SECTION V DEFINITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM and to section F. of the EMPLOYEE BENEFITS LIABILITY Terrorism means activities against persons organizations or property of any nature a. That involves 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 or IT7828 version date 08 2010 Page 2 of 3 K4F 2122016 | 2 |
4 Use release or escape or nuclear materials or 5 Commission or threat of an act that directly or indirectly results or threatens to result in nuclear reaction or radiation or radioactive contamination or 6 Dispersal or application of pathogenic or poisonous biological or chemical materials or Release of pathogenic or poisonous biological or chemical materials and it appears that one purpose of the terrorism was to release such materials and b. When one or both of the following applies 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 2 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. Terrorism shall also include any incident determined to be such by a government official department or agency that has been specifically authorized by federal statute or executive order to make such a determination. All other terms and conditions of this policy remain unchanged. IT7828 version date 08 2010 Page 3 of 3 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 007 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Gompany ACE AMERICAN INSURANCE COMPANY LIMITED ELECTRONIC DATA LOSS COVERAGE ACCESS COLLECTION RELEASE DISCLOSURE LIMITED BODILY INJURY AND PROPERTY DAMAGE SEPARATE OCCURRENCE AND AGGREGATE LIMIT This endorsement modifies coverage under the following COMMERCIAL GENERAL LIABILITY DECLARATIONS COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. This Endorsement provides you with limited electronic data loss coverage as set forth below but only for those losses that fall within the terms of this Endorsement. B. This policy does not provide coverage for claims arising out of an electronic data loss other than as provided in this Endorsement. C. The COVERAGES AND LIMITS OF INSURANCE Item of the Commercial General Liability Declarations is amended by adding the following Electronic Data Loss Coverage Limit 1000000 Each Occurrence Electronic Data Loss Aggregate Limit 1000000 D. The Commercial General Liability Coverage Form is amended as follows 1. Exclusion 2.p. of Section Coverages Coverage A Bodily Injury And Property Damage Liability is deleted in its entirety and replaced by the following p. Access Collection Release or Disclosure of Confidential Or Personal Information Damages arising out of an electronic data event. This exclusion does not apply to those damages that constitute an electronic data loss. 2. The following paragraph is added to Section Ill Limits Of Insurance IT7377 version date 12 2014 Page 1 of 3 K4F 2122016 | 2 |
The Electronic Data Loss Aggregate Limit is the most we will pay for the sum of all damages for bodily injury and property damage because of all electronic data loss. Subject to 8. above the Electronic Data Loss Coverage Limit shown in the Declarations is the most we will pay under Coverage A for the sum of all damages for bodily injury and property damage because of all electronic data loss arising out of any one occurrence and the sum of all damages for all bodily injury and property damage because of all electronic data loss. 3. The following exclusion is added to paragraph 2. Exclusions of Section Coverages Coverage B Personal And Advertising Injury Liability This insurance does not apply to Access Collection Release or Disclosure Of Confidential Or Personal Information Damages arising out of an electronic data event. This exclusion applies even if damages are claimed for notification costs credit monitoring expenses forensic expenses public relations expenses crisis management expenses or any other loss cost or expense incurred by you or others arising out of any access to collection of release of or disclosure of any person s or organization s confidential or personal information. This exclusion does not apply to those damages that constitute an electronic data loss. Notwithstanding anything to the contrary in the foregoing provisions or elsewhere in this policy this insurance does not apply to notification costs credit monitoring expenses forensic expenses public relations expenses crisis management expenses or any other loss cost or expense incurred by you or others arising out of an electronic data loss or an electronic data event. Definitions For purposes of this endorsement only Bodily injury means physical injury sickness or disease sustained by a person including death resulting from any of these at any time. Electronic data means any information facts or programs stored as or on created or used on or transmitted to or from any computer software or system including systems and applications software hard or floppy disks CD ROMs tapes drives cells data processing devices or any other media that IT7377 version date 12 2014 Page 2 of 3 K4F 2122016 | 2 |
are used with electronically controlled equipment or other electronic backup facilities and data transmission or storage provided by means of the Internet. Electronic data event means any access to collection of release of 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 information health or medical information or any other type of nonpublic information other than those damages that constitute an electronic data loss or b. the loss of loss of use of damage to corruption of inability to access or inability to manipulate electronic data other than those damages that constitute an electronic data loss. Electronic data loss means damages because of bodily injury or property damage arising out of an Electronic data event. 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. Electronic data is not tangible property. All other terms and conditions of this policy remain unchanged. IT7377 version date 12 2014 Page 3 of 3 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 008 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY PRODUCTS COMPLETED OPERATIONS HAZARD EXCLUSION with an expanded definition of Your product This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is agreed that 1. The last sentence under the definition of Your product in SECTION V DEFINITIONS i.e. Your product does not include vending machines or other property rented to or located for the use of others but not sold is deleted and replaced with Your product does not include vending machines. 2. The following exclusion is added to SECTION COVERAGES COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY EXCLUSIONS This insurance does not apply to Products Completed Operations Hazard Bodily injury or property damage 1. arising out of the products completed operations hazard or 2. for which liability for bodily injury or property damage included within the products completed operations hazard is assumed under any contract or agreement. 3. The following exclusion is added to SECTION COVERAGES COVERAGE B. PERSONAL AND ADVERTISING INJURY LIABILITY EXCLUSIONS This insurance does not apply to Personal injury or advertising injury 1. arising out of the products completed operations hazard or 2. for which liability included within the products completed operations hazard is assumed under any contract or agreement. Al other terms and conditions of this policy remain unchanged. IT7792 version date 07 2010 Page 1 of 1 Includes material reprinted with permission of ISO Properties Inc. K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 009 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies coverage under the following COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMON POLICY CONDITIONS It is agreed that solely with regard to the insurance provided by the COMMERCIAL GENERAL LIABILITY COVERAGE FORM paragraph 13. Transfer Of Rights Of Recovery Against Others To Us of the COMMON POLICY CONDITIONS is amended by the addition of the following to sub paragraph b. Applicable To Liability Coverages Name of Person or Organization Any person or organization against whom you have agreed to waive your right of recovery in a written contract provided such contract was executed prior to the date of loss. However we waive any right of recovery we may have against the person or organization shown above because of payments we make for injury or damage arising out of your ongoing operations or your work 1 done under a written contract with that person or organization executed prior to the applicable date of loss and 2 included in the products completed operations hazard. This waiver applies only to the person or organization shown above. Al other terms and conditions of this policy remain unchanged. IT7460 version date 09 2011 Page 1 of 1 Material reprinted in part with permission of ISO Properties Inc. K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 010 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY ADDITIONAL INSURED CONTINGENT AUTO REQUIRED BY WHO IS AN INSURED Section lll is amended to include as an insured any person or organization you are required in a written contract or agreement to name as an Additional Insured on your policy but only for WRITTEN CONTRACT This endorsement modifies insurance provided under the following CONTINGENT AUTO LIABILITY COVERAGE FORM bodily injury or property damage to which this insurance applies if the accident is caused by 1. You while using a covered auto or 2. Any other person while using a covered auto with your permission. The insurance provided by this endorsement shall be subject to the following additional conditions 1. The Limit of Insurance provided for the Additional Insured shall not be greater than those required by contract and in no event shall the policy Limits of Insurance be increased by the contract. 2. Allinsuring agreements exclusions terms and conditions of the policy shall apply to the coverages provided to the Additional Insured and such coverage shall not be enlarged or expanded by reason of the contract. 3. Coverage provided by this endorsement shall be excess over any other valid and collectible insurance available to the Additional Insureds whether primary excess contingent or on any other basis unless the contract specifically requires that this insurance be primary or you request that it apply on a primary basis prior to loss. Al other terms and conditions of this policy remain unchanged. K4F 2122016 IT7134 version date 02 2011 Page 1 of 1 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 011 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY AUTO MEDICAL PAYMENTS COVERAGE This endorsement modifies coverage under the following CONTINGENT AUTO LIABILITY COVERAGE FORM SCHEDULE Limits 50000 Each Accident It is agreed that With respect to coverage provided by this endorsement the provisions of the Coverage Form apply unless modified by the endorsement. A. Coverage We will pay reasonable expenses incurred for necessary medical and funeral services to or for an insured who sustains bodily injury caused by accident. We will pay only those expenses incurred for services rendered within three years from the date of the accident. B. Wholls An Insured 1. You while occupying or while a pedestrian when struck by any auto. 2. If you are an individual any family member while occupying or while a pedestrian when struck by any auto. 3. 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. Exclusions This insurance does not apply to any of the following 1. Bodily injury sustained by an insured while occupying a vehicle located for use as a premises. IT7504 version date 03 2007 Page 10f 3 K4F 2122016 Material reprinted in part with permission of ISO Properties Inc. K4F 2122016 | 2 |
2. Bodily injury sustained by you or any family member while occupying or struck by any vehicle other than a covered auto owned by you or furnished or available for your regular use. 3. Bodily injury sustained by any family member while occupying or struck by any vehicle other than a covered auto owned by or furnished or available for the regular use of any family member. 4. Bodily injury to your employee arising out of and in the course of employment by you. However we will cover bodily injury to your domestic employees if not entitled to workers compensation benefits. For the purposes of this endorsement a domestic employee is a person engaged in household or domestic work performed principally in connection with a residence premises. 5. Bodily injury to an insured while working in a business of selling servicing repairing or parking autos unless that business is yours. 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. 7. Bodily injury to anyone using a vehicle without a reasonable belief that the person is entitled to do so. 8. Bodily Injury sustained by an insured while occupying any covered auto while used in any professional racing or demolition contest or stunting activity or while practicing for such contest or activity. This insurance also does not apply to any bodily injury sustained by an insured while the auto is being prepared for such a contest or activity. 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 bodily injury for each insured injured in any one accident is the Limit Of Insurance for Auto Medical Payments Coverage shown in the Schedule above. No one will be entitled to receive duplicate payments for the same elements of loss under this coverage and any Liability Coverage Form Uninsured Motorists Coverage Endorsement or Underinsured Motorists Coverage Endorsement attached to this Coverage Part. Changes In Conditions The Conditions are changed for Auto Medical Payments Coverage as follows 1. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply. 2. The reference in Other Insurance in the Business Auto and Garage Coverage Forms and Other Insurance Primary And Excess Insurance Provisions in the Truckers and Motor Carrier Coverage Forms to other collectible insurance applies only to other collectible auto medical payments insurance. IT7504 version date 03 2007 Page 20f 3 Material reprinted in part with permission of ISO Properties Inc. K4F 2122016 | 2 |
F. Additional Definitions As used in this endorsement 1. 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. 2. Occupying means in upon getting in on out or off. All other terms and conditions of this policy remain unchanged. IT7504 version date 03 2007 Page 30of 3 Material reprinted in part with permission of ISO Properties Inc. K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 012 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY EXCLUSION WAR OR TERRORISM This endorsement modifies coverage under the following CONTINGENT AUTO LIABILITY COVERAGE FORM Itis agreed that 1. SECTION I LIABILITY COVERAGE is amended by deleting subsection C. Exclusions part 12. War in its entirety and replacing it with the following 12. War or Terrorism 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 or d. Terrorism including any action taken in hindering or defending against an actual or expected incident of terrorism regardless of any other cause or event that contributes concurrently or in any sequence to the injury or damage. We will have no duty of any kind with respect to any such loss demand claim or suit. 2. The following definition is added to the SECTION VI DEFINITIONS Terrorism means activities against persons organizations or property of any nature 1. That involves the following or preparation for the following a. Use or threat of force or violence or IT7829 version date 03 2007 Page 1 of 2 K4F 2122016 | 2 |
b. Commission or threat of a dangerous act or c. Commission or threat of an act that interferes with or disrupts an electronic communication information or mechanical system or d. Use release or escape or nuclear materials or e. Commission or threat of an act that directly or indirectly results or threatens to result in nuclear reaction or radiation or radioactive contamination or f. Dispersal or application of pathogenic or poisonous biological or chemical materials or g. Release of pathogenic or poisonous biological or chemical materials and it appears that one purpose of the terrorism was to release such materials and 2. When one or both of the following applies a. 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 b. 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. Terrorism shall also include any incident determined to be such by a government official department or agency that has been specifically authorized by federal statute or executive order to make such a determination. All other terms and conditions of this policy remain unchanged. IT7829 version date 03 2007 Page 2 of 2 K4F 2122016 | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 013 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY FELLOW EMPLOYEE COVERAGE This endorsement modifies coverage under the following CONTINGENT AUTO LIABILITY COVERAGE FORM It is agreed that With respect to coverage provided by this endorsement the provisions of the Coverage Form apply unless modified by the endorsement. The Fellow Employee Exclusion contained in Section 1.C.5. does not apply. Al other terms and conditions of this policy remain unchanged. IT7508 version date 12 2011 Page 1 of 1 Material reprinted in part with permission of ISO Properties Inc. K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
o aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 014 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY HIRED AUTO PHYSICAL DAMAGE COVERAGE ENDORSEMENT This endorsement modifies coverage under the following CONTINGENT AUTO LIABILITY COVERAGE FORM SECTION Il COVERED AUTOS paragraph B. Hired Autos is amended to include the following HIRED AUTO PHYSICAL DAMAGE COVERAGE INSURING AGREEMENT We will reimburse you at replacement cost up to 50000 per accident for physical damage loss to a hired auto or its equipment while in the care custody or control of an insured. You may pay for loss to a hired auto that was damaged while in your care custody or control. We will reimburse you for that payment. Our consent for such payment is not required but we do require proof of loss and proof that the payment was made for loss to a covered auto before we will reimburse you. EXCLUSIONS In addition to the Contingent Auto Liability Coverage Form exclusions we will not pay for loss to any covered hired auto 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 1. Racing or Demolition 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. Also we will not pay for loss to any covered auto while that covered auto is being prepared for such a contest or activity. 2. Wear and tear We will not pay for loss caused by or resulting from any of the following a. Wear and tear freezing mechanical or electrical breakdown. b. Blowouts punctures or other road damage to tires. 3. Tapes Records and Equipment We will not pay for loss to any of the following IT7510 version date 11 2012 Page 1 of 2 K4F 2122016 K4F 2122016 | 2 |
a. Tapes records discs or other similar audio visual or data electronic devices designed for use with audio visual or data electronic equipment. b. Equipment designed or used for the detection or location of radar or laser emissions. c. Any electronic equipment without regard to whether this equipment is permanently installed that receives or transmits audio visual or data signals and that is not designed solely for the reproduction of sound. d. Any accessories used with the electronic equipment described in paragraph 3 above. Care Custody or Control The exclusion for care custody or control is deleted solely with respects to any coverage provided pursuant to this endorsement. With respects to this endorsement SECTION IV LIMIT OF INSURANCE is amended to include the following The most we will pay for loss in any one accident or in any one policy period for hired auto physical damage coverage is the lesser of 1. The replacement cost 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 or 3. 50000 for any one accident or 50000 in any one policy period. With respects to this endorsement SECTION V AUTO CONDITIONS is amended to include the following Duties in the Event of Accident Claim Suit or Loss For hired auto physical damage coverage to apply you must also do the following if there is a loss to a hired auto or its equipment 3. Promptly notify the local police civil guard militia or other appropriate local legal authority if the hired auto or any of its equipment is stolen. 4. Take all reasonable steps to protect the hired auto from further damage. Also keep a record of your expenses for consideration in the settlement of the claim. 5. Assume no obligation make no payment or incur any expense other than for hired auto physical damage coverage without our consent except at the insured s own cost. All other terms and conditions of this policy remain unchanged. K4F 2122016 IT7510 version date 11 2012 Page 2 of 2 | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 015 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US AUTO LIABILITY This endorsement modifies coverage under the following CONTINGENT AUTO LIABILITY COVERAGE FORM SCHEDULE Name of Persons or Organizations Any person or organization against whom you have agreed to waive your right of recovery in a written contract provided such contract was executed prior to the date of loss. It is agreed that 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 the use of a covered auto. The waiver applies only to the person or organization shown in the Schedule. Al other terms and conditions of this policy remain unchanged. IT7513 version date 03 2007 Page 1 of 1 Material reprinted in part with permission of ISO Properties Inc. K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 016 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY AMENDMENT EMERGENCY POLITICAL REPATRIATION AND EMERGENCY RELOCATION This endorsement modifies insurance provided under the following EMPLOYERS RESPONSIBILITY COVERAGES WITH EXECUTIVE ASSISTANCE It is agreed that the limit for Emergency Political Repatriation and Emergency Relocation is amended under the Security Assistance section of EXECUTIVE ASSISTANCE SERVICES as follows The most we will reimburse is 5000 Per Employee per Insured Event for Emergency Political Repatriation and 5000 Per Employee per Insured Event for Emergency Relocation subject to a policy limit of 10000 regardless of the number of Insured Events. Al other terms and conditions of this policy remain unchanged. K4F 2122016 IT1695 version date 12 2011 Page 1 of 1 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
ace usa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Named Insured Endorsement Number East West Copolymer Rubber LLC 017 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY AMENDMENT VOLUNTARY COMPENSATION COVERAGE ENDORSEMENT This endorsement modifies insurance under the following EMPLOYERS RESPONSIBILITY COVERAGES A. ltis agreed that those policy sections titted VOLUNTARY COMPENSATION COVERAGE and WE WILL PAY BENEFITS are deleted and replaced by the following VOLUNTARY COMPENSATION COVERAGE Voluntary Compensation coverage applies to any claim for bodily injury by accident bodily injury by disease or bodily injury by endemic disease whether or not it is subject to or governed by any workers compensation law. This bodily injury must be injury to your employee and must arise out of and in the course of employment by you. Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the Policy Period. 2. Bodily injury by disease must be caused or aggravated by the conditions of employment by you. The employee s last day of exposure to the conditions causing or aggravating such bodily injury by disease must occur during the Policy Period. 3. Bodily injury by endemic disease must be caused by disease which your employee may reasonably be thought to have contracted by being in a place as a result of employment by you. The employee must have been in a place where the disease contracted is known to occur. The time the employee was in the place where the disease occurs must have been within the Policy Period. The employee s last day of exposure to the conditions causing or aggravating such bodily injury by endemic disease must occur during the Policy Period. We will adjust the claim with the employee by applying the workers compensation law of the state or country of origin that applies. The state or country of origin must be shown in the Declarations. The workplace of the employee must be within the coverage territory. In the event an employee seeks andor receives Workers Compensation benefits our obligation to pay Voluntary Compensation to such employee under this policy ends. We Will Pay Benefits We will pay promptly the benefits which would be required of you by the workers compensation law of the state you choose when making the claim. The state you choose must be one which is shown in the Declarations for the following K4F 2122016 IT1490 version date 11 2004 Page 1 of 2 | 2 |
1. North Americans means employees who are citizens or legal permanent residents of the United States including its territories and possessions Puerto Rico or Canada. 2. Third Country Nationals means employees who are neither citizens nor permanent residents of the country of their workplace and who are not described as North Americans. 3. Local Nationals means employees who are citizens or permanent residents of the country of their workplace but who are not described as North Americans. If State of Hire appears after the words North Americans in the Declarations for Voluntary Compensation then with respect to employees for whom you wish to provide the benefits of a state of the United States of America including its territories and possessions or Puerto Rico but who were not hired in any of those places the benefits will be 1. those of the state which you agreed with the employee prior to the accident or the discovery of the disease or 2. if no state was agreed with the employee prior to the accident or the discovery of the disease the benefits of the specific state shown in the Declaration for North Americans as an alternative to the state of hire or 3. if no state was agreed with the employee prior to the accident or the discovery of the disease and no specific state is shown above for North Americans the benefits of the state shown in the address of the insured on the first page of the Declarations for this policy. If your employee files a claim for workers compensation benefits under one of the states shown in the Declarations you are solely responsible for the proper administration and handling of such claim. Upon receipt of satisfactory proof of payment we will reimburse you or someone on your behalf for all payments that you or someone on your behalf has made in connection with such claim however we will not reimburse you or any other person or entity for payments voluntarily made or for payments made in whole or in part as a result of improper or inadequate claim handling or defense. B. The following are added to the section titled DEFINITIONS ALL COVERAGES of the Employers Responsibility Coverages form Legal Permanent Residents means employees who are not citizens or nationals of the United States who legally and permanently reside in the United States. Permanent Residents means employees who are not citizens of the country of their workplace and who permanently reside in the country of their workplace. Al other terms and conditions remain unchanged. K4F 2122016 IT1490 version date 11 2004 Page 2 of 2 | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 018 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY WAR COVERAGE This endorsement modifies insurance under the following EMPLOYERS RESPONSIBILITY COVERAGES FORMS The War Exclusion under EXCLUSION ALL COVERAGES is deleted but subject to the following conditions A. The insurance provided under this endorsement applies only with respect to 1. North Americans meaning employees who are citizens or legal permanent residents of the United States including its territories and possessions Puerto Rico and 2. Third Country Nationals meaning employees who are not citizens of the country of their workplace and who are not described in 1 above. B. TERRITORY For the purpose of this endorsement only the Coverage Territory is amended to read ANYWHERE IN THE WORLD but excludes 1. 2. The United States of America including its territories or possessions Puerto Rico and any country or jurisdiction which is the subject of trade or economic sanctions imposed by the laws or regulations of the United States of America and Afghanistan Algeria Angola Bahrain Bosnia Herzegovina Burundi Cambodia Central African Republic Colombia Cote dlvoire Cuba Democratic Republic of Congo Egypt Ethiopia Guinea Bissau Haiti India Indonesia Iran Iraq Israel Kosovo Kuwait Kyrgyz Republic Lebanon Liberia Libya Mali Niger Nigeria North Korea Northern Ireland Pakistan Peru Sierra Leone Somalia South Sudan Sudan Syria Turkey Uganda Venezuela West Bank and Gaza Yemen Zimbabwe. C. CANCELLATION Coverage provided by this endorsement is subject to 10 days Notice of Cancellation notwithstanding any cancellation clause to the contrary contained elsewhere in the Policy. All other terms and conditions of this policy remain unchanged. IT1228 version date 06 2013 Page 1 of 1 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 019 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM KIDNAP AND EXTORTION COVERAGE This endorsement modifies insurance provided under the following CORPORATE KIDNAP AND EXTORTION COVERAGE FORM A. Cap On Certified Terrorism Losses Certified act of terrorism means an act that is certified by the Secretary of the Treasury in accordance with the provisions of the federal Terrorism Risk Insurance Act to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a certified act of terrorism include the following 1. The act resulted in insured losses in excess of 5 million in the aggregate attributable to all types of insurance subject to the Terrorism Risk Insurance Act and 2. The act is a violent act or an act that is dangerous to human life property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed 100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act we shall not be liable for the payment of any portion of the amount of such losses that exceeds 100 billion and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. B. Application Of Exclusions The terms and limitations of any terrorism exclusion or the inapplicability or omission of a terrorism exclusion do not serve to create coverage for any loss which would otherwise be excluded under this Policy. Al other terms and conditions of this Policy remain unchanged. 2007 2000 KR Includes copyrighted material of Insurance Services Office Inc. with its permission. IT7542b version date 01 2015 Page 1 of 1 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT Named Insured Endorsement Number East West Copolymer Rubber LLC 020 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Gompany ACE AMERICAN INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following CORPORATE KIDNAP AND EXTORTION COVERAGE FORM Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act we are required to provide you with a notice disclosing the portion of your premium if any attributable to coverage for terrorist acts certified under the Terrorism Risk Insurance Act. The portion of your premium attributable to such coverage is shown in this endorsement or in the policy Declarations. Disclosure Of Federal Participation In Payment Of Terrorism Losses The United States Government Department of the Treasury will pay a share of terrorism losses insured under the federal program. The federal share equals 85 for year 2015 84 beginning on January 2016 83 beginning on January 1 2017 82 beginning on January 1 2018 81 beginning on January 1 2019 and 80 beginning on January 1 2020 of that portion of the amount of such insured losses that exceeds the applicable insurer retention. However if aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed 100 billion in a calendar year the Treasury shall not make any payment for any portion of the amount of such losses that exceeds 100 billion. Cap On Insurer Participation In Payment Of Terrorism Losses If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed 100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act we shall not be liable for the payment of any portion of the amount of such losses that exceeds 100 billion and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. Terrorism Risk Insurance Act premium 0. Authorized Representative Includes copyrighted material of Insurance Services office Inc. with its permission. IT7537 version date 01 2015 Page 1 0of 1 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 021 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY This endorsement modifies insurance provided under if a check mark is shown COVERAGE TERRITORY ENDORSEMENT It is agreed that XCOMMERCIAL GENERAL LIABILITY COVERAGE FORM and LIABILITY COVERAGES DECLARATIONS XCONTINGENT AUTO LIABILITY COVERAGE FORM and LIABILITY COVERAGES DECLARATIONS XEMPLOYERS RESPONSIBILITY COVERAGES and EMPLOYERS RESPONSIBILITY COVERAGES DECLARATIONS 1. The COVERAGE TERRITORY FOR LIABILITY COVERAGES Item of the LIABILITY COVERAGES DECLARATIONS is deleted in its entirety and replaced by the following COVERAGE TERRITORY FOR LIABILITY COVERAGES The Coverage Territory for COMMERCIAL GENERAL LIABILITY COVERAGE and EMPLOYEE BENEFITS COVERAGE means ANYWHERE IN THE WORLD but excluding the United States of America including its territories and possessions and except as otherwise limited or extended by this insurance. The Coverage Territory also excludes Notwithstanding X Puerto Rico Canada Other Not Applicable Guam United States Virgin Islands USVI Other Not Applicable the above the Coverage Territory includes the following territories IT7142 version date 04 2015 Page 1 of 3 K4F 2122016 | 2 |
The Coverage Territory for CONTINGENT AUTO LIABILITY COVERAGE means ANYWHERE IN THE WORLD but excluding the United States of America including its territories and possessions and except as otherwise limited or extended by this insurance. The Coverage Territory also excludes X Puerto Rico Canada X Other Not Applicable Notwithstanding the above the Coverage Territory includes the following territories Guam United States Virgin Islands USVI X Other Not Applicable In jurisdictions where we may be prevented by law or otherwise from paying on behalf of or defending the Insured we will a. indemnify the insured for those sums that the insured becomes legally obligated to pay as damages to which this insurance applies and b. pay the cost of defense and aid and manage the insured s defense. SECTION V DEFINITIONS of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended as follows Definition 7. Coverage territory is deleted in its entirety and replaced by the following 7. Coverage territory means Coverage Territory for Liability Coverages shown in the section titled COVERAGE TERRITORY FOR LIABILITY COVERAGES on page 1 of this endorsement. The coverage territory also includes a. International waters or air space provided the injury or damage does not occur in the course of travel or transportations from one place to another when both places are not within the Coverage Territory for Liability Coverages as shown in the section titted COVERAGE TERRITORY FOR LIABILITY COVERAGES on page 1 of this endorsement and b. The United States of America including its territories and possessions if the insured s responsibility to pay damages is determined in a suit on the merits in any country within the Coverage Territory for Liability Coverages as shown in the section tited COVERAGE TERRITORY FOR LIABILITY COVERAGES on page 1 of this endorsement. SECTION VI DEFINITIONS of the CONTINGENT AUTO LIABILITY FORM is amended as follows Definition E. Coverage Territory is deleted in its entirety and replaced by the following K4F 2122016 IT7142 version date 04 2015 Page 2 of 3 | 2 |
E. Coverage Territory means Coverage Territory for Liability Coverages shown in the section titled COVERAGE TERRITORY FOR LIABILITY COVERAGES on page 1 of this endorsement. The coverage territory also includes a. International waters or air space provided the injury or damage does not occur in the course of travel or transportations from one place to another when both places are not within the Coverage Territory for Liability Coverages as shown in the section titted COVERAGE TERRITORY FOR LIABILITY COVERAGES on page 1 of this endorsement and b. The United States of America including its territories and possessions if the insured s responsibility to pay damages is determined in a suit on the merits in any country within the Coverage Territory for Liability Coverages as shown in the section tited COVERAGE TERRITORY FOR LIABILITY COVERAGES on page 1 of this endorsement. 4. The Coverage Territory for Employers Responsibility Coverages Item of the EMPLOYERS RESPONSIBILITY COVERAGES DECLARATIONS is amended by deleting the following ANYWHERE IN THE WORLD but excluding 1. the United States of America including its territories and possessions Puerto Rico and Canada and except as otherwise limited or extended by this insurance. 2. any country or jurisdiction which is the subject of trade or economic sanctions imposed by the laws or regulations of the United States of America. and replacing it with the following ANYWHERE IN THE WORLD but excluding 1. the United States of America including its territories and possessions and 2. any country or jurisdiction which is the subject of trade or economic sanctions imposed by the laws or regulations of the United States of America and 3. the following countries X Puerto Rico Canada X Other Not Applicable 4. Notwithstanding the above the Coverage Territory includes the following Guam United States Virgin Islands USVI X Other Not Applicable All other terms and conditions of this policy remain unchanged. K4F 2122016 IT7142 version date 04 2015 Page 3 of 3 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number East West Copolymer Rubber LLC 022 Policy Symbol Policy Number Policy Period Effective Date of Endorsement PHF D38338985 003 04162016 to 04162017 04162016 Issued By Name of Insurance Company ACE AMERICAN INSURANCE COMPANY LOCA L INSURER FINANCIAL IMPAIRMENT COLLECTABILITY ENDORSEMENT This endorsement modifies the COMMON POLICY CONDITIONS included under the following ONLY those forms indicated by a mark below X ACCIDENTAL DEATH AND DISMEMBERMENT AND MEDICAL COVERAGE FOR EDUCATIONAL SERVICES COVERAGE FORM ACCIDENTAL DEATH AND DISMEMBERMENT MEDICAL COVERAGE INCLUDING OCCUPATIONAL INJURY COVERAGE FORM ACCIDENTAL DEATH AND DISMEMBERMENT AND MEDICAL EXPENSE COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTY COVERAGE FORM CONTINGENT AUTO LIABILITY COVERAGE FORM CORPORATE KIDNAP AND EXTORTION COVERAGE FORM EMPLOYEE BENEFITS LIABILITY COVERAGE FORM ENDORSEMENT EMPLOYEE DISHONESTY COVERAGE FORM EMPLOYERS RESPONSIBILITY COVERAGES. Notwithstanding anything to the contrary contained in the Policy when the insurance policy to which these COMMON POLICY CONDITIONS are attached is issued in conjunction with a coordinated multi national insurance program that includes local policies issued by local insurers itt is agreed that the COMMON POLICY CONDITIONS are modified to include the following additional provisions Financial Impairment Collectability 1. Ifa covered claim is made under a local policy and is not paid solely due to the financial impairment of the local insurer we shall indemnify the First Named Insured but only to the extent that we would have paid the claim had it been made by an insured under this policy. However we will not pay any claim by any conservator liquidator or statutory successor of any local insurer. K4F 2122016 IT7109a version date 08 2014 Page 1 of 2 | 2 |
We have no obligation to pay any a. Amounts within any applicable retained limit that would have applied under such local policy or b. Claim by any conservator liquidator or statutory successor of the local insurer or c. Amount payable under any insurance policy that is not a local policy. When this endorsement applies the following conditions apply in addition to the conditions provided elsewhere in this policy. The First Named Insured shall a. Take all necessary steps to ensure the insured under the local policy pursues all rights available under the local policy b. Take all necessary steps to ensure the insured under the local policy complies with all duties and obligations under such local policy c. Submit if requested by us a sworn statement of loss even if such a statement has already been submitted by the insured under the local policy d. Cooperate with us and take all necessary steps to obtain for our benefit all possible recoveries or indemnification from whatever source including without limit governmental or state entities including guarantee funds and e. Reimburse us for any payment made under this Condition if payment is ultimately made with respect to a previously uncollectible claim under a local policy. This endorsement does not apply to any local policy issued in any country listed in the below Schedule of Excluded Countries. The following DEFINITIONS are added to the policy but only to the extent that the provisions contained in this Endorsement otherwise apply Financial Impairment means an adjudicated bankruptcy or insolvency of a local insurer or its refusal or inability to pay a final judgment or settlement solely because of anticipated imminent insolvency. Local insurer means an insurance company that is either i an ACE affiliate or ii a member of ACE s network of non affiliated insurers issuing a local policy. Local policy means a property or casualty insurance policy issued by a local insurer in a country other than the United States to a subsidiary of the First Named Insured or any other organization under its control or management as part of a multi national insurance program coordinated by us. Local policy does not include any policy issued by an insurance company other than us or a local insurer. Schedule of Excluded Countries Al other terms and conditions of the policy remain unchanged. K4F 2122016 IT7109a version date 08 2014 Page 2 of 2 | 2 |
aceusa ACE INA Privacy Statement The ACE INA group of companies strongly believes in maintaining the privacy of information we collect about individuals. We want you to understand how and why we use and disclose the collected information. The following provides details of our practices and procedures for protecting the security of nonpublic personal information that we have collected about individuals. This privacy statement applies to policies underwritten by the ACE INA group member companies listed below. INFORMATION WE COLLECT The information we collect will vary depending on the type of product or service individuals seek or purchase and may include Information we receive from individuals such as their name address age phone number social security number assets income or beneficiaries Information about individuals transactions with us with our affiliates or with others such as policy coverage premium payment history motor vehicle records and Information we receive from a consumer reporting agency such as a credit history. INFORMATION WE DISCLOSE We do not disclose any personal information to anyone except as is necessary in order to provide our products or services to a person or otherwise as we are required or permitted by law. We may disclose any of the information that we collect to companies that perform marketing services on our behalf or to other financial institutions with whom we have joint marketing agreements. THE RIGHT TO VERIFY THE ACCURACY OF INFORMATION WE COLLECT Keeping information accurate and up to date is important to us. Individuals may see and correct their personal information that we collect except for information relating to a claim or a criminal or civil proceeding. CONFIDENTIALITY AND SECURITY We restrict access to personal information to our employees our affiliates employees or others who need to know that information to service the account or in the course of conducting our normal business operations. We maintain physical electronic and procedural safeguards to protect personal information. CONTACTING US If you have any questions about this privacy statement or would like to learn more about how we protect privacy please write to us at ACE INA Customer Services P.O. Box 1000 436 Walnut Street WAO4F Philadelphia PA 19106. Please include the policy number on any correspondence with us. ACE American Insurance Company Century Indemnity Company ACE Fire Underwriters Insurance Company lllinois Union Insurance Company ACE Indemnity Insurance Company Indemnity Insurance Company of North America ACE Insurance Company of the Midwest Insurance Company of North America ACE Property and Casualty Insurance Company Pacific Employers Insurance Company Atlantic Employers Insurance Company Westchester Fire Insurance Company Bankers Standard Fire and Marine Company Westchester Surplus Lines Insurance Company Bankers Standard Insurance Company ESIS Inc. IT7060 version date 01 2009 Page 1 of 1 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa ACE Producer Compensation Practices Policies ACE believes that policyholders should have access to information about ACE s practices and policies related to the payment of compensation to brokers and independent agents. You can obtain that information by accessing our website athttpwww.aceproducercompensation.com or by calling the following toll free telephone number 1 866 512 2862. IT7055 version date 10 2006 Page 1 of 1 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa PREMIUM COLLECTION POLICY Dear ACE USA Foreign Casualty Producer Producers are expected to bill clients based on ACE s binder for New Business and automatically for Renewals. PREMIUM IS DUE TO ACE 30 DAYS AFTER INVOICE DATE. A premium statement will be sent to your accounting department the 20th day of every month. Please keep ACE abreast of any address changes to prevent unnecessary cancellation activity. Manual bills may accompany policy documents in special instances. Please review the manual invoices carefully and remit premium payments in accordance with the due dates noted. ACE will send you a 5 day notice of cancellation upon notification of non payment by our accounting department. Immediate payment is required for reinstatement. HOW TO PAY YOUR CLIENT S PREMIUM THAT IS BILLED TO YOU SEND CHECKS THROUGH REGULAR MAIL PAYABLE TO ACE USA DEPT CH 10678 PALATINE IL 60055 0678 OVERNIGHT MAIL PAYABLE TO ACE USA ACE American Insurance Company 5505 N. CUMBERLAND AVE SUITE 307 CHICAGO IL 60656 1471 ATTN BOX 10678 OUR ACCOUNTING DEPARTMENT IS LOCATED IN WILMINGTON DELAWARE. FOR ANY QUESTIONS REGARDING YOUR PREMIUM STATEMENT PLEASE CALL OUR CUSTOMER SERVICE DESK AT 1.800.323.6129. WIRE INSTRUCTIONS PROVIDED BELOW MELLON BANK WEST 3 MELLON BANK CENTER PITTSBURGH PA 15259 ABA 043000261 ACCOUNT 093 8373 IT7059 version date 09 2011 Page 1 of 1 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa U.S. TREASURY DEPARTMENT S OFFICE OF FOREIGN ASSETS CONTROL OFAC ADVISORY NOTICE TO POLICYHOLDERS No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your policy. You should read your policy and review your Declarations page for complete information on the coverages you are provided. This Notice provides information concerning possible impact on your insurance coverage due to directives issued by OFAC. Please read this Notice carefully. The Office of Foreign Assets Control OFAC administers and enforces sanctions policy based on Presidential declarations of national emergency. OFAC has identified and listed numerous Foreign agents Front organizations e Terrorists e Terrorist organizations and Narcotics traffickers as Specially Designated Nationals and Blocked Persons. This list can be located on the United States Treasury s web site httpwww.treas.gov ofac. In accordance with OFAC regulations if it is determined that you or any other insured or any person or entity claiming the benefits of this insurance has violated U.S. sanctions law or is a Specially Designated National and Blocked Person as identified by OFAC this insurance will be considered a blocked or frozen contract and all provisions of this insurance are immediately subject to OFAC. When an insurance policy is considered to be such a blocked or frozen contract no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments also apply. IT7058 04 2005 1SO form IL P 001 01 04 Page 1 of 1 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
ACE INTERNATIONAL ADVANTAGE ACE EXECUTIVE ASSISTANCE Trip planning travel assistance and emergency REGISTER NOW response services are available to all ACE.. it www.acetravelapp.com to Register International Advantage insureds including their employees volunteers and students. Please communicate this notice to your international travelers in order to provide them access and.... POLICY NUMBER PHFD38338985 incorporate the registration process into your company s travel policy. A One stop Travel Tool Download the ACE Travel App Trip planning travel assistance and emergency response services are available to all ACE International Advantage insureds including their employees volunteers and students. Please communicate this notice to your international travelers in order to provide them access and incorporate the registration process into your company s travel policy. 8 insured. IT7065 version date 09 2013 K4F 2122016 | 2 |
SERVICES AVAILABLE TO OUR INSUREDS The following are just some of the services and information available to our insureds through our mobile app or at www.acetravelapp.com. Trip Planning Emergency Assistance Immunization requirements Embassy locations Visa Passport Requirements Culture and Etiquette Country Information Crime and Country Risk Levels Travel Alerts Political Instability Union Strikes and Service Disruption Natural Disasters and Weather Crime Terrorism or Disease Outbreaks Security Services Political Evacuation Natural Disaster Evacuation Consultation Services Legal Assistance Bail Emergency Travel Arrangements Passport Replacement Interpretation Translation Emergency Medical Transport Hospital Admission Guarantee Emergency Medical Payment Advance and Guarantee Medical Monitoring and Referrals Doctor or Specialist Dispatch Medication and Eye wear Replacement Medical Evacuation and Repatriation Family Reunion Travel Arrangements Transportation Escort Return of Dependent Children and Travelling Companion Repatriation of Remains Concierge Services Hotel Car and Airline Reservations Restaurant Referrals Tee Times Personalized Retail Shopping Assistance ements sk Levels e Disruption ather ase Outbreaks IT7065 version date 09 2013 ACE Commercial Risk Services is an operation within the ACE Group that is dedicated to providing specialty insurance products that offer solutions for small business insurance needs in North America. ACE Gommercial Risk Services offers its products through retail agent and brokers wholesale brokers program agents and other alternative distribution models. Additional nformation can be found at www.acecrs.com. ACE USA s the U.S based retail operating division of the ACE Group a global leader in insurance and reinsurance serving a diverse group of clients. Headed by ACE Limited NYSE ACE a component of the SP 500 stock index the ACE Group conducls i business on a worldwide basis with operating subsidiaries in more than 50 countries. Additional information can be found at www.acegroup.comus. K4F 2122016 | 2 |
aceusa HOW TO REPORT YOUR CLAIMS In the event of a claim suit or loss under your Policy contact your agent or broker. To report a claim occurrence accident suit loss or injury to us in accordance with and as provided in the respective coverage parts of your Policy please use any of the following methods and please provide the information listed below as well as any information your Policy requires EMAIL ACECIlaimsFirstNoticeacegroup.com This e mail address is to be used for new claim reporting only. FAX 877 395 0131 Toll Free 302 476 7254 Local PHONE 800 433 0385 Business Hours 800 523 9254 After Hours MAIL ACE North American Claims P.O. Box 5122 Scranton PA 18505 0554 Please be sure to include the following information in addition to any specific information required by the applicable coverage part Policy Holder Name Policy Number Type of loss Date of Event Description of loss Insured contact name and details phone e mail etc. Third Party contact name and details phone e mail etc. Any other pertinent information available If your policy includes Executive Assistance Services the following information pertains KEY CONTACT NUMBERS FOR EMERGENCY SERVICES 24 Hour Emergency Response Executive Assistance Services Emergency Medical Personal Travel Assistance Emergency Political Evacuation and Concierge Services. Calling the numbers below will provide the caller access to the Executive Assistance Services. Calling the following numbers does not constitute the report of a claim occurrence accident suit loss or injury as provided for in the respective coverage parts of your Policy. K4F 2122016 IT7053 version date 01 2012 Page 1 of 2 | 2 |
To report a claim occurrence accident suit loss or injury to us you must follow one of the methods set out above. Executive Assistance Toll Free Inside U.S. and Canada 1 800 766 8206 Executive Assistance Toll Free Outside U.S. and Canada IDD800 0200 8888 available from 40 countries Executive Assistance Collect Calls Outside the U.S. and Canada 1 202 659 7777 Where Toll Free or Collect Calls are not available Executive Assistance Outside the U.S. and Canada IDD 1 202 659 7777 K4F 2122016 IT7053 version date 01 2012 Page 2 of 2 | 2 |
aceusa KIDNAP EXTORTION CLAIMS REPORTING PROCEDURES COMPANY NOTIFICATION Notification must be made to the Company in compliance with the notice provisions of the policy. Notification should be made to Henry Minissale ACE North American Claims Business Mailing Address PO Box 5108 Scranton PA 18505 0525 Office Phone 215.640.2641 Fax 1 866 635 5687 Cell Phone 215 518 1149 EMERGENCY RESPONSE In the event of an actual or suspected incident that may be covered under this policy inmediate contact should be made to red24 at the 24 hour priority response number below red24 Phone Numbers 44 0 207 741 2075 1877 7816193 See detailed information sheet provided. IT7540 version date 04 2012 Page 1 of 1 2012 K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
aceusa What to do in a Kidnap and Extortion Crisis In the event of a crisis incident that may be covered under the terms of the policy red24 s Crisis Response Management CRM Centre should be the first point of contact PHONE NUMBERS 44 0 207 741 2075 PHONE NUMBERS 1 877 781 6193 red24 s Crisis Response Management CRM Centre is staffed every hour of the day by multilingual staff. The CRM Centre can advise assist or respond depending on the situation incident. Notification to the CRM Centre is independent of and does not supersede policy requirements of notice to the Company. The red24 Response Process Initial Call red24 will take the details of the crisis Quote your policy number if possible Provide your contact details Within the next hour... red24 s security consultants will have assessed the situation and have made possible deployment decisions You will receive a call within an hour of your initial call Strategy The security consultant will agree on a strategy for dealing with the early stages of the potential crisis red24 will stay in contact with the company and people involved in the crisis to ensure consistent information In the event of an incident that may be covered under this policy and whether or not red24 have been contacted one of the following Company representatives are to be notified in order of preference in accordance with the terms of the notice requirements of this policy ACE North American Claims Contact Information Claims Contact Business Contact Numbers Business email address Henry Minissale Office Phone 215.640.2641 Henry.Minissaleacegroup.com Cell Phone 215 518 1149 Fax 1.866.635.5687 Business Mailing Address PO Box 5108 Scranton PA 18505 0525 IT7547 04 2012 Page 1 of 1 K4F 2122016 i K4F 2122016 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
FORMS AND ENDORSEMENTS DECLARATIONS COMPANY NAME ACE AMERICAN INSURANCE COMPANY NAMED INSURED East West Copolymer Rubber LLC POLICY NUMBER PHFD38338985 003 DECLARATIONS EFFECTIVE 04162016 This policy consists of the Declarations pages and the following forms and endorsements attached to this policy at inception IT7001 08 2010 General Declarations IT7003 04 2015 Liability Coverages Declarations Occurrence IT1X70 04 2015 Employers Responsibility Coverage Declarations with Executive Assistance 1T7009 11 2010 IT7006 12 2011 1T7029 04 2010 Accidental Death and Dismemberment and Medical Expense Declarations Corporate Kidnap and Extortion Declarations Common Policy Conditions Effective 4122010 IT7025 07 2014 Commercial General Liability Coverage Form 1T7026 11 2012 Employee Benefits Liability Coverage Form Endorsement IT7027 08 2013 Contingent Auto Liability Coverage Form 1T1084 09 2008 Employers Responsibility Coverages with Executive Assistance 1T7033 05 2011 Accidental Death and Dismemberment and Medical Expense Coverage Form 1T7037 07 2012 Corporate Kidnap and Extortion Coverage Form IT7101 09 2011 Broad Named Insured 1T7325 05 2012 The ACE GPS Global Program Solutions Endorsement Non Admitted Included LD 34280 10 11 LD34280 1011 ACE GPS Global Program Solutions Endorsement Non Admitted Included IT7955 03 2014 Minimum Earned Premium Endorsement 1T7133 02 2011 Additional Insured By Contract 1T7828 08 2010 Exclusion War or Terrorism IT7377 12 2014 Limited Electronic Data Loss Coverage Access Collection Release Disclosure Limited Bodily Injury and Property Damage Separate Occurrence and Aggregate Limit Products Completed Operations Hazard Exclusion Waiver of Transfer of Rights of Recovery Against Others To Us Additional Insured Contingent Auto Required by Written Contract 1T7504 03 2007 Auto Medical Payments Coverage 1T7829 03 2007 Exclusion War or Terrorism IT7792 07 2010 032007 IT7508 12 2011 Fellow Employee Coverage 1T7460 09 2011 1T7134 02 2011 IT7510 11 2012 Hired Auto Physical Damage Coverage Endorsement 1T7513 03 2007 Waiver of Transfer of Rights of Recovery Against Other To Us IT1695 12 2011 Amendment Emergency Political Repatriation and Emergency Relocation 1T1490 11 2004 Amendment Voluntary Compensation Coverage Endorsement 1T1228 06 2013 War Coverage 1T7542b 01 2015 Cap on Losses From Certified Acts of Terrorism Kidnap and Extortion Coverage IT7537 01 2015 Disclosure Pursuant to Terrorism Risk Insurance Act 1T7142 04 2015 Coverage Territory Endorsement 1T7109a 08 2014 Local Insurer Financial Impairment Collectability Endorsement IT7065 09 2013 Ace Executive Assistance Services Travel App The Declarations pages and the Coverage Forms and endorsements listed above and attached complete the above numbered policy. ONS EFFECTIVE 04162016 K4F 2122016 1T7998 07 2010 Page 1 of 1 | 2 |
THIS PAGE IS INTENTIONALLY LEFT BLANK | 2 |
SAFETY NATIONAL CASUALTY CORPORATION PRIVACY STATEMENT Our Commitment To Our Customers Safety National Casualty Corporation Safety National is proud to have provided quality products and services to its customers for over 50 years. We greatly appreciate the trust that you and all of our customers place in us. We protect that trust by respecting the privacy of all of our customers both present and past. The following will explain our privacy practices so that you will understand our commitment to your privacy. We Respect Your Privacy When you apply to Safety National for any type of insurance you disclose information about you to us. The collection use and disclosure of such information is regulated by law. Safety National and its affiliates maintain physical electronic and procedural safeguards that comply with state and federal regulations to guard your personal information. Our employees are also advised of the importance of maintaining the confidentiality of your information. Types Of Information We Collect Safety National obtains most of our information directly from you your agent or broker. The application you complete as well as any additional information you provide generally gives us most of the details we need to know. Depending on the nature of your insurance transaction we may need further details about you. We may obtain information from third parties such as other insurance or reinsurance companies medical providers government agencies information clearinghouses and other public records. We may also obtain information about you from your other transactions with us our affiliates or others. non affiliates as described in this notice or as otherwise permitted by law. To Whom Do We Disclose Your Information We will not disclose any non public personal information about our customers or former customers except as permitted by law. That means we may disclose information we have collected about you to the following types of third parties e Our affiliated companies Members and subsidiaries of the Tokio Marine Holdings Inc. group of companies. Your agent or broker. e Parties who perform a business or insurance function for Safety National including reinsurance underwriting claims administration or adjusting investigation loss control and computer systems companies. e Other insurance companies or agents as reasonably necessary concerning your application policy or claim. Insurance statistical agencies. regulatory or reporting e Law enforcement or governmental authorities in connection with suspected fraud or illegal activities. Authorized persons as ordered by subpoena warrant or court order or as required by law. We do not disclose any non public personal information about you to non affiliated companies for marketing purposes or for any other purpose except those specifically allowed by law and described above. What We Do With Your Information Information that has been collected about you will be retained in our files. We will review your information in evaluating your request for insurance coverage determining your rates or underwriting risk servicing your policy or adjusting claims. We may retain information about our former customers and would disclose that information only to affiliates and to Independent Sales Agents or Brokers Your policy may have been placed with us through an independent agent or broker Sales Agent. Your Sales Agent may have gathered information about you. The use and protection of information obtained by your Sales Agent is their responsibility not Safety National s. If you have questions about how your Sales Agent uses or discloses your information please contact them directly. PN 99 02 0209 | 2 |
SAFETY NATIONAL CASUALTY CORPORATION 1832 Schuetz Road St. Louis MO 63146 888 995 5300 A STOCK COMPANY COMMERCIAL POLICY o SECRETARY Q Mif A m. PRESIDENT THESE POLICY PROVISIONS WITH THE DECLARATIONS PAGE COVERAGE FORM AND ENDORSEMENTS IF ANY COMPLETE THIS POLICY. CP 990303 14 | 2 |
COMMERCIAL GENERAL LIABILITY DECLARATIONS SAFETY NATIONAL CASUALTY CORP ggvgAFLOEnNEERtAr gPS ST. LOUIS MO 63146 888 995 5300 Policy Number From Policy Period To GL 4056109 01012019 01012020 1201 AM. Standard Time at the described location Previous Policy Number GL 4056109 Transaction ATLANTA GA 30328 Renewal Named Insured and Address Agent FIRST DATA CORPORATION 58531 5565 GLENRIDGE CONNECTOR NE WILLIS INSURANCE SERVICES OF GEORGIA INC. ATLANTA GA 30342 5 CONCOURSE PARKWAY 18TH FLOOR Telephone Business Description Type of Business COMPUTER PROCESSING AND DATA PREPARATION CORPORATION POLICY WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. IN RETURN FOR THE PAYMENT OF THE PREMIUM AND SUBJECT TO ALL THE TERMS OF THIS LIMITS OF INSURANCE EACH OCCURRENCE LIMIT 1000000 Combined BI PD DAMAGE TO PREMISES RENTED TO YOU LIMIT 1000000 Any one premises MEDICAL EXPENSE LIMIT S 10000 Any one person PERSONAL ADVERTISING INJURY LIMIT 1000000 Any one person or organization GENERAL AGGREGATE LIMIT 3000000 PRODUCTS COMPLETED OPERATIONS AGGREGATE LIMIT 3000000 DESCRIPTION OF BUSINESS FORM OF BUSINESS O INDIVIDUAL 0O PARTNERSHIP O JOINT VENTURE O TRUST BUSINESS DESCRIPTION COMPUTER PROCESSING AND DATA PREPARATION O LIMITED LIABILITY COMPANY ORGANIZATION INCLUDING A CORPORATION BUT NOT INCLUDING A PARTNERSHIP JOINT VENTURE OR LIMITED LIABILITY COMPANY SAFETY NATIONAL CASUALTY CORP ST. LOUIS MO 63146 888 995 5300 565 GLENRIDGE CONNECTOR NE TLANTA GA 30342 ILLIS INSURANCE SERVICES OF GEORGIA INC. CONCOURSE PARKWAY 18TH FLOOR TLANTA GA 30328 RY LIMIT or organization RUST ION BUT NOT INCLUDING A LIABILITY COMPANY Includes copyrighted material of Insurance Services Office Inc. with its permission. Safety National Casualty Corporation CG 10011109 Page 1 of 2 | 2 |
SAFETY NATIONAL CASUALTY CORP ST.LOUIS MO 63146 888 995 5300 COMMERCIAL GENERAL LIABILITY DECLARATIONS Policy Number GL 4056109 Named Insured FIRST DATA CORPORATION Agent WILLIS INSURANCE SERVICES OF GEORGIA INC. Effective Date 01012019 ALL PREMISES YOU OWN RENT OR OCCUPY LOCATION NUMBER ADDRESS OF ALL PREMISES YOU OWN RENT OR OCCUPY Schedule on File with Company See Schedule on File with Company CLASSIFICATION AND PREMIUM LOCATION CLASSIFICATION CODE PREMIUM RATE ADVANCE PREMIUM NUMBER NO. BASE Prem Prod Comp Prem Prod Comp Ops Ops Ops Ops Schedule Office 98111 us See Composite Rating Plan Premium on file Machines or Employee Endorsement SNGL 045 05 14 Attached with Appliances Headcount Company installation inspection adjustment or repair TOTAL PREMIUM SUBJECT TO AUDIT 44429 STATE SURCHARGES if applicable 9 TOTAL DUE AT INCEPTION 44438 AT EACH ANNIVERSARY IF POLICY PERIOD IS MORE THAN ONE YEAR AND PREMIUM IS PAID IN ANNUAL INSTALLMENTS AUDIT PERIOD IF APPLICABLE ANNUALLY O SEMI O QUARTERLY O MONTHLY ANNUALLY ENDORSEMENTS ENDORSEMENTS ATTACHED TO THIS POLICY See Attached Schedule of Forms and Endorsements THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS AND COVERAGE FORMS AND ANY ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. Countersigned By Date Authorized Representative Endorsenrlent SNGL 0454 05 14 Attached able licable 9 44438 THAN ONE YEAR AND PREMIUM IS PAID IN Includes copyrighted material of Insurance Services Office Inc. with its permission. Safety National Casualty Corporation CG 10011109 Page 2 of 2 | 2 |
SCHEDULE OF SURCHARGES SAFETY NATIONAL CASUALTY CORP From igflfg GL 4056109 01012019 01012020 888 995 5300 Policy Number Policy PTeoriod 1201 AM. Standard Time at the described location Named Insured and Address Agent FIRST DATA CORPORATION WILLIS INSURANCE SERVICES OF GEORGIA INC. 5565 GLENRIDGE CONNECTOR NE 5 CONCOURSE PARKWAY 18TH FLOOR ATLANTA GA 30342 ATLANTA GA 30328 Telephone State Surcharge Description Surcharge Amount KY General Liability Kentucky Municipal Tax 4.00 KY Kentucky Insurance Premium Surcharge 4.00 sc South Carolina Municipality Tax 1.00 565 GLENRIDGE CONNECTOR NE TLANTA GA 30342 CONCOURSE PARKWAY 18TH FLOOR TLANTA GA 30328 Page 1 of 1 IL10011208 | 2 |
SCHEDULE OF FORMS AND ENDORSEMENTS SAFETY NATIONAL CASUALTY CORP Policy Number Policy Period ST.LOUIS MO 63146 From To 888 995 5300 GL 4056109 01012019 01012020 1201 AM. Standard Time at the described location Named Insured and Address Agent FIRST DATA CORPORATION WILLIS INSURANCE SERVICES OF GEORGIA INC. 5565 GLENRIDGE CONNECTOR NE 5 CONCOURSE PARKWAY 18TH FLOOR ATLANTA GA 30342 ATLANTA GA 30328 Telephone Form Number Form Title PN 99 02 02 09 Privacy Statement CP 99 03 03 14 Commercial Policy Cover CG 10 01 11 09 Commercial General Liability Declarations IL 10 01 12 08 Schedule Of Surcharges IL 10 06 12 08 Schedule Of Forms And Endorsements IL N 001 09 03 Fraud Statement IL P 001 01 04 U.S. Treasury Department s Office Of Foreign Assets Control IL N 013 02 13 Alabama Fraud Statement IL N 012 09 03 Alaska Fraud Statement IL N 014 09 03 Arizona Fraud Statement IL N 016 09 03 Arkansas Fraud Statement SNIL PN 001 03 1109 Arkansas Policyholder Notice IL N 018 09 03 California Fraud Statement IL N 020 09 03 Colorado Fraud Statement SNGL PN 001 06 06 13 Connecticut Advisory Notice to Policyholders IL N 026 06 09 District Of Columbia Fraud Statement SNIL PN 001 08 0609 District Of Columbia Waiver Of Premium Disclosure Notice SNIL PN 001 09 0509 Florida Important Notice IL N 034 08 09 Hawaii Fraud Statement IL N 036 09 03 Idaho Fraud Statement PN 11 99 01 1013 Idaho Policyholder Notice SNGL PN 018A 12 1109 Illinois Acknowledgment By Policyholder IL N 175 11 11 Illinois Notice to Policyholders Regarding the Religious IL N 040 09 03 Indiana Fraud Statement IL N 120 10 05 Indiana Notice To Policyholders Regarding Filing IL N 043 01 16 Kansas Fraud Statement IL N 048 09 03 Louisiana Fraud Statement IL N 050 09 03 Maine Fraud Statement IL N 167 01 13 Maryland Fraud Statement SNIL PN 001 21 0411 Michigan Disclosure Notice For Exempt Commercial Policy IL N 058 09 03 Minnesota Fraud Statement IL N 070 09 03 New Hampshire Fraud Statement IL N 072 03 04 New Jersey Fraud Statement Application IL N 073 03 04 New Jersey Fraud Statement Claim Form IL N 074 09 03 New Mexico Fraud Statement 565 GLENRIDGE CONNECTOR NE TLANTA GA 30342 CONCOURSE PARKWAY 18TH FLOOR TLANTA GA 30328 IL 10 06 12 08 Page 1 0of 6 | 2 |
SAFETY NATIONAL CASUALTY CORP ST. LOUIS MO 63146 888 995 5300 SCHEDULE OF FORMS AND ENDORSEMENTS location Policy Period Policy Number From To GL 4056109 01012019 01012020 1201 AM. Standard Time at the described Named Insured and Address Agent FIRST DATA CORPORATION 5565 GLENRIDGE CONNECTOR NE ATLANTA GA 30342 WILLIS INSURANCE SERVICES OF GEORG 5 CONCOURSE PARKWAY 18TH FLOOR ATLANTA GA 30328 Telephone IA INC. SNGL PN 001 N 01 N N 09 P SNIL IL N SNIL SNIL SNIL IL CG CG CG CG CG CG CG N 20 20 20 20 20 20 20 084 79 085 088 10 006 09 10 02 09 07 11 PN 004 098 09 PN 003 PN 002 PN 001 106 02 05 26 11 37 10 15 SNGL 028 SNGL 004 SNGL 044 CG 24 12 SNGL 048 CG 21 70 SNGL 012 IL 10 05 SNGL 045 CG 21 39 SNGL 018 IL 09 85 SNGL 002 CG 02 24 SNGL 049 CG 04 35 09 11 04 04 04 04 04 04 11 11 05 11 05 01 12 12 05 10 02 01 09 10 05 12 31 03 02 11 03 02 05 42 03 42 42 42 03 85 13 13 13 13 13 13 11 11 14 85 14 15 09 08 14 93 10 15 08 93 14 07 0210 0909 0610 0409 0113 New York Advisory Notice To Policyholders Oklahoma Fraud Statement Oklahoma Notice Oregon Fraud Statement Pennsylvania Fraud Statement Pennsylvania Notice Rhode Island Notice To Policyholders Concerning Availab Special Texas Notice Notification Of The Availability Tennessee Fraud Statement Texas Exclusion Asbestos Advisory Notice Texas Exclusion Lead Contamination Advisory Notice Texas Important Notice Virginia Fraud Statement Additional Insured Club Members Additional Insured Controlling Interest Additional Insured Designated Person or Organization Additional Insured Managers Or Lessors Of Premises Additional Insured Owners Lessees Or Contractors C Additional Insured Owners Lessees Or Contractors S Additional Insured Vendors Alienated Premises Amended Definition Of Bodily Injury Asbestos Exclusion Boats Broadened Named Insured Endorsement Cap On Losses from Certified Acts of Terrorism Co Employee Exclusion Deleted Common Policy Change Endorsement Composite Rating Plan Premium Endorsement Contractual Liability Limitation Deductible Liability Coverage Disclosure Pursuant To Terrorism Risk Insurance Act ERISA Exclusion Earlier Notice Of Cancellation Provided By Us Earlier Notice of Nonrenewal Employee Benefits Liability Coverage ility 565 GLENRIDGE CONNECTOR NE TLANTA GA 30342 CONCOURSE PARKWAY 18TH FLOOR TLANTA GA 30328 IL 10 06 12 08 Page 2 of 6 | 2 |
SCHEDULE OF FORMS AND ENDORSEMENTS SAFETY NATIONAL CASUALTY CORP Policy Number Policy Period ST.LOUIS MO 63146 From To 888 995 5300 GL 4056109 01012019 01012020 location Named Insured and Address Agent FIRST DATA CORPORATION 5565 GLENRIDGE CONNECTOR NE 5 CONCOURSE PARKWAY 18TH FLOOR ATLANTA GA 30342 ATLANTA GA 30328 Telephone CG 21 47 12 07 CG 21 07 05 14 CG 21 16 04 13 CG 22 38 07 98 CG 22 48 04 13 SNGL 030 11 11 SNGL 036 11 11 CG 21 67 12 04 SNGL 032 11 11 SNGL 020 11 11 SNGL 043 05 14 SNGL 046 05 14 IL 00 23 07 02 IL 00 21 07 02 IL 00 21 09 08 IL 00 21 05 02 CG 22 75 04 13 CG 21 96 03 05 CG 21 65 12 04 SNGL 038 11 11 SNGL 021 11 11 CG 24 04 05 09 IL 01 21 09 08 IL 02 80 09 08 CG 26 70 10 01 CG 21 30 04 13 CG 32 73 09 08 CG 26 97 03 06 IL 02 58 12 14 CG 01 42 07 11 IL 02 31 09 08 CG 26 08 04 90 IL 01 99 09 08 IL 02 70 09 12 IL 02 28 09 07 IL 01 25 11 13 Employment Related Practices Exclusion Exclusion Access or Disclosure of Confidential Exclusion Designated Professional Services Exclusion Fiduciary Or Representative Liability Of Financial Exclusion Insurance And Related Operations Expected Or Intended Acts Extended Definition Personal Advertising Injury Fungi Or Bacteria Exclusion Incidental Emergency Medical Malpractice Liability Knowledge Of Occurrence Lead Contamination Exclusion Majority Interest Broadened Named Insured Endorsement Nuclear Energy Liability Exclusion End Broad Form Nuclear Energy Liability Exclusion End Broad Form Nuclear Energy Liability Exclusion End Broad Form Nuclear Energy Liability Exclusion End Broad Form Professional Liability Exclusion Computer Software Silica Or Silica Related Dust Exclusion Total Pollution Exclusion With A Building Heating Cooling Unintended Failure To Provide Notice Of Occurrence Unintentional Failure To Disclose Hazards Or Occurrence Waiver Of Transfer Of Rights Of Recovery Against Others Alaska Changes Attorney s Fees Alaska Changes Cancellation And Nonrenewal Alaska Changes Definition Of Metatag Alaska Recording and Distribution of Material or Information Alaska Silica Or Silica Related Dust Exclusion Alaska War Liability Exclusion Arizona Changes Cancellation and Nonrenewal Arkansas Changes Arkansas Changes Cancellation And Nonrenewal Arkansas Changes Multi Year Policies Arkansas Changes Transfer Of Rights Of Recovery California Changes Cancellation And Nonrenewal Colorado Changes Cancellation And Nonrenewal Colorado Changes Civil Union 1201 AM. Standard Time at the described WILLIS INSURANCE SERVICES OF GEORGIA INC. 565 GLENRIDGE CONNECTOR NE TLANTA GA 30342 CONCOURSE PARKWAY 18TH FLOOR TLANTA GA 30328 IL 10 06 12 08 Page 3 of 6 | 2 |
SCHEDULE OF FORMS AND ENDORSEMENTS ST.LOUIS MO 63146 888 995 5300 SAFETY NATIONAL CASUALTY CORP Policy Number 110 Folicy Period GL 4056109 01012019 01012020 location Named Insured and Address Agent FIRST DATA CORPORATION 5565 GLENRIDGE CONNECTOR NE 5 CONCOURSE PARKWAY 18TH FLOOR ATLANTA GA 30342 ATLANTA GA 30328 Telephone CG 33 78 05 10 IL 02 60 02 10 IL 01 40 09 08 CG 27 21 04 13 IL 01 51 01 12 IL 02 37 04 12 IL 02 78 09 08 CG 02 20 03 12 IL 02 62 02 15 IL 02 65 07 02 IL 01 49 01 12 IL 02 04 09 08 CG 02 00 01 18 IL 01 47 09 11 IL 01 62 10 13 IL 01 58 09 08 IL 02 72 09 07 CG 01 23 03 97 IL 01 17 12 10 IL 09 13 04 98 IL 02 76 09 08 CG 01 09 11 85 IL 02 61 09 07 IL 02 63 09 08 IL 02 77 01 18 CG 32 10 04 05 CG 01 25 03 03 CG 01 18 12 04 CG 26 84 12 04 IL 02 47 02 11 CG 02 01 12 17 CG 26 73 12 04 CG 01 68 10 09 IL 02 86 04 17 CG 26 05 02 07 IL 02 45 09 08 Colorado Changes Employee Benefits Liability Coverage Connecticut Changes Cancellation And Nonrenewal Connecticut Changes Civil Union Connecticut Employee Benefits Liability Coverage Delaware Changes Civil Union Delaware Changes Termination Provisions District Of Columbia Changes Cancellation And Nonrenewal Florida Changes Cancellation And Nonrenewal Georgia Changes Cancellation And Nonrenewal Hawaii Changes Cancellation And Nonrenewal Hawaii Changes Civil Union Idaho Changes Cancellation And Nonrenewal Illinois Changes Cancellation And Nonrenewal Illinois Changes Civil Union Illinois Changes Defense Costs Indiana Changes Indiana Changes Cancellation And Nonrenewal Indiana Changes Pollution Exclusion Indiana Changes Workers Compensation Exclusion Insurance Inspection Services Exemption From Liability Iowa Changes Cancellation And Nonrenewal Kansas And Oklahoma Changes Transfer Of Rights Kansas Changes Cancellation And Nonrenewal Kentucky Changes Cancellation And Nonrenewal Louisiana Changes Cancellation And Nonrenewal Louisiana Changes Fungi Or Bacteria Exclusion Louisiana Changes Insuring Agreement Louisiana Changes Legal Action Against Us Louisiana Changes Transfer Of Rights Of Recovery Maine Changes Cancellation And Nonrenewal Maryland Changes Maryland Changes Premium Audit Condition Michigan Changes Michigan Changes Cancellation And Nonrenewal Minnesota Changes Minnesota Changes Cancellation And Nonrenewal 1201 AM. Standard Time at the described WILLIS INSURANCE SERVICES OF GEORGIA INC. 565 GLENRIDGE CONNECTOR NE TLANTA GA 30342 CONCOURSE PARKWAY 18TH FLOOR TLANTA GA 30328 IL 10 06 12 08 Page 4 of 6 | 2 |
SCHEDULE OF FORMS AND ENDORSEMENTS SAFETY NATIONAL CASUALTY CORP Policy Number 5 Policy Period ST.LOUIS MO 63146 rom iIo 888 995 5300 GL 4056109 01012019 01012020 1201 AM. Standard Time at the described location Named Insured and Address Agent FIRST DATA CORPORATION WILLIS INSURANCE SERVICES OF GEORGIA INC. 5565 GLENRIDGE CONNECTOR NE 5 CONCOURSE PARKWAY 18TH FLOOR ATLANTA GA 30342 ATLANTA GA 30328 Telephone CG 01 22 12 07 Minnesota Changes Contractual Liability Exclusion Supplementary CG 26 81 12 04 Minnesota Changes Duties Condition IL 02 82 09 08 Mississippi Changes Cancellation And Nonrenewal IL 09 90 01 15 Missouri Disclosure Pursuant To Terrorism Risk Insurance IL 02 74 02 13 Missouri Changes Cancellation And Nonrenewal CG 26 25 04 05 Missouri Changes Guaranty Association CG 26 50 04 13 Missouri Changes Medical Payments CG 01 34 08 03 Missouri Changes Pollution Exclusion IL 02 43 09 07 Montana Changes IL 01 67 10 13 Montana Changes Conformity With Statutes CG 26 61 10 01 Montana Changes Medical Payments CG 27 16 12 07 Montana Employee Benefits Liability Coverage IL 02 59 12 17 Nebraska Changes Cancellation And Nonrenewal IL 02 51 09 07 Nevada Changes Cancellation And Nonrenewal IL 01 15 01 10 Nevada Changes Domestic Partnership CG 21 29 04 13 New Hampshire Amendment of Liquor Liability Exclusion CG 01 12 06 15 New Hampshire Changes CG 26 55 11 08 New Hampshire Changes Amendment Of Representations IL 01 35 01 19 New Hampshire Changes Cancellation And Nonrenewal CG 01 52 04 17 New Hampshire Changes Premium Audit CG 27 19 07 09 New Hampshire Employee Benefits Liability Coverage IL 02 08 09 07 New Jersey Changes Cancellation And Nonrenewal IL 01 41 09 08 New Jersey Changes Civil Union CG 26 53 06 99 New Jersey Changes Coverage Exclusion Liability for Hazard CG 26 20 10 93 New Jersey Changes Loss Information IL 02 98 05 15 New Mexico Changes Cancellation And Nonrenewal IL 02 68 01 14 New York Changes Cancellation And Nonrenewal CG 01 63 07 11 New York Changes Commercial General Liability Coverage CG 01 04 12 04 New York Changes Premium Audit CG 26 21 10 91 New York Changes Transfer Of Duties IL 02 69 09 08 North Carolina Changes Cancellation And Nonrenewal IL 02 36 09 07 Oklahoma Changes Cancellation And Nonrenewal IL 02 79 09 08 Oregon Changes Cancellation And Nonrenewal IL 01 42 09 08 Oregon Changes Domestic Partnership IL 02 46 09 07 Pennsylvania Changes Cancellation And Nonrenewal IL 01 20 10 13 Pennsylvania Changes Defense Costs 565 GLENRIDGE CONNECTOR NE TLANTA GA 30342 CONCOURSE PARKWAY 18TH FLOOR TLANTA GA 30328 IL 10 06 12 08 Page 5 of 6 | 2 |
SCHEDULE OF FORMS AND ENDORSEMENTS SAFETY NATIONAL CASUALTY CORP Policy Number 5 Policy PTeriod ST.LOUIS MO 63146 rom o 888 995 5300 GL 4056109 01012019 01012020 1201 AM. Standard Time at the described location Named Insured and Address Agent FIRST DATA CORPORATION 5565 GLENRIDGE CONNECTOR NE ATLANTA GA 30342 5 CONCOURSE PARKWAY 18TH FLOOR ATLANTA GA 30328 Telephone WILLIS INSURANCE SERVICES OF GEORGIA INC. IL 01 97 09 08 IL 02 73 01 10 IL 01 61 03 12 IL 01 28 09 08 IL 02 49 09 08 CG 01 44 10 11 IL 02 32 09 08 IL 02 50 09 08 CG 01 03 06 06 IL 02 75 11 13 IL 01 68 03 12 CG 26 39 12 07 CG 01 86 12 04 IL 02 66 09 08 CG 01 47 11 13 IL 02 19 06 15 IL 01 09 09 08 CG 01 54 04 13 IL 01 26 09 08 CG 01 79 07 10 IL 01 38 10 15 CG 32 98 07 10 IL 02 81 04 89 CG 01 24 01 93 IL 02 83 11 18 IL 00 17 11 98 CG 00 01 04 13 Rhode Rhode Rhode Rhode South South South Texas Island Changes Island Changes Island Changes Island Changes Carolina Changes Cancellation And Nonrenewal Civil Union Prejudgment Interest Dakota Changes Dakota Changes Tennessee Changes Cancellation And Nonrenewal Changes Cancellation And Nonrenewal Texas Changes Cancellation And Nonrenewal Provisions Texas Changes Duties Texas Changes Employment Related Practices Exclusion Utah Changes Utah Changes Cancellation And Nonrenewal Utah Changes Common Interest Associations Vermont Changes Vermont Changes Vermont Changes Vermont Changes Virginia Changes Virginia Changes Cancellation and Nonrenewal Virginia Employee Benefits Liability Coverage West Virginia Changes Cancellation Wisconsin Changes Amendment Of Policy Conditions Wisconsin Changes Cancellation And Nonrenewal Common Policy Conditions Commercial General Liability Coverage Form Cancellation And Nonrenewal Civil Union Pollution Statutory Liability Cancellation And Nonrenewal 565 GLENRIDGE CONNECTOR NE TLANTA GA 30342 CONCOURSE PARKWAY 18TH FLOOR TLANTA GA 30328 IL 10 06 12 08 Page 6 of 6 | 2 |
IL N 001 09 03 FRAUD STATEMENT Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly pre sents false information in an application for insurance is guilty of a crime and may be subject to fines and con finement in prison. 1SO Properties Inc. 2003 Page 1 of 1 IL N 001 09 03 | 2 |
IL P 001 01 04 U.S. TREASURY DEPARTMENT S OFFICE OF FOREIGN ASSETS CONTROL OFAC ADVISORY NOTICE TO POLICYHOLDERS No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your policy. You should read your policy and review your Declarations page for complete information on the coverages you are provided. This Notice provides information concerning possible impact on your insurance coverage due to directives issued by OFAC. Please read this Notice carefully. The Office of Foreign Assets Control OFAC administers and enforces sanctions policy based on Presidential declarations of national emergency. OFAC has identified and listed numerous Foreign agents Front organizations Terrorists Terrorist organizations and Narcotics traffickers as Specially Designated Nationals and Blocked Persons. This list can be located on the United States Treasury s web site httpwww.treas.gov ofac. In accordance with OFAC regulations if it is determined that you or any other insured or any person or entity claiming the benefits of this insurance has violated U.S. sanctions law or is a Specially Designated National and Blocked Person as identified by OFAC this insurance will be considered a blocked or frozen contract and all pro visions of this insurance are immediately subject to OFAC. When an insurance policy is considered to be such a blocked or frozen contract no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments also apply. ISO Properties Inc. 2004 Page 1 of 1 IL P 0010104 | 2 |
ILN 0130213 ALABAMA FRAUD STATEMENT Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution fines or confinement in prison or any combination thereof. Insurance Services Office Inc. 2013 Page 1 of 1 ILN 0130213 | 2 |
ILN 01209 03 ALASKA FRAUD STATEMENT A person who knowingly and with intent to injure defraud or deceive an insurance company files a claim contain ing false incomplete or misleading information may be prosecuted under state law. 1SO Properties Inc. 2003 Page 1 of 1 ILN 01209 03 | 2 |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.