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Insurance - Davis Farr, LLPDAVIFAR-01 AJ922A2R '4� 6} CERTIFICATE OF LIABILITY INSURANCE D 06/211201 YY) 05/21/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # OE77964 CONTACT Suzanne Posada Integro USA Inc., dba: Integro Insurance Brokers 362U Birch StreetINC Newport Beach, CA 92660 j INSURED: Davis Farr, LLP POLICY NO.: 6804JI54861 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read all the PRO- VISIONS of this endorsement carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured B. Damage To Premises Rented To You Extension • Perils of fire, explosion, lightning, smoke, water • Limit increased to $300,000 C. Blanket Waiver of Subrogation D. Blanket Additional Insured— Managers or Lessors of Premises E. Blanket Additional Insured — Lessor of leased Equipment F. Incidental Medical Malpractice G. Personal injury— Assumed by Contract H. Extension of Coverage — Bodily Injury PROVISIONS A. BROADENED NAMED INSURED 1. The Named Insured in Item 1. of the Declara- tions is as follows: The person or organization named in Item 1. of the Declarations and any organization, other than a partnership or joint venture, over which you maintain ownership or majority in- terest on the effective date of the policy. However, coverage for any such organization will cease as of the date during the policy pe- riod that you no longer maintain ownership of, or majority interest in, such organization. 2. WHO IS AN INSURED (Section II) Item 4,a. is deleted and replaced by the following: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, unless reported in writing to us within 180 days. 3. This Provision A. does not apply to any per- son or organization for which coverage is ex- cluded by endorsement. I. Injury to Co -Employees and Co -Volunteer Workers J. Aircraft Chartered with Crew K. Non -Owned Watercraft — Increased from 25 feet to 50 feet L. Increased Supplementary Payments • Cost for bail bonds increased to $2,500 • Loss of earnings increased to $500 per day M. Knowledge and Notice of Occurrence or Offense N. Unintentional Omission O. Reasonable Force — Bodily Injury or Property Damage B. DAMAGE TO PREMISES RENTED TO YOU EXTENSION 1. The last paragraph of COVERAGE A. BOD- ILY INJURY AND PROPERTY DAMAGE Lk ABILITY (Section I — Coverages) is deleted and replaced by the following: Exclusions c. through n. do not apply to dam- age to premises while rented to you, or tem- porarily occupied by you with permission of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water, A separate limit of insurance applies to this coverage as described in LIMITS OF INSUR- ANCE (Section III). 2. This insurance does not apply to damage to premises while rented to you, or temporarily CG D1 86 11 03 Copyright, The Travelers Indemnity Company, 2003 Page 1 of 5 COMMERCIAL GENERAL LIABILITY occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pres- sure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from wa- ter; c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 3. Part 6. of LIMITS OF INSURANCE (Section III) is deleted and replaced by the following: Subject to 5. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under COVERAGE A. for damages be- cause of. "property damage" to any one prem- ises while rented to you, or temporarily occu- pied by you with permission of the owner, caused by fire, explosion, lightning, smoke resulting from such fire, explosion, or light- ning, or water. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same 'occur- rence", whether such damage results from fire, explosion, lightning, smoke resulting from such fire, explosion, or lightning, or water, or any combination of any of these. The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or b. The amount shown on the Declarations for Damage To Premises Rented To You Limit. 4. Under DEFINITIONS (Section V), Paragraph a. of the definition of "insured contract' is amended so that it does not include that por- tion of the contract for a lease of premises that indemnities any person or organization for damage to premises while rented to you, or temporarily occupied by you with permis- sion of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section (— Coverages) is excluded by endorsement. C. BLANKET WAIVER OFSUBROGATION We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. D. BLANKET ADDITIONAL INSURED — MANAG- ERS OR LESSORS OF PREMISES WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization (referred to below as "additional insured") with whom you have agreed in a written contract, exe- cuted prior to loss, to name as an additional in- sured, but only with respect to liability arising out of the ownership, maintenance or use of that part of any premises leased to you, subject to the fol- lowing provisions: 1. Limits of Insurance. The limits of insurance afforded to the additional insured shall be the limits which you agreed to provide, or the lim- its shown on the Declarations, whichever is less. 2. The insurance afforded to the additional in- sured does not apply to: a. Any 'occurrence" that takes place after you cease to be a tenant in that premises; b. Any premises for which coverage is ex- cluded by endorsement; or c. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. 3. The insurance afforded to the additional in- sured is excess over any valid and collectible insurance available to such additional in- sured, unless you have agreed in a written contract for this insurance to apply on a pri- mary or contributory basis. E. BLANKET ADDITIONAL INSURED — LESSOR OF LEASED EQUIPMENT e. Water. WHO IS AN INSURED (Section II) is amended to 5. This Provision B. does not apply if coverage include as an insured any person or organization for Damage To Premises Rented To You of (referred to below as "additional insured") with Page 2 of 5 Copyright, The Travelers Indemnity Company, 2003 CG D1 8611 03 whom you have agreed in a written contract, exe- cuted prior to loss, to name as an additional in- sured, but only with respect to their liability arising 3 out of the maintenance, operation or use by you of equipment leased to you by such additional in- sured, subject to the following provisions: 1. Limits of Insurance. The limits of Insurance afforded to the additional insured shall be the limits which you agreed to provide, or the lim- its shown on the Declarations, whichever is less. 2. The Insurance afforded to the additional in- sured does not apply to: a. Any "occurrence" that takes place after 4. the equipment lease expires; or b. "Bodily injury" or "property damage" aris- ing out of the sole negligence of such ad- ditional Insured. 3. The insurance afforded to the additional in- sured Is excess over any valid and collectible insurance available to such additional in- sured, unless you have agreed in a written 5 contract for this insurance to apply on a pri- mary or contributory basis. F. INCIDENTAL MEDICAL MALPRACTICE 1. The definition of 'bodily injury" in DEFINI- TIONS (Section V) is amended to include "In- cidental Medical Malpractice Injury". 2. The following definition is added to DEFINI- TIONS (Section V): "Incidental medical malpractice injury" means bodily injury, mental anguish, sickness or dis- ease sustained by a person, including death resulting from any of these at any time, aris- ing out of the rendering of, or failure to ren- der, the following services: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances; or c. First aid. COMMERCIAL GENERAL LIABILITY for which no remuneration is demanded or received. Paragraph 2.a.(1)(d) of WHO IS AN IN- SURED (Section 11) does not apply to any registered nurse, licensed practical nurse, emergency medical technician or paramedic employed by you, but only while performing the services described in paragraph 2. above and while acting within the scope of their em- ployment by you. Any "employees" rendering "Good Samaritan services" will be deemed to be acting within the scope of their employ- ment by you. The following exclusion is added to paragraph 2. Exclusions of COVERAGE A. — BODILY INJURY AND PROPERTY DAMAGE LIABIL- ITY (Section I — Coverages): (This insurance does not apply to:) Liability arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuticals by or with the knowledge or consent of the insured. For the purposes of determining the applica- ble limits of insurance, any act or omission, together with all related acts or omissions in the furnishing of the services described in paragraph 2. above to any one person, will be considered one "occurrence". 6. This Provision F. does not apply if you are in the business or occupation of providing any of the services described in paragraph 2, above. 7. The insurance provided by this Provision F. shall be excess over any other valid and col- lectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance pur- chased specifically by you to be excess of this policy. G. PERSONAL INJURY — ASSUMED BY CON- TRACT 1. The Contractual Liability Exclusion in Part 2., Exclusions of COVERAGE B. PER- SONAL AND ADVERTISING INJURY LIABIL- ITY (Section I — Coverages) Is deleted and replaced by the following: (This insurance does riot apply to:) d. "Good Samaritan services". Asa used in Contractual Liability this Provision F., "Good Samaritan ser- vices" are those medical services ren- "Advertising injury" for which the insured has deredor provided in an emergency and assumed liability in a contract or agreement. This exclusion does not apply to liability for CG D1 86 11 03 Copyright, The Travelers Indemnity Company, 2003 Page 3 of 5 COMMERCIAL GENERAL LIABILITY damages that the Insured would have in the absence of the contract of agreement. 2. Subparagraph f, of the definition of "insured contract" (DEFINITIONS — Section V) is de- leted and replaced by the following: f. That part of any other contract or agree- ment pertaining to your business (includ- ing an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury," "property damage" or "per- sonal injury" to a third party or organize tion. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. 3. This Provision G. does not apply if COVER- AGE B. PERSONAL AND ADVERTISING IN- JURY LIABILITY is excluded by endorse- ment. H. EXTENSION OF COVERAGE — BODILY IN- JURY The definition of "bodily injury' (DEFINITIONS — Section V) is deleted and replaced by the follow- ing: "Bodily injury" means bodily injury, mental an- guish, mental injury, shock, fright, disability, hu- miliation, sickness or disease sustained by a per- son, including death resulting from any of these at any time. I. INJURY TO CO -EMPLOYEES AND CO - VOLUNTEER WORKERS 1, Your "employees" are insureds with respect to "bodily injury" to a co -"employee" in the course of the co -"employee's" employment by you, or to your "volunteer workers" while per- forming duties related to the conduct of your business, provided that this coverage for your "employees" does not apply to acts outside the scope of their employment by you or while performing duties unrelated to the conduct of your business. 2. Your "volunteer workers" are insureds with respect to "bodily injury" to a co -"volunteer worker" while performing duties related to the conduct of your business, or to your "employ- ees" In the course of the "employee's" em- ployment by you, provided that this coverage for your "volunteer workers" does not apply while performing duties unrelated to the con- duct of your business. 3. Subparagraphs 2.a -(1)(a), (b) and (c) and 3.a. of WHO IS AN INSURED (Section II) do not apply to "bodily injury" for which insurance is provided by paragraph 1. or 2. above, J. AIRCRAFT CHARTERED WITH CREW 1. The following is added to the exceptions con- tained in the Aircraft, Auto Or Watercraft Exclusion in Part 2., Exclusions of COVER- AGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I— Coverages): (This exclusion does not apply to:) Aircraft chartered with crew to any insured. 2. This Provision J. does not apply if the char- tered aircraft is owned by any insured. 3. The insurance provided by this Provision J. shall be excess over any other valid and col- lectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance pur- chased specifically by you to be excess of this policy. K. NON -OWNED WATERCRAFT 1. The exception contained in Subparagraph (2) of the Aircraft, Auto Or Watercraft Exclu- sion in Part 2., Exclusions of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I — Coverages) is deleted and replaced by the following: (2) A watercraft you do not own that is: (a) Fifty feet long or less; and (b) Not being used to carry persons or property for a charge; 2. This Provision K. applies to any person who, with your expressed or implied consent, either uses or is responsible for the use of a water- craft. 3. The insurance provided by this Provision K. shall be excess over any other valid and col- lectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance pur- chased specifically by you to be excess of this policy. L. INCREASED SUPPLEMENTARY PAYMENTS Parts b. and d. of SUPPLEMENTARY PAY- MENTS — COVERAGES A AND B (Section I — Coverages) are amended as follows: 1. In Part b. the amount we will pay for the cost of bail bonds is increased to $2500. Page 4 of 5 Copyright, The Travelers Indemnity Company, 2003 CG D1 86 11 03 2. In Part d. the amount we will pay for loss of earnings is increased to $500 a day. M. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE 1. The following is added to COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), paragraph 2. (Duties In The Event of Oc- currence, Offense, Claim or Suit): Notice of an "occurrence" or of an offense which may result in a claim under this insur- ance shall be given as soon as practicable af- ter knowledge of the "occurrence" or offense has been reported to any insured listed under Paragraph 1. of Section it — Who Is An In- sured or an "employee" (such as an insur- ance, loss control or risk manager or adminis- trator) designated by you to give such notice. Knowledge by other "employee(s)" of an "oc- currence" or of an offense does not imply that you also have such knowledge. 2. Notice shall be deemed prompt if given in good faith as soon as practicable to your workers' compensation Insurer. This applies only if you subsequently give notice to us as soon as practicable after any insured listed under Paragraph 1. of Section II —Who Is An Insured or an "employee" (such as an insur- ance, loss control or risk manager or adminis- trator) designated by you to give such notice discovers that the "occurrence", offense or claim may involve this policy. 3. However, this Provision M. does not apply as respects the specific number of days within COMMERCIAL GENERAL LIABILITY which you are required to notify us in writing of the abrupt commencement of a discharge, release or escape of "pollutants" which causes "bodily injury" or "property damage" which may otherwise be covered under this policy. N. UNINTENTIONAL OMISSION The following is added to COMMERCIAL GEN- ERAL LIABILITY CONDITIONS (Section IV), paragraph 6. (Representations): The unintentional omission of, or unintentional error in, any information provided by you shall not prejudice your rights under this insurance. How- ever, this Provision N. does not affect our right to collect additional premium or to exercise our right of cancellation or nonrenewal in accordance with applicable state insurance laws, codes or regula- tions. 0. REASONABLE FORCE — BODILY INJURY OR PROPERTY DAMAGE The Expected Or Intended Injury Exclusion in Part 2., Exclusions of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I — Coverages) is deleted and replaced by the following: (This insurance does not apply to:) Expected or Intended Injury or Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "properly damage" resulting from the use of rea- sonable force to protect persons or property. CG D1 8611 03 Copyright, The Travelers Indemnity Company, 2003 Page 5 of 5 INSURED: Davis Farr, LLP POLICY NO.: 6804J154861 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), Paragraph 4. (Other Insurance), is amended as follows: 1. The following is added to Paragraph a. Primary Insurance: However, if you specifically agree in a written con- tract or written agreement that the insurance pro- vided to an additional insured under this Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insur- ance is primary to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The "bodily injury" or "property. damage" for which coverage is sought occurs; and b. The "personal injury" or "advertising injury' for which coverage is sought arises out of an of- fense committed subsequent to the signing and execution of that contract or agreement by you, 2. The first Subparagraph (2) of Paragraph b. Ex- cess Insurance regarding any other primary in- surance available to you is deleted. 3. The following is added to Paragraph b. Excess Insurance, as an additional subparagraph under Subparagraph (1): That is available to the insured when the insured Is added as an additional insured under any other policy, including any umbrella or excess policy. CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1 TRAVELERS) k WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: UB -6x048648 -18-42-G WAIVEROF OUR RIGHTTO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- mium. Schedule Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. INCLUDING: Job Description AUDITING AND BOOKKEEPING This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05-21-2018 Policy No. U661<048648 Endorsement No. Insured Davis Farr, LLP Premium Insurance Company Travelers Property Casualty Co. of America Countersigned byl7u DATE OF ISSUE: 04-06-18 ST ASSIGN: Page 1 of 1 INSURED: Davis Farr, LLP POLICY NO.: 6804J154861 COMMON POLICY CONDITIONS All Coverage Parts Included in this policy are subject to the following conditions: A. CANCELLATION 1. The first Named Insured shown in the Decla- rations may cancel this policy by mailing or delivering to us advance written notice Of cancellation. 2. We may cancel this policy or any Coverage Part by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of can- cellation if we cancel for nonpayment of premium; or b. 30 days before the effective date of can- cellation if we cancel for any other rea- son. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. If the policy is cancelled, that date will become the end of the policy period. If a Coverage Part is cancelled, that date will become the end of the policy period as respects that Coverage Part only. 5. If this policy or any Coverage Part is can- celled, we will send the first Named Insured any premium refund due. If we cancel, the re- fund will be pro rata. If the first Named In- sured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a re- fund. 6. If notice is mailed, proof of mailing will be sufficient proof of notice. B. CHANGES This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declara- tions is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us as part of this policy. C. EXAMINATION OF YOUR BOOKS AND RECORDS We may examine and audit your books and re- cords as they relate to this policy at any time dur- ing the policy period and up to three years after- ward. D. INSPECTIONS AND SURVEYS 1. We have the right to: a. Make inspections and surveys at any time; b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspec- tions, surveys, reports or recommendations and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety Inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advi- sory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or rec- ommendations we may make relative to certi- fication, under state or municipal statutes, or- dinances or regulations, of boilers, pressure vessels or elevators. E. PREMIUMS 1. The first Named Insured shown in the Decla- rations: a. Is responsible for the payment of all pre- miums; and b. Will be the payee for any return premi- ums we pay. IL T3 15 09 07 (Rev. 03-11) Includes the copyrighted matedat of Insurance Services Office, Inc. with its permission. Page 1 of 2 2. We compute all premiums for this policy in accordance with our rules, rates, rating plans, premiums and minimum premiums. The pre- mium shown in the Declarations was com- puted based on rates and rules in effect at the time the policy was issued. On each re- newal, continuation or anniversary of the ef- fective date of this policy, we will compute the premium in accordance with our rates and rules then in effect. F. TRANSFER OF YOUR RIGHTS AND DUTIES UNDER THIS POLICY Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named in- sured. If you die, your rights and duties will be trans- ferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary cus- tody of your property will have your rights and duties but only with respect to that property. G. BUSINESSOWNERS COVERAGE PART — REFERENCES TO FORMS AND ENDORSE- MENTS In some instances, the Common Policy Declara- tions may list endorsements included in the Busi- nessowners Coverage Part that reference: 1. The Commercial Property Coverage Part; 2. The Commercial General Liability or Liquor Liability Coverage Part; or 3. Standard Property forms including, but not limited to, the following: a. Building and Personal Property Coverage Form; b. Business Income Coverage Form; c. Commercial Property Conditions; d. Condominium Association Coverage Form; e. Condominium Commercial Unit -Owners Coverage Form; f. Causes of Loss Basic Form; g. Causes of Loss Special Form; and h. Causes of Loss Earthquake Form. Endorsements referencing the Commercial Property Coverage Part or the Standard Property Forms referenced above apply to the Businessowners Property Coverage Spe- cial Form In the same manner as they apply to the forms they reference. Endorsements referencing the Commercial General Liability Coverage Part apply to the Commercial General Liability Coverage Form (included in the Businessowners Coverage Part) in the same manner as they apply to the form they reference. H. INSURANCE UNDER TWO OR MORE COVER- AGE PARTS If two or more of this policy's Coverage Parts ap- ply to the same loss or damage, we will not pay more than the actual amount of the loss or dam- age. This policy consists of the Common Policy Declarations and the Coverage Parts and endorsements listed in that. declarations form. In return for payment of the premium, we agree with the Named Insured to provide the insurance afforded by a Coverage Part forming part of this policy. That insurance will be provided by the company indicated as insuring company in the Common Policy Declarations by the abbreviation of its name opposite that Coverage Part. One of the companies listed below (each a stock company) has executed this policy, and this policy is counter- signed by the officers listed below: The Travelers Indemnity Company (IND) The Phoenix Insurance Company (PHX) The Charter Oak Fire Insurance Company (COF) Travelers Property Casualty Company of America (TIL) The Travelers Indemnity Company of Connecticut (TCT) The Travelers Indemnity Company of America (T(A) Travelers Casualty Insurance Company of America (ACJ) � �� � C Secretary President Page 2 of 2 Includes the copyrighted material of Insurance Services Office, Inc. vdth its permission. IL T3 15 09 ll% (Rev. 03-11)