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Insurance - Charles King Co. Inc. - 2013-04-02 CHAKIN-001 CEDE ACC:,REY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ki►------ 4/2/2013 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 PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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). . CONT PRODUCER •-- - .. (888)825-4322 NAMEACT Denise Cerna Bowermaster&Associates PHONE FAX P.O.Box 6026 RECEIVED (A c,No,Ext):I14-733 6200 219 (AIC,No): 714-252-8253 10805 Holder Street-Suite 350 E-MAIL SS:dcerna bowermaster.com Cypress,CA 90630 APR 0 4 2013 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Fire Insurance of Hartford INSURED Charles King Company, I196IA MESA SANITARY DISIR_A INSURER B:Continental Casualty Co. 2841 Gardena Avenue INSURER C:Travelers Property&Casualty Co of Amer. Signal Hill, CA 90755 INSURER D:Chards Specialty Insurance INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR I POLICY EFF I POLICY EXP W LTR INSR VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X X 4034952911 3/30/2013 3/30/2014 DAMAGE TO RENTED 100 000 . PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR - MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEt_J'L AGGREGATE LIMIT APPLIES PER: • PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO LOC $ JECT lir OMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ A NY AUTO X 5091114974 3/30/2013 3/30/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE 5091114988 3/30/2013 3/30/2014 AGGREGATE $ 3,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X WC STATU- 1°A'- AND EMPLOYERS'LIABILITY TORY LIMITS ER Y/N C ANY PROPRIETOR/PARTNER/EXECUTIVE X DTJUB3452N74312 6/2/2012 6/2/2013 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE--POLICY LIMIT $ 1,000,000 0 Pollution Liability CPL3850939 3/30/2013 3/30/2014 :$10,000/$5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Project No.192 System Wide Sewer Reconstruction Phase II Costa Mesa Sanitary District,its employees and agents are Additional Insured with respects to General Liability per attached endorsement form G140331C,Primary and Non-Contributory included.Waiver of Subrogation applies to WorkComp per attached endorsement form WC990376. Waiver of Subrogation applies to Auto Liability per form 923186B and General Liability per form G18652J.Cancellation policy forms attached ILT0010107 and IL02700908. CERTIFICATE HOLDER CANCELLATION IP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa Sanitary District r' ACCORDANCE WITH THE POLICY PROVISIONS. • 628 W. 19th Street j— \� J Costa Mesa, CA 92627- `� AUTHORIZED REPRESENTATIVE h ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD G-140331-C CNAPolicy Number: 403495291/ (Ed. 10/10) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by"written contract" per Paragraph A. below.) Locations of Covered Operations (As per the"written contract,"provided the location is within the"coverage territory"of this Coverage Part.) A. Section II - Who Is An Insured is amended to 2. We will not provide the additional insured any include as an additional insured: broader coverage or any higher limit of • 1. Any person or organization whom you are insurance than the least that is: required by "written contract" to add as an a. Required by the"written contract' additional insured on this Coverage Part; and b. Described in B.1. above; or 2. The particular person or organization, if any, c. Afforded to you under this policy. scheduled above. B. The insurance provided to the additional insured is 3. This insurance is excess of all other insurance limited as follows: available to the additional insured whether on a primary, excess, contingent or any other basis. 1. The person or organization is an additional But if required by the "written contract," this insured only with respect to liability for "bodily insurance will be primary and non-contributory injury," "property damage," or "personal and relative to insurance on which the additional advertising injury"caused in whole or in part by: insured is a Named Insured. a. Your acts or omissions; or 4. The insurance provided to the additional insured does not apply to "bodily injury," "property b. The acts or omissions of those acting on damage," or "personal and advertising injury your behalf arising out of: in the performance of your ongoing operations a. The rendering of, or the failure to render, specified in the"written contract"; or any professional architectural, engineering, c. "Your work" that is specified in the "written or surveying services, including: contract" but only for "bodily injury" or (1) The re arin a rovin or failing to "property damage" included in the ( ) p p g' pp g' g prepare or approve maps, shop "products-completed operations hazard," and only if: drawings, opinions, reports, surveys, field orders, change orders or drawings (1) The "written contract" requires you to and specifications; and provide the additional insured such (2) Supervisory, inspection, architectural or coverage; and engineering activities; or • (2) This Coverage Part provides such coverage. G-140331-C Includes copyrighted material of Insurance Services Office, Inc.,with its permission Page 1 of 2 (Ed. 10/10) .. . .......... ... ... CND G1101 Policy Number:4034952911 (Ed.. 10/10) b. Any premises or work for which the We have no duty to defend or indemnify an 411 additional insured is specifically listed as an additional insured under this endorsement until additional insured on another endorsement we receive from the additional insured written attached to this Coverage Part. notice of a claim or"suit." C. SECTION IV — COMMERCIAL GENERAL 2. With respect only to the insurance provided by LIABILITY CONDITIONS is amended as follows: this endorsement, the first sentence of Paragraph 4.a. of the Other Insurance Condition 1. The Duties In The Event of Occurrence, is deleted and replaced with the following: Offense, Claim or Suit condition is amended to add the following additional conditions 4. Other Insurance applicable to the additional insured: a. Primary Insurance An additional insured under this endorsement will as soon as practicable: This insurance is primary and non- contributory except when rendered (1) Give us written notice of an "occurrence" or excess by endorsement G-140331-C, an offense which may result in a claim or or when Paragraph b. below applies. "suit" under this insurance, and of any claim D. Only for the purpose of the insurance provided by or"suit"that does result; this endorsement, SECTION V — DEFINITIONS is (2) Except as provided in Paragraph B.3 of this amended to add the following definition: endorsement, agree to make available any 'Written contract" means a written contract or other insurance the additional insured has written agreement that requires you to make a for a loss we cover under this Coverage person or organization an additional insured on this Part; Coverage Part, provided the contract or agreement: (3) Send us copies of all legal papers received, 1. Is currently in effect or becomes effective during and otherwise cooperate with us in the the term of this policy; and investigation, defense, or settlement of the claim or"suit"; and 2. Was executed prior to: (4) Tender the defense and indemnity of any a. The"bodily injury"or"property damage"; or • claim or "suit" to any other insurer or self insurer whose policy or program applies to a b The offense that caused the "personal and loss we cover under this Coverage Part. advertising injury" But if the "written contract" requires this for which the additional insured seeks coverage insurance to be primary and non- under this Coverage Part. contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. G-140331-C Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 2 of 2 (Ed. 10/10) G-18652-J CMA Policy Number: 4034952911 (Ed. 07-12) • CONTRACTORS' GENERAL LIABILITY EXTENSION ENDORSEMENT It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows. The changes this endorsement makes do not apply with respect to any coverage that has been excluded or amended by another endorsement attached to this policy. SCHEDULE Coverage is summarized below. For particulars and limitations affecting each coverage, please refer to the corresponding policy provisions in the body of this endorsement. 1. Additional Insureds Seven additional insured extensions. 2. Bodily Injury—Expanded Definition 3. Broad Knowledge of Occurrence/Notice of Occurrence 4. Broad Named Insured 5. Broadened Liability Coverage For Damage To"Your Product"And "Your Work" Limit: $100,000. 6. Contractual Liability—Railroads Expanded definition of"insured contract." 7. Contractual Liability For Personal And Advertising Injury 8. Electronic Data Liability Loss of Electronic Data Limit: $100,000. 9. Expanded Personal And Advertising Injury-Discrimination Or Humiliation 10. Expected Or Intended Injury Reasonable force—"bodily injury"or"property damage." 11. General Aggregate Limits Of Insurance-Per Project 12. In Rem Actions • 13. Incidental Health Care Malpractice Coverage 14. Joint Ventures/Partnership/Limited Liability Companies Coverage for your interest in such terminated or ended organizations. • 15. Legal Liability/Alienated Premises/Borrowed Equipment Coverage Extended perils. Default limit increased to$500,000 for Damage to Premises Rented To You. $25,000 limit for"property damage"to borrowed tools or equipment at a jobsite. 16. Liberalization Clause 17. Liquor Liability Coverage Extension 18. Medical Payments Limits increased to$15,000. Reporting increased to three years from the date of accident. 19. Non-owned Aircraft Coverage 20. Non-owned Watercraft Increased to 75 feet. 21. Primary And Non-Contributory To Other Insurance 22. Property Damage-Elevators 23. Supplementary Payments Cost of bail bonds increased to$5,000. Daily loss of earnings increased to$1,000. 24. Unintentional Failure To Disclose Hazards 25. Waiver of Subrogation -Blanket Waiver of subrogation where required by written contract or written agreement. 26. Wrap-Up Extension • G-18652-J (Ed. 07-12) Page 1 of 12 Copyright,CNA All Rights Reserved. .. . ........ ..... G-18652-J CNAPolicy Number: 4034952911 (Ed. 07-12) 1. ADDITIONAL INSURED 2. With respect to the insurance afforded to • these additional insureds, this insurance SECTION II—WHO IS AN INSURED is amended to does not apply to any "occurrence" which include as an insured any person or organization takes place after the equipment lease (called additional insured)described in paragraphs expires. A. through G. below whom you are required to add as an additional insured on this policy under a D. Lessor- Land written contract or written agreement, provided the An owner or other interest from whom land has written contract or written agreement: been leased by you but only with respect to i. Is currently in effect or becomes effective liability arising out of the ownership, during the term of this policy; and maintenance or use of that specific part of the land leased to you and subject to the following ii. Was executed prior to the "bodily injury," additional exclusions: "property damage" or "personal injury and advertising injury" for which the additional This insurance does not apply to: insured seeks coverage. 1. Any "occurrence" which takes place after However, we will not provide the additional you cease to lease that land; or insured any broader coverage or any higher limit 2. Structural alterations, new construction or of insurance than the least that is: demolition operations performed by or on a. The maximum permitted by law; behalf of such additional insured. b. Required in the written contract or written E. Lessor- Premises agreement; A manager or lessor of premises but only with c. Afforded to you under this policy; or respect to liability arising out of the ownership, maintenance or use of that specific part of the d. Described in the applicable paragraphs A. premises leased to you and subject to the through G. below. following additional exclusions: A. Controlling Interest This insurance does not apply to: • Any persons or organizations with a controlling 1. Any "occurrence" which takes place after interest in you but only with respect to their you cease to be a tenant in that premises; liability arising out of: or 1. Their financial control of you; or 2. Structural alterations, new construction or 2. Premises they own, maintain or control demolition operations performed by or on while you lease or occupy these premises. behalf of such additional insured. This insurance does not apply to structural F. Mortgagee, Assignee or Receiver alterations, new construction and demolition A mortgagee, assignee or receiver but only with operations performed by or for such additional respect to their liability as mortgagee, assignee, insured. or receiver and arising out of the ownership, B. Co•owner of Insured Premises maintenance, or use of a premises by you. A co-owner of a premises co-owned by you and This insurance does not apply to structural covered under this insurance but only with alterations, new construction or demolition respect to the co-owner's liability as co-owner of operations performed by or for such additional such premises. insured. C. Lessor-Equipment G. State or Governmental Agency or Subdivision or Political Subdivisions 1. Any person or organization from whom you lease equipment, but only with respect to A state or governmental agency or subdivision liability for"bodily injury,""property damage" or political subdivision subject to the following or "personal and advertising injury" caused, provisions: in whole or in part, by your maintenance, 1. This insurance applies only with respect to operation or use of equipment leased to you the following hazards for which the state or by'such person or organization. governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises • G-18652-J (Ed. 07-12) Page 2 of 12 Copyright,CNA All Rights Reserved. G-18652-J CNAPolicy Number: 4034952911 (Ed. 07-12) you own, rent, or control and to which this You must give us or our authorized insurance applies: representative notice of an "occurrence," a. The existence, maintenance, repair, offense, claim, or "suit" only when the construction, erection, or removal of "occurrence," offense, claim or "suit" is known to: advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, (1) You, if you are an individual; manholes, marquees, hoistaway openings, sidewalk vaults, street (2) A partner, if you are a partnership; banners, or decorations and similar (3) An executive officer or the employee exposures; or designated by you to give such notice, if you b. The construction, erection, or removal are a corporation; or of elevators; or (4) A manager, if you are a limited liability c. The ownership, maintenance or use of company. any elevators covered by this insurance. B. NOTICE OF OCCURRENCE 2. This insurance applies only with respect to Your rights under this Coverage Part will not be operations performed by you or on your prejudiced if you fail to give us notice of an behalf for which the state or governmental "occurrence,"offense, claim or"suit"and that agency or subdivision or political subdivision failure is solely due to your reasonable belief has issued a permit or authorization. that the"bodily injury"or"property damage"is 3. This insurance does not apply to: not covered under this Coverage Part. However, you shall give written notice of this "occurrence," a. "Bodily injury," "property damage" or offense, claim or"suit"to us as soon as you are "personal and advertising injury" arising aware that this insurance may apply to such out of operations performed for the "occurrence,"offense claim or"suit." federal government, state or 4. BROAD NAMED INSURED municipality; or • b. "Bodily injury" or "property damage" A. Any subsidiary or affiliate organization, other included within the "products completed than a partnership, joint venture or limited operations hazard." liability company, in which a Named Insured specifically shown in the Declarations has A governmental permit which requires you to management control, directly or through one or add the governmental entity as an additional more subsidiary organizations, at the time of insured will trigger this Provision 1. as if the loss will qualify as a Named Insured but only if permit were a written contract. there is no other similar insurance available to 2. BODILY INJURY—EXPANDED DEFINITION such organization, nor similar insurance which would be available but for exhaustion of its SECTION V—DEFINITIONS, the definition of limits. For the purpose of this provision, similar "bodily injury"is changed to read: insurance means general liability or equivalent insurance, no matter whether its coverage is "Bodily injury"means bodily injury, sickness or broader or narrower than that provided by this disease sustained by a person, including death, insurance. But if the only other similar insurance humiliation, shock, mental anguish or mental injury is for a "consolidated (wrap-up) program," then by that person at any time which results as a a subsidiary that qualifies as a Named Insured consequence of the bodily injury, sickness or on such project-specific insurance can still disease. qualify as a Named Insured on this insurance, 3. BROAD KNOWLEDGE OF OCCURRENCE/ but not for projects covered by the"consolidated NOTICE OF OCCURRENCE (wrap-up) program." Condition 2. Duties in The Event of Occurrence, [Please see Item 26.C. of this endorsement for Offense, Claim or Suit of SECTION IV— the definition of"consolidated (wrap-up) COMMERCIAL GENERAL LIABILITY program."] CONDITIONS is amended to add the following B. This endorsement does not apply to any provisions: - organization for which coverage is excluded by A. BROAD KNOWLEDGE OF OCCURRENCE another endorsement attached to this policy. C. Only for the purpose of this endorsement: G-18652-J (Ed. 07-12) Page 3 of 12 Copyright,CNA All Rights Reserved. CNA Gd.07-1 ) Policy Number: 4034952911 (Ed. 07-12) 1. Management control means: I. Damage to Your Work • a. Ownership interest representing more "Property damage"to"your work"arising out of than 50% of the voting, appointment, or it, or any part of it and included in the"products- - designation power for the subsidiary completed operations hazard." organization's governing body; or This exclusion does not apply: b. Having the right, pursuant to a written contract, or pursuant to the by-laws, (1) If the damaged work or the work out of charter, operating agreement, or similar which the damage arises was document of a specifically shown performed on your behalf by a Named Insured or controlled subsidiary subcontractor; or organization to select, appoint, or (2) If the cause of loss to the damaged designate a majority of the subsidiary work arises as a result of: organization's governing body. Such contract or document must have been (a) Fire; created prior to the time of loss; or (b) Smoke; c. Having the right, pursuant to a written (c) Collapse; or trust agreement, to protect, control the use of, encumber or transfer and sell (d) Explosion. property held by a trust. B. The following paragraph is added to SECTION 2. Governing body means the Board of III—LIMITS OF INSURANCE: Directors of a corporation. Subject to 5. above, $100,000 is the most we 3. • Loss means: will pay under Coverage A for the sum of damages arising out of any one"occurrence" a. The occurring of the "bodily injury" or because of"property damage"to"your product" "property damage"; or and"your work"that is caused by fire, smoke, b. The committing of the offense that collapse or explosion and is included within the caused the "personal and advertising "product completed operations hazard." This injury." sublimit does not apply to"property damage"to • "your work" if the damaged work or the work out D. The insurance provided by this policy applies to of which the damage arises was performed on Named Insureds when trading under their own your behalf by a subcontractor. names, or under such trading names or doing- business-as (DBA) names as any should C. This Provision 5. Broadened Liability choose to employ. Coverage For Damage To "Your Product" And "Your Work" does not apply if an 5. BROADENED LIABILITY COVERAGE FOR endorsement of the same name is attached to DAMAGE TO "YOUR PRODUCT" AND "YOUR this policy. WORK" 6. CONTRACTUAL LIABILITY—RAILROADS A. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE With respect to operations performed-within 50 feet LIABILITY, Paragraph 2. Exclusions is amended of railroad property, the definition of"insured to delete exclusions k. and I. and replace them contract"in SECTION V—DEFINITIONS is with the following: replaced by the following: [This insurance does not apply to:) "Insured Contract"means: k. Damage to Your Product a. A contract for a lease of premises. However, that portion of the contract for a lease of "Property damage"to"your product"arising premises that indemnifies any person or out of it, or any part of it except when organization for damage by fire to premises caused by or resulting from: while rented to you or temporarily occupied by (1) Fire; you with permission of the owner is not an "insured contract"; (2) Smoke; b. A sidetrack agreement; (3) Collapse; or c. Any easement or license agreement; • (4) Explosion. G-18652-J (Ed. 07-12) • Page 4 of 12 . Copyright,CNA All Rights Reserved. G-18652-J • CNAPolicy Number: 4034952911 (Ed. 07-12) d. An obligation, as required by ordinance, to Damages arising out of the loss of, loss of use indemnify a municipality, except in connection of, damage to, corruption of, inability to access, with work for a municipality; or inability to manipulate "electronic data" that e. An elevator maintenance agreement; does not result from physical injury to tangible property. f. That part of any other contract or agreement However, this exclusion does not apply to pertaining to your business (including an liability for damages because of"bodily injury." indemnification of a municipality in connection with work performed for a municipality) under B. The following paragraph is added to SECTION which you assume the tort liability of another III—LIMITS OF INSURANCE: party to pay for "bodily injury" or "property Subject to 5. above, $100,000 is the most we damage" to a third person or organization. Tort will pay under Coverage A for all damages liability means a liability that would be imposed arising out of any one"occurrence"because of by law in the absence of any contract or "property damage"that results from physical agreement. injury to tangible property and arises out of Paragraph f. does not include that part of any "electronic data." contract or agreement: C. The following definition is added to the (1) That indemnifies an architect, engineer or SECTION V—DEFINITIONS: surveyor for injury or damage arising out of: "Electronic data"means information, facts or (a) Preparing, approving or failing to programs stored as or on, created or used on, prepare or approve maps, shop or transmitted to or from computer software drawings, opinions, reports, surveys, (including systems and applications software), field orders, change orders or drawings hard or floppy disks, CD-ROMS, tapes, drives, and specifications; or - cells, data processing devices or any other (b) Giving directions or instructions, or media which are used with electronically controlled equipment. failing to give them, if that is the primary . cause of the injury or damage; D. For the purposes of the coverage provided by (2) Under which the insured, if an architect, this endorsement, the definition of "property engineer or surveyor, assumes liability for damage" in SECTION V — DEFINITIONS is an injury or damage arising out of the replaced by the following: insured's rendering or failure to render 17. "Property damage"means: professional services, including those listed in (1) above and supervisory, inspection, a. Physical injury to tangible property, architectural or engineering activities. including all resulting loss of use of that property. All such loss of use shall be 7. CONTRACTUAL LIABILITY FOR PERSONAL deemed to occur at the time of the AND ADVERTISING INJURY physical injury that caused it; Under SECTION I—COVERAGE B—PERSONAL b. Loss of use of tangible property that is AND ADVERTISING INJURY LIABILITY,.Paragraph not physically injured. All such loss of 2. Exclusions is amended to delete exclusion e. use shall be deemed to occur at the Contractual Liability. time of the "occurrence" that caused it; This provision 7. does not apply to any person or or organization who otherwise qualifies as an c. Loss of, loss of use of, damage to, additional insured on this Coverage Part. corruption of, inability to access, or 8. ELECTRONIC DATA LIABILITY inability to properly manipulate "electronic data," resulting from physical A. Under SECTION I — COVERAGE A — BODILY injury to tangible property. All such loss INJURY AND PROPERTY DAMAGE, of "electronic data" shall be deemed to Paragraph 2. Exclusions is amended to delete occur at the time of the "occurrence" exclusion p. Electronic Data and replace it with that caused it. the following: For the purposes of this insurance, [This insurance does not apply to:] "electronic data" is not tangible property. p. Electronic Data E. If Electronic Data Liability is provided at a higher • limit by another endorsement attached to this G-18652-J (Ed. 07-12) Page 5of12 Copyright,CNA All Rights Reserved. G-18652-J WAPolicy Number: 4034952911 (Ed. 07-12) policy, then the $100,000 limit provided by this Intended Injury and replace it with the • Provision 8. Electronic Data Liability is part of, following: and not'in addition to, that higher limit. [This insurance does not apply to:j 9. EXPANDED PERSONAL AND ADVERTISING INJURY- DISCRIMINATION OR HUMILIATION a. Expected or Intended Injury A. SECTION V—DEFINITIONS is amended to add "Bodily injury"or"property damage" the following to the definition of "Personal and expected or intended from the standpoint of advertising injury": the insured. This exclusion does not apply to"bodily injury"or"property damage" h. Discrimination or humiliation that results in resulting from the use of reasonable force injury to the feelings or reputation of a to protect persons or property. natural person, but only if such 11. GENERAL AGGREGATE LIMITS OF discrimination or humiliation is: INSURANCE- PER PROJECT (1) Not done intentionally by or at the direction of: A. For each construction project away from premises you own or rent, a separate (a) The insured; or Construction Project General Aggregate (b) Any "executive officer," director, Limit, equal to the amount of the General Aggregate Limit, is the most we will pay for stockholder, partner, member or the sum of: manager(if you are a limited liability company)of the insured; and 1. All damages under Coverage A, except (2) Not directly or indirectly related to the damages because of "bodily injury" or • employment, prospective employment, "property damage" included in the past employment or termination of "products completed operations employment of any person or persons hazard"; and by any insured. 2. All medical expenses under Coverage B. Under SECTION I — COVERAGE B — C' PERSONAL AND ADVERTISING INJURY that arise from "occurrences" or • LIABILITY, Paragraph 2. . Exclusions is accidents which can be attributed solely amended to add the following additional to ongoing operations at that exclusions: construction project. Such payments [This insurance does not apply to:j shall not reduce the General Aggregate Limit shown in the Declarations, nor the Discrimination Relating To Room, Construction Project Aggregate Limit of Dwelling or Premises any other construction project. "Personal or advertising injury"caused by B. All: discrimination directly or indirectly related to 1. Damages under Coverage B, regardless of the sale, rental, lease or sub lease or the number of locations or construction prospective sale, rental, lease or sub-lease projects involved; of any room, dwelling or premises by or at the direction of any insured. 2. Damages under Coverage A, caused by Fines Or Penalties "occurrences" which cannot be attributed solely to ongoing operations at a single Fines or penalties levied or imposed by a construction project, except damages governmental entity because of because of "bodily injury" or "property discrimination. damage" included in the "products- This provision 9. does not apply to any person completed operations hazard"; and or organization who otherwise qualifies as an 3. Medical expenses under Coverage C additional insured on this Coverage Part. caused by accidents which cannot be 10. EXPECTED OR INTENDED INJURY attributed solely to ongoing operations at a single construction project, Under SECTION I—COVERAGE A— BODILY Will reduce the General Aggregate Limit shown INJURY AND PROPERTY.DAMAGE in the Declarations. LIABILITY, Paragraph 2. Exclusions is . amended to delete exclusion a. Expected or G-18652-J (Ed. 07-12) - Page6of12 Copyright,CNA All Rights Reserved. G-18652-J CNAPolicy Number: 4034952911 (Ed. 07-12) iC. The limits shown in the Declarations for Each (a) "Bodily injury" caused by a "health Occurrence, for Damage To Premises Rented care incident" will be considered To You and for Medical Expense continue to caused by an "occurrence"; and apply, but will be subject to either the Construction Project Aggregate Limit or the (b) All acts, errors or omissions that General Aggregate Limit, depending on whether are logically connected by any the "occurrence" can be attributed solely to common fact, circumstance, ongoing operations at a particular construction situation, transaction, event, advice project. or decision will be considered to constitute a single"occurrence"; 'D. When coverage for liability arising out of the "products-completed operations hazard" is (2) The "bodily injury" occurs during the provided, any payments for damages because policy period. All "bodily injury" arising of "bodily injury" or "property damage" included from an "occurrence" will be deemed to in the "products-completed operations hazard," have occurred at the time of the first regardless of,the number,of locations involved act, error, or omission that is part of the will reduce the Products-Completed Operations "occurrence"; and Aggregate Limit shown in the Declarations. B. With respect only to the insurance provided by E. If a single construction project away from this Provision 13., Exclusion 2.e. Employer's premises owned by or rented to the insured has Liability of SECTION I — COVERAGE A — been abandoned and then restarted, or if the BODILY INJURY AND PROPERTY DAMAGE, authorized contracting parties deviate from is amended to append the following: plans, blueprints, designs, specifications or Only for "bodily injury" not covered by other timetables, the project will still be deemed to be liability insurance (including state-sanctioned the same construction project. self insurance) available to the insured (or which F. The provisions of SECTION III — LIMITS OF would be available but for exhaustion of its INSURANCE not otherwise modified by this limits), this exclusion does not apply to "bodily endorsement shall continue to apply as injury"that arises out of a "health care incident." III stipulated. C. SECTION V—DEFINITIONS is amended to add 12. IN REM ACTIONS the following new definition: Any action in rem against any vessel owned or "Health care incident" means a negligent act, operated by or for you, or chartered by or for you will error or omission by your "employees" or be treated in the same manner as though the action "volunteer workers" working on your behalf in were in personam against you. the rendering of or failure to render professional health care services in any of the following In rem is a term used to designate actions instituted capacities, or the related furnishing of food, against the thing, as distinct from actions against beverages, medical supplies or appliances: the person, which are said to be in personam. a. Physician; 13. INCIDENTAL HEALTH CARE MALPRACTICE COVERAGE b. Nurse; A. With respect only to "bodily injury" that arises c. Emergency medical technician, out of a "health care incident," COVERAGE A — d. Paramedic; BODILY INJURY AND PROPERTY DAMAGE LIABILITY OF SECTION I — COVERAGES is e. Chiropractor; amended to replace Insuring Agreement f. Dentist; Paragraphs 1.b.(1) and 1.b.(2) with the following: g. Athletic trainer; b. This insurance applies to "bodily injury" only h. Audiologist; • if you are not in the business of providing i. Physical therapist; professional health care services, and only if: j. Psychologist; (1) The "bodily injury" is caused by an k. Speech therapist; "occurrence" that takes place in the I. Other allied health professional; or "coverage territory." For the purpose of this insurance: • G-18652-J (Ed. 07-12) Page 7 of 12 Copyright,CNA All Rights Reserved. G-18652-J - CNAPolicy Number: 4034952911 •Ed. 07-12) m. Provider of first aid or Good Samaritan a. "bodily injury"to a co-"volunteer worker" services rendered in an emergency and for while performing duties related to the which no payment is demanded or received. conduct of your business; and D. SECTION I—COVERAGE A—BODILY INJURY b. "bodily injury" to an "employee" while in AND PROPERTY DAMAGE, Paragraph 2. the course of the "employee's" Exclusions is amended to add the following employment by you or while performing additional exclusions. These new exclusions duties related to the conduct of your apply only to this Incidental Health Care business; Malpractice Coverage: when such "bodily injury" arises out of a [This insurance does not apply to:] "health care incident." Dishonesty or Crime 3. Paragraphs 2.a. (1)(a), (b) and (c) of Any dishonest, criminal or malicious act, error or SECTION II — WHO IS AN INSURED do not apply to "bodily injury" for which omission. insurance is provided this Provision 13. Clinical Trials/Product Testing 4. Paragraph 2.a.(1)(d) of SECTION II—WHO Acts, errors or omissions that occur in the IS AN INSURED is deleted. course of human clinical trials or product G. With respect to the insurance provided by this testing. Provision 13., the following is added to Medicare/Medicaid Fraud Paragraph 4.b.(1) of SECTION IV — Medicare or Medicaid fraud or abuse. COMMERCIAL GENERAL LIABILITY CONDITIONS: Services Excluded by Endorsement To the extent this insurance applies, it is excess Any"health care incident" for which coverage is over any of the .other insurance (including excluded by endorsement. qualified self insurance), whether primary, excess, contingent or on any other basis, except 'E. SECTION V—DEFINITIONS is amended to add for insurance purchased specifically by you to the following subparagraph to Paragraph f. of be excess of this policy. the definition of"insured contract": 14. JOINT VENTURES / PARTNERSHIP / LIMITED Paragraph f. does not include that part of any LIABILITY COMPANIES contract or agreement: A. The following is added to SECTION II — WHO (4) Under which you assume another's tort IS AN INSURED: liability for "bodily injury" arising out of the rendering of or failure to render professional 4. You are an insured when you had an health care services. interest in a joint venture, partnership or limited liability company which terminated or F. SECTION II — WHO IS AN INSURED is ended prior to or during this policy period, amended to add the following provisions: but only to the extent of your interest in such 1. Your "employees" are insureds with respect 'joint venture, partnership or limited liability to: company. This coverage does not apply: a. "bodily injury" to a co-"employee" while a. Prior to the termination date of any joint in the course of the co-employee's" venture, partnership or limited liability employment by you or while performing company; duties related to the conduct of your b. If there is other valid and collectible business; and insurance purchased specifically to b. "bodily injury" to a "volunteer worker" insure the partnership, joint venture or while performing duties related to the limited liability company; or conduct of your business; c. To a joint venture, partnership or limited when such "bodily injury"arises out of a liability company which is or was "health care incident." insured under a"consolidated (wrap-up) insurance program." 2. Your "volunteer workers" are insureds with • respect to: • - • G-18652-J (Ed. 07-12) 4110 • Page 8 of 12 Copyright,CNA All Rights Reserved. • G-18652-J CNAPolicy Number: 4034952911 (Ed. 07-12) • [Please see Item 26.C. of this endorsement Paragraphs (1), (3) and (4) of this exclusion for the definition of "consolidated (wrap-up) do not apply to "property damage" (other program."] than damage by fire) to premises rented to B. The last paragraph of SECTION II — WHO IS you or temporarily occupied by you with the AN INSURED is deleted and replaced by the permission of the owner, or to'the contents following: of premises rented to you for a period of 7 or fewer consecutive days. A separate limit Except as provided under the Contractors' of insurance applies to Damage To General Liability Extension Endorsement or by Premises Rented To You as described in the attachment of another endorsement (if any), SECTION III—LIMITS OF INSURANCE. no person or organization is an insured with respect to the conduct of any current or past Paragraphs (3), (4), (5) and (6) of this partnership, joint venture or limited liability exclusion do not apply to liability assumed under a sidetrack agreement. company that is not shown as a Named Insured in the Declarations. • Paragraph (6) of this exclusion does not 15. LEGAL LIABILITY/ALIENATED PREMISES/ apply to "property damage" included in the BORROWED EQUIPMENT "products-completed operations hazard." A. B. Under SECTION I — COVERAGE A — BODILY . Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, INJURY AND PROPERTY DAMAGE the last paragraph of Paragraph 2. Exclusions is deleted Paragraph 2. Exclusions is amended to delete exclusion j. Damage to Property in its entirety and replaced by the following. and replace it with the following: Exclusions c. through n. do not apply to [This insurance does not apply to:] damage by fire to premises while rented to you or temporarily occupied by you with permission j. Damage to Property of the owner nor to the contents of premises "Property damage"to: rented to you for a period of 7 or fewer consecutive days. • (1) Property you own, rent, or occupy; A separate limit of insurance applies to this (2) Premises you sell, give away or coverage as described in SECTION III—LIMITS abandon, if the "property damage" OF INSURANCE. arises out of any part of those C. The following paragraph is added to SECTION premises; III—LIMITS OF INSURANCE: (3) Property loaned to you; Subject to 5. above, $25,000 is the most we will (4) Personal property in the care, custody pay under Coverage A for damages arising out or control of the insured; of any one "occurrence" because of "property damage" to tools or equipment loaned to you by (5) That particular part of real property on others that occurs while the equipment is being which you or any contractors or used to perform operations. sub contractors working directly or indirectly on your behalf.are performing D. Paragraph 6. Damage To Premises Rented To operations, if the "property damage" You Limit of SECTION III — LIMITS OF arises out of those operations; or INSURANCE is replaced by the following: (6) That particular part of any property that 6. Subject to Paragraph 5. above, (the Each must be restored, repaired or replaced Occurrence Limit), the Damage To because "your work" was incorrectly Premises Rented To You Limit is the most performed on it. we will pay under SECTION — I — COVERAGE A for damages because of Paragraph (2) of this exclusion does not "property damage" to any one premises apply if the premises are"your work." while rented to you or temporarily occupied Paragraphs (3) and (4) of this exclusion do by you with the permission of the owner, not apply to "property damage" to tools or including contents of such premises rented equipment loaned to you. A separate limit to you for a period of 7 or fewer consecutive of insurance applies to such tools or days. The Damage To.Premises Rented To equipment that are damaged while being You Limit is the greater of: used in your operations. a. $500,000; or • G-18652-J (Ed. 07-12) Page 9 of 12 Copyright,CNA All Rights Reserved. • G-18652-J CNAPolicy Number: 403495291/ (Ed. 07-12) b. The Damage To Premises Rented To This paragraph B. does not apply to medical • You Limit shown in the Declarations. expenses incurred in the state of Missouri. E. Paragraph 4.b.(1)(a)(ii) of SECTION IV — .19. NON-OWNED AIRCRAFT COMMERCIAL GENERAL LIABILITY Under SECTION I—COVERAGE A—BODILY CONDITIONS is deleted and replaced by the INJURY AND PROPERTY DAMAGE LIABILITY. following: Paragraph 2. Exclusions is amended such that (ii) That is property insurance for premises exclusion g.Aircraft,Auto or Watercraft does not rented to you, for premises temporarily apply to an aircraft you do not own, provided that: occupied by you with the permission of the 1. The pilot in command holds a currently effective owner; or for personal property of others in your care, custody or control; certificate issued by the duly constituted authority of the United States of America or F. This Provision 15. does not apply if Damage To Canada, designating that person as a Premises Rented To You Liability :under commercial or airline transport pilot; SECTION — I COVERAGE A is excluded by 2. The aircraft is rented to you with a trained, paid endorsement. crew; and 16. LIBERALIZATION CLAUSE 3. The aircraft does not transport persons or cargo If we adopt a change in our forms or rules which for a charge. would broaden coverage for contractors under this 20. NON-OWNED WATERCRAFT endorsement without an additional premium charge, your policy will automatically provide the additional Under SECTION I—COVERAGE A—BODILY coverage as of the date the revision is effective in INJURY AND PROPERTY DAMAGE LIABILITY, your state. Paragraph 2. Exclusions is amended to delete 17. LIQUOR LIABILITY subparagraph (2) of exclusion g.Aircraft,Auto or Watercraft and replace it with the following. Under SECTION I—COVERAGE A—BODILY [This exclusion does not apply to:] INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion c. (2) A watercraft you do not own that is: • Liquor Liability. (a) Less than 75 feet long; and This provision 17. does not apply to any person or organization who otherwise qualifies as an (b) Not being used to carry persons or property additional insured on this Coverage Part. for a charge. 18. MEDICAL PAYMENTS 21. PRIMARY AND NON-CONTRIBUTORY TO OTHER INSURANCE A. Paragraph 7. Medical Expense Limit, of SECTION III — LIMITS OF INSURANCE is With respect to any person or organization that is an deleted and replaced by the following: additional insured under this Coverage Part, the following is added to Paragraph 4. of SECTION IV— 7. Subject ,to Paragraph 5. above (the Each COMMERCIAL GENERAL LIABILITY Occurrence Limit), the Medical Expense CONDITIONS: Limit is the most we will pay under SECTION — I — COVERAGE C for all If you have agreed in writing in a contract or medical expenses because of"bodily injury" agreement that this insurance is primary and non- sustained by any one person. The Medical contributory relative to an additional insured's own Expense Limit is the greater of: insurance, then this insurance is primary and we will not seek contribution from that other insurance. For (1) $15,000; or the purpose of this Provision 21., the additional (2) The amount shown in the Declarations insured's own insurance means insurance on which for Medical Expense Limit. the additional insured is a Named Insured. B. Paragraph 1.a.(3)(b) of SECTION I — This Provision 21, does not apply in situations COVERAGE C MEDICAL PAYMENTS, is where the endorsement on this policy affording replaced by the following: coverage to the additional insured specifies that this insurance is excess over any other insurance (b) The expenses are incurred and reported to available to that additional insured. us within three years of the date of the 22. PROPERTY DAMAGE—ELEVATORS accident; and G-18652-J (Ed. 07-12) • Page 10 of 12 Copyright,CNA All Rights Reserved. G-18652-J - Policy Number: 4034952911 (Ed. 07-12) . A. Under SECTION I — COVERAGE A — BODILY However, this waiver applies only when you have INJURY AND PROPERTY DAMAGE, agreed in writing to waive such rights of recovery in Paragraph 2. Exclusions is amended such that a contract or agreement, and only if the contract or exclusion k. Damage to Your Product, and agreement: subparagraph (3), (4) and (6) of exclusion j. 1. Is in effect or becomes effective during the term Damage to Property do not apply "property damage"that results from the use of elevators. of this policy; and B. With respect only to the coverage provided by 2. Was executed prior to loss. this endorsement, Condition 4. Other 26. WRAP-UP EXTENSION: OWNER CONTROLLED Insurance in SECTION IV — COMMERCIAL INSURANCE PROGRAM, CONTRACTOR GENERAL LIABILITY CONDITIONS is CONTROLLED INSURANCE PROGRAM OR amended to add the following subparagraph CONSOLIDATED (WRAP-UP) INSURANCE b.(1)(a)(v): PROGRAMS 4. Other Insurance •Note: The following provision does not apply to any • b. Excess Insurance public consteuction project in the state of Oklahoma, nor to any construction project in the state of (1) This insurance is excess over: Alaska, that is not permitted to be insured under a (a) Any of the other insurance, "consolidated (wrap-up)insurance program"by applicable state statute or regulation: whether primary, excess, contingent or on any other If the endorsement EXCLUSION— basis: CONSTRUCTION WRAP-UP or another (v) That is Property insurance exclusionary endorsement pertaining to Owner covering Property insurance rance Controlled Insurance Programs (O.C.I.P.)or damaged from the use others Contractor Controlled Insurance Programs elevators. (C.C.I.P.)is attached to this policy, then the following changes apply: 23. SUPPLEMENTARY PAYMENTS A. The following wording is added to the • A. Under Section I —Supplementary Payments— endorsement: Coverages A and B, Paragraph 1.b.,the limit of $250 With respect to a "consolidated (wrap-up) 250 shown for the cost of bail bonds is replaced by$5,000: insurance program" project in which you are or were involved, this exclusion does not apply to B. In Paragraph 1.d., the limit of $250 shown for those sums you become legally obligated to pay daily loss of earnings is replaced by$1,000. as damages because of: 24. UNINTENTIONAL FAILURE TO DISCLOSE 1. "Bodily injury," "property damage," or HAZARDS "personal or advertising injury" that occurs If unintentionally you should fail to disclose all during your ongoing operations at the existing hazards at the inception date of your policy, project, or during such operations of anyone we will not deny coverage under this-Coverage Part acting on your behalf; nor because of such failure. 2. "Bodily injury" or "property damage" 25. WAIVER OF SUBGROGATION -BLANKET included within the "products-completed operations hazard" that arises out of those Under SECTION IV—COMMERCIAL GENERAL portions of the project that are not LIABILITY CONDITIONS, The Transfer Of Rights "residential structures." Of Recovery Against Others To Us Condition is B. SECTION IV — COMMERCIAL GENERAL amended by the addition of the following: LIABILITY CONDITIONS is amended to add the We waive any right of recovery we may have following subparagraph 4.b.(1)(c) to Condition against any person or organization because of 4. Other Insurance: payments we make for injury or damage arising out [This insurance is excess over:] of: 1. Your ongoing operations; or (c) Any of the other insurance whether primary, excess, contingent or any other basis that is 2. "Your work" included in the "products completed insurance available to you as a result of operations hazard." your being a participant in a "consolidated • (wrap-up) insurance program," but only as G-18652-J (Ed. 07-12) Page 11 of 12 Copyright,CNA Ali Rights Reserved. G-18652-J CNAPolicy Number:4034952911 (Ed. 07-12) respects your involvement in that residency including but not limited to single or 410 "consolidated (wrap-up) insurance multifamily housing, apartments, condominiums, program." townhouses, co-operatives or planned unit C. SECTION V—DEFINITIONS is amended to add developments and also includes their common the following definition: areas and/or appurtenant structures(including pools, hot tubs, detached garages, guest "Consolidated (wrap-up) insurance program" houses or any similar structures). When there is means a construction, erection or demolition no individual ownership of units, residential project for which the prime contractor/project structure does not include military housing, manager or owner of the construction project college/university housing or dormitories, long has secured general liability insurance covering term care facilities, hotels, or motels. some or all of the contractors or subcontractors Residential structure also does not include involved in the project, such as an Owner hospitals or prisons. Controlled Insurance Program (O.C.I.P.) or This provision 26. does not apply to any person Contractor Controlled Insurance Program or organization who otherwise qualifies as an (C.C.I.P.). additional insured on this Coverage Part. "Residential structure" means any structure where 30% or more of the square foot area is used or is intended to be used for human All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. Material used with permission of ISO Properties, Inc • G-18652-J (Ed. 07-12) • Page 12 of 12 Copyright,CNA All Rights Reserved. • COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions: A. Cancellation during the policy period and up to three years 1. The first Named Insured shown in the Decla- afterward, rations may cancel this policy by mailing or D. Inspections And Surveys delivering to us advance written notice of 1. We have the right to: cancellation. 2. We may cancel this policy or any Coverage a. Make inspections and surveys at any time; Part by mailing_ or delivering to the first Named Insured written notice of cancellation b. Give you reports on the conditions we at least: • find; and a. 10 days before the effective date of can- c. Recommend changes. cellation if we cancel for nonpayment of 2. We are not obligated to make any inspec- premium; or tions, surveys, reports or recommendations b. 30 days before the effective date of can- and any such actions we do undertake relate cellation if we cancel for any other rea- only to insurability and the premiums to be son. charged. We do not make safety inspections. 3. We will mail or deliver our notice to the first We do not undertake to perform the duty of Named Insured's last mailing address known any person or organization to provide for the health or safety of workers or the public. And to us. we do not warrant that conditions: 4. Notice of cancellation will state the effective a. Are safe or healthful; or date of cancellation. If the policy is cancelled, that date will become the end of the policy b. Comply with laws, regulations, codes or period. If a Coverage Part is cancelled, that standards. date will become the end of the policy period 3. Paragraphs 1. and 2. of this condition apply as respects that Coverage Part only. not only to us, but also to any rating, advi- 5. If this policy or any Coverage Part is can- sory, rate service or similar organization celled, we will send the first Named Insured which makes insurance inspections, surveys, any premium refund due. If we cancel, the re- reports or recommendations. fund will be pro rata. If the first Named In- 4. Paragraph 2. of this condition does not apply sured cancels, the refund may be less than to any inspections, surveys, reports or rec- pro rata. The cancellation will be effective ommendations we may make relative to certi- even if we have not made or offered a re- fication, under state or municipal statutes, or- fund. dinances or regulations, of boilers, pressure 6. If notice is mailed, proof of mailing will be vessels or elevators. sufficient proof of notice. E. Premiums B. Changes 1. The first Named Insured shown in the Decla- This policy contains all the agreements between rations: you and us concerning the insurance afforded. a. Is responsible for the payment of all pre- The first Named Insured shown in the Declare- miums; and tions is authorized to make changes in the terms b. Will be the payee for any return premi- of this policy with our consent. This policy's terms can be amended or waived only by endorsement urns we pay. issued by us as part of this policy. 2. We compute all premiums for this policy in C. Examination Of Your Books And Records accordance with our rules, rates, rating plans, premiums and minimum premiums. The pre- We may examine and audit your books and mium shown in the Declarations was corn- • records as they relate to this policy at any time puted based on rates and rules in effect at IL TO 01 01 07 (Rev.06-09) Includes the copyrighted material of Insurance Services Office,Inc.with its permission . Page 1 of 2 the time the policy was issued. On each re= acting within the scope of duties as your legal re- newal continuation or anniversary of the of representative. Until your legal representative is fective date of this policy, we will compute appointed, anyone having proper temporary cus- the premium in accordance with our rates tody of your property will have your rights and and rules then in effect. duties but only with respect to that property. F. Transfer Of Your Rights And Duties Under This Policy G. Equipment Breakdown Equivalent to Boiler Your rights and duties under this policy may not and Machinery be transferred without our written consent except On the Common Policy Declarations, the term in the case of death of an individual named in- Equipment Breakdown is understood to mean sured. and include Boiler and Machinery and the term If you die, your rights and duties will be trans- Boiler and Machinery is understood to mean and ferred to your legal representative but only while include Equipment Breakdown. 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 (TIA) Travelers Casualty Insurance Company of America (ACJ) //Secretar y President • Page 2"of 2 Includes the copyrighted material of Insurance Services Office.Inc.with its permission. IL TO 01 01 07(Rev.06-09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraphs 2. and 3. of the Cancellation Corn- date of the policy, of one or more of the mon Policy Condition are replaced by the follow- following: Ong: (1) Nonpayment of premium, including 2. All Policies In Effect For 60 Days Or Less payment due on a prior policy we is- If this policy has been in effect for 60 days or sued and due during the current pol- • less, and is not a renewal of a policy we have icy term covering the same risks. previously issued, we may cancel this policy (2) Discovery of fraud or material misrep- by mailing or delivering to the first Named In- resentation by: sured at the mailing address shown in the (a) Any insured or his or her repre- policy and to the producer of record, advance sentative in obtaining this insur- written notice of cancellation, stating the rea- ance; or son for cancellation, at least: (b) You or your representative in a. 10 days before the effective date of can- pursuing a claim under this pol- cellation if we cancel for: icy. (1) Nonpayment of premium; or (3) A judgment by a court or an adminis- (2) Discovery of fraud by: trative tribunal that you have violated (a) Any insured or his or her repre a California or Federal law, having as sentative in obtaining this insur- one of its necessary elements an act which materially increases any of the ance; or risks insured against. (b) You or your representative in (4) Discovery of willful or grossly negli- pursuing a claim under this pol gent acts or omissions, or of any vio- icy. lations of state laws or regulations es- b. 30 days before the effective date of can- tablishing safety standards, by you or cellation if we cancel for any other rea- your representative, which materially son. increase any of the risks insured 3. All Policies In Effect For More Than 60 against. Days (5) Failure by you or your representative a. If this policy has been in effect for more to implement reasonable loss control than 60 days, or is a renewal of a policy requirements, agreed to by you as a we issued, we may cancel this policy only condition of policy issuance, or which • upon the occurrence, after the effective were conditions precedent to our use of a particular rate or rating plan, if IL 02 70 09 08 © ISO Properties, Inc., 2007 Page 1 of 3 that failure materially increases any cel this coverage for any reason, except S of the risks insured against. as provided in b. and c. below. b. (6) A determination by the Commissioner We may not cancel this policy solely be- of Insurance that the: cause the first Named Insured has: (a) Loss of, or changes in, our rein- (1) Accepted an offer of earthquake cov- surance covering all or part of the erage;or risk would threaten our financial (2) Cancelled or did not renew a policy integrity or solvency; or issued by the California Earthquake (b) Continuation of the policy cover- Authority (CEA) that included an age would: earthquake policy premium sur- (i) Place us in violation of Cali- charge. fornia law or the laws of the However, we shall cancel this policy if the state where we are domi- first Named Insured has accepted a new oiled; or or renewal policy issued by the CEA that (ii) Threaten our solvency. includes an earthquake policy premium surcharge but fails to pay the earthquake (7) A change by you or your representa- policy premium surcharge authorized by tive in the activities or property of the the CEA. commercial or industrial enterprise, c. We may not cancel such coverage solely which results in a materially added, because corrosive soil conditions exist on increased or changed risk, unless the the premises. This Restriction (C.)applies added, increased or changed risk is only if coverage is subject to one of the included in the policy. following, which exclude loss or damage b. We will mail or deliver advance written caused by or resulting from corrosive soil notice of cancellation, stating the reason conditions: for cancellation, to the first Named In- (1) Capital Assets Program Coverage sured, at the mailing address shown in Form (Output Policy); • the policy, and to the producer of record, at least: (2) Commercial Property Coverage Part (1) 10 days before the effective date of —Causes Of Loss—Special Form; or cancellation if we cancel for nonpay- (3) Farm Coverage Part — Causes Of ment of premium or discovery of Loss Form — Farm Property, Para- fraud; or graph D. Covered Causes Of Loss — (2) 30 days before the effective date of Special. cancellation if we cancel for any other C. The following is added and supersedes any pro- reason listed in Paragraph 3.a. visions to the contrary: B. The following provision is added to the Cancella- NONRENEWAL tion Common Policy Condition: 1. Subject to the provisions of Paragraphs C.2. 7. Residential Property and C.3. below, if we elect not to renew this This provision applies to coverage on real policy, we will mail or deliver written notice property which is used predominantly for stating the reason for nonrenewal to the first residential purposes and consisting of not Named Insured shown in the Declarations more than four dwelling units, and to cover- and to the producer of record, at least 60 age on tenants' household personal property days, but not more than 120 days, before the in a residential unit, if such coverage is writ- expiration or anniversary date. ten under one of the following: We will mail or deliver our notice to the first Commercial Property Coverage Part Named Insured, and to the producer of re- cord, at the mailing address shown in the pol- Farm Coverage Part — Farm Property— Farm icy. Dwellings, Appurtenant Structures And Household Personal Property Coverage Form 2. Residential Property a. If such coverage has been in effect for 60 This provision applies to coverage on real days or less, and is not a renewal of cov- property used predominantly for residential erage we previously issued, we may can- purposes and consisting of not more than four • dwelling units, and to coverage on tenants' household property contained in a residential Page 2 of 3 ©ISO Properties, Inc., 2007 IL 02 70 09 08 unit, if such coverage is written under one of and equitable, and that is responsive • the following: to the changes in our reinsurance po- sition. Assets Program (Output Policy) Coy- sition. erage Part :c. We will not refuse to renew such cover- Commercial Property Coverage Part age solely because the first Named In- sured has cancelled or did not renew a Farm Coverage Part — Farm Property— Farm policy, issued by the California Earth- Dwellings, Appurtenant Structures And quake Authority that included an earth- Household Personal Property Coverage Form quake policy premium surcharge. a. We may elect not to renew such cover- d. We will not refuse to renew such cover- age for any reason, except as provided in age solely because corrosive soil condi- b., c. and d. below: tions exist on the premises. This Restric- b. We will not refuse to renew such cover- Lion (d.) applies only if coverage is sub- age solely because the first Named In- ject to one of the following, which exclude sured has accepted an offer of earth- loss or damage caused by or resulting quake coverage. from corrosive soil conditions: However, the following applies only to in- (1) Capital Assets Program Coverage surers who are associate participating in- Form (Output Policy); surers as established by Cal. Ins. Code (2) Commercial Property Coverage Part Section 10089.16. We may elect not to —Causes Of Loss—Special Form; or renew such coverage after the first Named Insured has accepted an offer of (3) Farm Coverage Part — Causes Of earthquake coverage, if one or more of Loss Form — Farm Property, Para the following reasons applies: graph D. Covered Causes Of Loss — Special. (1) The nonrenewal is based on sound underwriting principles that relate to 3. We are not required to send notice of nonre- the coverages provided by this policy newal in the following situations: • and that are consistent with the ap- a. If the transfer or renewal of a policy, with- -proved rating plan and related docu- ments out any changes in terms, conditions, or filed with the Department of rates, is between us and a member of our Insurance as required by existing law; insurance group. (2) The Commissioner of Insurance finds b. If the policy has been extended for 90 that the exposure to potential losses days or less, provided that notice has will threaten our solvency or place us been given in accordance with Paragraph in a hazardous condition. A hazard- C.1. ous condition includes, but is not lim- c. If you have obtained replacement cover- ited to, a condition in which we make age, or if the first Named Insured has claims payments for losses resulting agreed, in writing, within 60 days of the from an earthquake that occurred termination of the policy, to obtain that within the preceding two years and coverage. that required a reduction in policy- holder surplus of at least 25% for d. If the policy is for a period of no more payment of those claims; or than 60 days and you are notified at the time of issuance that it will not be re- (3) We have: newed. (a) Lost or experienced a substantial e. If the first Named Insured requests a reduction in the availability or change in the terms or conditions or risks scope of reinsurance coverage; covered by the policy within 60 days of or the end of the olic p y period. (b) Experienced a substantial in- f. If we have made a written offer to the first crease in the premium charged Named Insured, in accordance with the for reinsurance coverage of our timeframes shown in Paragraph C.1., to residential property insurance renew the policy under changed terms or policies; and conditions or at an increased premium the Commissioner has approved a rate, when the increase exceeds 25%. • plan for the nonrenewals that is fair IL 02 70 09 08 0 ISO Properties, Inc., 2007 Page 3 of 3 • • TRAVE�.ER J WORKERS COMPENSATION v PP[[ AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76( A)- 001 POLICY NUMBER; DTJUB3452N74312 WAIVER OF OUR RIGHT TO 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 1 .o % of the California workers' comperisaliun pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT • EXECUTED PRIOR TO LOSS IO FURNISH THIS WAIVER. 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 0610212012 Policy No. DTJUB3452N74312 Endorsement No. Insured Charles King Company, Inc. or hunt ..'fir Insurance Company Countersigned by___. DATE OF ISSUE: ST ASSIGN: Page 1 of 1 •