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PROOF OF INSURANCE (2013) CLOSEDPolicy Number. 605067657 Date Entered:
AC CERTIFICATE OF LIABILITY INSURANCE DATE(MMID°"YYY)
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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(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).
PRODUCER (.. ....,,,..,.,__ --
Jason Ortega Insurance Agency, Inc. P�At�L ° "' ° " °' - "• FAQ'
3553 Camino Mira Costa, Suite G ��mt (949)429 3620 IyN 949)661 -2066
I. .�_
San Clemente, CA 92672
A -MAIL _SS' jor °tega farmersagent com
INSURERf51 AFFORDING COVERAGE NAIC M
INSURED GSE Solutions, LLC
3622 Pontiac Drive
Carlsbad, CA 92010
INSURER C:
INSURER E
Farmera Insurance Exchange
Philadelphia Insurance Company
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.
.TYPE OF INSURANCE AbUt 8U8Pi POLICY ........................
.........,,QTR ...._ ._......._ NUMBER
.... P"OLICT ,_ .,. ,... e, ...,, , ... . e. ........,,... ...... _
F PMdDDt [°:XP LIMITS
MMkOD,PY'YYM MMFDDCYYYY .. ,.„-..,,,....._... -,-, ...._ ... -,-, -, w......_�
GENERAL LIABILITY
EACH OCCURRENCE $ 1,
COMMERCIAL GENERAL LIABILITY
"000"_000
$75,000
A �..� ® 605067657
(, eJ
01/09/2012 Ol/09/2013 MED EXP (Any one pers n)
PERSONAL &ADV INJURY $]-,
........ ............. .. .................
GENERAL AGGREGATE...... �?----._.._._.
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $l100O.r000
POLICY PRO LOC
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$
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AUTOMOBILE LIABILITY
iF y Acu�doE7t,
'.ANYAUTO
BODILY INJURY (Per person) $
.,.B ...,......0 ....,,___ ._........... .,.
ALL OWNED SCHEDULED
BODILY INJURY (Per accident) $
_.. AUTOS AUTOS
NON
PROPERTY DAMIwr";�E $
GOWNED
HIRED AUTOS
PergcenR).
_,d, _.. __. ._ ..._ . _..._.......
$
UMBRELLA LIAB OCCUR
EACH OCCURRENCE $
EXCESS LIAB '... CLAIMS -MADE
AGGREGATE $
DED RETENTION $
$
WORKERS COMPENSATION
}WC STATU �OTH
TQR.Y..
AND EMPLOYERS' LIABILITY YIN
... .b- 1MIT.. �l�_ .... ....... .....
ANY PROPRIETOR /PARTNER /EXECUTIVE
EXCLUDED?
FMEn
EL EACH ACCIDENT ...m
NH
(Mandatory ' )
E L DISEASE - EA EMP LOYEE $ _____'_
-
If yes, describe under
DESCRIPTION OF OPERATIONS below
........ ......_.._.._
L E DISEASE POLICY LIMIT
...............� � ....._i _....�
B Professional Liab PHSD711983
02/01/2012 o2 /Ol /2013 Limit ,000,000
1,000,000
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach A C ORD 107, Additional Remarks Schedule, if more space is required)
Named: The City of E1 Segundo, its officers, officials,
employees, agents, representatives, and certificate
volunteers are Additional Insureds as respects to General Liability coverage as required by contract.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of El Segundo
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Maryam Jonas
ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
El Segundo, CA 90295
AUTHORIZED REPRESENTATIVE tar
4'
© 1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
Producedusing Fortes Boss Plus soft ware. www.. ForrnsBoss- cwmlmpressivePublishing 800- 208 -1977
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY NUMBER:
60506 -76 -57
E0002
1St Edition
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS-
SCHEDULED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
BUSINESSOWNERS COMMON POLICY CONDITIONS
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-
fied by the endorsement.
SCHEDULE
Name Of Additional Insured Person(s) The City of El Segundo, its officers, officials, employ-
Or Organ ization s : ees acient, re resentatives
Location Of Covered Operation(s): 350 Main Street El Segundo CA 90245
Effective Date Of Endorsement: 03101/2012
If no entry appears above, information required to complete this endorsement will be shown in the Declarations.
The BUSINESSOWNERS LIABILITY COVERAGE FORM is amended as follows:
A. With respect to the additional insured described in paragraph B. of this endorsement, the following exclusions
are added to paragraph 1. Applicable To Business Liability Coverage under Section B. Exclusions:
This insurance does not apply to:
1. "Bodily injury" or "property damage" for which the additional insured(s) is obligated to pay damages by
reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability
for damages that the additional insured(s) would have in the absence of the contract or agreement.
2. "Bodily injury" or "property damage" occurring after:
a. Your ongoing operations at the location of covered operations other than service maintenance or re-
pairs performed by you or on your behalf have been completed; or
b. The portion of your ongoing operation out of which the "bodily injury" or "property damage" arises has
been put to its intended use by any person or organization.
But in no event shall this insurance apply to "bodily injury" or "property damage" arising out of your
operations that were completed prior to the effective date of this endorsement.
3. "Bodily injury" or "property damage" arising out of any act or omission of the additional insured(s) or any of
its "employees ", agents or contractors other than you, except for general supervision by the additional in-
sured(s) of your ongoing operations performed by that additional insured.
4. "Property damage" to:
a. Property owned, used or occupied by or rented to the additional insured(s);
XX -XXXX 1st Edition XX- Includes Copyrighted Material of Insurance Services Office, Inc. with its permission Page 1 of 2
XX
b. Property in the care custody or control of the additional insured(s) or over which the additional in-
sured(s) exercise physical control; or
c. Any work including materials, parts or equipment furnished in connection with such work which is per-
formed for the additional insured by you.
B. Section C. Who Is An Insured is amended to include as an insured the person(s) or organization(s) shown in
the Schedule, but only to the extent that the additional insured(s) is held liable for "bodily injury" or "property
damage" caused in whole or in part by:
1. Your ongoing operations performed for such person or organization at the location designated above;
2. The acts or omissions of your subcontractors acting on "your" behalf on the scheduled project in the per-
formance of your ongoing operations for the additional insured(s) which start and are completed within the
effective period of this endorsement; or
3. The acts or omissions of such additional insured(s) in connection with its general supervision of such op-
erations.
C. With respect to this endorsement, "wrap up policy" means an Owner or Contractor Controlled Insurance Pro-
gram providing one or a series of policies designed to cover a specific construction project that insures all of
the persons and entities working on such project.
The BUSINESSOWNERS COMMON POLICY CONDITIONS are amended as follows:
With respect to the additional insured described in paragraph B. of this endorsement, Section H. Other Insur-
ance is replaced by the following:
H. Other Insurance
1. Primary and Non Contributory Insurance
The coverage provided to an additional insured under this endorsement shall be primary and non con-
tributory ONLY to any insurance issued directly to the additional insured if:
a. The Named Insured agreed in a written contract or written agreement to provide the additional
insured coverage on a primary and non contributory basis;
b. Such written contract or written agreement referenced in a. above was executed prior to the is-
suance of this endorsement;
C. The additional insured designated herein has a policy with an Other Insurance provision making
this policy excess; and
d. There is no "wrap up policy" in effect for the work performed at the location designated in the
Schedule of this endorsement.
2. Excess Insurance
If there is other valid and collectable insurance available to the additional insured(s) as an additional
insured under other policies covering the work performed at the location designated and described in
the schedule of this endorsement, this insurance will be excess over those policies.
This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise sub-
ject to all the terms of the policy.
XX -XXXX 15t Edition XX -XX Includes Copyrighted Material of Insurance Services Office, Inc. with its permission Page 2 of 2
INSURED
This section is for policy: 60506 -76 -57
Assembled -on Date:
03/13/12
Assembled -on Time:
01:12:23
Full Policy Number:
6050676570000
Transaction Number:
002
Operator id:
R9433
TRANSACTION:
ENDORSEMENT
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy Number: 60506 -76 -57
POLKY CHANGES
Effective Date of Change: 01/09/12
Change Endorsement No.: 002
Named Insured: GSE SOLUTIONS, LLC
3622 PONTIAC DRIVE
CARLSBAD CA 92010
The following item (s):
Expiration Date: 01/09/13
Agent: 97 -15 -358
kEE me Insured's Mailing Address
.M..... ..r Company
iration Date Insured's Legal Status /Business of Insured
Premium Determination
X Additional Interested Parties Coverage Forms and Endorsements
WV_._....... .._............... _... ....... -L�
Limits / Exposures Deductibles
Covered Property / Location Description Classification / Class Codes
Rates Underlying Insurance
... _ .......... __.. .... ._ _ ....... ....... . .............. ..... ................
...._..... ....._....................�_...
is (are) changed to read {See Additional Page(s) }:
The above amendments result in a change in the premium as follows:
X I No Changes I I To Be Adjusted At Audit Additional Premium
Authorized Representative Signature:
Return Premium
E4277
1 st Edition
'.� -..: FARM ERSu
91 -0277 1STEDITION 7 -02 Includes Copyrighted Material, Insurance Services Office, Inc, with its permission. E4277101 PAGE 1 OF 2
14277 -ID1
91 4277 1ST EDITION 7 -02 Includes Copyrighled Malerial, Insurance Services Office, Inc, vilh hs penum. E4277102 PAGE 2 OF 2
E4277401
Attach to your policy with the same policy number shown on this endorsement.
ENDORSEMENT
Effective
Date 01 /09/12 60506 -76 -57
Policy Number
of the Company designated
in the Declarations
ISSUED ADDITIONAL INSURED THE CITY OF EL SEGUNDO
ITS OFFICIERS, OFFICIALS,EMPLOYEES, AGENTS, REPRESENTATIVES
ON E0002 FORM: ADDITIONAL INSURED - OWNERS, LESSEES
OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION.
FORM IS LOCATED IN FILENET DATABASE.
This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject
to all other terms of the policy.
COUNTERSIGNED
(Date)
81.0002 (E 0002) 1ST EDITION 3 -88
BUSINESSOWNERS
BP 00 06 01 97
BUSINESSOWNERS LIABILITY COVERAGE FOI1
Various provisions in this policy restrict coverage. b. This insurance applies:
Read the entire policy carefully to determine rights, (1) To "bodily injury" and "property dam -
duties and what is and is not covered. age" only if:
Throughout this policy the words "you" and "your'
refer to the Named Insured shown in the Declara-
tions. The words "we ", "us" and "our" refer to the
Company providing this insurance.
The word "insured" means any person or organization
qualifying as such under Section C — Who Is An In-
sured.
Other words and phrases that appear in quotation
marks have special meaning. Refer to Section F —
Liability And Medical Expenses Definitions.
A. Coverages
1. Business Liability
a. We will pay those sums that the insured
becomes legally obligated to pay as dam-
ages because of "bodily injury", "property
damage ", "personal injury" or "advertising
injury" to which this insurance applies. We
will have the right and duty to defend the
insured against any "suit" seeking those
damages. However, we will have no duty to
defend the insured against any "suit" seek-
ing damages for "bodily injury", "property
damage ", "personal injury", or "advertising
injury" to which this insurance does not ap-
ply. We may at our discretion, investigate
any "occurrence" and settle any claim or
"suit" that may result. But:
(1) The amount we will pay for damages is
limited as described in Section D — Li-
ability And Medical Expenses Limits Of
Insurance; and
(2) Our right and duty to defend end when
we have used up the applicable limit of
insurance in the payment of judgments
or settlements or medical expenses.
No other obligation or liability to pay sums
or perform acts or services is covered un-
less explicitly provided for under Coverage
Extension — Supplementary Payments.
(a) The "bodily injury" or "property dam-
age" is caused by an "occurrence"
that takes place in the "coverage
territory"; and
(b) The "bodily injury" or "property dam-
age" occurs during the policy period.
(2) To:
(a) "Personal injury" caused by an of-
fense arising out of your business,
excluding advertising, publishing,
broadcasting or telecasting done by
or for you;
(b) "Advertising injury" caused by an
offense committed in the course of
advertising your goods, products or
services;
but only if the offense was committed in
the "coverage territory" during the policy
period.
c. Damages because of "bodily injury" include
damages claimed by any person or organi-
zation for care, loss of services or death re-
sulting at any time from the "bodily injury".
d. Coverage Extension — Supplementary
Payments
In addition to the Limit of Insurance we will
pay, with respect to any claim we investi-
gate or settle, or any "suit" against an in-
sured we defend:
(1) All expenses we incur.
(2) Up to $250 for cost of bail bonds re-
quired because of accidents or traffic
law violations arising out of the use of
any vehicle to which Business Liability
Coverage for "bodily injury" applies.
We do not have to furnish these bonds.
(3) The cost of bonds to release attach-
ments, but only for bond amounts within
our Limit of Insurance. We do not have
to furnish these bonds.
BP 00 06 01 97 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 15 ❑
(4) All reasonable expenses incurred by the
insured at our request to assist us in the
investigation or defense of the claim or
"suit ", including actual loss of earnings
up to $250 a day because of time off
from work.
(5) All costs taxed against the insured in the
"suit ".
(6) Prejudgment interest awarded against
the insured on that part of the judgment
we pay. If we make an offer to pay the
Limit of Insurance, we will not pay any
prejudgment interest based on that pe-
riod of time after the offer.
(7) All interest on the full amount of any
judgment that accrues after entry of the
judgment and before we have paid, of-
fered to pay, or deposited in court the
part of the judgment that is within our
Limit of Insurance.
If we defend an insured against a "suit" and an
indemnitee of the insured is also named as a
party to the "suit ", we will defend that indemni-
tee if all of the following conditions are met:
a. The "suit" against the indemnitee seeks
damages for which the insured has as-
sumed the liability of the indemnitee in a
contract or agreement that is an "insured
contract ";
b. This insurance applies to such liability
assumed by the insured;
c. The obligation to defend, or the cost of the
defense of, that indemnitee, has also been
assumed by the insured in the same
"insured contract";
d. The allegations in the "suit" and the infor-
mation we know about the "occurrence" are
such that no conflict appears to exist be-
tween the interests of the insured and the
interests of the indemnitee:
e. The indemnitee and the insured ask us to
conduct and control the defense of that in-
demnitee against such "suit" and agree that
we can assign the same counsel to defend
the insured and the indemnitee; and
f. The indemnitee:
(1) Agrees in writing to:
(a) Cooperate with us in the investiga-
tion, settlement or defense of the
"suit ";
(b) Immediately send us copies of any
demands, notices, summonses or
legal papers received in connection
with the "suit ";
(c) Notify any other insurer whose cov-
erage is available to the indemnitee;
and
(d) Cooperate with us with respect to
coordinating other applicable insur-
ance available to the indemnitee;
and
(2) Provides us with written authorization
to:
(a) Obtain records and other information
related to the "suit "; and
(b) Conduct and control the defense of
the indemnitee in such "suit ".
So long as the above conditions are met, at-
torneys' fees incurred by us in the defense of
that indemnitee, necessary litigation expenses
incurred by us and necessary litigation ex-
penses incurred by the indemnitee at our re-
quest will be paid as Supplementary Pay-
ments. Notwithstanding the provisions of
Paragraph B.1.b.(2) of Exclusions, such pay-
ments will not be deemed to be damages for
"bodily injury" and "property damage" and will
not reduce the limits of insurance.
Our obligation to defend an insured's indemni-
tee and to pay for attorneys' fees and neces-
sary litigation expenses as Supplementary
Payments ends when:
a. We have used up the applicable limit of
insurance in the payment of judgments or
settlements; or
b. The conditions set forth above, or the terms
of the agreement described in Paragraph f.
above are no longer met.
Page 2 of 15 Copyright, Insurance Services Office, Inc., 1997 BP 00 06 01 97 ❑
2. Medical Expenses
a. We will pay medical expenses as described
below for "bodily injury" caused by an acci-
dent:
(1) On premises you own or rent;
(2) On ways next to premises you own or
rent; or
(3) Because of your operations;
provided that:
(a) The accident takes place in the
"coverage territory" and during the
policy period;
(b) The expenses are incurred and
reported to us within one year of the
date of the accident; and
(c) The injured person submits to ex-
amination, at our expense, by phy-
sicians of our choice as often as we
reasonably require.
b. We will make these payments regardless of
fault. These payments will not exceed the
Limit of Insurance. We will pay reasonable
expenses for:
(1) First aid administered at the time of an
accident;
(2) Necessary medical, surgical, x -ray and
dental services, including prosthetic
devices; and
(3) Necessary ambulance, hospital, profes-
sional nursing and funeral services.
B. Exclusions
1. Applicable To Business Liability Coverage
This insurance does not apply to:
a. Expected Or Intended Injury
"Bodily injury" or "property damage" ex-
pected or intended from the standpoint of
the insured. This exclusion does not apply
to "bodily injury" resulting from the use of
reasonable force to protect persons or
property.
b. Contractual Liability
"Bodily injury" or "property damage" for
which the insured is obligated to pay dam-
ages by reason of the assumption of liabil-
ity in a contract or agreement. This exclu-
sion does not apply to liability for damages:
(1) That the insured would have in the
absence of the contract or agreement;
or
(2) Assumed in a contract or agreement
that is an "insured contract ", provided
the "bodily injury" or "property damage"
occurs subsequent to the execution of
the contract or agreement. Solely for
the purposes of liability assumed in an
"insured contract ", reasonable attorney
fees and necessary litigation expenses
incurred by or for a party other than an
insured are deemed to be damages be-
cause of "bodily injury" or "property
damage ", provided:
(a) Liability to such party for, or for the
cost of, that party's defense has also
been assumed in the same "insured
contract "; and
(b) Such attorney fees and litigation
expenses are for defense of that
party against a civil or alternative
dispute resolution proceeding in
which damages to which this insur-
ance applies are alleged.
c. Liquor Liability
"Bodily injury" or "property damage" for
which any insured may be held liable by
reason of:
(1) Causing or contributing to the intoxica-
tion of any person;
(2) The furnishing of alcoholic beverages to
a person under the legal drinking age or
under the influence of alcohol; or
(3) Any statute, ordinance or regulation
relating to the sale, gift, distribution or
use of alcoholic beverages.
This exclusion applies only if you are in the
business of manufacturing, distributing,
selling, serving or furnishing alcoholic bev-
erages.
d. Workers' Compensation And Similar
Laws
Any obligation of the insured under a work-
ers' compensation, disability benefits or
unemployment compensation law or any
similar law.
BP 00 06 01 97 Copyright, Insurance Services Office, Inc., 1997 Page 3 of 15 ❑
e. Employer's Liability
"Bodily Injury" to:
(1) An "employee" of the insured arising out
of and in the course of:
(a) Employment by the insured; or
(b) Performing duties related to the
conduct of the insured's business; or
(2) The spouse, child, parent, brother or
sister of that "employee" as a conse-
quence of Paragraph (1) above.
This exclusion applies:
(a) Whether the insured may be liable
as an employer or in any other ca-
pacity; and
(b) To any obligation to share damages
with or repay someone else who
must pay damages because of the
injury.
This exclusion does not apply to liability
assumed by the insured under an "insured
contract ".
f. Pollution
(1) "Bodily injury" or "property damage"
arising out of the actual, alleged or
threatened discharge, dispersal, seep-
age, migration, release or escape of
pollutants:
(a) At or from any premises, site or
location which is or was at any time
owned or occupied by, or rented or
loaned to, any insured;
(b) At or from any premises, site or
location which is or was at any time
used by or for any insured or others
for the handling, storage, disposal,
processing or treatment of waste;
(c) Which are or were at any time trans-
ported, handled, stored, treated, dis-
posed of, or processed as waste by
or for any insured or any person or
organization for whom you may be
legally responsible; or
(d) At or from any premises, site or
location on which any insured or any
contractors or subcontractors work-
ing directly or indirectly on any in-
sured's behalf are performing opera-
tions:
(i) If the pollutants are brought on or
to the premises, site or location
in connection with such opera-
tions by such insured, contractor
or subcontractor; or
(ii) If the operations are to test for,
monitor, clean up, remove, con-
tain, treat, detoxify or neutralize,
or in any way respond to, or as-
sess the effects of pollutants.
Subparagraph (d)(i) does not apply to
"bodily injury" or "property damage"
arising out of the escape of fuels, lubri-
cants or other operating fluids which are
needed to perform the normal electrical,
hydraulic or mechanical functions nec-
essary for the operation of "mobile
equipment" or its parts, if such fuels, lu-
bricants or other operating fluids escape
from a vehicle part designed to hold,
store or receive them. This exception
does not apply if the fuels, lubricants or
other operating fluids are intentionally
discharged, dispersed or released, or if
such fuels, lubricants or other operating
fluids are brought on or to the premises,
site or location with the intent to be dis-
charged, dispersed or released as part
of the operations being performed by
such insured, contractor or subcontrac-
tor.
Subparagraphs (a) and (d)(i) do not
apply to "bodily injury" or "property
damage" arising out of heat, smoke or
fumes from a hostile fire.
As used in this exclusion, a hostile fire
means one which becomes uncontrol-
lable or breaks out from where it was
intended to be.
(2) Any loss, cost or expense arising out of
any:
(a) Request, demand or order that any
insured or others test for, monitor,
clean up, remove, contain, treat,
detoxify or neutralize, or in any way
respond to, or assess the effects of
pollutants; or
Page 4 of 15 Copyright, Insurance Services Office, Inc., 1997 BP 00 06 01 97 ❑
(b) Claim or "suit' by or on behalf of a
governmental authority for damages
because of testing for, monitoring,
cleaning up, removing, containing,
treating, detoxifying or neutralizing,
or in any way responding to, or as-
sessing the effects of pollutants.
Pollutants means any solid, liquid, gaseous
or thermal irritant or contaminant, including
smoke, vapor, soot, fumes, acids, alkalis,
chemicals and waste. Waste includes ma-
terials to be recycled, reconditioned or re-
claimed.
g. Aircraft, Auto Or Watercraft
"Bodily injury" or "property damage" arising
out of the ownership, maintenance, use or
entrustment to others of any aircraft, "auto"
or watercraft owned or operated by or
rented or loaned to any insured. Use in-
cludes operation and "loading or unload-
ing".
This exclusion does not apply to:
(1) A watercraft while ashore on premises
you own or rent;
(2) A watercraft you do not own that is:
(a) Less than 26 feet long; and
(b) Not being used to carry persons or
property for a charge;
(3) Parking an "auto" on, or on the ways
next to, premises you own or rent, pro-
vided the "auto" is not owned by or
rented or loaned to you or the insured;
(4) Liability assumed under any "insured
contract' for the ownership, mainte-
nance or use of aircraft or watercraft; or
(5) "Bodily injury" or "property damage"
arising out of the operation of any of the
following equipment:
(a) Cherry pickers and similar devices
mounted on automobile or truck
chassis and used to raise or lower
workers; and
(b) Air compressors, pumps and genera-
tors, including spraying, welding,
building cleaning, geophysical explo-
ration, lighting and well servicing
equipment.
h. Mobile Equipment
"Bodily injury" or "property damage" arising
out of:
(1) The transportation of "mobile equip-
ment' by an "auto" owned or operated
by or rented or loaned to any insured; or
(2) The use of "mobile equipment' in, or
while in practice for, or while being pre-
pared for, any prearranged racing,
speed, demolition or stunting activity.
i. War
"Bodily injury" or "property damage" due to
war, whether or not declared, or any act or
condition incident to war. War includes civil
war, insurrection, rebellion or revolution.
This exclusion applies only to liability as-
sumed under a contract or agreement.
Professional Services
"Bodily injury", "property damage ",
"personal injury" or "advertising injury" due
to rendering or failure to render any pro-
fessional service. This includes but is not
limited to:
(1) Legal, accounting or advertising ser-
vices;
(2) Preparing, approving, or failing to pre-
pare or approve maps, drawings, opin-
ions, reports, surveys, change orders,
designs or specifications;
(3) Supervisory, inspection or engineering
services;
(4) Medical, surgical, dental, x -ray or nurs-
ing services treatment, advice or in-
struction;
(5) Any health or therapeutic service treat-
ment, advice or instruction;
(6) Any service, treatment, advice or in-
struction for the purpose of appearance
or skin enhancement, hair removal or
replacement or personal grooming;
(7) Optometry or optical or hearing aid
services including the prescribing,
preparation, fitting, demonstration or
distribution of ophthalmic lenses and
similar products or hearing aid devices;
BP 00 06 01 97 Copyright, Insurance Services Office, Inc., 1997
i
Page 5of15 ❑
(8) Body piercing services; and
(9) Services in the practice of pharmacy;
but this exclusion does not apply to an
insured whose operations include those
of a retail druggist or drugstore.
k. Damage To Property
"Property damage" to:
(1) Property you own, rent or occupy;
(2) Premises you sell, give away or aban-
don, if the "property damage" arises out
of any part of those premises;
(3) Property loaned to you;
(4) Personal property in the care, custody
or control of the insured;
(5) That particular part of real property on
which you or any contractor or subcon-
tractor working directly or indirectly on
your behalf is performing operations, if
the "property damage" arises out of
those operations; or
(6) That particular part of any property that
must be restored, repaired or replaced
because "your work" was incorrectly
performed on it.
Paragraph (2) of this exclusion does not
apply if the premises are "your work" and
were never occupied, rented or held for
rental by you.
Paragraphs (3), (4), (5) and (6) of this ex-
clusion do not apply to liability assumed
under a sidetrack agreement.
Paragraph (6) of this exclusion does not
apply to "property damage" included in the
"products — completed operations hazard ".
I. Damage To Your Product
"Property damage" to "your product" arising
out of it or any part of it.
m. Damage To Your Work
"Property damage" to "your work" arising
out of it or any part of it and included in the
"products — completed operations hazard ".
This exclusion does not apply if the dam-
aged work or the work out of which the
damage arises was performed on your be-
half by a subcontractor.
n. Damage To Impaired Property Or
Property Not Physically Injured
"Property damage" to "impaired property"
or property that has not been physically in-
jured, arising out of:
(1) A defect, deficiency, inadequacy or
dangerous condition in "your product" or
"your work "; or
(2) A delay or failure by you or anyone
acting on your behalf to perform a con-
tract or agreement in accordance with
its terms.
This exclusion does not apply to the loss of
use of other property arising out of sudden
and accidental physical injury to "your
product" or "your work" after it has been put
to its intended use.
o. Recall Of Products, Work Or Impaired
Property
Damages claimed for any loss, cost or ex-
pense incurred by you or others for the loss
of use, withdrawal, recall, inspection, re-
pair, replacement, adjustment, removal or
disposal of:
(1) "Your product ";
(2) "Your work "; or
(3) "Impaired property ";
if such product, work or property is with-
drawn or recalled from the market or from
use by any person or organization because
of a known or suspected defect, deficiency,
inadequacy or dangerous condition in it.
p. Personal Or Advertising Injury
"Personal injury" or "advertising injury":
(1) Arising out of oral or written publication
of material, if done by or at the direction
of the insured with knowledge of its
falsity;
(2) Arising out of oral or written publication
of material whose first publication took
place before the beginning of the policy
period;
Page 6 of 15 Copyright, Insurance Services Office, Inc., 1997 BP 00 06 01 97 ❑
(3) Arising out of the willful violation of a
penal statute or ordinance committed by
or with the consent of the insured;
(4) For which the insured has assumed
liability in a contract or agreement. This
exclusion does not apply to liability for
damages that the insured would have in
the absence of the contract or agree-
ment; or
(5) Arising out of the actual, alleged or
threatened discharge, dispersal, seep-
age, migration, release or escape of
pollutants at any time.
(6) With respect to any loss, cost or ex-
pense arising out of any:
(a) Request, demand or order that any
insured or others test for, monitor,
clean -up, remove, contain, treat,
detoxify or neutralize or in any way
respond to, or assess the effects of
pollutants; or
(b) Claim or suit by or on behalf of a
governmental authority for damages
because of testing for, monitoring,
cleaning up, removing, containing,
treating, detoxifying or neutralizing
or in any way responding to, or as-
sessing the effects of pollutants.
Pollutants means any solid, liquid, gaseous
or thermal irritant or contaminant, including
smoke, vapor, soot, fumes, acids, alkalis,
chemicals and waste. Waste includes ma-
terials to be recycled, reconditioned or re-
claimed.
q. Advertising Injury
"Advertising injury" arising out of:
(1) Breach of contract, other than misap-
propriation of advertising ideas under an
implied contract;
(2) The failure of goods, products or serv-
ices to conform with advertised quality
or performance;
(3) The wrong description of the price of
goods, products or services; or
(4) An offense committed by an insured
whose business is advertising, broad-
casting, publishing or telecasting.
Exclusions c., d., e., f., g., h., i., k., I., m., n.
and o. do not apply to damage by fire or ex-
plosion to premises while rented to you, or
temporarily occupied by you with permission of
the owner. A separate Limit of Insurance ap-
plies to this coverage as described in Section
D., Limits of Insurance.
2. Applicable To Medical Expenses Coverage
We will not pay expenses for "bodily injury":
a. To any insured.
b. To a person hired to do work for or on be-
half of any insured or a tenant of any in-
sured.
c. To a person injured on that part of prem-
ises you own or rent that the person nor-
mally occupies.
d. To a person, whether or not an "employee"
of any insured, if benefits for the "bodily
injury" are payable or must be provided un-
der a workers' compensation or disability
benefits law or a similar law.
e. To a person injured while taking part in
athletics.
f. Included within the "products — completed
operations hazard ".
g. Excluded under Business Liability Cover-
age.
h. Due to war, whether or not declared, or any
act or condition incident to war. War in-
cludes civil war, insurrection, rebellion or
revolution.
3. Applicable To Both Business Liability
Coverage And Medical Expenses Coverage
— Nuclear Energy Liability Exclusion
This insurance does not apply:
a. Under Business Liability Coverage, to
"bodily injury" or "property damage ":
(1) With respect to which an insured under
the policy is also an insured under a
nuclear energy liability policy issued by
Nuclear Energy Liability Insurance As-
sociation, Mutual Atomic Energy Liabil-
ity Underwriters or Nuclear Insurance
Association of Canada, or would be an
insured under any such policy but for its
termination upon exhaustion of its limit
of liability; or
BP 00 06 01 97 Copyright, Insurance Services Office, Inc., 1997 Page 7 of 15 ❑
(2) Resulting from the "hazardous proper-
ties" of "nuclear material' and with re-
spect to which:
(a) Any person or organization is re-
quired to maintain financial protec-
tion pursuant to the Atomic Energy
Act of 1954, or any law amendatory
thereof; or
(b) The insured is, or had this policy not
been issued would be, entitled to in-
demnity from the United States of
America, or any agency thereof, un-
der any agreement entered into by
the United States of America, or any
agency thereof, with any person or
organization.
b. Under Medical Expenses Coverage, to
expenses incurred with respect to "bodily
injury" resulting from the "hazardous prop-
erties" of "nuclear material' and arising out
of the operation of a "nuclear facility" by
any person or organization.
c. Under Business Liability Coverage, to
"bodily injury" or "property damage" result-
ing from the "hazardous properties" of the
"nuclear material'; if:
(1) The "nuclear material':
(a) Is at any "nuclear facility" owned by,
or operated by or on behalf of, an in-
sured; or
(b) Has been discharged or dispersed
therefrom;
(2) The "nuclear material' is contained in
"spent fuel" or "waste" at any time pos-
sessed, handled, used, processed,
stored, transported or disposed of by or
on behalf of an insured; or
(3) The "bodily injury" or "property damage"
arises out of the furnishing by an in-
sured of services, materials, parts or
equipment in connection with the plan-
ning, construction, maintenance, opera-
tion or use of any "nuclear facility "; but if
such facility is located within the United
States of America, its territories or pos-
sessions or Canada, this Exclusion (3)
applies only to "property damage" to
such "nuclear facility" and any property
thereat.
As used in this exclusion:
"By- product material" has the meaning given it
in the Atomic Energy Act of 1954 or in any law
amendatory thereof;
"Hazardous properties" include radioactive,
toxic or explosive properties;
"Nuclear facility" means:
(a) Any "nuclear reactor";
(b) Any equipment or device designed or used
for:
(1) Separating the isotopes of uranium or
plutonium;
(2) Processing or utilizing "spent fuel'; or
(3) Handling, processing or packaging
"waste ";
(c) Any equipment or device used for the
processing, fabricating or alloying of
"special nuclear material' if at any time the
total amount of such material in the custody
of the insured at the premises where such
equipment or device is located consists of
or contains more than 25 grams of pluto-
nium or uranium 233 or any combination
thereof, or more than 250 grams of ura-
nium 235;
(d) Any structure, basin, excavation, premises
or place prepared or used for the storage or
disposal of "waste ";
and includes the site on which any of the fore-
going is located, all operations conducted on
such site and all premises used for such op-
erations;
"Nuclear material" means "source material',
"special nuclear material' or "by- product mate-
rial';
"Nuclear reactor" means any apparatus de-
signed or used to sustain nuclear fission in a
self - supporting chain reaction or to contain a
critical mass of fissionable material;
"Property damage" includes all forms of radio-
active contamination of property.
"Source material" has the meaning given it in
the Atomic Energy Act of 1954 or in any law
amendatory thereof;
"Special nuclear material" has the meaning
given it in the Atomic Energy Act of 1954 or in
any law amendatory thereof;
"Spent fuel" means any fuel element or fuel
component, solid or liquid, which has been
used or exposed to radiation in a "nuclear re-
actor";
Page 8 of 15 Copyright, Insurance Services Office, Inc., 1997 BP 00 06 01 97 ❑
"Waste" means any waste material:
(a) Containing "by- product material" other than
the tailings or wastes produced by the ex-
traction or concentration of uranium or tho-
rium from any ore processed primarily for
its "source material' content; and
(b) Resulting from the operation by any person
or organization of any "nuclear facility" in-
cluded under Paragraphs (a) and (b) of the
definition of "nuclear facility ".
C. Who Is An Insured
1. If you are designated in the Declarations as:
a. An individual, you and your spouse are
insureds, but only with respect to the con-
duct of a business of which you are the sole
owner.
b. A partnership or joint venture, you are an
insured. Your members, your partners and
their spouses are also insureds, but only
with respect to the conduct of your busi-
ness.
c. A limited liability company, you are an
insured. Your members are also insureds,
but only with respect to the conduct of your
business. Your managers are insureds, but
only with respect to their duties as your
managers.
d. An organization other than a partnership,
joint venture or limited liability company,
you are an insured. Your "executive offi-
cers" and directors are insureds, but only
with respect to their duties as your officers
or directors. Your stockholders are also in-
sureds, but only with respect to their liability
as stockholders.
2. Each of the following is also an insured:
a. Your "employees ", other than either your
"executive officers" (if you are an organiza-
tion other than a partnership, joint venture
or limited liability company) or your man-
agers (if you are a limited liability com-
pany), but only for acts within the scope of
their employment by you or while perform-
ing duties related to the conduct of your
business. However, none of these
"employees" is an insured for:
(1) "Bodily injury" or "personal injury"
(a) To you, to your partners or members
(if you are a partnership or joint
venture), to your members (if you
are a limited liability company), or to
a co- "employee" while that co-
"employee" is either in the course of
his or her employment or performing
duties related to the conduct of your
business;
(b) To the spouse, child, parent, brother
or sister of that co-"employee" as a
consequence of Paragraph (1)(a)
above;
(c) For which there is any obligation to
share damages with or repay some-
one else who must pay damages of
the injury described in Paragraphs
(1)(a) or (1)(b); or
(d) Arising out of his or her providing or
failing to provide professional health
care services. However, if you have
"employees" who are pharmacists in
your retail druggist or drugstore op-
eration, they are insured with respect
to their providing or failing to provide
professional health care services; or
(2) "Property damage" to property:
(a) Owned, occupied or used by,
(b) Rented to, in the care, custody or
control of, or over which physical
control is being exercised for any
purpose by
you, any of your "employees ", any part-
ner or member (if you are a partnership
or joint venture), or any member (if you
are a limited liability company).
b. Any person (other than your "employee "),
or any organization while acting as your
real estate manager.
c. Any person or organization having proper
temporary custody of your property if you
die, but only:
(1) With respect to liability arising out of the
maintenance or use of that property;
and
(2) Until your legal representative has been
appointed.
BP 00 06 01 97 Copyright, Insurance Services Office, Inc., 1997 Page 9 of 15 ❑
d. Your legal representative if you die, but
only with respect to duties as such. That
representative will have all your rights and
duties under this policy.
3. With respect to "mobile equipment" registered
in your name under any motor vehicle regis-
tration law, any person is an insured while
driving such equipment along a public highway
with your permission. Any other person or or-
ganization responsible for the conduct of such
person is also an insured, but only with respect
to liability arising out of the operation of the
equipment, and only if no other insurance of
any kind is available to that person or organi-
zation for this liability. However, no person or
organization is an insured with respect to:
a. "Bodily injury" to a co-"employee" of the
person driving the equipment; or
b. "Property damage" to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured under this provision.
No person or organization is an insured with
respect to the conduct of any current or past
partnership, joint venture or limited liability
company that is not shown as a Named In-
sured in the Declarations.
D. Liability And Medical Expenses Limits Of
Insurance
1. The Limits of Insurance shown in the Declara-
tions and the rules below fix the most we will
pay regardless of the number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or
bringing "suits ".
2. The most we will pay for the sum of all dam-
ages because of all:
a. "Bodily injury", "property damage" and
medical expenses arising out of any one
"occurrence "; and
b. "Personal injury" and "advertising injury"
sustained by any one person or organiza-
tion;
is the Liability and Medical Expenses limit
shown in the Declarations. But the most we will
pay for all medical expenses because of
"bodily injury" sustained by any one person is
the Medical Expenses limit shown in the Dec-
larations.
The most we will pay under Business Liability
Coverage for damages because of "property
damage" to premises while rented to you or
temporarily occupied by you with permission of
the owner, arising out of any one fire or explo-
sion is the Fire Legal Liability limit shown in
the Declarations.
4. Aggregate Limits
The most we will pay for:
a. Injury or damage under the "products —
completed operations hazard" arising from
all "occurrences" during the policy period is
the Liability and Medical Expenses limit;
and
b. All other injury or damage, including medi-
cal expenses, arising from all "occurrences"
during the policy period is twice the Liability
and Medical Expenses limit. This limitation
does not apply to "property damage" to
premises while rented to you or temporarily
occupied by you with permission of the
owner, arising out of fire or explosion.
The Limits of Insurance of this policy apply sepa-
rately to each consecutive annual period and to
any remaining period of less than 12 months,
starting with the beginning of the policy period
shown in the Declarations, unless the policy pe-
riod is extended after issuance for an additional
period of less than 12 months. In that case, the
additional period will be deemed part of the last
preceding period for purposes of determining the
Limits of Insurance.
E. Liability And Medical Expenses General
Conditions
1. Bankruptcy
Bankruptcy or insolvency of the insured or of
the insured's estate will not relieve us of our
obligations under this policy.
2. Duties In The Event Of Occurrence,
Offense, Claim Or Suit
a. You must see to it that we are notified as
soon as practicable of an "occurrence" or
an offense which may result in a claim. To
the extent possible, notice should include:
(1) How, when and where the "occurrence"
or offense took place;
(2) The names and addresses of any in-
jured persons and witnesses; and
(3) The nature and location of any injury or
damage arising out of the "occurrence"
or offense.
Page 10 of 15 Copyright, Insurance Services Office, Inc., 1997 BP 00 06 01 97 ❑
b. If a claim is made or "suit" is brought
against any insured, you must:
(1) Immediately record the specifics of the
claim or "suit" and the date received;
and
(2) Notify us as soon as practicable.
You must see to it that we receive written
notice of the claim or "suit" as soon as
practicable.
c. You and any other involved insured must:
(1) Immediately send us copies of any
demands, notices, summonses or legal
papers received in connection with the
claim or "suit ";
(2) Authorize us to obtain records and other
information;
(3) Cooperate with us in the investigation,
or settlement of the claim or defense
against the "suit "; and
(4) Assist us, upon our request, in the en-
forcement of any right against any per-
son or organization that may be liable to
the insured because of injury or damage
to which this insurance may also apply.
d. No insured will, except at that insured's own
cost, voluntarily make a payment, assume
any obligation, or incur any expense, other
than for first aid, without our consent.
3. Financial Responsibility Laws
a. When this policy is certified as proof of
financial responsibility for the future under
the provisions of any motor vehicle finan-
cial responsibility law, the insurance pro-
vided by the policy for "bodily injury" liabil-
ity and "property damage" liability will
comply with the provisions of the law to the
extent of the coverage and limits of insur-
ance required by that law.
b. With respect to "mobile equipment" to
which this insurance applies, we will pro-
vide any liability, uninsured motorists, un-
derinsured motorists, no -fault or other cov-
erage required by any motor vehicle law.
We will provide the required limits for those
coverages.
4. Legal Action Against Us
No person or organization has a right under
this policy:
a. To join us as a party or otherwise bring us
into a "suit" asking for damages from an in-
sured; or
b. To sue us on this policy unless all of its
terms have been fully complied with.
A person or organization may sue us to re-
cover on an agreed settlement or on a final
judgment against an insured obtained after an
actual trial; but we will not be liable for dam-
ages that are not payable under the terms of
this policy or that are in excess of the applica-
ble limit of insurance. An agreed settlement
means a settlement and release of liability
signed by us, the insured and the claimant or
the claimant's legal representative.
5. Separation Of Insureds
Except with respect to the Limits of Insurance,
and any rights or duties specifically assigned in
this policy to the first Named Insured, this in-
surance applies:
a. As if each Named Insured were the only
Named Insured; and
b. Separately to each insured against whom
claim is made or "suit" is brought.
F. Liability And Medical Expenses Definitions
1. "Advertising injury" means injury arising out of
one or more of the following offenses:
a. Oral or written publication of material that
slanders or libels a person or organization
or disparages a person's or organization's
goods, products or services;
b. Oral or written publication of material that
violates a person's right of privacy;
c. Misappropriation of advertising ideas or
style of doing business; or
d. Infringement of copyright, title or slogan.
BP 00 06 01 97 Copyright, Insurance Services Office, Inc., 1997 Page 11 of 15 ❑
2. "Auto" means a land motor vehicle, trailer or
semitrailer designed for travel on public roads,
including any attached machinery or equip-
ment. But "auto" does not include "mobile
equipment ".
3. "Bodily injury" means bodily injury, sickness or
disease sustained by a person, including death
resulting from any of these at any time.
4. "Coverage territory" means:
a. The United States of America (including its
territories and possessions), Puerto Rico
and Canada;
b. International waters or airspace, provided
the injury or damage does not occur in the
course of travel or transportation to or from
any place not included in a. above; or
c. All parts of the world if:
(1) The injury or damage arises out of:
(a) Goods or products made or sold by
you in the territory described in a.
above; or
(b) The activities of a person whose
home is in the territory described in
a. above, but is away for a short
time on your business; and
(2) The insured's responsibility to pay dam-
ages is determined in a "suit" on the
merits in the territory described in a.
above or in a settlement we agree to.
5. "Employee" includes a "leased worker ".
"Employee" does not include a "temporary
worker ".
6. "Executive officer" means a person holding
any of the officer positions created by your
charter, constitution, by -laws or any other
similar governing document.
7. "Impaired property" means tangible property,
other than "your product" or "your work ", that
cannot be used or is less useful because:
a. It incorporates "your product" or "your work"
that is known or thought to be defective,
deficient, inadequate or dangerous; or
b. You have failed to fulfill the terms of a
contract or agreement;
if such property can be restored to use by:
(1) The repair, replacement, adjustment or
removal of "your product" or "your
work "; or
(2) Your fulfilling the terms of the contract
or agreement.
8. "Insured contract" means:
a. A contract for a lease of premises. How-
ever, that portion of the contract for a lease
of premises that indemnifies any person or
organization for damage by fire to premises
while rented to you or temporarily occupied
by you with permission of the owner is not
an "insured contract ";
b. A sidetrack agreement;
c. Any easement or license agreement, ex-
cept in connection with construction or
demolition operations on or within 50 feet
of a railroad;
d. An obligation, as required by ordinance, to
indemnify a municipality, except in connec-
tion with work for a municipality;
e. An elevator maintenance agreement;
f. That part of any other contract or agree-
ment pertaining to your business (including
an indemnification of a municipality in con-
nection with work performed for a munici-
pality) under which you assume the tort li-
ability of another party to pay for "bodily
injury" or "property damage" to a third per-
son or organization. Tort liability means a
liability that would be imposed by law in the
absence of any contract or agreement.
Paragraph f. does not include that part of
any contract or agreement:
(1) That indemnifies a railroad for "bodily
injury" or "property damage" arising out
of construction or demolition operations,
within 50 feet of any railroad property
and affecting any railroad bridge or
trestle, tracks, road beds, tunnel, under-
pass or crossing;
(2) That indemnifies an architect, engineer
or surveyor for injury or damage arising
out of:
(a) Preparing, approving or failing to
prepare or approve maps, drawings,
opinions, reports, surveys, change
orders, designs or specifications; or
Page 12 of 15 Copyright, Insurance Services Office, Inc., 1997 BP 00 06 01 97 ❑
(b) Giving directions or instructions, or
failing to give them, if that is the
primary cause of the injury or dam-
age; or
(3) Under which the insured, if an architect,
engineer or surveyor, assumes liability
for an injury or damage arising out of
the insured's rendering or failure to ren-
der professional services, including
those listed in (2) above and supervi-
sory, inspection or engineering services.
9. "Leased worker" means a person leased to you
by a labor leasing firm under an agreement
between you and the labor leasing firm, to
perform duties related to the conduct of your
business. "Leased worker" does not include a
"temporary worker ".
10. "Loading or unloading" means the handling of
property:
a. After it is moved from the place where it is
accepted for movement into or onto an air-
craft, watercraft or "auto ";
b. While it is in or on an aircraft, watercraft or
"auto "; or
c. While it is being moved from an aircraft,
watercraft or "auto" to the place where it is
finally delivered;
but "loading or unloading" does not include the
movement of property by means of a me-
chanical device, other than a hand truck, that
is not attached to the aircraft, watercraft or
"auto ".
11. "Mobile equipment" means any of the following
types of land vehicles, including any attached
machinery or equipment:
a. Bulldozers, farm machinery, forklifts and
other vehicles designed for use principally
off public roads;
b. Vehicles maintained for use solely on or
next to premises you own or rent;
c. Vehicles that travel on crawler treads;
d. Vehicles, whether self - propelled or not, on
which are permanently mounted:
(1) Power cranes, shovels, loaders, diggers
or drills; or
(2) Road construction or resurfacing
equipment such as graders, scrapers or
rollers;
e. Vehicles not described in a., b., c. or d.
above that are not self - propelled and are
maintained primarily to provide mobility to
permanently attached equipment of the
following types:
(1) Air compressors, pumps and genera-
tors, including spraying, welding, build-
ing cleaning, geophysical exploration,
lighting and well servicing equipment; or
(2) Cherry pickers and similar devices used
to raise or lower workers;
f. Vehicles not described in a., b., c. or d.
above maintained primarily for purposes
other than the transportation of persons or
cargo.
However, self - propelled vehicles with the
following types of permanently attached
equipment are not "mobile equipment" but
will be considered "autos ":
(1) Equipment designed primarily for:
(a) Snow removal;
(b) Road maintenance, but not con-
struction or resurfacing; or
(c) Street cleaning;
(2) Cherry pickers and similar devices
mounted on automobile or truck chassis
and used to raise or lower workers; and
(3) Air compressors, pumps and genera-
tors, including spraying, welding, build-
ing cleaning, geophysical exploration,
lighting and well servicing equipment.
12. "Occurrence" means an accident, including
continuous or repeated exposure to substan-
tially the same general harmful conditions.
13. "Personal injury" means injury, other than
"bodily injury", arising out of one or more of the
following offenses:
a. False arrest, detention or imprisonment;
b. Malicious prosecution;
c. The wrongful eviction from, wrongful entry
into, or invasion of the right of private oc-
cupancy of a room, dwelling or premises
that a person occupies, by or on behalf of
its owner, landlord or lessor;
BP 00 06 01 97 Copyright, Insurance Services Office, Inc., 1997 Page 13 of 15 ❑
d. Oral or written publication of material that
slanders or libels a person or organization
or disparages a person's or organization's
goods, products or services; or
e. Oral or written publication of material that
violates a person's right of privacy.
14. "Products — completed operations hazard ":
a. Includes all "bodily injury" and "property
damage" occurring away from premises
you own or rent and arising out of "your
product" or "your work" except:
(1) Products that are still in your physical
possession; or
(2) Work that has not yet been completed
or abandoned. However, "your work" will
be deemed completed at the earliest of
the following times:
(a) When all of the work called for in
your contract has been completed.
(b) When all of the work to be done at
the job site has been completed if
your contract calls for work at more
than one job site.
(c) When that part of the work done at
the job site has been put to its in-
tended use by any other person or
organization other than another con-
tractor or subcontractor working on
the same project.
Work that may need service, mainte-
nance, correction, repair or replace-
ment, but which is otherwise complete,
will be treated as completed.
The "bodily injury" or "property damage"
must occur away from premises you own or
rent, unless your business includes the
selling, handling or distribution of "your
product" for consumption on premises you
own or rent.
b. Does not include "bodily injury" or "property
damage" arising out of:
(1) The transportation of property, unless
the injury or damage arises out of a
condition in or on a vehicle not owned
or operated by you, and that condition
was created by the "loading or unload-
ing" of that vehicle by any insured; or
(2) The existence of tools, uninstalled
equipment or abandoned or unused
materials.
15. "Property damage" means:
a. Physical injury to tangible property, includ-
ing all resulting loss of use of that property.
All such loss of use shall be deemed to oc-
cur at the time of the physical injury that
caused it; or
b. Loss of use of tangible property that is not
physically injured. All such loss of use shall
be deemed to occur at the time of the
"occurrence" that caused it.
16. "Suit" means a civil proceeding in which dam-
ages because of "bodily injury", "property
damage ", "personal injury" or "advertising in-
jury" to which this insurance applies are al-
leged. "Suit" includes:
a. An arbitration proceeding in which such
damages are claimed and to which the in-
sured must submit or does submit with our
consent; or
b. Any other alternative dispute resolution
proceeding in which such damages are
claimed and to which the insured submits
with our consent.
17. "Temporary worker" means a person who is
furnished to you to substitute for a permanent
"employee" on leave or to meet seasonal or
short-term workload conditions.
18. "Your product" means:
a. Any goods or products, other than real
property, manufactured, sold, handled, dis-
tributed or disposed of by:
(1) You;
(2) Others trading under your name; or
(3) A person or organization whose busi-
ness or assets you have acquired; and
b. Containers (other than vehicles), materials,
parts or equipment furnished in connection
with such goods or products.
"Your product" includes:
a. Warranties or representations made at any
time with respect to the fitness, quality, du-
rability, performance or use of "your prod-
uct"; and
b. The providing of or failure to provide
warnings or instructions.
"Your product" does not include vending ma-
chines or other property rented to or located
for the use of others but not sold.
Page 14 of 15 Copyright, Insurance Services Office, Inc., 1997 BP 00 06 01 97 ❑
19. "Your work" means:
a. Work or operations performed by you or on
your behalf; and
b. Materials, parts or equipment furnished in
connection with such work or operations.
"Your work" includes:
a. Warranties or representations made at any
time with respect to the fitness, quality, du-
rability, performance or use of "your work ";
and
b. The providing of or failure to provide
warnings or instructions.
BP 00 06 01 97 Copyright, Insurance Services Office, Inc., 1997 Page 15 of 15 ❑
r
Interinsurance Exchange of the Automobile Club
P.O. BOX 25001, SANTA ANA, CALIFORNIA 92799 -5001
Leased Automobile Endorsement
Forming a part of Policy No. G 9197209 issued by the INTERINSURANCE EXCHANGE OF THE AUTOMOBILE CLUB
to STEVENS, GREGORY AND STEVENS, JENNIFER
Effective 01 -05 -12 12:01 A.M. Pacific Standard Time
PRI
1 -4 -12
HOUSEHOLD AUTO FIN CORP
P O BOX 17902
SAN DIEGO CA 92177
DESIGNATED AUTOMOBILE:
01 FORD 1 FTYR14UOl PB24760
It is agreed that:
1. The lessor is the registered owner of the designated automobile and a person insured under this policy with respect to the designated
automobile only.
2. Insurance does not apply to the lessor if the designated automobile is returned to the possession, custody or control of the lessor for
reasons other than servicing or repair.
In the event of:
• material change to this policy affecting the designated automobile; or
• suspension or nonrenewal of this policy; or
• cancellation of this policy at the request of other than the Interinsurance Exchange; or
• cancellation of this policy at the request of the Interinsurance Exchange for nonpayment of premium;
10 days' written notice thereof will be given by regular mail to the lessor named above.
In the event of cancellation of this policy by the Interinsurance Exchange for other than nonpayment of premium, 20 days' written
notice thereof will be given by regular mail to the lessor named above.
4. Insurance under this policy is primary as respects any other insurance of the lessor.
All provisions of your policy not affected by this endorsement remain unchanged.
ACSC Management Services, Inc.
ATTORNEY -IN -FACT
CERTIFICATE OF INSURANCE FOR LESSOR
This is to certify to the lessor named above that the Interinsurance Exchange of the Automobile Club has issued the above listed
Member's Automobile Policy to the policyholder named above. Subject to its terms and provisions, this policy, including any applicable
endorsement, provides the coverages and limits of liability indicated below by specific entries for the designated automobile:
POLICY
I - LIABILITY
III - PHYSICAL DAMAGE
PART
COVERAGES
BODILY INJURY LIABILITY
PROPERTY DAMAGE
COMPREHENSIVE
COLLISION
LIABILITY
_
L
"r6^@OUSANrA
THOUSAND
TI ° #01,9;SAh8'C"y
ACTUAL CASH
VALUE. OR
LESS
ACTUAL CASH
VALUE OR
LESS
SPECIFIED
DOLLARS
DOLLARS
DOLLARS"
A,IMITOF
DEDUCTIBLE'
LIMITOF
DF'MJCTIB,I.E'"
M
EACH P� R»SON
EACH OCCUR,
EACH OCCUR
JAWLITY
LIABILITY
I
T
1000
1000
1000
ACV
250
ACV
500
S
* If the lease agreement requires lower deductibles for Comprehensive and /or Collision coverages, the maximum deductibles specified in
the lease agreement will apply to the interest of the lessor only,
This Certificate of Insurance is not an insurance policy and does not am extend or alter the coverages afforded by and the terms and
conditions applicable to the policy to which it pertains.
ACSC Management Services, Inc.
ATTORNEY -IN -FACT
ITS0120A 2052S
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X Philadelphia Indemnity Insurance Company i.1 Philadelphia Insurance Company
DECLARATIONS
Page 1 of 1
Shilling, Mona
From: Garcia, Angelina
Sent: Tuesday, March 27, 2012 9:20 AM
To: Jonas, Maryam
Cc: Shilling, Mona
Subject: Re: GSE Solutions, LLC
Thanks Maryam.
Sent from my Whone
On Mar 22, 2012, at 6:30 PM, "Jonas, Maryam" <MJonaskelsegundo.org> wrote:
Mona and Angie,
Please see email below from Greg Stevens.
Thank you,
Maryam
From: Gregory Stevens [mailto :gstevens @gse- solutions.com]
Sent: Thursday, March 22, 2012 6:12 PM
To: Jonas, Maryam
Subject: GSE Solutions, LLC
Maryam,
In response to your inquiry about Workers Compensation Insurance, I am the only
employee of GSE Solutions, LLC.
Thank you,
Greg Stevens
GSE Solutions, LLC (GSE)
760.214.6805
3/27/2012
Page 1 of 1
Shilling, Mona
From: Jonas, Maryam
Sent: Thursday, March 22, 2012 6:31 PM
To: Shilling, Mona; Garcia, Angelina
Subject: FW: GSE Solutions, LLC
Mona and Angie,
Please see email below from Greg Stevens.
Thank you,
Maryam
From: Gregory Stevens [mailto :gstevens @gse- solutions.com]
Sent: Thursday, March 22, 2012 6:12 PM
To: Jonas, Maryam
Subject: GSE Solutions, LLC
Maryam,
In response to your inquiry about Workers Compensation Insurance, I am the only employee of GSE
Solutions, LLC.
Thank you,
Greg Stevens
GSE Solutions, LLC (GSE)
760.214.6805
3/26/2012