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PROOF OF INSURANCE (2017) CLOSEDClient #: 1324219 BE8 DATE (MMIDD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 8101/2016 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 CONTACT Marilyn Rasco USI Insurance Services LLC PH INE 3 � I✓ X. IAI , N 44 317 - 689 -8437 c No 317-689-8422 11611 N Meridian Street, Suite 230 E-MAIL rnarll n,rasco a -- ---- Carmel. IN 46032 ADDRESS, .1_ - -. -.- ---- - - -, -_ ..11 -1 -. INSURED Padded Surfaces by B &E, Inc. 2339 Distributors Dr. Indianapolis, IN 46241 INSURER D: INSURER E: 1_S,URLf81S) AFFORDING CC&VERAGE NAIC # .-�..... Selective Insurance Company 12572 1, .. w .......... .......,_..... Accident Fund Ins Company of Am 10166 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 CONTRACTOR 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 ADDL SUSR POLICY EFF POLICY EXP LTF1 TYPE OF INSURANCE INR+Y POLICY NUMBER �MMIDDIYYYY; (uMM/DD/YYYY� LIMITS A X COMMERCIAL GENERAL LIABILITY S2167811 7/01/2016 07/01/201 EACH OCCURRENCE ,$1,000,000 -- A�Mp�AA,, EE pp - - -I CLAIMS -MADE � X1 OCCUR �92r:MG C Eac, a aonus) $100,000 -. -. ... , ... -. X PD Ded:500 MED EXP (Anyone person) $10,000 ............................................. PERSONAL &ADVINJURY $1,000,000 .. ,.,...,,n. ,,.......�..... W... _ . GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY OTHER: X JECT X LOC PRODUCTS COMP /OPAGG $2,000}OOO ❑ PRO - A AUTOMOBILE LIABILITY 52167811 7/01/2016 07/01/2017 COMBINED SINGLE LIMIT 1000,000 JCsaccident) $1,000,000 - X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED ASCHEDULED AUTOS UTO S BODILY INJURY (Per accident $ ......... ......,. X NON -OWNED PROPERTY DAMAGE HIRED AUTOS $ m.X .AUTOS ,(Peraccidentf...w ............. $ ...._ _......._._ _._.. - - - -- ---._._._._._._.. _._._._._._. A X Excess uA.BAB... �X OCCUR........... S2167811 7/01/2016 0 ....... ............................... _...... 7/01/201 EACH OCCURRENCE $S,OOO,OOO -- -- wCLAIMS -MADE AGGREGATE $51000 -,000, ,,.......�. ,�. ...— ---- --' DED X RETENTION $o $ ..B AND EMPLOYERS' EX ABILITY 9 PROPRIETOR/PARTNER/EXECUTIVE YNN......... NIA ... WCV801144 ....... .. M. ........ ......... ----17 ��.. E8 ._ 0 ............. ANY PROP ... 8 7/0112016 071011201 X O EACH �T ACC T zs.l 00 ,0 (Mandatory In NH) " "� E L D SEASECEA EMPLOYEE $1 OOO OOO If yes, describe under ,., ....... ....w._a_ ---- DESCRIPTION OF OPERATIONS below .................. - -__ _____ - .E,L DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of El Segundo is included as an Additional Insured with regards to the General Liability, Auto Liability & Umbrella Liability when required in a written contract. The General Liability & Auto Liability policies are Primary & Non - Contributory when required in a written contract. Waiver of Subrogation applies in favor of the Certificate Holder /Additional Insured with regards to the General Liability, Automobile Liability, Umbrella Liability & Workers Compensation when required in a written contract. City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street, Room 5 El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE a.e-rv�.ma� ca.J ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S18353882/M18146950 MXRAT COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this Coverage Part restrict SUPPLEMENTARY PAYMENTS - COV- this insurance. Read the entire Coverage Part ERAGES A AND B. carefully to determine rights, dudes and what is and is not covered. b. This insurance applies to "bodily injury" and "property damage" only if: Throughout this Coverage Part the words "you" and "your" refer to the Named Insured shown in the Declarations, and any other person or organi- zation qualifying as a Named Insured under this Coverage Part. The words "we ", "us" and "our" refer to the Company providing this insurance. The word "insured" means any person or organi- zation qualifying as such under SECTION II - WHO IS AN INSURED. Other words and phrases that appear in quotation marks have special meaning. Refer to SECTION V - DEFINITIONS. SECTION I - COVERAGES COVERAGE A. BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY 1. Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" to which this insur- ance 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 in- sured against any "suit" seeking dam- ages for "bodily injury" or "property dam- age" to which this insurance does not apply. We may, at our discretion, investi- gate 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 III - LIMITS OF INSURANCE; and (2) Our right and duty to defend ends when we have used up the applica- ble limit of insurance in the payment of judgments or settlements under SECTION I - COVERAGES, COW ERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY; SECTION I - COVERAGES, COW ERAGE B. PERSONAL AND AD- VERTISING INJURY LIABILITY; or medical expenses under SECTION I - COVERAGES, COVERAGE C. MEDICAL PAYMENTS. No other obligation or liability to pay sums or perform acts or services is covered unless expressly provided for under (1) The "bodily injury" or "property dam- age" is caused by an "occurrence" that takes place in the "coverage ter- ritory"; (2) The "bodily injury' or "property dam- age" occurs during the policy period; and (3) Prior to the "coverage term" in which "bodily injury" or "property damage" occurs, you did not know, per Para- graph i.d. below, that the "bodily in- jury" or "property damage" had oc- curred or had begun to occur, in whole or in part. c. "Bodily mnjury" or "property damage which: (1) Occurs during the "coverage term "; and (2) Was not, prior to the "coverage term ", known by you, per Paragraph 1.d. below, to have occurred; includes any continuation, change or re- sumption of that "bodily injury" or "prop- erty damage" after the end of the "cover- age term" in which it first became known by you. d. You will be deemed to know that 'bodily injury" or "property damage" has oc- curred at the earliest time when any "authorized representative ": (1) Reports all, or any part, of the 'bodily injury" or "property damage" to us or any other insurer; (2) Receives a written or verbal demand or claim for damages because of the "bodily injury" or "property damage "; (3) First observes, or reasonably should have first observed, the "bodily in- jury" or "property damage "; (4) Becomes aware, or reasonably should have become aware, by any means other than as described in (3) above, that "bodily injury" or "prop- erty damage" had occurred or had begun to occur; or (5) Becomes aware, or reasonably should have become aware, of a Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with its permission. Page 1 of 22 condition from which "bodily injury" or "property damage" is substantially certain to occur. e. Damages because of "bodily injury" in- clude damages claimed by any person or organization for care, loss of services or death resulting at any time from the "bod- ily injury". 2. Exclusions This insurance does not apply to: a. Expected or Intended Injury "Bodily injury" or "property damage" which may reasonably be expected to re- sult from the intentional or criminal acts of the insured or which is in fact expected or intended by the insured, even if the injury or damage is of a different degree or type than actually expected or intended. 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 damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages: (1) That the insured would have in the absence of the contract or agree- ment; or (2) Assumed in a contract or agreement that is an "insured contract ", pro- vided the "bodily injury" or "property damage" occurs subsequent to the execution of the contract or agree- ment. When a claim for such "bodily injury" or "property damage" is made, we will defend that claim pro- vided the insured has assumed the obligation to defend such claim in the "Insured contract ". Such defense payments will not reduce the limits of Insurance. 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 intoxi- cation of any person; (2) The furnishing of alcoholic bever- ages 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, distribut- ing, selling, serving or furnishing alcoholic beverages. d. Workers' Compensation and Similar Laws Any obligation of the insured under a workers' compensation, disability benefits or unemployment compensation law or any similar law. e. Employer's Liability "Bodily injury" m: (1) An "employee" of the insured sus- tained in the "workplace "; (2) An "employee" of the Insured arising out of the performance of duties re- lated to the conduct of the insured's business; or (3) The spouse, child, parent, brother or sister of that "employee" as a conse- quence of Paragraphs (1) or (2) above. This exclusion applies: (1) Whether the insured may be liable as an employer or in any other ca- pacity; and (2) 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 "in- sured contract ". L Pollutant (1) "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge„ dispersal, seepage, migration, release, escape or emission of "pollutants ": (a) At or from any premises, site or location which is or was at any time owned or occupied by, or rented or loaned to, any insured. However, Paragraph (a) does not apply to: 1) "Bodily injury" to any person injured while on any prem- ises, site or location owned or occupied by, or rented or loaned to, you provided: Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with its permission. Page 2 of 22 a) The injury is caused by airborne irritants or con - the inadequate ventila- taminants used in a manu- tion of vapors; factoring process or which means any gaseous or air- is the product or by- product b The arson inured is p 1 of any manufacturing proc- frcst exposed to such ess; vapors during the pol- "pollutants" are brought on or to icy period; and 2) "Bodily injury" or "property tos, which is discharged, damage" for which you may c) Within 30 days of such in 0 day be held liable, if you are a first the per- P p contractor, and the owner son injured is clinically or lessee of such premises, diagnosed or treated site or location has been by a physician for the added to this Coverage Part medical condition as an additional insured caused by the expo- with respect to your ongo- sure to such vapors. ing operations or "your However, Paragraph c) work" performed for that does not apply if the additional insured at that "bodily injury" is caused premises, site or location by vapors produced by and such premises, site or or originating from location is not and never equipment that is used was owned or occupied by, to heat, cool or dehu- or rented or loaned to, any midify the building, or insured, other than that ad- equipment that is used ditional insured; or to heat water for per- sonal use, by the 3) "Bodily injury" or "property building's occupants or damage" arising out of heat, their guests. smoke or fumes from a This exception 1) shall ap- "hostile fire "; ply only to Named Insureds; (b) At or from any premises, site or we shall have no duty to location which is or was at any defend or pay damages for time used by or for any insured any person or organization or others for the handling, stor- that is not a Named In- age, disposal, processing or sured. However, this para- treatment of waste; graph does not apply if the bodily injury" is caused by (c) Which are or were at any time vapors produced by or transported, handled, stored, originating from equipment treated, disposed of, or proc- that is used to heat, cool or essed as waste by or for: dehumidify the building, or 1) Any insured; or equipment that is used to heat water for personal use, 2) Any person or organization by the building's occupants for whom you may be le- or their guests. gally responsible; For the purpose of the ex- (d) At or from any premises, site or ception granted in Para- location on which any insured or graph 1) only, vapors any contractors or subcontrac- means any gaseous or air- tors working directly or indirectly bome irritant or airborne on any insured's behalf are contaminant, including performing operations if the smoke, fumes, vapor or "pollutants" are brought on or to soot, but excluding asbes- the premises, site. or location in tos, which is discharged, connection with such operations dispersed, emitted, re- by such insured, contractor or leased or escapes from subcontractor. However, Para - materials, machinery or graph (d) does not apply to: equipment used in the service or maintenance of 1) "Bodily injury" or "property the premises. Vapors does damage" arising out, of the not mean any gaseous or discharge, dispersal, seep- age, migration, release, es- Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with its permission. Page 3 of 22 cape or emission of fuels, erations are to test for, monitor, lubricants or other operating clean up, remove, contain, treat, fluids, or exhaust gases, detoxify or neutralize, or in any which are needed to per- way respond to, or assess the form, or are the result of, effects of, "pollutants ". the normal electrical, hy- draulic or mechanical func- (2) Any loss, cost or expense arising out dons necessary for the op- of any. oration of "mobile equip- (a) Request, demand, order or ment" or its parts, if such statutory or regulatory require - fuels, lubricants or other merit that any insured or others operating fluids, or exhaust test for, monitor, clean up, re- gases, escape, seep or mi- move, contain, treat, detoxify or grate, or are discharged, neutralize, or in any way re- dispersed, released or spond to, or assess the effects emitted from a vehicle part of, "pollutants "; or designed to hold, store or receive them. This excep- (b) Claim or suit by or on behalf of a lion does not apply if the fu- governmental authority for dam - els, lubricants or other op- ages because of testing for, eeating fluids, or exhaust monitoring, cleaning up, remov- gases, escape, seep or mi- ing, containing, treating, detoxi- grate, or are discharged, Eying or neutralizing, or in any dispersed, released or way responding to, or assessing emitted with the intent to the effects of, "pollutants ". cause "bodily injury" or "property damage" or with However, Paragraphs (2)(a) and (b) the knowledge that "bodily do not apply to liability for damages "property injury" or "property damage" because of damage" that is substantially certain to the insured would have in the ab- occur, or If such fuels, lubd- sence of such request, demand, or- cants or other operating der or statutory or regulatory re- "suit" fluids, or exhaust gases, quirement, or such claim or by are brought on or to the or on behalf of a governmental premises, site or location authority. with such intent to escape, g, Aircraft, Auto or Watercraft seep or migrate, or be dis- charged, dispersed, re- "Bodily injury" or "property damage" aris- leased or emitted as part of ing out of the ownership, maintenance, the operations being per- use or entrustment to others of any air - formed by such insured, craft, "auto" or watercraft owned or oper- contractor or subcontractor; ated by or rented or loaned to any in- sured. Use includes operation and g y 1 ry" "loading or unloading ". damage" sustained within a building and caused by the This exclusion applies even if the claims release of gases, fumes or against any insured allege negligence or vapors from materials other wrongdoing in the supervision, hir- brought into that building in ing, employment, training or monitoring of connection with operations others by that insured, if the "occurrence" being performed by you or which caused the "bodily injury" or "prop - on your behalf by a con- erty damage" Involved the ownership, tractor or subcontractor; or maintenance, use or entrustment to oth- ers of any aircraft, "auto" or watercraft y injury" or "property that is owned or operated by or rented or damage" arising out of heat, loaned to any insured. smoke or fumes from a "hostile fire "; or This exclusion does not apply to: (e) At or from any premises, site or (1) A watercraft while ashore on prem- location on which any insured or ises you own or rent; any contractors or subcontrac- tors working directly or indirectly (2) A watercraft you do not own that is: on any Insured's behalf are (a) Less than 51 feet long; and performing operations if the op- Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with its permission. Page 4 of 22 (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, provided the "auto" is not owned by or rented or loaned to you or the in- sured; (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: (a) The operation of machinery or equipment that is on, attached to, or part of, a land vehicle that would qualify under the defini- tion of "mobile equipment" if it were not subject to a compul- sory or financial responsibility law or other motor vehicle insur- ance law in the state where it is licensed or principally garaged; or (b) The operation of any of the ma- chinery or equipment listed in Paragraph Q.(2) or f.(3) of the definition of "mobile equipment ". h. Mobile Equipment "Bodily injury" or "property damage" aris- ing out of: (1) The transportation of "mobile equip- ment" by an "auto" owned or oper- ated by or rented or loaned to any insured; or (2) The use of "mobile equipment" in, or while in practice for, or while being prepared for, any prearranged rac- ing, speed, demolition, or stunting activity. I. War "Bodily injury" or "property damage ", however caused, arising, directly or indi- rectly, out of: (1) War, including undeclared or civil war; (2) Warlike action by a military force, in- cluding action in hindering or de- fending against an actual or ex- pected attack, by any government, sovereign or other authority using military personnel or other agents; or governmental authority in hindering or defending against any of these. j. Damage to Property "Property damage" to: (1) Property you own, rent or occupy, including any costs or expenses in- curred by you, or any other person, organization or entity, for repair, re- placement, enhancement, restora- tion or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those prem- ises; (3) Property loaned to you; (4) Personal property in the care, cus- tody or control of an insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are per- forming operations, if the "property damage" arises out of those opera- tions; or (6) That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraphs (1), (3) and (4) of this exclu- sion do not apply to "property damage" (other than damage by fire or explosion) to premises, including the contents of such premises, rented to you for a period of 7 or fewer consecutive days, for which the amount we will pay is limited to the Damage To Premises Rented To You Limit as described in SECTION 111 - LIM- ITS OF INSURANCE. Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. Paragraphs (3), (4), (5) and (6) of this 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 haz- ard". (3) Insurrection, rebellion, revolution, k. Damage to Your Product usurped power, or action taken by "Property damage" to "your product" arising out of it or any part of it Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with its permission. Page 5 of 22 I. Damage to Your Work q. Employment - Related Practices "Property damage" to "your work" arising out of it or any part of it and included in the "products - completed operations haz- ard". This exclusion does not apply if the dam- aged work or the work out of which the damage arises was performed on your behalf by a subcontractor. m. Damage to Impaired Property or Prop- erty Not Physicatlly Injured "Property damage" to "impaired property" or property that has not been physically injured, arising out of: (1) A defect, deficiency, inadequacy or dangerous condition in "your prod- uct" or "your work "; or (2) A delay or failure by you or anyone acting on your behalf to perform a contract 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, n. Recall of Products, Work or Impaired Property Any liability or damages claimed for any loss, cost or expense incurred by you or others for the loss of use, withdrawal, re- call, inspection, repair, replacement, ad- justment, 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 be- cause of'a known or suspected defect, deficiency, Inadequacy or dangerous condition in it. o. Personal and Advertising Injury "Bodily injury" arising out of "personal and advertising injury". p. Asbestos "Bodily injury" or "property damage" aris- ing out of, attributable to, or any way re- lated to asbestos in any form or trans- mitted in any manner. "Bodily Injury" to: (1) A person arising out of any: (a) Refusal to employ that person; (b) Termination of that person's employment; or (c) Other employment - related prac- tices, policies, acts or omissions including but not limited to coer- cion, criticism, demotion, evaluation, failure to promote, reassignment, discipline, defa- mation, harassment, humiliation or discrimination directed at that person; or (2) The spouse, child, parent, brother or sister of that person as a conse- quence of "bodily injury" to that per- son at whom any of the employment - related practices described in Para- graphs (a), (b) or (c) above is di- rected. This exclusion applies: (1) Whether the insured may be liable as an employer or in any other ca- pacity; and (2) To any obligation to share damages with or repay someone else who must pay damages because of the injury. r. Additional Insured Prior Knowledge An additional insured added by attach- ment of an endorsement to this Coverage Part that is seeking coverage for a claim or "suit ", if that additional insured knew, per the following paragraph, that "bodily injury" or "property damage" had oc- curred or had begun to occur, in whole or in part, prior to the "coverage term" in which such "bodily injury" or "property damage" occurs or begins to occur. An additional insured added by attach- ment of an endorsement to this Coverage Part will be deemed to have known that "bodily injury" or "property damage" has occurred or has begun to occur at the earliest time when that additional insured, or any one of its owners, members, part- ners, managers, executive officers, "em- ployees" assigned to manage that addi- tional insured's insurance program, or "employees" assigned to give or receive notice of an *occurrence", "personal and advertising injury" offense, claim or "suit": Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc,, with its permission. Page 6 of 22 (1) Reports all, or any part, of the "bodily injury" or "property damage" to us or any other insurer; (2) Receives a written or verbal demand or claim for damages because of the "bodily injury" or "property damage "; (3) First observes, or reasonably should have first observed, the "bodily in- jury" or "property damage "; (4) Becomes aware, or reasonably should have become aware, by any means other than as described in (3) above, that "bodily injury" or "prop- erty damage" had occurred or had begun to occur; or (5) Becomes aware, or reasonably should have become aware, of a condition from which "bodily injury" or "property damage" is substantially certain to occur. s. Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, in- ability to access, or Inability to manipulate "electronic data ", t. Distribution of Material in Violation of Statutes "Bodily injury" or "property damage" aris- ing directly or indirectly out of any action or omission that violates or is alleged to violate: a. The Telephone Consumer Protection Act (TCPA), including any amend- ment of or addition to such law; or b. The CAN -SPAM Act of 2003, includ- ing any amendment of or addition to such law; or c. Any statute, ordinance or regulation, other than the TCPA or CAN -SPAM Act of 2003, that prohibits or limits the sending, transmitting, communicating or distribution of material or informa- tion. Exclusions c. through q. do not apply to "property damage" by fire or explosion to premises while rented to you or temporarily occupied by you with permission of the owner, for which the amount we will pay is limited to the Damage to Premises Rented To You Limit as described in SECTION III - LIMITS OF IN- SURANCE. a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "personal and ad- vertising injury" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking damages for "personal and advertising injury" to which this insurance does not apply. We may, at our discretion, investigate any offense and settle any claim or "suit" that may re- sult. But: (1) The amount we will pay for damages is limited as described in SECTION III - LIMITS OF INSURANCE; and (2) Our right and duty to defend ends when we have used up the applica- ble limit of insurance in the payment of judgments or settlements under SECTION I - COVERAGES, COW ERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY; SECTION I - COVERAGES, COV- ERAGE B. PERSONAL AND AD- VERTISING INJURY LIABILITY; or medical expenses under SECTION - COVERAGES, COVERAGE C. MEDICAL PAYMENTS. No other obligation or liability to pay sums or perform acts or services is covered unless expressly provided for under SUPPLEMENTARY PAYMENTS - COW ERAGES A AND B. b. This insurance applies to "personal and advertising injury" only if: (1) The "personal and advertising injury" is caused by an offense arising out of your business; and (2) The "personal and advertising injury' offense was committed in the "cov- erage territory' during the policy pe- riod; and (3) Prior to the "coverage term" in which the "personal and advertising injury" offense Is committed, you did not know, per Paragraph 1.d. below, that the offense had been committed or had begun to be committed, in whole or in part. c. "Personal and advertising injury" caused by an offense which: COVERAGE B. PERSONAL AND ADVERTISING (1) Was committed during the "coverage INJURY LIABILITY term"; and 1. Insuring Agreement Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc., with its permission. Page 7 of 22 (2) Was not prior to the "coverage term ", known by you, per Paragraph 1.d. below, to have been committed; includes any continuation, change or re- sumption of that offense after the end of the "coverage term" in which it first be- came known by you. d. You will be deemed to know that a "per- sonal and advertising injury" offense has been committed at the earliest time when any "authorized representative ": (1) Reports all, or any part, of the "per- sonal and advertising injury" to us or any other insurer; (2) Receives a written or verbal demand or claim for damages because of the "personal and advertising injury"; (3) First observes, or reasonably should have first observed, the offense that caused the "personal and advertis- ing injury"; (4) Becomes aware, or reasonably should have become aware, by any means, other than as described in (3) above, that the offense had been committed or had begun to be com- mitted; or (5) Becomes aware, or reasonably should have become aware, of a condition from which "personal and advertising injury" is substantially certain to occur. 2. Exclusions This insurance does not apply to: a. Knowing Violation of Rights of Another "Personal and advertising injury" caused by or at the direction of the insured with the knowledge that the act would violate the rights of another and would inflict "personal and advertising injury". b. Material Published With Knowledge of Falsity "Personal and advertising injury" arising out of oral or written publication of mate- rial, if done by or at the direction of the in- sured with knowledge of its falsity. c. Material Published Prior to Coverage Term (1) The inception of this Coverage Part; or (2) The "coverage term" in which insur- ance coverage is sought. d. Criminal Acts "Personal and advertising injury" arising out of a criminal act committed by or at the direction of the insured. e. Contractual Liability "Personal and advertising injury" for which the insured 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: (1) That the insured would have in the absence of the contract or agree- ment; or (2) Assumed in a contract or agreement that is an "insured contract ", pro- vided the "personal and advertising injury" is caused by or arises out of an offense committed subsequent to the execution of the contract or agreement. When a claim for such "personal and advertising injury" is made, we will defend that claim, pro- vided the insured has assumed the obligation to defend such claim in the "insured contract ". Such defense payments will not reduce the limits of insurance. f. Breach of Contract "Personal and advertising injury" arising out of a breach of contract, except an im- plied contract to use another's advertising idea in your "advertisement. g. Quality or Performance of Goods - Faiiure to Conform to Statements "Personal and advertising injury" arising out of the failure of goods, products or services to conform with any statement of quality or performance made in your "ad- vertisement". h. Wrong Description of Prices "Personal and advertising injury" arising out of the wrong description of the price of goods, products or services stated in your "advertisement ". "Personal and advertising injury" arising i. Infringement of Copyright, Patent, out of oral or written publication of mate- Trademark or Trade Secret rial whose first publication took place be- fore the later of the following: "Personal and advertising injury" arising out of the infringement of copyright, pat - Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with Its permission. Page 8 of 22 ent, trademark, trade secret or other in- tellectual property rights. However, this exclusion does not apply to infringement, in your "advertisement ", of copyright, trade dress or slogan. j. Insureds in Media and Internet Type Businesses "Personal and advertising injury" com- mitted by an insured whose business is: (1) Advertising, broadcasting, publishing or telecasting; (2) Designing or determining content of web -sites for others; or (3) An Internet search, access, content or service provider. However, this exclusion does not apply to Paragraphs 17. a., b. and c. of "personal and advertising injury" under SECTION V - DEFINITIONS. For the purposes of this exclusion, the placing of frames, borders or links, or ad- vertising, for you or others anywhere on the Internet is not, by itself, considered the business of advertising, broadcasting, publishing or telecasting. k. Electronic Chatrooms or Bulletin Boards "Personal and advertising injury" arising out of an electronic chatroom or bulletin board any insured hosts, owns, or over which any insured exercises control. I. Unauthorized Use of Another's Name or Product 'Personal and advertising injury' arising out of the unauthorized use of another's name or product in your e-mail address, domain name or metatag, or any other similar tactics to mislead another's poten- tial customers. m. Employment Related Practices "Personal and advertising injury" to: (1) A person arising out of any: (a) Refusal to employ that person; (b) Termination of that person's employment; or (c) Other employment- related prac- tices, policies, acts or omissions including but not limited to coer- cion, criticism, demotion, evaluation, failure to promote, reassignment, discipline, defa- mation, harassment, humiliation or discrimination directed at that person; or (2) The spouse, child, parent, brother or sister of that person as a conse- quence of "personal and advertising injury" to that person at whom any of the employment - related practices described in Paragraphs (a), (b) or (c) above is directed. This exclusion applies: (1) Whether the insured may be liable as an employer or in any other ca- pacity; and (2) To any obligation to share damages with or repay someone else who must pay damages because of the injury. n. Pollutant "Personal and advertising injury" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release, escape or emission of "pollut- ants" at any time. o. Pollutant - Related Any loss, cost or expense arising out of any: (1) Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (2) 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 ". p. Asbestos "Personal and advertising injury" arising out of, attributable to, or any way related to asbestos in any form or transmitted in any manner. q. Additional Insured Prior Knowledge An additional insured added by attach- ment of an endorsement to this Coverage Part that is seeking coverage for a claim or "suit ", if that additional insured knew, per the following paragraph, that a "per- sonal and advertising injury" offense had been committed or had begun to be committed, in whole or in part, prior to the "coverage term" in which such offense Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with Its permission. Page 9 of 22 was committed or began to be commit- ted. An additional insured added by attach- ment of an endorsement to this Coverage Part will be deemed to have known that a "personal and advertising injury" offense has been committed or has begun to be committed at the earliest time when that additional insured, or any one of its own- ers, members, partners, managers, ex- ecutive officers, "employees" assigned to manage that additional insured's insur- ance program, or "employees" assigned to give or receive notice of an 'occur- rence", "personal and advertising injury" offense, claim or "suit ": (1) Reports all, or any part, of the "per- sonal and advertising injury" to us or any other insurer; (2) Receives a written or verbal demand or claim for damages because of the "personal and advertising injury"; (3) First observes, or reasonably should have first observed, the offense that caused the "personal and advertis- ing injury"; (4) Becomes aware, or reasonably should have become aware, by any means other than as described in (3) above, that the "personal and adver- tising injury" offense had been com- mitted or had begun to be commit- ted; or (5) Becomes aware, or reasonably should have become aware, of a condition from which "personal and advertising injury" is substantially certain to occur. r. War "Personal and advertising injury", how- ever caused, arising, directly or indirectly, out of: (1) War, including undeclared or civil war; (2) Warlike action by a military force, in- cluding action in hindering or de- fending against an actual or ex- pected attack, by any government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. "Personal and advertising injury" arising directly or indirectly out of any action or omission that violates or is alleged to violate: a. The Telephone Consumer Protection Act (TCPA), including any amend- ment of or addition to such law; or b. The CAN -SPAM Act of 2003, includ- ing any amendment of or addition to such law; or c. Any statute, ordinance or regulation, other than the TCPA or CAN -SPAM Act of 2003, that prohibits or limits the sending, transmitting, communicating or distribution of material or informa- tion. COVERAGE C. MEDICAL PAYMENTS 1. Insuring Agreement a. We will pay medical expenses as de- scribed below for "bodily injury" caused by an accident: (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: (1) The accident takes place in the "coverage territory" and during the policy period; (2) The expenses are incurred and re- ported to us within three years of the date of the accident; and (3) The injured person submits to ex- amination, at our expense, by physi- cians of our choice as often as we reasonably require. b. We will make these payments regardless of fault. These payments will not exceed the applicable limit of insurance. We will pay reasonable expenses for: (1) First aid administered at the time of an accident; (2) Necessary medical, surgical, x -ray and dental services, including pros- thetic devices; and (3) Necessary ambulance, hospital, professional nursing and funeral services. 2. Exclusions s. Distribution of Material in Violation of We will not pay expenses for "bodily injury": Statutes Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with its permission. Page 10 of 22 a. Any Insured To any insured, except "volunteer work- ers". b. Hired Person To a person hired to do. work for or on behalf of any insured or a tenant of any insured. c. Injury on Normally Occupied Premises To a person injured on that part of prem- ises you own or rent that the person nor- mally occupies. d. Workers' Compensation and Similar Laws To a person, whether or not an "em- ployee" of any insured, if benefits for the "bodily injury" are payable or must be provided under a workers' compensation or disability benefits law or a similar law. e. Athletic Activities To any person injured while officiating, coaching, practicing for, instructing or participating in any physical exercises or games, sports, or athletic contests or ex- hibitions of an athletic or sports nature. I. Products - Completed Operations Haz- ard Included within the "products- completed operations hazard ". g. Coverage A Exclusions Excluded under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE U- ABIUTY. SUPPLEMENTARY PAYMENTS - COVERAGES A AND B We will pay, with respect to any claim we investi- gate or settle, or any "suit" against an insured we defend: 1. All expenses we incur. 2. Up to $250 for cost of bail bonds required be- cause of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 3. The cost of bonds to release attachments, but only for bond amounts within the applicable limit of insurance. We do not have to furnish these bonds. 4. All reasonable expenses incurred by the in- sured at our request to assist us in the inves- tigation or defense of the claim or "suit ", in- cluding 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 be- come obligated to pay and which falls within the applicable limit of insurance. If we make an offer to pay the applicable limit of insur- ance, we will not pay any prejudgment interest based on that period 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, offered to pay, or de- posited in court the part of the judgment that is within the applicable limit of insurance. These payments will not reduce the limits of insur- ance. SECTION II - 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 conduct of a business of which you are the sole owner. b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. c. A limited liability company, you are an in- sured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are in- sureds, but only with respect to their du- ties 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 offi- cers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders, e. A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. 2. Each of the following is also an insured: a. Your "volunteer workers" only while per- forming duties related to the conduct of your business, or your "employees ", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company 4 or your managers (if ou are a limited Nia( ility company , but on (y for acts within the scope of their employment by Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with its permission. Page 111 of 22 you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1) "Bodily injury' or "personal and ad- vertising injury": (a) To you, to your partners or members (if you are a partner- ship or joint venture), to your members (if you are a limited li- ability company), to a co- "employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co- "employee" or "volunteer worker" as a consequence of Paragraph (1)(a) above; (c) For which there is an obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or (b) above; or (d) Arising out of his or her provid- ing or failing to provide profes- sional health care services. (2) "Property damage" to property: (a) Owned, occupied or used by; or (b) Rented to, in the care, custody or control of, or over which physical control is being exer- cised for any purpose by, you, any of your "employees ", "vol- unteer workers ", any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). b. Any person (other than your "employee" or "volunteer worker"), or any organize- tion while acting as your real estate man- ager. 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 prop- erty; and (2) Until your legal representative has been appointed. d. Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this Coverage Part, 3. Any organization you newly acquire or form, other than a partnership, joint venture or lirn- ited liability company, and over which you maintain ownershi) or majority interest, will quaiity as a Name Insured if there is no other similar Insurance available to that organiza- tion. However: a. Insurance under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY does not apply to "bodily injury" or "property damage" that occurred before you ac- quired or formed the organization; and c. COVERAGE B. PERSONAL AND AD- VERTISING INJURY LIABILITY does not apply to "personal and advertising injury" arising out of an offense committed be- fore you acquired or formed the organi- zation. No person or organization is an insured with re- spect to the conduct of any current or past part- nership, joint venture or limited liability company that is not shown as a Named Insured in the Dec- larations. SECTION III - 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. a. The General Aggregate Limit is the most we will pay for the sum of: (1) Medical expenses under COVER- AGE C. MEDICAL PAYMENTS; (2) Damages under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, except dam- ages because of "bodily injury" or "property damage" included in the "products - completed operations hazard "; and (3) Damages under COVERAGE B. PERSONAL AND ADVERTISING INJURY LIABILITY. This General Aggregate Limit will not ap- ply if either the Location General Aggre- Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc., with its permission. Page 12 of 22 gate Limit of Insurance, Paragraph 2.b., or the Construction Project General Ag- gregate Limit of Insurance, Paragraph 2.c. applies. b. A separate Location General Aggregate Limit of Insurance, equal to the amount of the General Aggregate Limit shown in file 3. Declarations, shall appiy to each location owned by, or rented or lensed to you and is the most we will pay for the sum of: (1) Damages under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, except dam- ages because of "bodily injury" or 4. "property damage" included in the "products - completed operations hazard'; and (2) Medical expenses under COVER- AGE C. MEDICAL PAYMENTS, which can be attributed to operations at only a single location owned by, or rented or leased to you. c. A separate Construction Project General Aggregate Lirnit of Insurance, equal to the amount of the General Ag negate Limit shown in the Declarations. Nall ap- ply to each construction project and is the most we will pay for the sum of: your behalf at the same location for the same persons or organizations, no matter how often or under how many different contracts, will be deemed to be a single construction project. The Products - Completed Operations ArV- ate Limit is the most we will ay under RAGE A. BODILY INJUA AND PROP- ERTY DAMAGE LIABILITY for damages be- cause of "bodily injury" and - property dam- age" included in the "products - completed op- erations hazard ", Subject to 2.e. above, the Personal and Ad- vertising Injury Limit is the most we will pay under COVERAGE B. PERSONAL AND AD- VERTISING INJURY LIABILITY for the sum of all damages because of all "personal and ad- vertising injury" sustained by any one person or organization, 5. Subject to 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LI- ABILITY; and (1) Damages under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, except dam- ages because of "bodily Injury" or 6. property damage" included in the "products -completed operations hazard "; and (2) Medical expenses under COVER -' AGE C. MEDICAL PAYMENTS; which can be attributed only to ongoing operations and only at a single construc- tion project. d. Only for the purpose of determining which General Aggregate Limit of Insurance, 2.a., 2.b., or 2.c., applies: (1) Location means premises involving the same or connecting lots, or premises, whose connection is inter- rupted only by a street, roadway, waterway or right- of-way of a rail- road. (2) Construction project means a loca- tion you do not own, rent or lease where ongoing improvements, al- terations, installation, demolition or maintenance work is performed by you or on your 'behalf. All connected ongoing, improvements, alterations, installation, demolition or mainte- nance work performed by you or on b. Medical expenses under COVERAGE C. MEDICAL PAYMENTS; because of all 'bodily Injury" and "property damage' arising out of any one "occurrence ". Subject to S. above, the Damage to Premises Rented to You Limit is the most we will pay under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY for dam- ages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire or explosion, while rented to you or temporarily occupied by you with permission of the owner. 7. Sub ),ect to S. above, the Medical Expense Limit is the most we will pay under COVER- AGE C. MEDICAL PAYMENTS for all medical expenses because of "bodily injury" sustained by any one person. The Limits of Insurance of this Coverage Part ap- ply separately to each "coverage term ". SECTION IV - COMMERCIAL GENERAL LI- ABILITY CONDITIONS 1. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part. 2. Duties in the Event of Occurrence, Offense, Claim or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence- or Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc,, with its permission. Page 13 of 22 a "personal and advertising injury" of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the occur- rence " or offense. b. If a claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the claim or "suit" and the date re- ceived; 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 investiga- tion or settlement of the claim or de- fense against the "suit "; and (4) Assist us, upon our request, in the enforcement of any right against any f erson or organization which may be able to the insured because of in- jury or damage to which this insur- ance may also apply. d. No insured will, except at that Insured's own cost, voluntarily make a payment, assume any obligation, or incur any ex- pense, other than for first aid, without our consent. 3. Legal Action Against Us No person or organization has a right under this Coverage Part: a. To Join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or under the terms of this Coverage Part or that are In excess of the applicable limit of insur- ance, An agreed settlement means a settle- ment and release of liability signed by us, the insured and the claimant or the claimant's le- gal representative. 4. Liberalization If, within 60 days prior to the beginning of this Coverage Part or during the policy period, we make any changes to any forms or endorse- ments of this Coverage Part for which there is currently no separate premium char e, and that change provides more coverage ffian this Coverage Part, the change will automatically apply to this Coverage Part as of the latter of: a. The date we implemented the change in your state; or b. The date this Coverage Part became ef- fective; and will be considered as included until the end of the current Ip'rlicy period. We will make no additional premium charge for this additional coverage during the interim. S. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY or COV- ERAGE B. PERSONAL AND ADVERTISING INJURY LIABILITY of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when b. below applies. If this insurance is pri- mary, our obligations are not affected unless an yy of the other insurance is also primary. Then, we will share with all that other insurance by the method described in c. below. b. Excess Insurance This insurance is excess over: (1) Any of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Cover- age, Builder's Risk, Installation Risk or similar insurance for "your work "; b. To sue us on this Coverage Part unless (b) That is Fire or Explosion insur- all of its terms have been fully complied ance for premises rented to you with. or temporarily occupied by you A person or organization may, sue us to re- with permission of the owner; cover on an agreed settlement or on a final (c) That is insurance purchased by judgment against an insured; but we will not you to cover your llabil ty as a be liable for damages that are not payable tenant for "property damage" to Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with its permission. Page 14 of 22 premises rented to you or tem- shown in the Declarations of this Cover - poradly occupied by you with age Part. permission of the owner; or C. Method of Sharing (d) If the loss arises out of the maintenance use of aircraft, If all of the other insurance permits con - .autos to autos" or watercraft to the ex- tribution b equal shares, we will follow y q tent not subject to SECTION I - this method also. Under this approach COVEftAGVS, COVERAGE A. each insurer contributes equal amounts BODILY INJURY AND PROP- until It has paid its applicable limit of in- ERTY DAMAGE LIABILITY, 2. surance or none of the loss remains, Exclusions, g. Aircraft, Auto or whichever comes first. Watercraft. If any of the other insurance does not (2) Any other primary insurance avail- permit contribution by equal shares, we able to the insured covering liability will contribute by limits. Under this for damages arising out of the method, each insurer's share is based on premises or operations, or the prod - the ratio of its applicable limit of insurance ucts and completed operations, for to the total applicable limits of insurance which the insured has been added of all insurers. as an additional insured by attach- 6. Premium Audit ment of an endorsement. (3) Any other insurance: a. We will compute all premiums for this Coverage Part in accordance with our (a) Whether primary, excess, con - rules and rates. tingent or on any other basis, b. Premium shown in this Coverage Part as except when such insurance is advance premium is a deposit premium written specifically to be excess only. At the close of each audit period we over this insurance; and will compute the earned premium for that (b) That is a consolidated (wrap -up) period and send notice to the first Named insurance program which has Insured. The due date for audit and ret- been provided by the prime rospective premiums is the date shown contractor /project manager or as the due date on the bill. If: owner of the consolidated proj- (1) The earned premium is less than the ect in which you are involved. deposit premium, we will return the When this insurance is excess, we will excess to the first Named Insured; or have no duty under COVERAGE A. (2) The earned premium is greater than BODILY INJURY AND PROPERTY the deposit premium, the difference DAMAGE LIABILITY or COVERAGE B. will be due and payable to by the PERSONAL AND ADVERTISING IN- first Named Insured upon notice from JURY LIABILITY to defend the insured US. against any "suit" if any other insurer has a duty to defend the insured against that c. The first Named Insured must keep rec- suit ", If no other insurer defends, we wilt ords of the information we need for pre - undertake to do so, but we will be entitled mium computation, and send us copies at to the insured's rights against all those such times as we may request. other insurers. T. Representations When this insurance is excess over other insurance, we will pay only our share of By accepting this Coverage Part, you agree: the amount of the loss, H any, that ex- a. The statements in the Declarations are ceeds the sum of: accurate and complete; (1) The total amount that all such other b. Those statements are based upon repre- insurance would pay for the loss in sentatlons you made to us; and the absence of this insurance; and (2) The total of all deductible and self- C. We have issued this Coverage Part in re- liance upon your representations. insured amounts under all that other insurance. 8. Separation of Insureds We will share the remaining loss, if any, Except with respect to the Limits of Insurance, with any other insurance that is not de- and any rights or duties speoffically assigned scribed in this Excess Insurance provi- in this Coverage Part to the first Named In- son and was not bought specifically to sured, this insurance applies: apply in excess of the Limits of Insurance Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc:, with its permission. Page 15 of 22 ,a 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. e. Transfer of Rights of Recovery Against Others to Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "sult" or transfer those rights to us and help us enforce them, 10. Two or More Coverage Forms or Policies Issued by Us If this Coverage Part and any other Coverage Form, Coverage Part or policy issued to you by us or any company affiliated with us apply to the same *occurrence" or "personal and advertising injury" offense, the aggregate maximum limit of insurance under all the Cov- erage Forms, Coverage Parts or policies shall not exceed the highest applicable limit of in- surance under any one Coverage Form, Cov- erage Part or policy. This condition does not apply to any Coverage Form, Coverage Part or policy issued by us or an affiliated company specific -ally to apply as excess insurance over this Coverage Part, 11. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named In- sured shown in the Declarations written notice of the nonrenewal not less than 30 days be- fore the expiration date. If notice is mailed, proof of mailing will be suf- ficient proof of notice. SECTION V - DEFINITIONS 1. "Advertisement" means a notice that is broad- cast, telecast or published to the general pub- lic or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. "Adver- tisement" includes a publicity article. For pur- poses of this definition: a. Notices that are published include mate- rial placed on the Internet or on similar electronic means of communication; and b. Regarding web - sites, only that part of a web -site that is about your goods, prod - ucts or services fear, the purposes of at- tracting customers or supporters is con- sidered an "advertisement . 2. "Authorized representative" means: a. If you are designated in the Declarations as: (1) An individual, you and your spouse are "authorized representatives ". (2) A partnership or joint venture, your members, your partners, and their spouses are "authorized representa- tives ". (3) A limited liability company, your members and your managers are "authorized representatives ". (4) An organization other than a part- nership, joint venture or limited liabil- ity company, your 'executive offi- cers" and directors are "authorized representatives ". Provided you are not a publicly traded organization, your stockholders are also "author- ized representatives ". (5) A trust, your trustees are "authorized representatives ". b. Your "employees ": (1) Assigned to manage your insurance program; or (2) Responsible for giving or receiving notice of an "occurrence ", "personal and advertising injury" offense, claim or "suit ". are also "authorized representatives" 3. "Auto" means: a. A land motor vehicle, trailer or semitrailer designed for travel on public roads, in- cluding any attached machinery or equipment; or b. Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law in the state where it is licensed or principally garaged. However, "auto" does not include "mobile equipment ". 4. "Bodily Injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. S. "Coverage term" means the following individ- ual increment, or if a multi-year policy period, increments„ of time, which comprise the policy period of this Coverage Part: a. The year commencing on the Effective Date of this Coverage Part at 12`:01 AM s4andard time at your mailing address shown in the Declarations, and if a multi- year policy period, each consecutive an- nual period thereafter, or ortion thereof if any period is for a perioof less than 12 months, constitute individual "coverage terms ". The last "coverage term" ends at Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc., with its permission. Page 16 of 22 12 :00 AM standard time at your mailing address shown in the Declarations on the earlier of: (1) The day the policy period shown in the Declarations ends; or (2) The day the policy to which this Cov- erage Part is attached is terminated or cancelled. b. However, if after the issuance of this Coverage Part, any "coverage term" is extended for an additional period of less than 12 months, that additional period of time will be deemed to be part of the last preceding "coverage term ". 6. "Coverage territory" means: a. The United States of America (including its territories and possessions), Puerto Rico and Canada; b. International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in a. above; or c. All other parts of the world if the injury or damage arises out of: (1) Goods or products made or sold by you in the territory described in a. above; (2) 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; or (3) "Personal and advertising injury" of- fenses that take place through the Internet or similar electronic means of communication, provided the insureds responsibility to pay damages is determined in a "suit" on the merits, in the territory described in a. above or in a settlement to which we agree. 7. "Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD -ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically con- trolled equipment. S. "Employee" includes a 'leased worker'. "Em- ployee" does not include a "temporary worker ". 10. "Hostile fire" means one which becomes un- controllable or breaks out from where it was intended to be. 11. "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 de- fective, deficient, inadequate or danger- ous; or b. You have failed to fulfill the terms of a contract or agreement; if such property can be restored to use by: a. The repair, replacement, adjustment or removal of "your product' or "your work "; or b. Your fulfilling the terms of the contract or agreement. 12. "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 "property damage" by fire or explosion to premises while rented to you or temporarily occu• pied 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 connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agree- ment pertaining to your business (inctud- ing an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily 'injury", "property damage" or "personal and advertising injury" to a third person 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: 9. "Executive officer" means a person holding (1) That indemnifies a railroad for "bodily any of the officer positions created by your injury", "property damage" or "per - charter, consfitution, by -laws or any other sonal and advertising injury" arising similar governing document, out of construction or demolition op- erations, within 50 feet of any rail - Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc., with its permission. Page 17 of 22 Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with its permission. Page 18 of 22 road property and affecting any rail- engines; marketing analysis; and road bridge or trestle„ trucks, road- providing access to the Internet or beds, tunnel, underpass or crossing; other similar networks, or (2) That Indemnifies an architect, engi- (7) Under which the insured, if a web - neer or surveyor for injury or damage site designer or content provider, or arising out of: Internet search, access, content or (a) Preparing, approving, or failing service provider, assumes liability for injury or damage arising out of the to prepare or approve, maps, shop drawings, opinions, re- insured's rendering or failure to ren- ports, surveys, field orders, der Internet services, including those listed in Paragraph (6), above, change orders or drawings and specifications; or 13. "Leased worker' means a person leased; to a (b) Giving directions or instructions, you by a labor leasing firm under an agree - ment between you and the labor leasing firm, or failing give them, if that is g g to perform duties related to the conduct of the primary cause of the injury your business. "Leased worker" includes su- or damage; pervisors furnished to you by the labor leasing (3) Under which the insured, if an archi- firm. "Leased worker" does not include a tect, engineer or surveyor, assumes temporary worker ". liability for an injury or damage aris- 14. "Loading or unloading" means the handling of ing out of the insured's rendering or property: failure to render professional serv- ices, including those listed in Para- a. After it is moved from the place where it is graph (2) above and supervisory, in- accepted for movement into or onto an spection, architectural or engineering aircraft, watercraft or "auto "; activities; . b. While it is in or on an aircraft, watercraft (4) That indemnifies an advertising, pub- or "auto "; or lic relations or media consulting firm for " "personal and advertising injury" c. While it is being t, c. moved from an aircraft, arising out of the planning, execution watercraft or "auto" to the place where it or failure to execute marketing com- is finally delivered; munications programs. Marketing but "loading or unloading" does not include communications programs include but are not limited to comprehensive the movement of property by means of a me- marketing campaigns; consumer, chanical device, other than a hand truck, that is not attached to the aircraft, watercraft or trade and corporate advertising for "auto" all media„ media planning, buyin, monitoring and analysis; direct mail; 15. "Mobile equipment" means any of the follow - promotion; sales materials, design; ing types of land vehicles, including any at- presentations; point -of -sale materi- tached machinery or equipment: als; market research; public relations and new product development; a. Bulldozers, farm machinery, forklifts and other vehicles designed for use princi- (5) Under which the insured, if an adver- pally off public roads, Using, public relations or media con- sulting firm, assumes liability for b. Vehicles maintained for use solely on or "personal and advertising injury" next to premises you own or rent; arising out of the insured's rendering c. Vehicles that travel on crawler treads; or failure to render professional services, including those services d. Vehicles, whether self - propelled or not, listed! in Paragraph (4), above; maintained primarily to provide mobility to (6) That indemnifies.a web -site designer permanently mounted: or content provider, or Internet (1) Power cranes, shovels, loaders, dig - search, access, content or service gers or drills; or provider for injury or damage arising out of the planning, execution or fail- (2) Road construction or resurfacing ure to execute Internet services, equipment such as graders, scrap- Internet services include but are not ers or rollers; limited to design, production, distri. bution, maintenance and administra- e. Vehicles not described In a., b., c. or d. bon of web -sites and web - banners; above that are not self - propelled and are maintained primarily to provide mobility to hosting web - sites; registering do- main names, registering with search Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with its permission. Page 18 of 22 D. Any structure, basin, excavation, prom- ises-or place prepared or used for the storage or disposal of "waste "; and includes the site on which any of the foregoing Is located, all operations conducted on such site and all premises used for such operations. "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 ra- dioactive contamination of property. Includes copyrighted material of insurance GA 101 12 04 Services Office, Inc., with its permission. Page 22 of 22 permanently attached equipment of the following types: (1) Air compressors, pumps and gen- erators, including spraying, welding, building cleaning, geophysical explo- ration, 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 gen- erators, including spraying, welding, building cleaning, geophysical explo- ration, lighting and well servicing equipment. However, "mobile equipment " does not in- clude any land vehicles that are subject to a compulsory or financial responsibility, law or other motor vehicle insurance law in the state where it is licensed or principally garaged. Land vehicles subject to a compulsory or fi- nancial responsibility law or other motor vehi- cle insurance law are considered "autos ". 16. "Occurrence" means an accident, including continuous or repeated exposure to substan- tially the same general harmful conditions. 17. "Personal and advertising injury" means in- jury, including consequential "bodily injury", arising out of one or more of the following of- fenses: a. False arrest, detention or imprisonment; b. Malicious prosecution; d. Oral or written publication, in any manner, of material that slanders or libels a per- son or organization or disparages a per- son's or organization's goods, products or services; e. Oral or written publication, in any manner, of material that violates a person's right of privacy; f. The use of another's advertising idea in your "advertisement "; or g. Infringing upon another's copyright, trade dress or slogan in your "advertisement". 18. "Pollutant" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals, petroleum, petroleum products and petroleum by- products, and waste. Waste includes materials to be recycled, re- conditioned or reclaimed. "Pollutants" include but are not limited to substances which are generally recognized in industry or govern- ment to be harmful or toxic to persons, prop- erty or the environment regardless of whether the injury or damage is caused directly or indi- rectly by the "pollutants" and whether: a. The insured is regularly or otherwise en- gaged.in activities which taint or degrade the environment; or b. The insured uses, generates or produces the "pollutant ". 19. "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 com- pleted or abandoned. However, "your work" will be deemed com- pleted at the earliest of the following times: (a) When all of the work called for in your contract has been com- pleted; or (b) When all of the work to be done at the job site has been com- pleted if your contract calls for work at more than one job site; or c. The wrongful eviction from, wrongful entry (c) When that part of the work done into, or invasion of the right of private oc- at a job site has been put to its cupancy of a room, dwelling or premises intended use by any person or that a person occupies, committed by or organization other than another on behalf of its owner, landlord or lessor; contractor or subcontractor working on the same project. Includes copyrighted material of Insurance GA 10112 04 Services Office,-Inc., with its permission. Page 19 of 22 Work that may need service, main- tenance, correction, repair or re- placement, but which is otherwise complete, will be treated as com- pleted. b. Does not include "bodily injury" or "prop- erty damage" arising out of: (1) The transportation of property, un- less 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 "load- ing or unloading" of that vehicle by any insured; (2) The existence of tools, uninstalled equlpITIent or abandoned or unused materials; or (3) Products or operations for which the classification, listed in the Declara- tions or in a schedule, states that products - completed operations are included. 20. "Property damage" means: a. Physical injury to tangible property, in- cluding all resulting loss of use of that property. All such loss of use shall be doomed to occur at the time of the physi- cal 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. For the purposes of this insurance, "electronic data" is not tangible property. 21. "Suit" means a civil proceeding in which money damages because of "bodily injurjr "„ "property damage" or "personal and adverbs - ing injury" to which this insurance applies are alleged. "Suit" includes: a. An arbitration proceeding in which such damages are claimed and to which the insured must submit or does submit with our consent; b. Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent; or c. An appeal of a civil proceeding. 22. "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. her work and acts at the direction of and within the scope of duties determined by you, and is not paid a fee, salary or other compen- sation by you or anyone else for their work performed for you. 24. "Workplace" means that place and during such hours to which the "employee" sustain - Ing "bodily injury" was assigned by you, or an other person or entity acting on your be- half, to work on the date of *occurrence ". 25. "Your product ": a. Means: (1) Any goods or products, other than real property, manufactured, sold, handled, distributed or disposed of by: (a) You; (b) Others trading under your name; or (c) A person or organization whose business or assets you have acquired; and (2) Containers (other than vehicles), materials, parts or equipment fur - nished' in connection with such goods'or products. b. Includes: (1) Warranties or representations made at any time with respect to the fit- ness, quality, durability, performance or use of "your product ": and (2) The providing of or failure to provide warnings or instructions. c. Does not include vending machines or other property rented to or located for the use of others but not sold. 26. "Your work ": a. Means: (1) Work or operations performed by you or on your behalf; and (2) Materials, parts or equipment fur- nished in connection with such work or operations. b. Includes: (1) Warranties or representations made at any time with respect to the fit- ness, quality, durability, performance or use of "your work "; and 23. "Volunteer worker" means a person who is (2) The providing of or failure to provide not your "employee ", and who donates his or warnings or instructions. Includes copyrighted material of Insurance GA 101 12 04 Services Office, Inc., with its permission. Page 20 of 22 NUCLEAR ENERGY LIABILITY EXCLUSION' (Broad Form) 1. The insurance does not apply: A. Under any Liability Coverage, to "bodily injury" or "property damage ": (1) With respect to which an insured un- der this Coverage Part is also an in- sured under a nuclear energy liability policy issued by Nuclear Energy Li- ability Insurance Association, Mutual Atomic Energy Liability Underwriters, Nuclear Insurance Association of Canada, or any of their successors, or would be an insured under any such policy but for its termination upon exhaustion of its limit of liability; or (2) Resulting from the "hazardous prop- erties" of "nuclear material" and with respect to which (a) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (b) the insured is, or had this Coverage Part not been issued would be, entitled to indemnity 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 any Medical Payments coverage, to expenses incurred with respect to. 'bodily injury" resulting from the "hazard- ous properties" of "nuclear material" and arising out of the operation of a "nuclear facility" by any person or organization. C. Under any Liability Coverage, to 'bodily injury" or "property damage" resulting from the "hazardous properties" of "nu- clear material", U: (1) The "nuclear material" (a) is at any "nuclear facility" owned by, or oper- ated by or on behalf of, an insured, or (b) has been discharged or dis- persed therefrom; (2) The "nuclear material" is contained in "spent fuel" or "waste" at any time possessed, handled, used, proc- essed, stored, transported or dis- posed of, by or on behalf of an in- sured; or (3) The "bodily injury" or "property dam- age" arises out of the furnishing by an insured of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any "nuclear facility", but if such fa- cility is located within the United States of America, its territories or possessions or Canada, this Exclu- sion (3) applies only to "property damage" to such "nuclear facility" and any property thereat 2. As used in this exclusion: "Hazardous properties" includes radioactive, toxic or explosive properties. "Nuclear material" means "source material ", "special nuclear material' or "by- product ma- terial'. "Source material ", "special nuclear material ", and "by- product material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. "Spent fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a "nuclear re- actor". "Waste" means any waste material (a) con- taining "by- product material' other than the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its "source material" content, and (b) resulting from the operation by any person or organization of any "nuclear facility" included under the first two paragraphs of the definition of "nuclear facility". "Nuclear facility" means: A. Any 'nuclear reactor "; B. Any equipment or device designed or 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 lo- cated consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235; Includes copyrighted material of Insurance GA 10112 04 Services Office, Inc., with its permission. Page 21 of 22 ELITEPAC General Liability Extension COMMERCIAL GENERAL LIABILITY CG 72 02 12 11 SUMMARY OF COVERAGES (including index) This is a summary of the various additional coverages and coverage modifications provided by this endorsement. No coverage is provided by this summary. Refer to the actual endorsement (Pages 3- through -8) for changes affecting your insurance protection. DESCRIPTION PAGE FOUND Primary and Non - Contributory Provision - Additional Insureds Page 7 Blanket Additional Insureds - As Required By Contract Page 5 Broad Form Vendors Coverage Page 6 Not -for- profit Members - Including Club Members Not - for - profit Members - as additional insureds Page 5 Not - for - profit Members Medical Payments Page 4 ry Not- for - profit Members - defined Page 8 a Damage To Premises Rented To You ($500,000) (Including Fire, Lightning or Explosion) Page 3 2 Electronic Data Liability ($100,000) Page 4 ry Golf Amendments Golfing Facilities - defined Page 8 Golf and Tennis Pros - as additional insureds Page 6 ® Limited Property Damage - caused by golf balls Page 3 ® Members Medical Payments Page 4 Products Amendment - Medical Payments - limited on premises coverage Page 4 Recreational Medical Payments - limited amateur golf coverage Page 4 Waiver of Rights of Recovery - members and guests Page 7 Incidental Malpractice Exclusion modified Page 6 Knowledge of Occurrence, Claim, Suit or Loss Page 7 Liberalization Clause Page 7 Medical Payments - increased limit ($15,000) Page 6 Mental Anguish Amendment (Not applicable to New York) Page 8 Newly Formed or Acquired Organizations Page 5 Non -Owned Aircraft Page 3 Copyright, 2011 Selective Insurance Company of America. All rights reserved. CG 72 02 12 11 Includes copyrighted material of insurance Services Office, Inc., with its permission. Page 1 of 8 INSURED'S COPY c DESCRIPTION PAGE FOUND Non -Owned Watercraft (under 60 feet) Page 3 Personal And Advertising Injury Contractual Exclusion Amended (Excludes Advertisement) Page 4 Discrimination and Humiliation Amendment (Not applicable in New York; Excludes Page 7 Advertisement) Products Amendment - Not - for - profit and Golf Page 4 Supplementary Payments Amended - Bail Bonds ($5,000) and Loss of Earnings ($1,000) Page 4 Temporary Workers Employee Definition Amended (including status as an insured) Page 8 Employer's Liability Exclusion Amended (Not applicable in New York) Page 3 Injuries or Damages by Certain Employees (oc)- employee damages) Page 5 Unintentional Failure to Disclose Hazards Page 7 Waiver of Transferof Rights of Recovery (subrogation) Page 7 When Two or More Coverage Parts of this Policy Apply to a Loss Page 3 Copyright, 2011 Selective Insurance Company of America. All rights reserved. CG 72 02 12 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 8 INSURED'S COPY ELITEPAC General. Liability Extension COMMERCIAL GENERAL LIABILITY CG 72 02 12 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies the Insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The SECTIONS of the Commercial General Liability Coverage Part identified in this endorsement will be ° ®a amended as shown below. However, when two or more Coverage Parts of this policy apply to a loss, only the broadest coverage of this policy will apply, unless specifically stated otherwise within the particular amendment covering that loss. COVERAGES - Amendments (7) Any aircraft, not owned or operated by any " SECTION 1 - COVERAGE A BODILY INJURY AND insured, that,is hired, chartered or loaned with a PROPERTY DAMAGE,LWBILITY paid crew. However,'if the insured has any other "bodily ., valid and collectible insurance for COVERAGE EXTENSION injury" or "property damage" that would be cov- Property Damage - "Golfing Facilities" ered under this provision, or on any other basis, If you operate a "golfing facility ", Paragraph 1, this coverage is then excess, and subject to Condition 4. Other Insurance, b. Excess Insur- Insuring Agreement under COVERAGE A BODILY once under SECTION IV - COMMERCIAL GEN- INJURY AND PROPERTY DAMAGE LIABILITY is ERAL LIABILITY CONDITIONS. amended to include the fallowing: 8 "Property damage" to any properly not owned by Damage To Premises Rented to You iv you, caused by golf balls originating from your A. The last paragraph of Paragraph 2. Exclusions premises, regardless of your legal liability for the under COVERAGE A BODILY INJURY AND damage. The most we will pay under this extension PROPERTY DAMAGE is deleted in its entirety Is a sub -limit of $2,500 per "occurrence ". No and replaced with the following: =_ deductible applies to loss under this extension. Exclusions c. through n. do not apply to damage EXCLUSIONS by fire, lightning or explosion to premises rented to you or temporarily occupied by you with the Employer's Liability Amendment permission of the owner. A separate limit of -_ (This provision is not applicable in New York). insurance applies to this coverage as described The following is added to Exclusion e. Employer's in SECTION III - LIMITS OF INSURANCE. Liability under COVERAGE A BODILY INJURY AND B. Paragraph 6. under SECTION III - LIMITS OF —_ PROPERTY DAMAGE LIABILITY, 2. Exclusions: INSURANCE is deleted in its entirety and This exclusion also does not apply to any "tempo- replaced with the following: rary worker ". 6. Subject to Paragraph S. above, the most we Non -Owned Aircraft, Auto or Watercraft will pay under COVERAGE A for damages because of "property damage" to any one The following is added to Exclusion g, Aircraft, Auto premises, while rented you, the case Or Watercraft under COVERAGE A BODILY INJURY a of damage caused by fire, lightning or i g • AND PROPERTY DAMAGE LIABILITY, 2. Exclusions: rarity sion, while rented to you or temporarily This exclusion does not apply to: occupied by you with permission of the (6) A watercraft you do not own that is less than 60 owner, for all such damage caused by fire, feet long, and not being used to carry persons lightning or explosion proximately caused by or property for a charge. Any person is an the same event, whether such damage insured who uses or is responsible for the use results from fire, lightning or explosion or of such watercraft with your expressed or any combination of the three, is the higher of implied consent. However, if the insured has $500,000 or the amount shown in the Decla- any other valid and collectible insurance for rations for the Damage To Premises Rented "bodily injury" or "property damage" that would To You Limit. be covered under this provision, or on any other basis, this coverage is then excess, and subject to Condition 4. Other Insurance, b. Excess Insur- ance under SECTION IV - COMMERCIAL GEN- ERAL LIABILITY CONDITIONS. Copyright, 2011 Selective Insurance Company of America. All rights reserved. CG 72 02 12 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of S INSURED'S COPY C. Paragraph a. of Definition 8. "Insured contract" under SECTION V - DEFINrrIlONS is deleted in its entirety and replaced with the following_ a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning or explosion to premises while rented to you or temporarily occupied by you with the per- mission of the owner is not an "insured con- tract"; Electronic Data Liability Exclusion p, Electronic Data under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABIL- ITY, 2. Exclusions is deleted in its entirety and replaced by the following: p. Electronic Data Damages arising out of, the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property. The most we will pay for damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that results from physical injury to tangible property is a sub -limit of $100,000 for "property damage" because of all applicable loss of "electronic data" arising out of anyone 'occurrence ". SECTION I - COVERAGE B PERSONAL AND ADVER- TISING INJURY LIABILITY EXCLUSIONS Contractual Exclusion Amendment Exclusion e. Contractual Liability under COVERAGE B PERSONAL AND ADVERTISING INJURY, 2. Exclu- sions is deleted in its entirety and replaced with the following: e. Contractual Liability "Personal and advertising Injury" for which the insured has assumed liability in a contract or agreement arising out of an "advertisement ". This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement. a, Any Insured To any insured. This exclusion does not apply to: (1) "Golfing facility" members who are not paid a fee, salary, or other compensation; (2) "Not- for - profit members "; or (3) "volunteer workers ". This exclusion exception does not apply if COVER- AGE C MEDICAL PAYMENTS Is excluded by another endorsement to this Coverage Part. Product Amendment Exclusion f. Products - Completed Operations Hazard under COVERAGE C MEDICAL PAYMENTS, 2. Exclu- sions Is deleted in Its entirety and replaced with the following: f. Products - Completed Operations Hazard Included within the "products - completed opera- tions hazard ". This exclusion does not apply to "your products" sold for use or consumption on your premises, while such products are still on your premises, if you are a not - for - profit operation or a "golfing facility ". This exclusion exception, does not apply if COVER- AGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. Recreational Medical Payments - Amateur Golf Exclusion e. Athletics Activities under COVERAGE C MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following: e, Athletics Activities To a person injured while practicing, instructing or participating in any physical exercises or games, sports or athletic contests. If you are a "golfing facility ", this exclusion does not apply to a person injured as a result of their participation in amateur athletics that are recre- ational in nature. This exclusion exception does not apply if COVER- AGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. SECTION I - SUPPLEMENTARY PAYMENTS - COV- ERAGES A AND B SECTION I - COVERAGE C MEDICAL PAYMENTS Expenses For Bali Bonds And Loss Of Earnings EXCLUSIONS A. Subparagraph 1.b. under SUPPLEMENTARY Any Insured Amendment PAYMENTS - COVERAGES A AND B is deleted Exclusion a. Any Insured under COVERAGE C MEDI- in its entirety and replaced with the following: CAL PAYMENTS, 2. Exclusions is deleted in its enti- b. Up to $5,000 for cost of ball bonds required rely and replaced with the following: because of accidents or traffic law violations arising out of the use of any vehicle to which Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. Copyright, 2011 Selective Insurance Company of America. All rights reserved. CG 72 02 12 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 8 INSURED'S COPY e w a g B. Subparagraph 1.d. under SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is deleted in its entirety and replaced with the following: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit ", including actual loss of earnings up to $1,000 a day because of time off from work. SECTION 11 - WHO IS AN INSURED - Amendments Not - for -Profit Organization Members The following paragraph is added to SECTION II - WHO IS AN INSURED: If you are an organization other than a partnership, joint venture, or a limited liability company, and you are a not - for - profit organization, your officials, trus- tees, board members, insurance managers, and "not- for - profit members" are included as additional Insureds, however only with respect to their liability for your activities or activities they perform on your behalf. Employees As Insureds Modified A. Subparagraph 2,a.(1xa) under SECTION II - WHO IS AN INSURED does not apply to "bodily Injury" to a "temporary worker" caused by a co- "employee" who is not a "temporary worker ", B. Subparagraph 2.a.(2) under SECTION 11 - WHO IS AN INSURED does not apply to "property damage" to the property of a "temporary work- er" caused by a co- "employee" who is not a "temporary worker ". C. Subparagraph 2.a.(1xd) under SECTION II WHO IS AN INSURED does not apply to "bodily injury" caused by cardio - pulmonary resuscita- tion or first aid services administered by a co- .,employee ". Newly Formed Or Acquired Organizations A. Subparagraph 3.a. under SECTION II - WHO IS AN INSURED is deleted in its entirety and replaced with the following: Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier. However, COVERAGE A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organiza- tion. B. The following paragraph is added to SECTION 11- WHO IS AN INSURED, Paragraph 3: If you are engaged In the business of construc- tion of dwellings three stories or less in height, or other buildings three stories or less in height and less than 25,000 square feet in area, you will also be an insured with respect to "your work" only, for the period of time described above, for your liability arising out of the con- duct of any partnership or joint venture of which you are or were a member, even If that partner- ship or joint venture is not shown as a Named Insured. However, this provision only applies if you maintain or maintained an interest of at least fifty percent in that partnership or joint venture for the period of that partnership or joint venture. This provision does not apply to any partnership or joint venture that has been'dissolved or otherwise ceased to function for more than thirty -six months. With respect to the insurance provided by this provision, Newly Formed or Acquired Organizations, the following is added to SECTION IV - COMMER- CIAL GENERAL LIABILITY, Paragraph 4. Other Insurance, Subparagraph b. Excess Insurance: The insurance provided by this provision, Newly Formed or Acquired Organizations, is excess over any other insurance available to the insured, whether primary, excess, contingent or on any other basis. (All other provisions of this section remain unchanged). Blanket Additional Insureds - As Required By Contract Subject to the Primary and Non - Contributory provi- sion set forth in this endorsement, SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization whom you have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your policy. Such person or organization is an addi- tional insured only with respect to liability for "bodily injury" or "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your ongoing operations, "your product ", or premises owned or used by you; however this provision does not include any architects, engi- neers, or surveyors with respect to any injury or damage arising out of the rendering or failure to render any professional services by or for you, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; and Copyright, 2011 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSURED'S COPY CG 72 02 12 11 Page 5 of B b. Supervisory, inspection, architectural or engineering activities. 2. Your maintenance, operation or use of equip- ment, other than aircraft, "auto" or watercraft, rented or leased to you by such person or organization. A person or organization's status as an additional insured under this endorsement ends when their contract, or agreement with you for such rented or leased equipment ends. With respect to the insurance afforded to these addi- tional insureds, this insurance does not apply to any "occurrence" which takes place after the rental agreement or equipment lease expires. The provisions of this coverage extension do not apply unless the written contract or written agree- ment has been executed (executed means signed by the named insured) or written permit Issued prior to the "bodily injury" or "property damage" or "per- sonal and advertising injury ". Broad Form Vendors Coverage Subject to the Primary and Now Contributory provi- sion set forth in this endorsement, SECTION II- WHO IS AN INSURED is amended to include as an additional insured any person or organization (re- ferred to below as vendor) whom you have agreed in a written contract or written agreement to add as an additional insured on your policy. Such person or organization is an additional insured only with respect to "bodily injury" or "property damage" aris- ing out of "your products" which are distributed or sold in the regular course of the vendor's business, however the insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay dam- ages by reason of the assumption of liability in a contract or agreement; however this exclusion does not apply to liability for dam- ages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, test- ing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the ven- dor has agreed to make or normally under- takes to make in the usual course of busi- ness in connection with the sale of the prod- uct; or Products which, after distribution or sale by you, have been labeled or re- labeled or used as a container, part of ingredient of any other thing or substance by or for the vendor; however this insurance does not apply to any insured person or organization, from who you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such prod- ucts. The provisions of this coverage extension do not apply unless the written contract or written agree- ment has been executed (executed means signed by the named insured) prior to the "bodily injury" or "property damage ". Incidental Malpractice Subparagraph 2.a.(1j(d) under SECTION II - WHO IS AN INSURED is deleted in its entirety and replaced with the following: (d) Arising out of his or her providing or failing to provide professional health care services. This does not apply to nurses, emergency medical technicians or paramedics. if you are not in the business or occupation of providing any such professional services. "Golfing Facilities " - Golf or Tennis Pros The following is added to SECTION II - WHO IS AN INSURED: If you operate a "golfing facility ", any golf or tennis pros are additional insureds. Golf or tennis pros means any person, other than your "employees ", whose primary responsibilities include golf or tennis instruction or operation of a golf or tennis pro shop, however only with respect to their liability for your activities, or activities they perform on your behalf, or their liability for the maintenance, use or opera- tion of golf or tennis pro shop premises you rent or lease to them. SECTION III - LIMITS OF INSURANCE Increased Medical Payments Paragraph 7. under SECTION III - LIMITS OF INSUR- ANCE is deleted in its entirety and replaced with the following: 7. Subject to Paragragh 5. above, the Medical Expense Limit under COVERAGE C will be $15,000, or the amount shown in the Declara- tions for Medical Expense Limit, whichever is higher, for all medical expenses because of "bodily injury" sustained by any one person. This provision, Increased Medical Payments, does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. Copyright, 2011 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSURED'S COPY CG 72 02 12 11 Page 6 of 8 n SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS - Amendments Knowledge Of Occurrence, Claim, Suit Or Loss The following is added to Paragraph 2. Duties in the Event of Occurrence, Offense, Claim or Suit under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: The requirements underthis paragraph do not apply until afterthe "occurrence" or offense is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. An "executive officer" or insurance manager, if you are a corporation; 4. Your members, managers or insurance man- ager, if you are a limited liability company; or 5. Your elected or appointed officials, trustees, board members, or your insurance manager if you are an organization other than a partner- ship, joint venture, or limited liability company. Primary and Non - Contributory Provision The following is added to Paragraph 4. Other Insur- ance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance shall be excess with respect to any person or organization included as an additional insured under this policy, any other insurance that person or organization has shall be primary with respect to this insurance, unless: (1) The additional insured is a Named Insured under such other insurance; (2) You have agreed in a written contract, written agreement or written permit to include that additional insured on your General Liability pol- icy on a primary and/or non - contributory basis; and (3) The written contract or written agreement has been executed (executed means signed by the named insured) or written permit issued prior to the "bodily injury" or "property damage" or "personal and advertising injury". Unintentional Failure To Disclose Hazards The following is added to Paragraph 6. Representa- tions under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: However, If you should unintentionally fail to dis- close any existing hazards in your representations to us at the inception date of the policy, or during the policy period in connection with any additional hazards, we shall not deny coverage under this Coverage Part based upon such failure to disclose hazards. Waiver Of Transfer Of Rights Of Recovery The following is added to Paragraph B. Transfer of Rights Of Recovery Against Others To Us under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: We will waive any right of recovery we may have against a person or organization because of pay- ments we make for "bodily injury" or "property dam- age" arising out of your ongoing operations or "your work" done under a written contract or written agreement and included in the "products- completed operations hazard ", if: You have agreed to waive any right of recovery against that person or organization in a written contract or written agreement; 2. Such person or organization is an additional insured on your policy; or 3. You have assumed the liability of that person or organization in that same contract, and it is an "insured contract ". The section above only applies to that person or organization identified above, and only if the "bodily injury" or "property damage" occurs subsequent to the execution of the written contract or written agreement. If you are a "golfing facility ", we will also waive any right of recovery we may have against any of your members or their guests because of payments we make for "bodily injury" or "property damage" aris- ing out of their actions at your premises to which this Coverage Part applies. However, this provision does not apply to "bodily injury" or "property dam- age" that is expected or intended by your member or their guest. Liberalization The following condition is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: If we revise this Coverage Part to provide more cov- erage without additional premium charge, subject to our filed company rules, your policy will automati- cally provide the additional coverage as of the day the revision is effective in your state. SECTION V - DEFINITIONS Discrimination And Humiliation (This provision does not apply In New York). A. The following is added to Definition 14. "Per- sonal and advertising injury": "Personal and advertising injury" also means "discrimination" or humiliation that results in injury to the feelings or reputation of a natural person, however only if such "discrimination" or humiliation is: Copyright, 2011 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSURED'S COPY CG 72 02 12 11 Page 7 of B 1. Not done by or at the direction of a. The insured: or b. Any "executive officer" director, stock- holder, partner, manager or member of the insured; 2. Not done intentionally to cause harm to another person. 3. Not directly or indirectly related to the employment, prospective employment or termination of employment of any person or persons by any insured. 4. Not arising out of any "advertisement" by the insured. B. The following definition is added to SECTION V - DEFINITIONS: "Discrimination" means: a. Any act or conduct that would be considered discrimination under any applicable federal, state, or local statute, ordinance or law; b. Any act or conduct that results in disparate treatment of, or has disparate impact on, a person, because of that person's race, reli- gion, gender, sexual orientation, age, disa- bility or physical impairment; or c. Any act or conduct characterized or inter- preted as discrimination by a person based on that person's race, religion, gender, sex- ual orientation, age, disability or physical impairment. Electronic Data The following definition is added to SECTION V - DEFINITIONS: "Electronic data" means information, facts or pro- grams stored as or on, created or used on, or trans- mitted to or from computer software (including sys- tems and applications software), hard or floppy disks, CD -ROMS, tapes, drives, cell, data process- ing devices or any other media which are used with electronically controlled equipment. For the purpose of the Electronic Data Liability cov- erage provided by this endorsement, Definition 17. "Property damage" is deleted in its entirety and replaced by the following: 17. "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 occur at the time of the physical injury that caused it: or b. loss of, loss of use of, damage to, cor- ruption of, inability to access, or inability to properly manipulate "electronic data ", resulting from physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused it. For the purpose of the Electronic Data Liability cov- erage provided by this endorsement, "electronic data" is not tangible property. Employee Amendment Definition 5. "Employee" under SECTION V - DEFINI- TIONS is deleted in its entirety and replaced by the following: 5. "Employee" includes a "leased worker ", or a "temporary worker ". Golfing Facility The following definition is added to SECTION V - DEFINITIONS: "Golfing facility" or "golfing facilities" means a golf course, golf club, driving range, or miniature golf course. Mental Anguish Amendment (This provision does not apply in New York)_ Definition 3. "Bodily injury" under SECTION V - DEFINITIONS is deleted in its entirety and replaced with the following: 3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. This includes mental anguish resulting from any bodily Injury, sickness or disease sustained by a person. (In New York, mental anguish has been determined to be "bodily injury"). Not-for-profit Member The following definition is added to SECTION V - DEFINITIONS: "Not - for- profit member" means a person who is a member of a not- for - profit organization, including clubs and churches, who receive no financial or other compensation. Copyright, 2011 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission, INSURED'S COPY CG 72 02 12 11 Page 8 of 8 tional insured is more re- 11. of this endorsement fix the strictive than was speciy- most we will pay in any one "oc- cally required in that written currence" regardless of the contract or agreement, the number of: terms of Paragraphs 9.a.(3)(a), 9.a.(3)(b) or 9.b. (a) Insureds; above, or any combination (b) Claims made or "suits" thereof, shall be interpreted brought; or as providing the limits or coverage required by the (c) Persons or organizations terms of the written contract making claims or bring or agreement, but only to "suits ". the extent that such limits or coverage is included within (2) Deductible Clause the terms of the Coverage (a) Our obligation to pay dam - Part to which this endorse- ages on your behalf applies ment is attached. If, how- ever, the written contract or only to the amount of dam - 'occurrence" agreement specifies the In- ages for each surance Services Office which are in excess of the additional insured form Deductible amount stated in number CG 20 10 but does Section B. Limits of Insur- not specify which edition, or ance, 11. of this endorse - specifies an edition that ment. The limits of insur- does not exist, Paragraphs ance will not be reduced by 9.a.(3)(a) and 9.a.(3)(b) of the application of such De- this endorsement shall not ductible amount. apply and Paragraph 9.b. of (b) Condition 2. Duties in the this endorsement shall ap- Event of Occurrence, Of- ply. fense, Claim or Suit, ap- 10. Broadened Contractual Liability - Work plies to each claim or "suit" irrespective of the amount. Within 50' of Railroad Property It is hereby agreed that Paragraph f.(1) of (c) We may pay any part or all Definition 12. "Insured contract" (SEC- of the deductible amount to TION V - DEFINITIONS) is deleted. effect settlement of any claim or suit' and, upon 11. Property Damage to Borrowed Equip- notification of the action ment taken, you shall promptly reimburse us for such part a. The following is hereby added to Ex- of the deductible amount as clusion j. Damage to Property of has been paid by us. Paragraph 2., Exclusions of SEC- TION I - COVERAGES, COVERAGE 12. Employees as Insureds - Specified A. BODILY INJURY AND PROP- Health Care Services ERTY DAMAGE LIABILITY: It is hereby agreed that Paragraph Paragraphs (3) and (4) of this exclu- 2.a.(1)(d) of SECTION II - WHO IS AN sion do not apply to tools or equip- INSURED, does not apply to your "em- ment loaned to you, provided they ployees" who provide professional health are not being used to perform opera- care services on your behalf as duly li- tions at the time of loss. censed: b. With respect to the insurance pro- a. Nurses; vided by this section of the en- dorsement, the following additional b. Emergency Medical Technicians; or provisions apply: c. Paramedics, (1) The Limits of insurance shown in the jurisdiction where an 'occurrence" in the Declarations are replaced or offense to which this insurance applies by the limits designated in Sec- takes place. tion B. Limits of Insurance, 11. of this endorsement with respect 13. Broadened Notice of Occurrence to coverage provided by this endorsement. These limits are Paragraph a. of Condition 2. Duties in inclusive of and not in addition to the Event of Occurrence, Offense, the limits being replaced. The Claim or Suit (SECTION IV - COMMER- Limits of Insurance shown in CIAL GENERAL LIABILITY CONDI- Section B. Limits of Insurance, Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 14 of 15 TIONS) is hereby deleted and replaced by the following: a. You must see to it that we are noti- fied 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 "oc- currence" or offense took place; (2) The names and addresses of any injured persons and wit- nesses; and (3) The nature and location of any injury or damage arising out of the 'occurrence" or offense. This requirement applies only when the 'occurrence" or offense is known to an "authorized representative ". Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 15 of 15 Policy #: WCV8011448 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any person or organization that you perform work for that is liable for an injury, covered by this policy, that prior to the injury has written contract requiring a waiver of our right to recover from them. /Ti 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 pallcy.) Endorsement ErfecWe 07/01/2016 Policy No. policy #: WCV8011448 Endorsement No. WC 00 03 13 Insured Premium $ Padded Surfaces by ME, Inc. Insurance Company Countersigned by Accident Fund Insurance Company of America WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance.