Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
PROOF OF INSURANCE (2019 - 2020) CLOSED
RHALAND-01 SGON'ZALt Z ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)02/08/2019 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(Nes)must have ADDITIONAL INSURED provisions or be endorsed. m 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 HUB Intern4ational Insurance Services Inc. O rar,E 1I.(951 j 77-9785-8-1- R •Ne)(951)231-2572 License#0757776 Jennif PO Box 53 Riverside,CA 92517 Iffyh pint 59.. ernationaj.co cal.c a .... m INSURERS)AFFORDING COVERAGE r_RAGE NAIL d INSuRuRA=The American Insurance C�q:�rly.__ 21.857— INSURED INSURER a:Citizens Insurance Company of America31534 RHA Landscape Architects-Planners,Inc. INSURER c:Security National Insurance Company(Am Trust) 1 9879 6800 Indiana Ave,Ste 245 I.N.,SURERD:Continental Casualty Com„panv 204431. Riverside,CA 92506 INSURER,E,: INSURER F: COVERAGES CERTIFICATE NUMBER: �........................ REVISIC.N+i.,NUM'BE'R: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, A COMMERCIAL GENERAL ADDLiSU. .. .- — RRPNGP .. ENE '”" "0"""""" POLICY EFF POLICY EXP, RENb• LIMITS 1 D GH OCCU 000,000 I ..___ RAL LIABILITY IN I BR POLICY NUMBER EAtu1ACaE TO '— /LTR .Xd - CLAIMS-MADE X OCCUR OB3D820387 02/03129'02/03/20201 ED 300,000 TYPE OF IN 1 ....1 -xi i x PREW$ES.(FaQ-wjfwmo) S, (Ary,one,person)-- 8, 10,000 GEN't AGGRI GATE:LIMIT APPLIES PER: GENFRAt L B ADV I AJTE $ 000,000 �' i _._ ... A��REGATE $ ... ,000,0 4,000,000 PRO- -- 2.— 0 X PCatl.IGY JECT I LOC PRODUCTS-GOMP(OP AGG $ ... 0 O'l HE R B....mmAUTOMOBILE LIABILITY ............... E'.'COMBINED SXp )`IN'I"uL,E:,LIMIT ^ _2,000,000 ANY AUTO OB3D820387 02/0312019 02/03/2020 BODILY IN JU Y IPerpersgq) ,„S OWNED SCHEDULED AUTOS ONLY AUOTOS ONLY 6�,�R{"3PEId'1'M.P MAGE ccidant) $ ( X AUTOS ONLY X AUTOS Per�p�.'u:rNon9 ars..... .. $, ...----- .. .... h.. ............-.......................... UMBRELLA LIAB .............. OCCUR EACH OCCURREN,C,E........................ $ ..................,,, CLAIMS-MADE -AGGREGATE................................ $ EXCESS LIAB _---., . DED RETENTION$ $ .. .. - ........_. I .. ....,ER C WORKERSCOMPENSATIONRS'LI A ILII SWC1203057 08/21/2018 08/21/2019 X J$.TATUT (OTH- 1,000,000 -- ANRCEMOE.MBEEXGLIU PROPRIETOR/PARTNER/EXECUTIVE YNN NIA X E L EACH ACCIDENT. $ 1,'000'000 (Mandatory in NH) DISEASE EMPLOYEE_$ 000 000, If yes,describe under E.L..., ,..................1.,000,000, ................. .. D Professional LiabRATIONS below – LAH003011898 08/06/2018 08/0612019 Each Claire POLICY LIMIT $ ,,,,,,,,,,,,,,,,,,,,,,,,, 1,000,000 D PROF DED:$15,000 LAH003011898 08/0612018 08/0612019 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Recreation Park,401 Sheldon Street,EI Segundo,CA. The City of EI Segundo,its officers,officials,employees,agents,and volunteers are Additional Insured With regard to the General Liability policy when required by a written contract,per the attached endorsements 391-1006 08/16,391-1448 08/16,Primary and Non-Contributory included.Waiver of Subrogation with regard to the Workers Compensation policy applies when required by a written contract,per the attached endorsement form WC040306 04/84. CERTIFICATE HOLDEN CA�ANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE ................................ ..�..,......�. .�., ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SUMMARY OF COVERAGES Limits Page ................ �1. Additional Insured by Contract, Agreement or Permit Included ( 1 2. Additional Insured—Broad Form Vendors Included I 2 13. Alienated Premises Included 3 4. Broad Form Property Damage—Borrowed Equipment, Customers Included 3 Goods and Use of Elevators ..............__ ........... 5. Incidental Malpractice (Employed Nurses, EMT's and Paramedics) Included 3 6. Personal and Advertising Injury—Broad Form Included 4 7. Product Recall Expense Included 4 Product Recall Expense Each Occurrence Limit $25,000 Occurrence 5 Product Recall Expense Aggregate Limit I $50,000 Aggregate 5 ..................... _._...... _._._._.......... Product Recall Deductible I $500 5 8. Unintentional Failure to Disclose Hazards I Included 6 p 19. Unintentional Failure to Notify Included 6 ..................... This endorsement amends coverages provided under the Businessowners Coverage Form through new coverages and broader coverage grants. This coverage is subject to the provisions applicable to the Businessowners Coverage Form, except as provided below. The following changes are made to SECTION II — (2) Premises you own, rent, lease or occupy; LIABILITY: or 1. Additional Insured by Contract, Agreement or (3) Your maintenance, operation or use of Permit equipment leased to you. The following is added to SECTION II — b. The insurance afforded to such additional LIABILITY, C.Who Is An Insured: insured described above: Additional Insured by Contract, Agreement or (1) Only applies to the extent permitted by Permit law; and a. Any person or organization with whom you (2) Will not be broader than the insurance agreed in a written contract, written agreement which you are required by the contract, or permit to add such person or organization agreement or permit to provide for such as an additional insured on your policy is an additional insured. additional insured only with respect to liability (3) Applies on a primary basis if that is for "bodily injury", "property damage", or required by the written contract, written 'personal and advertising injury' caused, in agreement or permit. whole or in part, by your acts or omissions, or the acts or omissions of those acting on your (4) Will not be broader than coverage behalf, but only with respect to: provided to any other insured. (1) "Your work" for the additional insured(s) (5) Does not apply if the "bodily injury", designated in the contract, agreement or "property damage" or "personal and permit; advertising injury' is otherwise excluded from coverage under this Coverage Part, including any endorsements thereto. 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 1 of 6 c. This provision does not apply: The most we will pay on behalf of the (1) Unless the written contract or written additional insured for a covered claim is the agreement was executed or permit was lesser of the amount of insurance: issued prior to the "bodily injury", "property 1. Required by the contract, agreement or damage", or "personal injury and permit described in Paragraph a.; or advertising injury". 2. Available under the applicable Limits of (2) To any person or organization included as Insurance shown in the Declarations. an insured by another endorsement This endorsement shall not increase the issued by us and made part of this applicable Limits of Insurance shown in the Coverage Part. Declarations (3) To any lessor of equipment: e. All other insuring agreements, exclusions, and (a) After the equipment lease expires; or conditions of the policy apply. (b) If the "bodily injury", "property 2. Additional Insured—Broad Form Vendors damage", "personal and advertising The following is added to SECTION II — injury" arises out of sole negligence of LIABILITY, C.Who Is An Insured: the lessor Additional Insured—Broad Form Vendors (4) To any: a. Any person or organization that is a vendor (a) Owners or other interests from whom with whom you agreed in a written contract or land has been leased if the written agreement to include as an additional "occurrence" takes place or the insured under this Coverage Part is an offense is committed after the lease insured, but only with respect to liability for for the land expires; or "bodily injury" or"property damage" arising out (b) Managers or lessors of premises if: of"your products"which are distributed or sold (i) The "occurrence" takes place or in the regular course of the vendor's business. the offense is committed after you b. The insurance afforded to such vendor cease to be a tenant in that described above: premises; or (1) Only applies to the extent permitted by (ii) The "bodily injury", "property law; damage", "personal injury" or (2) Will not be broader than the insurance "advertising injury" arises out of which you are required by the contract or structural alterations, new con- agreement to provide for such vendor; struction or demolition operations performed by or on behalf of the (3) Will not be broader than coverage manager or lessor. provided to any other insured; and (5) To "bodily injury', "property damage" or (4) Does not apply if the "bodily injury", "personal and advertising injury" arising "property damage" or "personal and out of the rendering of or the failure to advertising injury' is otherwise excluded render any professional services. from coverage under this Coverage Part, This exclusion applies even if the claims including any endorsements thereto against any insured allege negligence or c. With respect to insurance afforded to such other wrongdoing in the supervision, vendors, the following additional exclusions hiring, employment, training or monitoring apply: of others by that insured, if the The insurance afforded to the vendor does not "occurrence" which caused the "bodily apply to: injury" or"property damage" or the offense (1) "Bodily injury" or "property damage" for which caused the "personal and which the vendor is obligated to pay advertising injury" involved the rendering damages by reasons of the assumption of of or failure to render any professional liability in a contract or agreement. This services by or for you. exclusion does not apply to liability for d. With respect to the insurance afforded to damages that the insured would have in these additional insureds, the following is the absence of the contract or agreement; added to SECTION II — LIABILITY, D. (2) Any express warranty unauthorized by Liability and Medical Expense Limits of you; Insurance: 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 2 of 6 (3) Any physical or chemical change in the The most we will pay on behalf of the vendor product made intentionally by the vendor; for a covered claim is the lesser of the amount (4) Repackaging, unless unpacked solely for of insurance: the purpose of inspection, demonstration, 1. Required by the contract or agreement testing, or the substitution of parts under described in Paragraph a.; or instruction from the manufacturer, and 2. Available under the applicable Limits of then repackaged in the original container; Insurance shown in the Declarations; (5) Any failure to make such inspection, This endorsement shall not increase the adjustments, tests or servicing as the applicable Limits of Insurance shown in the vendor has agreed to make or normally Declarations. undertakes to make in the usual course of business in connection with the sale of the 3. Alienated Premises product; SECTION II — LIABILITY, B. Exclusions, 1. (6) Demonstration, installation, servicing or Applicable To Business Liability Coverage k. repair operations, except such operations Damage to Property, paragraph (2) is replaced performed at the vendor's premises in by the following: connection with the sale of the product; (2) Premises you sell, give away or abandon, if (7) Products which, after distribution or sale the"property damage" arises out of any part of by you, have been labeled or relabeled or those premises and occurred from hazards used as a container, part or ingredient of that were known by you, or should have any other thing or substance by or for the reasonably been known by you, at the time the vendor; property was transferred or abandoned. (8) "Bodily injury" or "property damage" 4. Broad Form Property Damage — Borrowed arising out of the sole negligence of the Equipment, Customers Goods, Use of vendor for its own acts or omissions or Elevators those of its employees or anyone else a. The following is added to SECTION II — acting on its behalf. However, this LIABILITY, B. Exclusions, 1. Applicable To exclusion does not apply to: Business Liability Coverage, k. Damage to (a) The exceptions contained within the Property: exclusion in subparagraphs (4) or (6) Paragraph (4) does not apply to "property above-, or damage" to borrowed equipment while at a (b) Such inspections, adjustments, tests jobsite and not being used to perform or servicing as the vendor has agreed operations. to make or normally undertakes to Paragraph (3), (4) and (6) do not apply to make in the usual course of business, "property damage" to "customers goods" while in connection with the distribution or on your premises nor to the use of elevators. sale of the products. b. For the purposes of this endorsement, the (9) "Bodily injury" or "property damage" following definition is added to SECTION II — arising out of an "occurrence" that took LIABILITY, F. Liability and Medical place before you have signed the contract Expenses Definitions: or agreement with the vendor. 1. "Customers goods" means property of (10)To any person or organization included as your customer on your premises for the an insured by another endorsement purpose of being: issued by us and made part of this a. Worked on; or Coverage Part. (11)Any insured person or organization, from b. Used in your manufacturing process. whom you have acquired such products, c. The insurance afforded under this provision is or any ingredient, part or container, excess over any other valid and collectible entering into, accompanying or containing property insurance (including deductible) such products. available to the insured whether primary, d. With respect to the insurance afforded to excess, contingent or on any other basis. these vendors, the following is added to 5. Incidental Malpractice — Employed Nurses, SECTION II — LIABILITY, D. Liability and EMT's and Paramedics Medical Expense Limits of Insurance: SECTION II — LIABILITY, C. Who Is An Insured, paragraph 2.a.(1)(d) does not apply to a nurse, 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 3 of 6 emergency medical technician or paramedic o. Recall of Products, Work or Impaired employed by you if you are not engaged in the Property is replaced by the following: business or occupation of providing medical, o. Recall of Products, Work or Impaired paramedical, surgical, dental, x-ray or nursing Property services. Damages claimed for any loss, cost or 6. Personal Injury—Broad Form expense incurred by you or others for the a. SECTION II — LIABILITY, B. Exclusions, 2. loss of use, withdrawal, recall, inspection, Additional Exclusions Applicable only to repair, replacement, adjustment, removal "Personal and Advertising Injury", or disposal of: paragraph e. is deleted. (1) "Your product"; b. SECTION II — LIABILITY, F. Liability and (2) "Your work"; or Medical Expenses Definitions, 14. "Personal and advertising injury", paragraph b. is (3) "Impaired property"; replaced by the following: If such product, work or property is b. Malicious prosecution or abuse of withdrawn or recalled from the market or process. from use by any person or organization c. The followingis added to SECTION II — because of a known or suspected defect, deficiency, inadequacy or dangerous LIABILITY, F. Liability and Medical condition in it, but this exclusion does not Expenses Definitions, Definition 14. apply to"product recall expenses"that you "Personal and advertising injury": incur for the "covered recall" of "your "Discrimination" (unless insurance thereof is product". prohibited by law) that results in injury to the However, the exception to the exclusion feelings or reputation of a natural person, but does not apply to "product recall only if such "discrimination Is: expenses" resulting from: (1) Not done intentionally by or at the (4) Failure of any products to accomplish direction of: their intended purpose; (a) The insured; (5) Breach of warranties of fitness, (b) Any officer of the corporation, director, quality, durability or performance; stockholder, partner or member of the (6) Loss of customer approval, or any insured; and cost incurred to regain customer (2) Not directly or indirectly related to an approval; "employee", not to the employment, (7) Redistribution or replacement of "your prospective employment or termination of product" which has been recalled by any person or persons by an insured. like products or substitutes; d. For purposes of this endorsement, the (8) Caprice or whim of the insured; following definition is added to SECTION II — A condition likely to cause loss of LIABILITY, F. Liability and Medical (9) Expenses Definitions: which any insured knew or had reason to know at the inception of this 1. "Discrimination" means the unlawful insurance; treatment of individuals based upon race, color, ethnic origin, gender, religion, age, (10)Asbestos, including loss, damage or or sexual preference. "Discrimination" clean up resulting from asbestos or does not include the unlawful treatment of asbestos containing materials; or individuals based upon developmental, (11)Recall of"your products" that have no physical, cognitive, mental, sensory or known or suspected defect solely emotional impairment or any combination because a known or suspected defect of these. in another of"your products" has been e. This coverage does not apply if liability found. coverage for "personal and advertising injury" b. The following is added to SECTION II — is excluded either by the provisions of the LIABILITY, C. Who Is An Insured, paragraph Coverage Form or any endorsement thereto. 3.b.: 7, Product Recall Expense "Product recall expense" arising out of any a. SECTION II — LIABILITY, B. Exclusions, 1. withdrawal or recall that occurred before you Applicable To Business Liability Coverage, acquired or formed the organization. 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 4 of 6 c. The following is added to SECTION II — a deductible amount, you shall promptly LIABILITY, D. Liability and Medical reimburse us for the part of the deductible Expenses Limits of Insurance: amount we paid. Product Recall Expense Limits of The Product Recall Expense Limits of Insurance Insurance apply separately to each a. The Limits of Insurance shown in the consecutive annual period and to any SUMMARY OF COVERAGES of this remaining period of less than 12 months, endorsement and the rules stated below starting with the beginning of the policy period fix the most that we will pay under this shown in the Declarations, unless the policy Product Recall Expense Coverage period is extended after issuance for an regardless of the number of: additional period of less than 12 months. In that case, the additional period will be deemed (1) Insureds; part of the last preceding period for the (2) "Covered Recalls initiated; or purposes of determining the Limits of (3) Number of"your products"withdrawn. Insurance. b. The Product Recall Expense Aggregate d. The following is added to SECTION II — Limit is the most that we will reimburse LIABILITY, E. Liability and Medical you for the sum of all "product recall Expense General Conditions, 2. Duties in expenses" incurred for all "covered recalls" the Event of Occurrence, Offense, Claim or initiated during the policy period. Suit: c. The Product Recall Each Occurrence Limit You must see to it that the following are done is the most we will pay in connection with in the event of an actual or anticipated any one defect or deficiency. "covered recall" that may result in "product recall expense": d. All"product recall expenses" in connection with substantially the same general (1) Give us prompt notice of any discovery or harmful condition will be deemed to arise notification that "your product" must be out of the same defect or deficiency and withdrawn or recalled. Include a considered one"occurrence". description of "your product" and the reason for the withdrawal or recall; e. Any amount reimbursed for"product recall expenses" in connection with any one (2) Cease any further release, shipment, "occurrence" will reduce the amount of the consignment or any other method of Product Recall Expense Aggregate Limit distribution of like or similar products until available for reimbursement of "product it has been determined that all such recall expenses" in connection with any products are free from defects that could other defect or deficiency. be a cause of loss under this insurance. f. If the Product Recall Expense Aggregate e. For the purposs of this endorsement, the Limit has been reduced by reimbursement following definitions are added to SECTION 11 of"product recall expenses" to an amount — LIABILITY, F. Liability and Medical that is less than the Product Recall Expenses Definitions: Expense Each Occurrence Limit, the 1. "Covered recall" means a recall made remaining Aggregate Limit is the most that necessary because you or a government will be available for reimbursement of body has determined that a known or "product recall expenses" in connection suspected defect, deficiency, inadequacy, with any other defect or deficiency. or dangerous condition in "your product" g. Product Recall Deductible has resulted or will result in "bodily injury" We will only pay for the amount of or"property damage". "product recall expenses" which are in 2. "Product recall expense(s)" means: excess of the $500 Product Recall a. Necessary and reasonable expenses Deductible. The Product Recall Deductible for: applies separately to each "covered (1) Communications, including radio recall". The limits of insurance will not be or television announcements or reduced by the amount of this deductible. printed advertisements including We may, or will if required by law, pay all stationary, envelopes and or any part of any deductible amount, if postage; applicable. Upon notice of our payment of 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc.,with its permission. Page 5 of 6 (2) Shipping the recalled products (1) If the "products — completed operations from any purchaser, distributor or hazard" is excluded from coverage under user to the place or places this Coverage Part including any designated by you; endorsement thereto; or (3) Remuneration paid to your regular (2) To "product recall expense" arising out of "employees" for necessary any of "your products" that are otherwise overtime; excluded from coverage under this (4) Hiring additional persons, other Coverage Part including endorsements than your regular"employees"; thereto. (5) Expenses incurred by 8. Unintentional Failure to Disclose Hazards "employees" including The following is added to SECTION II — transportation and LIABILITY, E. Liability and Medical Expenses accommodations; General Conditions: (6) Expenses to rent additional Representations warehouse or storage space; We will not disclaim coverage under this Coverage (7) Disposal of "your product", but Part if you fail to disclose all hazards existing as of only to the extent that specific the inception date of the policy provided such methods of destruction other than failure is not intentional. those employed for trash g, Unintentional Failure to Notify discarding or disposal are required to avoid "bodily injury" or The following is added to SECTION II — '.property damage" as a result of LIABILITY, E. Liability and Medical Expenses such disposal, General Conditions, 2. Duties in the Event of you incur exclusively for the purpose Occurrence, Offense, Claim or Suit: of recalling"your product"; and Your rights afforded under this Coverage Part shall not be prejudiced if you fail to give us notice b. Your lost profit resulting from such of an "occurrence", offense, claim or "suit", solely "covered recall". due to your reasonable and documented belief f. This Product Recall Expense Coverage does that the "bodily injury", "property damage" or not apply: "personal and advertising injury" is not covered under this Policy. ALL OTHER TERMS, CONDITIONS,AND EXCLUSIONS REMAIN UNCHANGED, 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc.,with its permission. Page 6 of 6 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AVENUES BUSINESSOWNERS DELUXE PLATINUM ARCHITECTS AND ENGINEERS PROGRAM BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT The following is added to SECTION I —PROPERTY: The limits applicable to the coverages included in this endorsement may either be in addition to or included within the applicable Limit of Insurance. For application of the limits, refer to each coverage within this endorsement. Words or phrases in quotation marks have special meanings. The meaning of words or phrases in quotation marks is explained within the applicable coverage section. The coverages in this endorsement amend the coverage provided under the Businessowners Coverage Form through new coverages and replace coverage grants. These coverages are subject to the provisions applicable to this policy,except where amended within this endorsement. If any of the property covered by this endorsement is also covered under any other provisions of the policy of which this endorsement is made a part of, or if more than one coverage under this endorsement applies, in the event of loss or damage, you may choose only one of these coverages to apply to that loss. The most we will pay in this case is the limit of insurance applying to the coverage you select.Coverages included in this endorsement apply either separately to each described premises or on an occurrence basis. Refer to each coverage within this endorsement for application of coverage. We provide no coverage for Business Income; Extended Business Income; Extra Expense; or Business Income and Extra Expense from Dependent Properties for any of the Coverages included as part of this endorsement unless specifically stated, and then only to the extent provided for within that Scheduled or Blanket Coverage provision. I. COVERAGES (Scheduled Coverages Limit Page 1. Accounts Receivable On Premises $250,000 3 Accounts Receivable Off Premises $250,000 2. Backup or Overflow of a Sewer, Drain or Sump Included 3 3. Brands and Labels Included 3 4. Business Income Billable Hours Option $25,000 4 5. Business Income and Extra Expense — Dependent Properties $100,000 4 16. Transit Business Income and Extra Expense $50,000 5 7. Business Income from Websites I $50,000/ 7 Days 5 8. Civil Authority 24 hour waiting 5 period 9. Computer Equipment Included Computer Equipment In Transit or Off Premises $100,000 6 Computer Equipment— Newly Acquired or Constructed Property $100,000 10. Computer and Funds Transfer Fraud $10,000 6 11. Consequential Loss to Stock Included 6 12. Contract Penalties $25,000 6 13. Denial of Access to Premises 30 Days; 72 Hour 6 Waiting Period 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 17 114. Electronic Vandalism I $100,000 7 115. Employee Theft Including ERISA Compliance I+ $50,000 7 16. Expediting Expenses 1 $25,000 7 17. Extended Business Income 90 Days 7 18. Fine Arts (Including Architectural Models) $100,000 8 19. Forgery or Alteration $50,000 8 120. Hired Auto - Physical Damage Di $50,000 8 121. Identity Theft Expense Reimbursement Q $15,000 9 I22. Interruption of Computer Operations On Premises $500,000 10 Interruption of Computer Operations Off Premises $25,000/$50,000 123. Marring and Scratching Included 11 24. Money and Securities Inside the Premises I $25,000 11 Money and Securities Outside the Premises $25,000 25. Money Orders and Counterfeit Money $25,000 11 26. Newly Acquired or Constructed Property — Business Income and Extra $500,000 11 Expense �27. Ordinance or Law — Demolition Cost Coverage and Increased Cost of� $25,000 11 Construction 28. Ordinance or Law— Increased Period of Restoration $50,000 11 29. Ordinance or Law(Tenants Improvement Extension) $25,000 12 130. Outdoor Property $25,000 12 131. Personal Effects 1 $75,000 12 32. Portable Electronic Devices Coverage Worldwide $10,000 12 133. Precious Metal Theft Payment Changes $25,000 13 134. Preservation of Property - Expense 1 $25,000 13 35. Personal Property in Transit Included 13 136. Sales Representative Samples $25,000 13 37. Temporary Relocation of Property $50,000 13 38. Tenant Signs Included 14 39. Utility Services Direct Damage (Including Overhead Transmission Lines) $25,000 14 Business Income (Including Overhead Transmission Lines) $25,000 40. Valuable Papers and Records (Other Than Electronic Data) On Premises $100,000 I 14 Valuable Papers and Records (Other Than Electronic Data) Off Premises $100,000 141. Worldwide Property Off Premises $50,000 14 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 17 SECTION II —LIABILITY Changes Limit Page 11. Additional Insured by Contract, Agreement or Permit—Amended Included 15 I2. Additional Insured by Contract, Agreement or Permit — Primary and Non- Included 15 contributory 13. Aggregate Limit of Insurance (Per Project) 16 I4. Damage to Premises Rented to You — Revised Limit a $1,000,000 16 15. Limits of Insurance— Medical Expenses $10,000 per person Q 16 * Newly Acquired or Formed Organizations 180 Days 17 �7. Non-Owned Watercraft 75 Feet 17 �8. Who Is An Insured —Unnamed Joint Venture Included 17 II. DEDUCTIBLES (1) We will pay for direct physical loss or Deductibles are subject to the provisions damage to Covered Property at the applicable to the Businessowners Coverage Form described premises, solely caused by or except as provided below. We will not pay for resulting from water or waterborne covered loss or damage in any one occurrence material carried or moved by water that unless the amount of loss or damage exceeds the backs up or overflows or is otherwise applicable Deductible amount. We will then pay discharged from a sewer, drain, sump, the amount of loss or damage in excess of the sump pump or related equipment. The Deductible up to the applicable Limit of Insurance. term drain includes a roof drain and its related fixtures. III. COVERED PROPERTY (2) For the purpose of this Additional Scheduled Coverages Coverage only, SECTION I—PROPERTY, 1. Accounts Receivable B. Exclusions, g.Water, paragraph(3)is SECTION I — PROPERTY, A. Coverage, 6. deleted. Coverage Extensions, f. Accounts (3) Payment under this Additional Coverage is Receivable, paragraphs (2) and (3) are included within the applicable Limit of replaced by the following: Insurance for Covered Property at a (2) We will pay under this Coverage premises described in the Declarations. Extension for loss or damage in any one This Additional Coverage does not occurrence at the described premises. increase the Limits of Insurance. The most we will pay is $250,000 for (4) Special Sewer Backup Exclusion accounts receivable at the described We will not pay for: premises, unless a higher Limit of Insurance for accounts receivable is (a) Loss or damage from water or other shown in the Additional Property materials that back-up or overflow Coverage Schedule. from any sewer or drain, sump, sump pump or related equipment when it is (3) We will pay under this Coverage caused by or results from any "flood", Extension for loss or damage in any one regardless of the proximity of the occurrence not at the described premises. back-up or overflow to the "flood" The most we will pay is $250,000 for condition; or accounts receivable not at the described premises. (b) Failure to keep a sump pump or its 2. Backupor Overflow of a Sewer, Drain or related equipment in proper working condition; or Sump (c) Failure to perform routine The following is added to SECTION I — maintenance or repair necessary to PROPERTY, A. Coverage, 5. Additional keep a sewer or drain free from Coverages: obstructions. Backup or Overflow of a Sewer, Drain or 3. Brands and Labels Sump 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 3 of 17 The following is added to SECTION I — (i) Income that would have been PROPERTY, A. Coverage, 6. Coverage generated from billable hours Extensions: normally charged by you to your Brands and Labels clients for services performed by 1 If Covered Property that has a brand or you or your employees u no ( ) p Y physical loss or damage occurred; label is damaged by a Covered Cause of Loss and we elect to take all or any part of (ii) Other income of your baseness the damaged property at an agreed or that would have been incurred if appraised value, you may extend the no physical loss or damage occurred; insurance that applies to your Business Personal Property to: (iii)Continuing normal operating (a) Pay expenses you incur to: expenses incurred, including "payroll expenses". However, if (i) Remove the brand or label and your business is not generating then relabel the damaged property any income because you are to comply with any applicable law; primarily in research or or development or have not yet (ii) Label or stamp the damaged brought your product to market, property Salvage, if doing so will your continuing normal operating not physically damage the expenses, including "payroll property. expenses"will not be offset by the (b) Cover any reduction in the salvage Net Loss; and value of the damaged property as a (iv) "Rental Value". result of the removal of the brand or For manufacturing risks, Net Income label. includes the net sales value of (2) Payment underthis Extension is included production. within the Limit of Insurance applicable to (4) For any occurrence, the two available your Business Personal Property. methods for adjusting and calculating 4. Business Income Billable Hours Option Business Income and Extra Expense The following is added to SECTION I — loss may not be combined. When the PROPERTY,A.Coverage,E. Property Loss alternative billable hours approach Conditions, 5. Loss Payment: described above is selected, the maximum coverage under this loss Business Income Billable Hours Option settlement option is $25,000 on an (1) At your option you may choose to settle a actual loss sustained basis. covered Business Income and Extra 5. Business Income and Extra Expense — Expense loss, as described under the Dependent Properties Business Income, Extra Expense and The heading for SECTION I—PROPERTY, A. Utility Services Additional Coverages, on a billable hours basis. If you choose this Coverage, 5. Additional Coverages, m. settlement method, the billable hours will Business Income from Dependent be verified through review of your Properties is replaced by the following: historical financial records or based on an m. Business Income and Extra Expense average of your billable hourly rate over from Dependent Properties the past 12 months. The following is added to Business (2) This loss settlement option is only Income and Extra Expense from available to you prior to your submission Dependent Properties: to us of calculations described under We will pay the necessary Extra Expense SECTION I—PROPERTY, A. Coverage, you incur due to direct physical loss of or 5. Additional Coverages, f. Business damage to "dependent property" caused Income. by or resulting from a Covered Cause of (3) If you choose this option, SECTION I — Loss. PROPERTY,A. Coverage,5..Additional The definition of Extra Expense for this Coverages, f. Business Income, Additional Coverage is replaced by the paragraph(c) is replaced by the following: following: (c) Business Income means the: 391-1448 08 16 Includes copyrighted material of Insurance services Office,Inc.,with its permission, Page 4 of 17 Extra Expense means necessary (1) You may extend this insurance to expenses you incur during the "period of apply to a"suspension"of"operations" restoration" for the "dependent property" caused by direct physical loss or that you would not have incurred if there damage to property that you depend had been no direct physical loss or on for "web site and communications damage to the premises of any services" from a Covered Cause of "dependent property" caused by or Loss. resulting from a Covered Cause of Loss: (2) We will not pay for any loss of (1) To avoid or minimize the"suspension" Business Income you incur during the of business and to continue first 12 hours that immediately follows "operations"; or the time when you first discovered the (2) To minimize the "suspension" of Covered Cause of Loss. This Waiting business if you cannot continue Period does not apply to Extra "operations". Expense. We will reduce the amount of your (3) The most we will pay for the actual Extra Expense loss to the extent you loss of Business Income and can return 'operations"to normal and necessary and reasonable Extra discontinue such Extra Expense. Expense in any one occurrence under 3 Paragraph 2 of this Additional this Additional Coverage is $50,000 ( ) 9 p ( ) and only for the 7-day period Coverage is replaced by the following: immediately following the Covered (2) The most we will pay under this Cause of Loss. Additional Coverage is $100,000 (4) Coverage does not apply to Websites per occurrence, regardless of the unless there is a duplicate or back-up number of"dependent properties" copy of your Web Page stored at a affected. location that is at least 1,000 feet 6. Transit Business Income and Extra away from the premises of the vendor Expense that provides "web site and The following is added to SECTION I — communications senrices". PROPERTY, A. Coverage, 5. Additional (5) "Web Site and Communication Coverages: Services" means: Transit Business Income and Extra (a) Internet access, e-mail, web Expense hosting, value added network (1) We will pay the actual loss of Business services and application software Income you sustain and necessary and services at the premises of others; reasonable Extra Expense you incur or caused by direct physical loss of or direct (b) Network and router infrastructure physical damage to Covered Property located more than 1,000 feet from while "in transit' caused by or resulting the described premises. from a Covered Cause of Loss. b. This Additional Coverage is not subject to (2) SECTION I — PROPERTY, B. SECTION I — PROPERTY, C. Limits of Exclusions, paragraphs 1.b Earth Insurance. Movement and 1.g Water do not apply to 8. Civil Authority this Additional Coverage: SECTION I — PROPERTY, A. Coverage, 5. (3) The most we will pay for loss in any one Additional Coverages, i. Civil Authority, occurrence under this Additional Coverage paragraph (2) is replaced by the following: is $50,000. (2) Civil Authority Coverage for Business (4) The amount payable under this Additional Income will begin 24 hours afterthe time of Coverage is additional insurance. the first action of civil authority that 7. Business Income from Websites prohibits access to the described premises a. The following is added to SECTION I — and will end: PROPERTY, A.Coverage,5.Additional (a) Four consecutive weeks after the time Coverages: of that action; or Business Income from Websites (b) When your Civil Authority Coverage for Business Income ends; 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 5 of 17 whichever is later. (1) You may extend the insurance that 9. Computer Equipment applies to your Business Personal SECTION I — PROPERTY, A. Coverage, 5. Property to apply to the reduction in value Additional Coverages, r. Computer of the remaining parts of"stock"in process g p of manufacture that are physically Equipment, paragraph (6) is replaced by the undamaged but are unmarketable as a hollowing: complete product because of direct (6) Regardless of the number of insured physical loss or damage from a Covered locations involved, the most we will pay for Cause of Loss to other parts of covered loss or damage under this Additional "stock" in process of manufacture at an Coverage in any one occurrence is the insured location. applicable Limit of Insurance for Covered (2) Should it be determined that such "stock" Property at the premises described in the retains only a salvage value, we retain the Declarations. . option of paying the full value of the The most we will pay for loss or damage "stock" as agreed within this policy, and under this Additional Coverage to property taking the damaged property for salvage described in paragraphs (1)and (2)above purposes. in any one occurrence while "in transit" or (3) Payment under this Coverage Extension is at a premises other than the described included within the applicable Limit of premises is $100,000. Insurance. The most we will pay for loss or damage 12. Contract Penalties under this Additional Coverage to property described in paragraphs (1) and (2)above The following is added to SECTION I — in any one occurrence for property that PROPERTY, A. Coverage, 5. Additional you newly acquire is $100,000. Coverages: With respect to newly acquired property Contract Penalties under this Additional Coverage, coverage (1) We will pay for contract penalties you are will end when any of the following occurs: required to pay due to your failure to (a) The policy expires; provide your product or service according to contract terms because of direct (b) 180 days after you acquire the physical loss or damage by a Covered property listed in (1)(a —d); Cause of Loss to Covered Property. (c) You report values to us. (2) The most we will pay for all penalties in The most we will pay for Extra Expense is any one occurrence is $25,000. $5,000 or the amount shown in the (3) The amount payable under this Additional Additional Property Coverage Schedule in Coverage is additional insurance. any one occurrence. 13. Denial of Access to Premises This Additional Coverage is not subject to The following is added to SECTION I — SECTION I — PROPERTY, C. Limits of PROPERTY, A. Coverage, 5. Additional Insurance. Coverages: 10. Computer and Funds Transfer Fraud Denial of Access to Premises SECTION I — PROPERTY, A. Coverage, 5. Additional Coverages, hh. Computer and (1) We will pay fortheactual loss ofBusiness Funds Transfer Fraud, paragraph (3) is Income you sustain and necessary Extra replaced by the following: Expense you incur when ingress to or egress from the described premises is (3) The most we will pay per occurrence under prevented, due to direct physical loss of or this Additional Coverage is$10,000 unless damage to property that is away from but a higher Limit of Insurance is shown in the within 2000 feet of the described Schedule of Amended Limits of premises, caused by or resulting from any Insurance. Covered Cause of Loss covered under 11. Consequential Loss to Stock this policy. The following is added to SECTION I — (2) The coverage for Business Income will PROPERTY, A. Coverage, 6. Coverage begin 72 hours after the loss or damage to Extensions: the premises that causes the denial of Consequential Loss to Stock access and will apply for a period of up to 391-1448 08 16 Includes copyrighted material of Insurance services Office,Inc.,with its permission. Page 6 of 17 30 consecutive days after coverage (6) The most we will pay for all loss resulting begins. directly from an occurrence is $50,000. (3) The coverage for Extra Expense will begin Regardless of the number of years this immediately after the loss or damage to policy remains in force or the number of the premises that causes the denial of premiums paid, no Limit of Insurance access and will end: cumulates from year to year. (a) 30 consecutive days after coverage 16. Expediting Expenses begins; or The following is added to SECTION I — (b) When your Business Income PROPERTY, A. Coverage, 5. Additional coverage ends; Coverages: whichever is earlier. Expediting Expenses (4) The definitions of Business Income and (1) When a Covered Cause of Loss occurs to Extra Expense contained in the Business Covered Property, we will pay for the Income Additional Coverage and the Extra reasonable and necessary additional Expense Additional Coverage also apply expenses you incur to: to this Denial of Access to Premises (a) Make temporary repairs; Additional Coverage. (b) Expedite permanent repair or 14. Electronic Vandalism replacement of damaged property; or SECTION I — Property, A. Coverage, 5. (c) Provide training on replacement Additional Coverages, dd. Electronic machines or equipment. Vandalism, paragraph (3) is replaced by the (2) The most we will pay for loss under this following: Additional Coverage in any one (3) The most we will pay for loss of or occurrence is $25,000. damage to computer "hardware" or (3) The amount payable under this Additional "software" in any one occurrence under Coverage is additional insurance. this Additional Coverage is $5,000. The most we pay for all covered losses to 17. Extended Business Income computer "hardware" or "software" under SECTION I — PROPERTY, A. Coverage, 5. this Additional Coverage during each Additional Coverages,f. Business Income, separate 12-month period of this policy is (2) Extended Business Income, (a) $100,000. Extended Business Income —Other Than The most we will pay under this Additional Rental Value, paragraph (ii) and (b) Coverage for all loss or damage sustained Extended Business Income—Rental Value, in any one policy year, regardless of the paragraph (ii)are replaced by the following: number of occurrences of loss or damage (a) Extended Business Income — Other or the number of premises, locations or Than Rental Value computer systems involved, is $100,000, (ii) Ends on the earlier of. unless a higher Limit of Insurance is shown in the Declarations. If loss payment 1) The date you could restore your on the first occurrence does not exhaust operations, with reasonable this amount, then the balance is available speed, to the level which would for subsequent loss or damage sustained generate the business income in, but not after, that policy year. With amount that would have existed if respect to an occurrence which begins in no direct physical loss or damage one policy year and continues or results in had occurred; or additional loss or damage in a subsequent 2) 90 consecutive days after the date policy year(s), all loss or damage is determined in (2)(a)(i)above. deemed to be sustained in the policy year (b) Extended Business Income — Rental in which the occurrence began. Value 15. Employee Theft Including ERISA (ii) Ends on the earlier of Compliance 1) The date you could restore tenant SECTION I — PROPERTY, A. Coverage, 5. Additional Coverages, p. Employee Theft occupancy, with reasonable Including ERISA, paragraph (6), is replaced speed, to the level which would b the followin generate the "Rental Value" that Y g: would have existed if no direct 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 7 of 17 physical loss or damage had (ii) The covered "auto's" overturn. occurred; or (b) Collision coverage 2) 90 consecutive days after the date (i) The covered "auto's"collision with determined in (2)(b)(i) above. another object; or 18. Fine Arts ii The covered "auto's" overturn. a. SECTION I—PROPERTY,A. Coverage, (2) For the purpose of this Additional 6. Coverage Extensions, x. Fine Arts, Coverage only, SECTION I—PROPERTY, paragraph(3) is replaced by the following: A. Coverage,2. Property Not Covered, (3) The most we will pay for loss under paragraph a. is replaced by the following: this Additional Coverage is $100,000 a. Aircraft, automobiles, motortrucks and per occurrence regardless of the other vehicles subject to motor vehicle number of locations or buildings registration and: involved. b. For the purpose of this Additional (1) Any "auto" as described in Covera e, SECTION I —PROPERTY G. paragraph (1) above, while used 9 in any professional or organized Property Definitions, 21. "Fine Arts" is racing or demolition contest or replaced by the following: stunting activity, or while 21. "Fine Arts" means architectural practicing for such contest or models, paintings, etchings, pictures, activity; tapestries, rare art glass, art glass (2) Tapes, records, discs or other windows, valuable rugs, statuary, similar audio visual or data sculptures, "antique" furniture, electronic devices designed for "antique" jewelry, bric-a-brac, use with audio, visual or data porcelains, and similar property of electronic equipment; rarity, historical\ralue, or artistic merit. (3) Any device designed or used to 19. Forgery or Alteration detect speed measuring SECTION I — PROPERTY, A. Coverage, 5. equipment such as radar or laser Additional Coverages, k. Forgery or detectors and any jamming Alteration, paragraph (5) is replaced by the apparatus intended to elude or following: disrupt speed measurement (5) The most we will pay for any loss, equipment; or including legal expenses, under this (4) Any electronic equipment, without Additional Coverage is $50,000. regard to whether this equipment 20. Hired Auto —Physical Damage is permanently installed, that The followingis added to SECTION I — receives or transmits audio, visual or data signals and that is not PROPERTY, A. Coverage, 5. Additional designed solely for the Coverages: reproduction of sound. Hired Auto—Physical Damage Coverage (3) For the purpose of this Additional (1) We will pay for loss to an "auto"you or an Coverage only, SECTION I—PROPERTY, "employee", at your direction, lease, hire B. Exclusions does not apply with the or rent without a driver for a period of 30 exception of the following exclusions: days or less for the purpose of conducting (a) 1.d. Nuclear Hazard; customary operations for your business. This does not include any "auto" you (b) 1.f. War and Military Action lease, hire or rent from any of your For the purpose of this Additional "employees" or members of their Coverage only, the following exclusions households. are added to SECTION I — PROPERTY, We will pay for loss to a covered"auto"or B. Exclusions: its equipment caused by: 1. We will not pay for loss to a covered (a) Comprehensive coverage "auto" caused by or resulting from someone causing you to voluntarily From any cause except: part with the"auto"by trick or scheme (i) The covered "auto's"collision with or under false pretenses; or another object; or 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 8 of 17 2. We will not pay for loss caused by or continues into subsequent policy resulting from wear and tear, freezing; period(s). mechanical or electrical breakdown; (2) With respect to this Additional Coverage: blowouts, punctures or other road damage to tires. (a) "Expenses" means: (4) For the purpose of this Additional (i) Costs for notarizing affidavits or Coverage only, the following is added to similar documents attesting to SECTION I — PROPERTY, C. Limits of fraud required by financial Insurance: institutions or similar credit Hired Auto Physical Damage Limits of grantors or credit agencies; Insurance (ii) Costs of certified mail to law enforcement agencies, credit The most we will pay for loss to any one agencies, financial institutions or covered "auto" is the lesser of: similar credit agencies; a. The actual cash value of the damaged (iii)Lost income resulting from: or stolen property as of the time of loss; 1) Time taken off work to complete fraud affidavits; or b. The cost of repairing or replacing the 2 damaged or stolen property with other ) Meeting talking , law enforcemenn property of like kind and quality; or t agencies, credit agencies or legal counsel. c. $50,000. 5 The followin is added to SECTION I — (iv) Loan application fees for ( ) g � reapplying fora loan or loans PROPERTY, D. Deductibles, paragraph when the original application is 5.: rejected solely because the lender Hired Auto— Physical Damage received incorrect credit (6) For the purpose of this Additional information; Coverage only, the following is added to (v) Reasonable attorney fees to: SECTION I — PROPERTY, G. Property 1) Defend lawsuits brought Definitions: against an "insured person" 1. "Auto" means a land motor vehicle, by merchants, financial trailer or semitrailer that is subject to institutions or their collection motor vehicle registration, or designed agencies; for travel on public roads, including 2) Remove any criminal or civil any attached machinery or equipment. judgments wrongly entered The amount payable under this Additional against an "insured person"; Coverage is additional insurance. or This coverage is excess to any other valid 3) Challenge the accuracy or insurance whether collectible or not. completeness of any 21. Identity Theft Expense Reimbursement information in a consumer The following is added to SECTION I — credit report; PROPERTY, A. Coverage, 5. Additional (vi) Charges for long distance Coverages: telephone calls due to "Identity theft to: Identity Theft Expense 1) Merchants; (1) We will pay for"expenses" incurred by an "insured person as a direct result of any 2) law enforcement agencies; one "Identity Theft" first discovered or 3) Financial institutions or other learned of by such"insured person"during similar credit grantors; or the policy period. 4) Credit agencies Any act or series of acts committed by one (vii)Reasonable fees for professional or more persons, or in which such persons financial advice or professional are aiding and abetting others against an credit advice. "insured person", is considered to be one "identity theft" even if a series of acts 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 9 of 17 The most we will pay for "expenses" (5) The most we will pay under this Additional under paragraph (2) (a) is $5,000, Coverage for all"Expenses" arising out of subject toa maximum of$200 per day. all "Identity Theft" against an "Insured (b) For purposes of this Additional Person" incurred in any one policy year, regardless of the number of "Identity Coverage, "identity theft' means: Thefts" involved, is $15,000 unless a The act of knowingly transferring or higher Limit of Insurance is shown in the using, without lawful authority, a Declarations. means of identification of an "insured (6) In order for coverage to be provided under person with the intent to commit,or to aid or abet another to commit, any this Additional coverage, you must send to unlawful activity that constitutes a us, within 60 days after our request, violation of Federal law or a felony receipts, bills or other records that support under any applicable state or local your claim for "expenses" under"identity theft" coverage. law; and (c) "Insured person" means: 22. Interruption of Computer Operations (i) For sole proprietorships: The SECTION I — PROPERTY, A. Coverage, 5. individual who is the sole Additional Coverages, ee. Interruption of proprietor of the Named Insured Computer Operations, paragraph (3) is shown in the Declarations; replaced by the following: (ii) For partnerships: Any individual (3) The most we will pay under this Additional that is a partner of the Named Coverage — Interruption of Computer Insured shown in the Operations for all loss sustained and Declarations; expense incurred in any one policy year, regardless of the number of interruptions (iii)For corporations or any other type or the number of premises, locations or of organization: The Chief computer systems involved is: Executive Officer, and any individual who has an ownership (a) $500,000 unless a higher Limit of interest of at least 20% of the Insurance is shown in the Named Insured, shown in the Declarations. If loss payment relating Declarations. to the first interruption does not exhaust this amount,then the balance (3) The following additional exclusions apply is available for loss or expense to this Additional Coverage: sustained or incurred as a result of We will not pay for: subsequent interruptions in that policy (a) Expenses incurred due to any year. A balance remaining at the end fraudulent, dishonest or criminal acts of a policy year does not increase the by: amount of insurance in the next policy year. With respect to any interruption (i) An "insured person'; which begins in one policy year and (ii) Any person aiding or abetting an continues or results in additional loss "insured person"; or or expense in a subsequent policy (iii)Any authorized representative of year(s), all loss and expense is an "insured person'; deemed to be sustained or incurred in the policy year in which the whether acting alone or in collusion interruption began. with others; or b Loss other than "expenses". Account (b) $25,000 in any one occurrence for ( ) p interruptions covered under balances which arise out of fraudulent paragraphs (1) and (2) above for loss or unauthorized charges would be one arising out of a Covered Cause of example of loss other than Loss occurring away from the "expenses". described premises. This per (4) Regardless of the amount of the occurrence limit applies regardless of deductible for Covered Property shown in the number of premises involved. the Declarations, the most we will deduct (c) $50,000 for all losses arising out of from any claim for "expenses" under this interruptions covered under Additional Coverage for any one "identity paragraphs (1) and (2) that arise out theft" is $250. of a Covered Cause of Loss occurring 391-1448 08 16 Includes copyrighted material of Insurance Sendces Office,Inc.,with its permission. Page 10 of 17 away from the described premises Counterfeit Money, paragraph(3)is replaced during each separate 12 month period by the following: of this policy. (3) The most we will pay for any loss under 23. Marring and Scratching this Additional Coverage is $25,000. The following is added to SECTION I — 26. Newly Acquired or Constructed Property— PROPERTY, A. Coverage, 6. Coverage Business Income and Extra Expense Extensions: SECTION I — PROPERTY, A. Coverage, 6. Marring and Scratching Coverage Extensions, a. Newly Acquired or (1) You may extend the insurance that Constructed Property, paragraph (3) is applies to Business Personal Property to replaced by the following: apply to damage caused directly by (3) Business Income and Extra Expense sudden and accidental marring and You may extend the insurance that scratching of: applies to Business Income and Extra (a) Your"stock"; Expense to apply to property at any (b) Your printing plates; or location you acquire. The most we will pay for loss or damage under this Extension is (c) Property of others that is in your care, $500,000 at each premises. custody or control. 27. Ordinance or Law — Demolition Cost and (2) This Coverage Extension does not apply Increased Cost of Construction to: SECTION I — PROPERTY, A. Coverage, 5. (a) Property at other than the described Additional Coverages, (.Ordinance or Law, premises; or (5) Loss Payment, paragraph (d) is replaced (b) Personal Property in transit. by the following: (3) Payment under this Coverage Extension is (d) The most we will pay for the total of all included within Limit of Insurance covered losses for Demolition Cost and applicable to your Business Personal Increased Cost of Construction for each Property. building described in the Declarations is 24. Money and Securities $25,000 or the amount shown in the Additional Property Schedule. If a SECTION I — PROPERTY, A. Coverage, 5. damaged building(s) is covered under a Additional Coverages, s. Money and Blanket Limit of Insurance and the Blanket Securities, paragraph (5) is replaced by the Limit of Insurance applies to more than following: one building or item of property, then the (5) The most we will pay for loss in any one most we will under this Additional occurrence is: Coverage, for each building, is$25,000, or (a) $25,000 or the amount shown in the the amount shown in the Additional Additional Property Coverage Property Coverage Schedule. Schedule Inside the Premises for 28. Ordinance or Law — Increased Period of "money" and "securities"while: Restoration (i) In or on the described premises; a. The following is added to SECTION I — or PROPERTY,A. Coverage,5.Additional (ii) Within a bank or savings Coverages, I. Ordinance or Law, institution in the coverage territory; paragraph (4) Coverage: and If a Covered Cause of Loss occurs to (b) $25,000 or the amount shown in the property at the premises described in the Additional Property Coverage Declarations, coverage is extended to Schedule Outside the Premises for include the amount of actual and "money" and "securities"while at any necessary loss you sustain during the other location listed in (1) above and increased period of suspension' of while in the coverage territory. "operations" caused by or resulting from the enforcement of any ordinance or law 25. Money Orders and Counterfeit Money that: SECTION I — PROPERTY, A. Coverage, 5. (a) Regulates the construction or repair of Additional Coverages,j.Money Orders and any property; 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 11 of 17 (b) Requires the tearing down of parts of b. The following is added to SECTION I — any property not damaged by a PROPERTY,A. Coverage,5.Additional Covered Cause of Loss; and Coverages, I. Ordinance or Law, (5) (c) Is in force at the time of loss. Loss Payment, paragraph (c): However, coverage is not extended under Regardless of the number of locations this endorsement to include loss caused insured or buildings involved, the most we by or resulting from the enforcement of will pay for any loss to tenant's any ordinance or law which requires: improvements and betterments under this Additional Coverage in any one (d) The demolition, repair, replacement, occurrence is $25,000. reconstruction, remodeling or remediation of property due to 30. Outdoor Property contamination by"pollutants"or due to SECTION I — PROPERTY, A. Coverage, 6. the presence, growth, proliferation, Coverage Extensions,c. Outdoor Property, spread or any activity of"fungi", wet or paragraph (3) is replaced by the following: dry rot or bacteria; or (3) Regardless of the number of described (e) Any insured or others to test for, premises involved, the most we will pay monitor, clean up, remove, contain, for loss or damage under this Extension, treat, detoxify or neutralize, or in any including debris removal expense, is way respond to, or assess the effects $25,000, but not more than$1,000 for any of"pollutants", "fungi", wet or dry rot or one tree, shrub or plant. bacteria. 31. Personal Effects b. The following is added to SECTION I — SECTION I — PROPERTY, A. Coverage, 6. PROPERTY,A.Coverage 5. Additional Coverage Extensions, d. Personal Effects, Coverages, 1. Ordinance or Law, (5) paragraph (3) is replaced by the following: Loss Payment, paragraph (c): (3) The most we will pay for loss or damage The most we will pay for loss under under this Extension is $75,000 at each Increased Period of Restoration in any described premises. one occurrence is $50,000 for each described building shown in the 32. Portable Electronic Devices Coverage Declarations or the amount shown in the Worldwide Additional Property Coverage Schedule. If The following is added to SECTION I — a damaged building(s) is covered on a PROPERTY, A. Coverage, 5. Additional blanket Limit of Insurance which applies to Coverages: more than one building or item of property, Portable Electronic Devices Coverage then the most we will pay for Increased Worldwide Period of Restoration for each described building in any one occurrence is$50,000. (1) We will pay for loss or damage caused by 29. Ordinance or Law(Tenant's Improvement or resulting from a Covered Cause of Loss Extension to portable electronic devices while anywhere in the world, including while"in a. The following is added to SECTION I — transit". PROPERTY,A. Coverage,5.Additional (2) For the purpose of this Additional Coverages, I. Ordinance or Law, Coverage, the following is added to paragraph (4) Coverage: SECTION I — PROPERTY, G. Property Coverage provided under paragraphs (a), Definitions: (b) and (c) above applies to tenant's Portable electronic devices includes Improvements and betterments but only if laptops, tablets, e-readers, smartphones a Limit of Insurance is shown in the or other lightweight, hand-held or Declarations for Business Personal wearable devices capable of storing, Property. Business Personal Property retrieving and processing data. must be insured on a replacement cost basis. (3) This coverage is provided when the rovisional and excess property is owned by you or owned by This extension is p others when in your or your"employees"' to any other valid insurance for tenant's care, custody or control, subject to improvements and betterments whether SECTION I — PROPERTY, E. Property collectible or not. 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 12 of 17 Loss Conditions, 5. Loss Payment, (1) $10,000 for furs, fur garments and paragraph d.(3)(b). garments trimmed with fur. (4) We will not pay for loss or damage to (2) $10,000 for jewelry, watches, watch portable electronic devices when caused movements, jewels, pearls, precious by, resulting from, or arising out of"theft" and semi-precious stones. This limit or unexplained loss when the property is does not apply to jewelry and watches checked baggage with a carrier for transit. worth $250 or less per item. (5) The provisions for a Business Income loss (3) $25,000 for bullion, gold, silver, will be governed by the terms of SECTION platinum and other precious alloys or I — PROPERTY, A. Coverage, 5. metals. Additional Coverages, f. Business 34. Preservation of Property— Expense Income except: The following is added to SECTION I — (a) There is no requirement that a loss PROPERTY, A. Coverage, 5. Additional occur within 1,000 feet or at the Coverages: described premises as stated in paragraph (1)(a); and Preservation of Property—Expense (b) The following are not included under (1) If it is necessary to move Covered this Additional Coverage: Property from the described premises to preserve it from loss or damage by a (i) Continuing normal operating Covered Cause of Loss, we will pay your expenses incurred, including expenses to move or store the Covered "payroll expense"; Property. (ii) Extended Business Income. (2) This coverage applies for 90 days after the (6) The provisions for Extra Expense loss will property is first moved, but does not be govemed by the terms of SECTION I — extend past the date on which this policy PROPERTY, A. Coverage,5.Additional expires. Coverages, g. Extra Expense except: (3) The most we will pay under this Additional (a) There is no requirement that a loss Coverage is $25,000. occur within 1,000 feet or at the This Additional Coverage is an additional described premises as stated in amount of insurance. paragraph g.(1) and g.(2). 35. Personal Property in Transit (7) Limitations, item b. does not apply to this Additional Coverage. SECTION I — PROPERTY, A. Coverage, 6. 8 SECTION I — PROPERTY, B. Coverage Extensions, i. Personal Property ( ) in Transit, paragraph (5) is replaced by the Exclusions, 5. Business Income and following: Extra Expense Exclusions, paragraph (4) does not apply to this Additional (5) Payment under this Coverage Extension is Coverage. included within the Limit of Insurance Regardless of the number of lost or applicable to your Business Personal (9) Re 9 Property damaged portable electronic devices, the most we will pay per occurrence including 36. Sales Representative Samples actual loss of Business Income you SECTION I — PROPERTY, 5. Additional sustain and necessary Extra Expense you Coverages, y. Sales Representative incur, is $10,000. Samples, paragraph (3) is replaced by the (10)The amount payable under this Additional following: Coverage is additional insurance. (3) The most we will pay for any loss or 33. Precious Metal Theft Payment Changes damage under this Additional Coverage is SECTION I — PROPERTY, A. Coverage, 4. $25,000. Limitations, paragraph c. is replaced by the 37. Temporary Relocation of Property following: The following is added to SECTION I — c. For loss or damage by "theft", the PROPERTY, A. Coverage, 5. Additional following types of property are covered Coverages: only up to the limits shown: Temporary Relocation of Property 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 13 of 17 (1) We will pay for loss of or damage to We will only pay for loss you sustain Covered Property from a Covered Cause after the first 24 hours following the of Loss while it is away from the described direct physical loss or damage to the premises, if it is being stored temporarily property described above. at a location you do not own, lease or The most we will pay for loss in any operate while the described premises is one occurrence under this Additional being renovated or remodeled. Coverage is $25,000 at each (2) This coverage applies for 90 days after the described premises or the Limit of property is first moved, but does not Insurance shown in the Additional extend past the date on which this policy Property Coverage Schedule. expires. b. SECTION I—PROPERTY, A. Coverage, (3) The most we will pay under this Additional 5. Additional Coverages, bb. Utility Coverage is $50,000. Services, paragraph (4) is deleted. (4) The amount payable under this Additional 40. Valuable Papers and Records(Other Than Coverage is additional insurance. Electronic Data) 38. Tenant Signs SECTION I — PROPERTY, A. Coverage, 6. SECTION I — PROPERTY, A. Coverage, 5. Coverage Extensions, e. Valuable Papers Additional Coverages, It. Tenant Signs, and Records(OtherThan Electronic Data), paragraph (4) is replaced by the following: paragraphs (2) and (3) are replaced by the (4) The most we will pay for loss or damage in following: any one occurrence is the Limit of (2) The most we will pay under this Coverage Insurance for Business Personal Property Extension for loss or damage to "valuable shown in the Declarations. papers and records" in any one occurrence at the described premises is 39. Utility Services (Including Overhead $100,000. Transmission Lines) (3) The most we will pay under this Coverage a. SECTION I—PROPERTY, A. Coverage, Extension for loss or damage to "valuable 5. Additional Coverages, bb. Utility papers and records" in any one Services, paragraphs (1) and (2) are occurrence not at the described premises replaced by the following: is $100,000. (1) We will pay for loss of or damage to 41. Worldwide Property Off Premises Covered Property caused by an The following is added to SECTION I — interruption in sendce to the described premises. The interruption must result PROPERTY, A. Coverage, 6. Coverage from direct physical loss or damage by Extensions: a Covered Cause of Loss to property Worldwide Property Off-Premises not on the described premises that (1) You may extend the insurance that provides the services shown in applies to your Business Personal paragraph (3) below. Property and Personal Property of Others The most we will pay for loss in any to apply to that property while it is one occurrence under this Additional temporarily outside the coverage territory Coverage is $25,000 at each if it is: described premises or the Limit of (a) Temporarily at a location you do not Insurance shown in the Additional own, lease or operate; Property Coverage Schedule. 2 We will a for the actual loss of (b) Temporarily on display or exhibit at ( ) pay any fair, trade show or exhibition; Business Income you sustain and necessary Extra Expense you incur (c) Samples of your"stocK'in trade in the caused by the interruption of service custody of your sales representatives; at the described premises. The or interruption must result from direct (d) While "in transit" between the physical loss or damage by a Covered described premises and a location Cause of Loss to property not on the described in (a), (b)or(c) above. described premises that provides the (2) The most we will pay for loss or damage services shown in paragraph (3) under this Extension is $50,000. below. 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 14 of 17 (3) This Extension provides an additional If you agree in a written contract, written amount of insurance. agreement or permit that the insurance SECTION II — LIABILITY provided to any person or organization included as an Additional Insured under Paragraphs 2. through 8. amend coverage provided SECTION II — LIABILITY, C. Who is an under SECTION II — LIABILITY. Insured, is primary and non-contributory, the 1. Additional Insured by Contract, Agreement or following applies: Permit—Amended If other valid and collectible insurance is For purposes of the coverage provided by this available to the Additional Insured for a loss endorsement, Coverage 1.Additional Insured by covered under SECTION II — LIABILITY of Contract,Agreement or Permit,subparagraph c. this Coverage Part, ourobligations are limited (5) of the Businessowners Liability Special as follows: Broadening Endorsement is replaced by the (1) Primary Insurance following: This insurance is primary to other This provision does not apply to: insurance that is available to the (5) All professional liability as an architect or Additional Insured which covers the engineer arising out of any construction Additional Insured as a Named Insured. agreement or activities under which any We will not seek contribution from any insured or anyone acting on any insured's other insurance available to the Additional behalf provides or provided service, Insured except: advice, expertise or work. Construction includes, but is not limited to, the plan, (a) For the sole negligence of the conception, design, build, construct, Additional Insured; assembly, development, safety, erection, (b) When the Additional Insured is an formation, reconstruct, rehabilitation, Additional Insured under another repair, or any improvement made to real primary liability policy; or property. Construction also includes the (c) When b. below applies. hiring, supervision or management of any of these activities. However, this If this insurance is primary, our obligations exclusion does not apply to liability arising are not affected unless any of the other out of an insured's presence at a jobsite insurance is also primary. Then, we will that was not caused by professional share with all that other insurance by the activities listed in the above paragraph. method described in c. below. This exclusion applies even if the claims (2) Excess Insurance against any insured allege negligence or (a) This insurance is excess over any of other wrongdoing in the supervision, the other insurance, whether primary, hiring, employment,training or monitoring excess, contingent or on any other of others by that insured, if the basis: "occurrence" which caused the "bodily (i) That is Fire, Extended Coverage, injury"or"property damage"or the offense Builder's Risk, Installation Risk or which caused the "personal and similar coverage for"your work"; advertising injury" involved professional liability as an architect or engineer arising (ii) That is Fire insurance for out of any construction agreement or premises rented to the Additional activities under which any insured or Insured or temporarily occupied anyone acting on any insured's behalf by the Additional Insured with provides or provided service, advice, permission of the owner; expertise or work. (iii)That is insurance purchased by 2. Additional Insured by Contract, Agreement or the Additional Insured to cover the Permit—Primary and Non-contributory Additional Insured's liability as a a. The followingis added to SECTION III — tenant for "property damage" to premises rented to the Additional COMMON POLICY CONDITIONS Insured or temporarily occupied (APPLICABLE TO SECTION I — PROPERTY by the Additional with permission AND SECTION II—LIABILITY), paragraph H. of the owner; or Other insurance: (iv) If the loss arises out of the Additional Insured — Primary and Non- maintenance or use of aircraft, Contributory 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission, Page 15 of 17 "autos"orwatercraft to the extent 1. "Unnamed joint venture" means any joint not subject to Exclusion g. of venture in which you are a member or SECTION II — LIABILITY. B. partner where: Exclusions, 1. Applicable to a. Each and every one of your co- Business Liability Coverage. ventures in that joint venture is a hair (v) That is insurance available to you salon. for your participation in any past b. That joint venture is not. or present "unnamed joint venture". 3. Aggregate Limit of Insurance (Per Project) (vi)That is any insurance you may a. For purposes of the coverage provided by this have that provides coverage for endorsement, the following is added to your professional services. SECTION II — LIABILITY, D. Liability and (b) When this insurance is excess, we will Medical Expenses Limits: have no duty to defend the insured The General Aggregate Limit under D. against any "suit" if any other insurer Liability and Medical Expenses Limits of has a duty to defend the insured Insurance applies separately to each of"your against that "suit". If no other insurer projects" or each location listed in the defends, we will undertake to do so, Declarations. but we will be entitled to the insured's b. For purposes of the coverage provided by this rights against all those other insurers. endorsement, the following definition is added (c) When this insurance is excess over to SECTION II—LIABILITY, F. Liability And other Insurance, we will pay only our Medical Expenses Definitions: share of the amount of the loss, if any, 1. "Your project" means: that exceeds the sum of. a. Any premises, site or location at, on, (i) The total amount that all such or in which "your work" is not yet other insurance would pay for the completed; and loss in the absence of this b. Does not include any location listed in insurance; and the Declarations. (ii) The total of all deductible and self- 4. Damage to Premises Rented To You—Revised insured amounts under all that Limit other insurance. SECTION II — LIABILITY, D. Liability And We will share the remaining loss, if Medical Expenses Limits of Insurance, any, with any other insurance that is not described in this Excess Insurance paragraph 4. is replaced by the following: provision and was not bought 4. The most we will pay under Business Liability specifically to apply in excess of the Coverage f or damages because of"property Limits of Insurance shown in the damage"to any one premises, while rented to Declarations of this Coverage Part. you or while temporarily occupied by you with (3) Method of Sharing permission of the owner will be the greater of If all of the other insurance permits a. $1,000,000; or contribution by equal shares, we will follow b. The Limit of Insurance f or Damage to this method also. Under this approach, Premises Rented To You shown in the each insurer contributes equal amounts Declarations. until it has paid its applicable limit of 5. Limits of Insurance —Medical Expenses insurance or none of the loss remains, For purposes of the coverage provided by this whichever comes first. If any of the other endorsement, SECTION II — LIABILITY, D. insurance does not permit contribution by Liability and Medical Expenses Limits of equal shares, we will contribute by limits. Insurance, paragraph 3. is replaced by the Under this method, each insurer's share is following: based on the ratio of its applicable limit of insurance to the total applicable limits of 3. Subject to the Liability and Medical Expenses insurance of all insurers. Limits Limit, the most we will pay for all b. For the purposes of coverage provided under medical expenses because of"bodily injury" this endorsement, the following definition is sustained by any one person is$10,000 orthe added to SECTION II — LIABILITY, F. Medical Expenses limit shown in the Liability and Medical Expense Definitions: Declarations, whichever is greater. 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission, Page 16 of 17 6. Newly Acquired or Formed Organizations an additional insured under Additional SECTION II—LIABILITY, C.Who is An Insured, Insureds—Unnamed Joint Venture below. paragraph 3. a. is replaced by the following: b. For purposes of the coverage provided by this a. Coverage underthis provision is afforded only endorsement, the following is added to until the 180u' day after you acquire or form SECTION II — LIABILITY, C. Who is an the organization or the end of the policy Insured: period, whichever is earlier. Additional Insureds — Unnamed Joint 7. Nonowned Watercraft Venture: SECTION II — LIABILITY, B. Exclusions, 1. You, as an insured for your participation in any Applicable to Business Liability Coverage, g. past or present "unnamed joint venture". Aircraft,Auto or Watercraft, (2)Aircraft(Other However, you are not an insured if the Than Unmanned Aircraft), paragraph (b) is "unnamed joint venture has: replaced by the following: (1) Direct employees; or (b) A watercraft you do not own that is: (2) Owns, rents, or leases any real or (i) Less than 75 feet long; and personal property. (ii) Not being used to carry persons or No other member or partner, or their spouses, property for a charge. of any past or present"unnamed joint venture" is an insured. 8. Who is an Insured —Unnamed Joint Venture c. For purposes of the coverage provided by this a. For purposes of the coverage provided by this endorsement, the following definition is added endorsement, the final paragraph of SECTION to SECTION II—LIABILITY, F. Liability And II — LIABILITY, C. Who Is An Insured is Medical Expenses Definitions: replaced by the following: 1. "Unnamed joint venture" means any joint Unnamed Joint Venture venture in which you are a member or No person or organization is an insured with partner where: respect to the conduct of any current or past a. Each and every one of your co- partnership, joint venture or limited liability ventures in that joint venture is an company that is not shown as a Named architectural, engineering or surveying Insured in the Declarations. However, this firm; and does not apply to you, for your participation in any past or present "unnamed joint venture", b. That joint venture is not named in the or if that person or organization is otherwise Declarations. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. 391-1448 08 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission, Page 17 of 17 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.04-84) WAIVER Of OUR RIGHT To RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration Of your employees While engaged In the work described In the Schedule. The additional premium For this endorsement shall be 2%Of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 8/21/2018 Policy No. SWC1203057 Endorsement No. 0 Insured RHA Landscape Architects-Planners,Inc. Premium$ 5072 Insurance Company Security National Insurance Company Countersigned by WC 04 03 06 (Ed.04-84)