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HomeMy WebLinkAbout5982CNA Policyholder Notice - Countrywide e . REQUEST FOR JURISDICTIONAL INSPECTION OF PRESSURE EQUIPMENT Many states and some cities issue certificates permitting the continued operation of certain equipment such as boilers, water heaters and pressure vessels. Periodic inspections are required to renew these certificates. In most jurisdictions, as part of an equipment breakdown policy, insurance company employees who have been licensed are authorized to perform these inspections. If: You own/operate pressure equipment that requires a certificate from a state, county, city or parish to operate legally, and We insure that equipment under this Policy, and You would like CNA to perform the next required inspection: Then: Complete the form on page 2 and email, mail or fax as instructed: No need to call or respond if you do not have boilers or pressure vessels that require operating certificates. BY EMAIL: EBinspections(&cna.com (please scan the completed form and attach) BY MAIL: CNA Equipment Breakdown Risk Control 184 Liberty Corner Road 4th Floor, Suite 402 Warren, NJ 07059 BY FAX: 609-524-3649 BY PHONE: call 866-262-0540 — press "4" Questions or inquiries can be made via any of the above methods of communication. Please note the following: Your jurisdiction(s) may charge you a fee for renewing a certificate. It is your responsibility to pay such a fee. If CNA is required to pay the fee on your behalf, CNA will invoice you to recover that fee. All the provisions of the INSPECTION AND SURVEYS condition apply to the inspections described in this notice. Failure to notify us can result in fines and penalties being issued to the equipment owner by the governing jurisdiction. CNA is not responsible for said fines or penalties. REMINDER If new equipment is installed or old equipment replaced that requires a jurisdictional inspection, please let us know by transmitting the new information to the postal address/fax number/email address listed above and on the following page. If this is a renewal and information (locations) has not changed, please disregard this notice. If inspection and maintenance are outside of your area of responsibility, we would appreciate your forwarding this notice to the appropriate person. If no response is received, we are assuming there are no jurisdictional objects at your location(s) and no inspections are required. Note: Jurisdictional inspections are not conducted outside of the United States, its territories, possessions, or Canada. CNA62823XX (07-2017) Copyright CNA All Rights Reserved. Page 1 of 2 CNA Policyholder Notice - Countrywide REQUEST FOR JURISDICTIONAL INSPECTION Insured Name: Facility/Location Name: Policy Number: Policy Term: Contact Person & Title: Contact Phone Number(s)—Office: Cell: Contact Email Address: Location Address' City State Zip 1. 2. 3. Equipment Type 2,1,1 Boiler, Pressure Vessel) Registration Number Certificate Expiration Date Completed By (Name & Date): Telephone #/Email Address: BY EMAIL: EBinspections(&cna.com (please scan the completed form and attach) BY MAIL: BY FAX: 609-524-3649 CNA Equipment Breakdown Risk Control 184 Liberty Corner Road 4th Floor, Suite 402 Warren, NJ 07059 BY PHONE: call 866-262-0540 – press "4" If multiple objects and/or multiple locations, please list all required information on separate page(s). 2Boiler is defined as an enclosed vessel heated by fuel or electricity to produce steam or hot water. 3Pressure Vessel is defined as an enclosed vessel (tank) greater than 6 cubic feet (18 inches x 40 inches) to store liquid or gas under pressure for use when needed. 4LPG (ex: propane, propylene, butane & butylenes) Tank with vapor pressures not exceeding that allowed for commercial propane. California requirement only. CNA62823XX (07-2017) Copyright CNA All Rights Reserved. Page 2 of 2 CNA Policy Holder Notice - Countrywide ma - r •r a THIS NOTICE DOES NOT FORM A PART OF THE POLICY, GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. As used herein, 1) "we" means the insurer listed on the Declarations or the Certificate of Insurance, as applicable; and 2) you" means the first person or entity named on the Declarations or the Certificate of Insurance, as applicable. You are hereby notified that under the Terrorism Risk Insurance Act, as extended and reauthorized ("Act"), you have a right to purchase insurance coverage of losses arising out of acts of terrorism, as defined in Section 102(1) of the Act, subject to all applicable policy provisions. The Terrorism Risk Insurance Act established a federal program within the Department of the Treasury, under which the federal government shares, with the insurance industry, the risk of loss from future terrorist attacks. This Notice is designed to alert you to coverage restrictions and to certain terrorism provisions in the policy. If there is any conflict between this Notice and the policy (including its endorsements), the provisions of the policy (including its endorsements) apply. CHANGE IN THE DEFINITION OF A CERTIFIED ACT OF TERRORISM The Act applies when the Secretary of the Treasury certifies that an event meets the definition of an act of terrorism. Originally, the Act provided that to be certified, an act of terrorism must cause losses of at least five million dollars and must have been committed by an individual or individuals acting on behalf of any foreign person or foreign interest to coerce the government or population of the United States. However, the 2007 re -authorization of the Act removed the requirement that the act of terrorism must be committed by or on behalf of a foreign interest, and now certified acts of terrorism may encompass, for example, a terrorist act committed against the United States government by a United States citizen, when the act is determined by the federal government to be "a certified act of terrorism." In accordance with the Act, we are required to offer you the ability to purchase coverage for losses resulting from an act of terrorism that is certified under the federal program. The other provisions of this policy, including nuclear, war or military 0 action exclusions, will still apply to such an act. 00 DISCLOSURE OF FEDERAL PARTICIPATION IN PAYMENT OF TERRORISM LOSSES The Department of the Treasury will pay a share of terrorism losses insured under the federal program. In 2015, the federal share equals 85% of that portion of the amount of such insured losses that exceeds the applicable insurer retention, and shall decrease by 1 percentage point per calendar year until equal to 80%. LIMITATION ON PAYMENT OF TERRORISM LOSSES If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year (January 1 through December 31), the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. CNA81758XX (Ed. 03-15) Copyright CNA All Rights Reserved. Page 1 of 2 CNA Policy Holder Notice - Countrywide Further, this coverage is subject to a limit on our liability pursuant to the federal law where, if aggregate insured losses attributable to terrorist acts certified under the Act exceed $100 billion in a calendar year (January 1 through December 31) and we have met our insurer deductible under the Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion. In such case, insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. CONFIRMATION OF ACCEPTANCE OF COVERAGE In accordance with the Act, we offered you coverage for losses resulting from an act of terrorism that is certified under the federal program. This notice confirms that you have chosen to accept our offer of coverage for certified acts of terrorism. The policy's other provisions, including nuclear, war or military action exclusions, will still apply to such an act. The premium charge for terrorism coverage, if any, is shown separately on the Declarations or the Certificate of Insurance, as applicable. CNA81758XX (Ed. 03-15) Copyright CNA All Rights Reserved. Page 2 of 2 CNA Policy Holder Notice NOTICE OF AMENDMENTS TO POLICY FORMS- CNA Connect 2016-1 If your expiring policy incorporated an earlier edition of any of the following forms attached to your renewal, a summary of the changes therein is described below. This Notice does not form a part of your policy. No coverage is provided by this Notice nor can it be construed to replace any portion of your policy. You should read your policy and review your Declarations page for complete information on the coverages you are provided. If there is any conflict between the policy and this Notice, THE PROVISIONS OF THE POLICY SHALL PREVAIL. Carefully read your policy, including the endorsements attached to your policy. Summary of Changes Made To Interline Forms: SB147052C (06/16) Notice of Cancellation or Material Change This form has been amended to specify at least 30 days notice of cancellation to the (non-insured) entity whose name and address are shown in its Schedule. Such entities are typically customers of a Named Insured. SB300022C (06/16) Waiver of Subrogation This form has been amended to clarify that its "blanket waiver" provision applies only to written commitments made prior to loss, and that specific beneficiaries can be scheduled on the endorsement itself, or in the Declarations. Summary of Changes Made To Property Forms — Choice Endorsements: SB300175G (06/16) Accountants Choice Endorsement and SB300181G (06/16) Lawyers Choice Endorsement Enhances coverage by deleting the 'Billable Hours' coverage extension, and replacing it with a redefinition of "Net Income" that makes the entire Business Income limit available for billable hours. Enhances coverage 4.d. (Business Personal Property at Unnamed Locations) to also apply to such property at leased storage locations. SB300845C (06/16) Advanced Medical Technology Gold Choice Endorsement Adds Summary of Coverages & Limits Retitles the Coverage Extension applicable to Research and Development Property, and makes the following changes: Defines "research animals" and includes them within the definition of "Research and Development Project 0 Property" eliminating the need for separate coverage of laboratory animals. 0 0 Will cover research and development continuing expenses without offset for net loss if the research and development project had not yet generated a net profit. Defines "period of restoration" to include the time required for the U.S. Food & Drug Administration to certify the described premises as ready to resume research and development projects at the same level of certification that existed prior to loss. Clarifies that the "period of restoration" can last no longer than 365 days following the date that the physical loss to the "research and development property" occurred. Subjects "Research and Development Project Property" to the same Off -Premises and Transit limits as apply to other types of property (eliminating special such limits applicable only to "Research and Development Project Property.") Added sublimited Decontamination Expense Coverage. Added sublimited Technology Services Provider Coverage. Added sublimited Contaminated and Reduced Quality Stock Coverage. CNA86716XX (Ed. 06/16) Copyright CNA All Rights Reserved. Page 1 of 6 CNA Policy Holder Notice Replaced 'Spoilage Coverage' with 'Spoilage (Temperature or Humidity Change) Coverage.' The replacement coverage does not require that the change in temperature or humidity result from particular perils. The replacement coverage applies to all Business Personal Property (and resulting Business Income), not just to perishable stock. The replacement coverage does not apply to contamination of perishable stock by refrigerant, but such contamination loss may be partially covered by Decontamination Expense Coverage or by Equipment Breakdown "Pollutants" coverage. SB300177H (06/16) Architects, Engineers and Surveyors Choice Endorsement Amends coverage 5. (Business Personal Property at Unnamed Locations) to: also apply to such property at leased storage locations (a coverage enhancement); and exclude property after delivery to others, property leased or rented to others, or property in the custody of the United States Postal Service (a coverage reduction). SB300616D (06/16) Business Services Choice Endorsement SB300618D (06/16) Choice Extra Endorsement SB300631 D (06/16) Fast Food Choice Endorsement SB300614D (06/16) Manufacturers Choice Endorsement SB300617D (06-16) Real Estate Agents and Brokers Choice Endorsement SB300627D (06/16) Super Choice Endorsement CNA79782XX (06-16) Technology Super Choice Endorsement and SB300628D (06/16) Wholesale/Distributors Choice Endorsement Enhances the Coverage Extension entitled Business Personal Property at Unnamed Locations to also apply to such property at leased storage locations. SB300179G (06/16) Choice Endorsement Corrects the limit shown in the Schedule for'Utility Services — Time Element' coverage to match the actual limit described in the text that provides this coverage. SB147046E (06/16) Technology Choice Endorsement Adds a Summary of Coverages And Limits. In paragraphs A.2. through A.4, and 7.a. through 7.f., the limit increases have been rephrased to be specified amounts of increase (to be added to the original values specified in the Coverage Extensions or Additional Coverages) rather than new totals that replace the original values. In the 'Computer Fraud' Coverage Extension's listing of Businessowners Special Property exclusions that do not apply to this Coverage Extension, an additional exclusion is exempted for this coverage, and the paragraph number of the first exempted exclusion is corrected. Enhances the Coverage Extension entitled Business Personal Property at Unnamed Locations to also apply to such property at leased storage locations. Adds a new Coverage Extension: Research and Development Business Income. Summary of Changes Made To Property Forms — Other Than Choice Endorsements: SB146802E (06/16) Business Income And Extra Expense Corrects a paragraph number reference contained in paragraph 3.b.2.. SB146805B (06/16) Claim Data Expense Clarifies that this Additional Coverage does not cover expenses for public adjusters, loss adjusters or loss consultants. CNA86716XX (Ed. 06/16) Copyright CNA All Rights Reserved. Page 2 of 6 CNA Policy Holder Notice SB146983E (06/16) Computer Fraud Enhances coverage by exempting it from the Businessowners Special Property exclusion entitled Malicious Code. SB146807E (06/16) Employee Dishonesty Coverage With respect only to this coverage, enhances the definition of "employee" to include any natural person serving the Named Insured's interest on a committee. SB300083C (06/16) Exclusion - Theft Corrects a paragraph number reference contained in paragraph B.. Summary of Changes Made To Liability Forms — Additional Insured Endorsements: SB300113D (06/16) Additional Insured — Designated Person or Organization Adds a provision that stipulates if the Named Insured has negotiated in a contract to provide an additional insured with lesser GL coverage or limits than the Named Insured carries for its own protection, then the additional insured's coverage is constrained to such lesser coverage and limits. SB146968B (06/16) Blanket Additional Insured Endorsement With Products -Completed Operations Coverage and Blanket Waiver of Subrogation — Architects Engineers and Surveyors Broadens the potential universe of additional insured's to include any entity stipulated in the written contract, rather than just the entity for which the Named Insured performs the work. Deletes the requirement that the additional insured's liability be 'due to your negligence specifically resulting from your work' and replaces it with more industry -standard wording that the additional insured's liability be 'caused in whole or in part by your acts or omissions or the acts omissions of those acting on your behalf.' Adds an exception to the 'mandatory tender' condition in Paragraph C. so that the additional insured need not tender the loss to its own GL insurer if the written contract makes the Named Insured's policy primary and noncontributory to the additional insured's own GL policy. Reorganizes and simplifies other text with no change in coverage intent. SB146932F (06/16) Blanket Additional Insured And Liability Extension Endorsement N Adds a Table of Contents to facilitate finding provisions, and to highlight that this endorsement provides more than just additional insured coverage. Adds 'Grantor of Franchise' and 'Trade Show Event Lessor' as types of business associates that qualify for additional 0 insured status. 0N Amends the 'Lessor of Equipment' provision to provide such additional insureds coverage only for liability caused in whole or in part by the Named Insured's ownership, maintenance or use of the leased equipment. Updates and simplifies several additional insured provisions with no change in coverage intent. Clarifies that if a separate endorsement on the policy also modifies a provision modified by this endorsement, then that other, separate endorsement's provisions control and take precedence. Adds a coverage provision for'Estates, Legal Representatives and Spouses. Retitles two "personal and advertising injury" provisions to better denote their intent. Clarifies that coverage for discrimination and humiliation does not apply to employment-related losses. SB146935D (06/161 Blanket Additional Insured — Owners. Lessees and Contractors — With Products Completed Operations Coverage And Liability Extension Endorsement Adds a Table of Contents to facilitate finding provisions, and to highlight that this endorsement provides more than just additional insured coverage. Updates and simplifies several additional insured provisions with no change in coverage intent. CNA86716XX (Ed. 06/16) Copyright CNA All Rights Reserved. Page 3 of 6 CNA Policy Holder Notice Clarifies that if a separate endorsement on the policy also modifies a provision modified by this endorsement, then that other, separate endorsement's provisions control and take precedence. Adds a coverage provision for'Estates, Legal Representatives and Spouses. Retitles two "personal and advertising injury" provisions to better denote their intent. Clarifies that coverage for discrimination and humiliation does not apply to employment-related losses. Summary of Changes Made To Liability Forms — Professional Liability Endorsements: SB300025F (06/16) Beauticians Malpractice Liability Coverage Adds coverage for the personal liability of volunteer workers. SB300035E (06/16) Veterinarian Professional Liability In Supplementary Payments, increases the limit for State Board defense costs to $25,000. (Previously was $10,000.). Summary of Changes Made To Liability Forms — Other: SB300176D (06/16) Architects, Engineers and Surveyors Liability Extension With Office Pollution Liability Coverage Increases the Supplementary Payments for Bail Bonds (was $3,000; now $5,000) and for Loss of Earnings (was $300 per day; now $1,000 per day). Removes the 90 day cap on Named Insured status for organizations newly acquired or formed during the policy period. Adds three more types of additional insureds: Lessor of Land; Trade Show Event Lessor; Engineer, Architect or Surveyor Engaged By You (for GL only, not for professional liability). In the Blanket Additional Insured / Waiver of Subrogation section: Updates and simplifies several additional insured provisions with no change in coverage intent. Clarifies that with respect to "personal and advertising injury", the written contract must have been executed prior to when the offense occurred for which the additional insured desires coverage. Broadens the potential universe of additional insured's to include any entity stipulated in the written contract, rather than just the entity for which the Named Insured performs the work. Adds an exception to the 'mandatory tender' condition in Paragraph C. so that the additional insured need not tender the loss to its own GL insurer if the written contract makes the Named Insured's policy primary and noncontributory to the additional insured's own GL policy. In the coverage for Retired Partners/Members, clarifies that such individuals are subject to the same coverage restrictions that apply to employees and volunteer workers. Adds ongoing operations coverage for "property damage" to alienated premises that are "your work." Adds coverage for "property damage" to certain property of others that results from use of an elevator. Adds "personal and advertising injury" coverage for certain instances of discrimination or humiliation. Increases the exception for non -owned watercraft (from the Aircraft, Auto or Watercraft exclusion) to 75 feet (from 51 feet). Clarifies that payments for "personal and advertising injury" are always subject to the General Aggregate Limit, and not to separate Per Project Limits. Clarifies that mental injury and anguish constitute "bodily injury" only if they result from covered physical injury. Also extends "bodily injury" to include shock and humiliation that result from covered physical injury. CNA86716XX (Ed. 06/16) Copyright CNA All Rights Reserved. Page 4 of 6 CNA Policy Holder Notice SB147040B (06/16) Exclusion — All Hazards In Connection With Designated Premises Deletes an extraneous reference to Exclusion P. SB300085C (06/16) Exclusion — Construction Management — Errors And Omissions & Construction And Demolition Work — Architects, Engineers and Surveyors Editorial corrections and clarifications, along with updated formatting, with no change in coverage intent. SB146902G (06/16) Hired Auto And Non -Owned Auto Liability In provision A., replaces the incorrect reference to 'Coverage A — Bodily Injury and Property Damage Liabilty' with a reference to the "bodily injury" and "property damage" coverage provided under Coverage A.1. Business Liability. Changes the coverage trigger to when the "occurrence" occurs (from when the "bodily injury" or "property damage" occurs). Corrects the Limit names referenced in the Limits section. Deletes the reference to policy period limits applying separately to each policy period (of a multi-year policy), since this coverage's limits apply per "occurrence", not per policy period. Corrects a Coverage name reference in the Exclusions section. Adds titles to the two exclusions added by this endorsement. Clarifies that the 'Fellow Employee' exclusion also applies to claims made by an injured fellow employee's relatives, not just to claims made by the injured fellow employee him/herself. Clarifies that the Insured status granted to employees in the Who Is An Insured section does not apply to autos rented from the employee or from members of the employee's household. Summary of Changes Made To Technology Errors & Omissions Liability Endorsements: SB300879C (06/16) Technology Errors & Omissions Liability Coverage Form Adds Assumed Liability Coverage (Coverage C) to the Insuring Agreement. Clarifies that the Insuring Agreement's "coverage territory", Retroactive Date, and claims -made provisions also apply to Coverage B, and to the newly added Coverage C. Clarifies that claims may be made during any applicable Extended Reporting Period. Deletes the provision that treated non -USA claims differently from USA claims. This creates a duty (not just a right) to 0 defend non -USA claims, but subjects non -USA claims to all of the defense requirements, valuation, and other 0 provisions applicable to USA claims. 0 Amends the Assumed Liability exclusion so as not to conflict with the coverage in the newly added Coverage C. Clarifies the Professional Services (now Professional Capacities) exclusion, especially as regards medical services. Amends the Extended Reporting Period section to specify the extension terms available and their premium charges. SB300881 D (06/16) Information Risk Endorsement Expands the list of covered "privacy event expenses." Also moves that list from the Privacy Event Expense provision in Supplemental Liability Coverage) to the definition of "privacy event expenses." Adds a subtitle (Network Security and Privacy Injury Liability) to better describe the coverage provided by the endorsement. SB300880C (06/16) Media Liability Endorsement Clarifies the Insuring Agreement to indicate this is'pay on behalf coverage, and that claims can also be made during any applicable Extended Reporting Period. CNA86716XX (Ed. 06/16) Copyright CNA All Rights Reserved. Page 5 of 6 CNA Policy Holder Notice Clarifies that the exclusion entitled Bodily Injury/Property Damage does not serve to exclude emotional distress or mental anguish alleged in a "content injury claim." Excepts "content injury claims" from the exclusion entitled Unfair Competition/Antitrust Claims/RICO Claims. Expands the definition of "wrongful acts" to apply to "content injury" committed by 'an insured' (previously only 'by you'). Expands the definition of "media activity" to include activities performed on 'an insured's' behalf (previously only on your behalf). Substitutes the term "matter" for the term "media" in several provisions, with no change in coverage intent. SB300880009 (06/16) Media Liability Endorsement - Florida Florida only) Same changes as described above for SB300880C, and also: Deletes the definition of "advertising injury." (Since the term is already defined in the Technology Errors & Omissions Liability Coverage Form that this endorsement attaches to.) CNA86716XX (Ed. 06/16) Copyright CNA All Rights Reserved. Page 6 of 6 CNA Connect Renewal Declaration POLICY NUMBER COVERAGE PROVIDED BY B 6021537469 VALLEY FORGE INSURANCE COMPANY 333 S. WABASH CHICAGO, IL. 60604 INSURED NAME AND ADDRESS INET, Inc. 1050 ROSECRANS ST STE G SAN DIEGO, CA 92106 AGENCY NUMBER AGENCY NAME AND ADDRESS 069154 IVES INSURANCE SERVICES, INC. 2850 WOMBLE RD, STE. 103 SAN DIEGO, CA 92106 Phone Number: (619)224-5337 BRANCH NUMBER BRANCH NAME AND ADDRESS 244 SAN DIEGO BRANCH 1455 FRAZEE ROAD SAN DIEGO, CA 92108 Phone Number: (619)682-3550 CNA FROM - POLICY PERIOD - TO 06/02/2018 06/02/2019 This policy becomes effective and expires at 12:01 A.M. standard time at your mailing address on the dates shown above. The Named Insured is a Corporation. Your policy is composed of this Declarations, with the attached Common Policy Conditions, Coverage Forms, and Endorsements, if any. The Policy Forms and Endorsement Schedule shows all forms applicable to this policy at the time of policy issuance. The Estimated Policy Premium Is Terrorism Risk Insurance Act Premium Audit Period is Not Auditable 9,599.00 36.00 INSURED Page 1 of 7 POLICY NUMBER B 6021537469 PROPERTY COVERAGE INSURED NAME AND ADDRESS INET, Inc. 1050 ROSECRANS ST STE G SAN DIEGO, CA 92106 LIMIT OF INSURANCE The following deductible applies unless a separate deductible is shown on the Schedule of Locations and Coverage. Deductible: $500 Business Income and Extra Expense Coverage Business Income and Extra Expense 12 Months Actual Loss Sustained Business Income and Extra Expense - Dependent Properties $10,000 Employee Dishonesty Forgery and Alteration LIABILITY COVERAGE 25,000 25,000 LIMIT OF INSURANCE Liability and Medical Expense Limit - Each Occurrence $2,000,000 Medical Expense Limit -- Per Person $10,000 Personal and Advertising Injury $2,000,000 Products/Completed Operations Aggregate $4,000,000 General Aggregate $4,000,000 Damage To Premises Rented To You $300,000 Employment Practices/Fiduciary Liability Retroactive Date: 06/01/2017 $10,000 EPLI Deductible: $0 Hired Auto Liability $1,000,000 Nonowned Auto Liability $1,000,000 Technology Errors & Omissions Liability Coverage THIS INSURANCE IS WRITTEN ON A "CLAIMS" MADE BASIS AND PROVIDES COVERAGE FOR THOSE CLAIMS" WHICH ARE THE RESULT OF "WRONGFUL ACTS" HAPPENING SUBSEQUENT TO THE RETROACTIVE DATE STATED ON THE DECLARATIONS AND WHICH ARE FIRST MADE AGAINST THE INSURED AND REPORTED TO US WHILE THIS POLICY IS IN FORCE. NO COVERAGE EXISTS FOR "CLAIMS" MADE AGAINST AN INSURED AFTER THE END OF THE POLICY PERIOD UNLESS, AND TO THE EXTENT, AN EXTENDED REPORTING PERIOD APPLIES. "CLAIM EXPENSES" REDUCE THE LIMIT OF INSURANCE AND ARE SUBJECT TO A DEDUCTIBLE. PLEASE REVIEW THE POLICY CAREFULLY AND DISCUSS THE COVERAGE WITH YOUR INSURANCE AGENT OR BROKER. Technology Errors and Omissions Liability Retro Active Date 06/01/2009 Per Claim Limit $1,000,000 Aggregate Limit $1,000,000 Deductible $2,500 Information Risk Retro Active Date 06/01/2017 INSURED Page 2 of 7 POLICY NUMBER INSURED NAME AND ADDRESS B 6021537469 INET, Inc. 1050 ROSECRANS ST STE G SAN DIEGO, CA 92106 SCHEDULE OF LOCATIONS AND COVERAGE LOCATION 1 BUILDING 1 93 CASTILIAN DR Store #2 GOLETA, CA 93117 Construction: Frame Class Description: SoftAKre & Internet Design Services Inflation Guard 30 PROPERTY COVERAGE LIMIT OF INSURANCE Accounts Receivable 25,000 Building Not Covered Business Personal Property 102,000 Customer's Property Coverage 25,000 Electronic Data Processing 50,000 Equipment Breakdown 102,000 Fine Arts 25,000 Ordinance or Law - Demolition Cost, Increased Cost of Construction $25,000 Seasonal Increase: 250 Sewer or Drain Back Up 25,000 Valuable Papers & Records 25,000 LOCATION 2 BUILDING 1 1050 ROSECRANS STREET SUITE G SAN DIEGO, CA 92106 Construction: Frame Class Description: SoftAKre & Internet Design Services Inflation Guard 30 PROPERTY COVERAGE LIMIT OF INSURANCE Accounts Receivable $25,000 Building Not Covered Business Personal Property $25,500 Electronic Data Processing $50,000 INSURED Page 3 of 7 POLICY NUMBER INSURED NAME AND ADDRESS B 6021537469 INET, Inc. 1050 ROSECRANS ST STE G SAN DIEGO, CA 92106 SCHEDULE OF LOCATIONS AND COVERAGE PROPERTY COVERAGE LIMIT OF INSURANCE Equipment Breakdown $25,500 Fine Arts $25,000 Ordinance or Law - Demolition Cost, Increased Cost of Construction $25,000 Seasonal Increase: 250 Sewer or Drain Back Up $25,000 Valuable Papers & Records $25,000 INSURED Page 4 of 7 POLICY NUMBER INSURED NAME AND ADDRESS B 6021537469 INET, Inc. 1050 ROSECRANS ST STE G SAN DIEGO, CA 92106 ADDITIONAL INTEREST SCHEDULE LOCATION 2 BUILDING 1 Type: Notice of Cancellation or Material Coverage Change Additional Interest Name and Address: CSU, NORTHRIDGE ATTN: INSURANCE & RISK MANAGEMENT 18111 NORDHOFF STREET NORTHRIDGE CA 91330-5089 Type: Notice of Cancellation or Material Coverage Change Additional Interest Name and Address: UNIVERSITY OF SAN FRANCISCO RISK SERVICES MANAGER 2130 Fulton Street SAN FRANCISCO CA 94117 LOSS PAYEE SCHEDULE All loss payees as their interests may appear in the Covered Property. The following provisions apply in accordance with the insurable interest of the loss payee: Loss Payee Description of Property: Any Covered Property in which a loss payee, creditor or lender holds an interest, including any person or organization you have entered a contract with for the sale of Covered Property. INSURED Page 5 of 7 POLICY NUMBER INSURED NAME AND ADDRESS B 6021537469 INET, Inc. 1050 ROSECRANS ST STE G SAN DIEGO, CA 92106 FORMS AND ENDORSEMENTS SCHEDULE The following list shows the Forms, Schedules and Endorsements by Line of Business that are a part of this policy. COMMON FORM NUMBER FORM TITLE SB146801I CNA79203XX 06/2014 Exclusion - Access or Disclosure of Confidential CNA80103XX 09/2014 Primary and Non Contributory Other Ins Condition CNA81751XX 03/2015 Cap on Losses from Certified Acts of Terrorism SB146916C 05/2017 California Changes SB146806B SB147052C 06/2016 Notice of Cancellation or Material Coverage Change SB147075A 01/2006 Economic and Trade Sanctions Condition SB147082E 04/2014 Businessowners Common Policy Conditions SB147086B 04/2010 Loss Payable Provisions SB146811A COMMERCIAL PROPERTY FORM NUMBER FORM TITLE SB146801I 04/2014 Businessowners Special Property Coverage Form SB146802E04 06/2016 Business Income and Extra Expense SB146803A 01/2006 Seasonal Increase SB146804A 01/2006 Arson and Theft Reward SB146805B 06/2016 Claim Data Expense SB146806B 01/2008 Debris Removal SB146807E 06/2016 Employee Dishonesty SB146808A 01/2006 Expediting Expenses SB146809C 07/2009 Fine Arts SB146810A 01/2006 Fire Department Service Charge SB146811A 01/2006 Fire Protective Equipment Discharge SB146812C 04/2010 Forgery and Alteration SB146813B 01/2008 Newly Acquired or Constructed Property SB146814B 03/2006 Ordinance or Law SB146815A 01/2006 Outdoor Trees, Shrubs, Plants and Lawns SB146816A 01/2006 Pollutant Clean Up and Removal SB146817A 01/2006 Preservation of Property SB146818A 01/2006 Temporary Relocation of Property SB146819A 01/2006 Water Damage, Other Liquids, Solder, Molten Damage SB146820C 06/2011 Accounts Receivable SB146821A 01/2006 Appurtenant Buildings and Structures SB146822A 01/2006 Building Glass SB146823B 01/2008 Business Income Extra Expense - Dependent Property SB146824B 01/2008 Business Income Extra Expense -Newly Acquired Locs SB146825C 06/2011 Business Personal Property Off Premises SB146826B 01/2008 Civil Authority SB146827F 06/2011 Electronic Data Processing SB146828E 04/2014 Equipment Breakdown SB146830B 01/2008 Money Orders and Counterfeit Paper Currency SB146831B 06/2011 Nonowned Detached Trailers SB146832B 01/2008 Ordinance or Law -Increased Period of Restoration SB146833A 01/2006 Outdoor Property SB146834A 01/2006 Personal Effects SB146835A 01/2006 Signs SB146836A 01/2006 Spoilage Consequential Loss SB146837A 01/2006 Theft Damage to Rented Property SB146838C 06/2011 Valuable Papers and Records SB146839F 06/2011 Sewer or Drain Back Up INSURED Page 6 of POLICY NUMBER B 6021537469 COMMERCIAL PROPERTY INSURED NAME AND ADDRESS INET, Inc. 1050 ROSECRANS ST STE G SAN DIEGO, CA 92106 FORMS AND ENDORSEMENTS SCHEDULE FORM NUMBER FORM TITLE SB146846B 01/2008 Customers Property Endorsement SB146936A 01/2006 Inflation Guard SB147084C04 04/2012 California Fungi, Wet Rot, Dry Rot, Microbe Exln SB300129B 01/2008 Targeted Hacker Attack SB300456A 07/2007 Concurrent Causation, Earth Movmnt, Water Excl Chg SB300596A 01/2008 Identity Theft/Recovery Services Endorsement COMMERCIAL GENERAL LIABILITY FORM NUMBER FORM TITLE SB146901B 04/2014 Technology Services Exclusion SB146902G 06/2016 Hired Auto and Non -owned Auto Liability SB146932F 06/2016 Blanket Additional Insured - Liability Extension SB147028A 03/2006 EXCEPTIONS TO PERSONAL AND ADVERTISING INJURY SB147079A 01/2006 War Liability Exclusion SB147080A 01/2006 Exclusion - Silica SB147083B 07/2009 Fungi/Mold/Mildew/Yeast/Microbe Exclusion SB147088A04 01/2006 Exclusion - Asbestos SB147089A 01/2006 Employment - Related Practices Exclusion SB300000D 04/2014 Businessowners Liability Coverage Form SB300092A 01/2006 Personal and Advertising Injury Exln - Limited SB300441A 01/2007 Fiduciary Liability Coverage Form SB300449A 01/2007 Single Limit of Insurance Endorsement SB300450A 01/2007 Employment Practices Liability Coverage Form SB300849A 07/2009 Recd and Distribution of Material or information SB300879C 06/2016 Technology Errors & Omission Liability Coverage SB300881D 06/2016 Information Risk Endorsement PLEASE READ THE ENCLOSED IMPORTANT NOTICES CONCERNING YOUR POLICY *** FORM NUMBER FORM TITLE CNA62823XX 07/2017 Req For Jurisdictional Inspection Of Pressure Equp CNA79240XX 06/2014 Important Info Excl App to Access or Disclosure CNA81758XX 03/2015 Notice - Offer of Terrorism Disclosure of Premium CNA86716XX 06/2016 Policy Holder Notice SB301000A 04/2010 Hired and Non -Owned Auto Liab Policyholder Notice Chairman of the Board Countersignature Secretary SB -146895-A (Ed. 01/06) INSURED Page 7 of XX CNA CNA7 ( 06314) EXCLUSION - ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION AND DATA-RELATED LIABILITY - WITH LIMITED BODILY INJURY EXCEPTION It is understood and agreed that this endorsement amends the BUSINESSOWNERS LIABILITY COVERAGE FORM as follows: Under Exclusions, the exclusions Applicable to Business Liability Coverage are amended to: I. Delete the exclusion entitled Electronic Data and replace it with the following: This insurance does not apply to: Access or Disclosure Of Confidential Or Personal Information And Data -related Liability 1) Damages, other than damages because of "personal and advertising injury," arising out of any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information; or 2) Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate electronic data. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which is described in Paragraph (1) or (2) above. However, unless Paragraph (1) above applies, this exclusion does not apply to damages because of "bodily injury." As used in this exclusion, 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 controlled equipment. II. Add the following to the exclusion entitled Personal and Advertising Injury: This insurance does not apply to: Personal And Advertising Injury Personal and advertising injury": Arising out of any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of any person's or organization's confidential or personal information. All other terms and conditions of the Policy remain unchanged. CNA79203XX (06-14) Page 1 of 1 Copyright, CNA All Rights Reserved. CNA CNA80103XX 09-14) 10:1RI: 401191t&*4kh1:40ito] :1_\0lei *" III :1 at] A[gymaqA&i:7: F_\1l11111ga_1:7:711' PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COMMON POLICY CONDITIONS The following is added to Paragraph H. Other Insurance and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: 1. The additional insured is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. All other terms and conditions of the Policy remain unchanged. CNA80103XX (09-14) Page 1 of 1 Copyright, CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission CNA CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM ENDORSEMENT SCHEDULE Solely with respect to any Coverage Part set forth in the Schedule, it is understood and agreed as follows: CNA81751 XX Ed. 3-15) Whenever used in this endorsement, 1) "we" means the insurer listed on the Declarations or the Certificate of Insurance, as applicable; and 2) "you" means the first person or entity named on the Declarations or the Certificate of Insurance, as applicable. A. Cap on Certified Terrorism Losses Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security and the Attorney General of the United States, to be an act of terrorism pursuant to the Terrorism Risk Insurance Act, as extended and reauthorized (the "Act'). The criteria contained in the Act for a certified act of terrorism" include the following: 1. The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and 2. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. If aggregate insured losses attributable to terrorist acts certified under the Act exceed $100 billion in a calendar year January 1 through December 31) and we have met our insurer deductible under the Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. B. Application of Exclusions The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for any loss which would otherwise be excluded under this Policy, such as losses excluded by the Nuclear Hazard Exclusion or the War And Military Action Exclusion. All other terms and conditions of the Policy remain unchanged. 0 000NOOO CNA81751XX (Ed. 3-15) Page 1 of 1 Copyright, CNA All Rights Reserved. 1-1 CNA S( Ed. 04-014) BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we," us" and 'bur" refer to the company providing the insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to SECTION G — PROPERTY DEFINITIONS, and SECTION H — MALICIOUS CODE, SYSTEM PENETRATION, AND DENIAL OF SERVICE DEFINITIONS. A. COVERAGE We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from a Covered Cause Of Loss. 1. Covered Property Covered Property includes Buildings as described under a. below, Business Personal Property as described under b. below, or both, depending on whether a Limit of Insurance is shown in the Declarations for the type of property. Regardless of whether coverage is shown in the Declarations for Buildings, Business Personal Property, or both, there is no coverage for property described under Paragraph A.2. Property Not Covered. a. Buildings, meaning the buildings and structures at the premises described in the Declarations, including: 1) Completed Additions; 2) Fences 3) Fixtures, including outdoor fixtures; 4) Retaining walls, whether or not attached; 5) Permanently installed: a) Machinery; and b) Equipment; 6) Outdoor swimming pools; 7) Personal Property owned by you that is used to maintain or service the building or structure or the premises, including: a) Fire extinguishing equipment; b) Outdoor furniture; c) Floor coverings; d) Appliances used for refrigerating, ventilating, cooking, dishwashing or laundering; e) Lawn maintenance and snow removal equipment; and f) Alarm systems; 8) If not covered by other insurance: a) Alterations and repairs to the building structure; b) Materials, equipment, supplies and temporary structures, on or within 1,000 feet of the described premises, used for making alterations or repairs to the building or structure. b. Business Personal Property located in or on the buildings at the described premises or in the open (or in a vehicle) within 1,000 feet of the described premises, including; 1) Property that you own that is used in your business; 2) Property of others that is in your care, custody or control; 3) Your use interest as tenant in improvements and betterments. Improvements and betterments are fixtures, alterations, installations or additions: a) Made a part of the building or structure you occupy or lease but do not own; and b) You acquired or made at your expense but are not permitted to remove; 4) Leased personal property for which you have a contractual responsibility to insure, unless otherwise provided for under Paragraph A.1.b.(2).; 5) Your leasehold interest in improvements and betterments which are not damaged or destroyed, but which you lose because your lease is cancelled by the lessor as a result of damage to the building from a Covered Cause of Loss. When this occurs, we will calculate the value of your interest in the improvements and SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 22 Ed. 04-14) 00 N 0 0 0 0 betterments as though they had been damaged or destroyed and not repaired or replaced promptly, as provided In the Valuation Loss Condition; 6) Your "money" and "securities"; 7) "Stock." 8) Tools and equipment owned by your employees which are used in your business operations. 2. Property Not Covered Covered Property does not include: a. Aircraft; b. Automobiles held for sale; c. Vehicles or self-propelled machines that are: 1) Licensed for use on public roads (subject to motor vehicle registration); or 2) Operated principally away from the described premises; This paragraph does not apply to: 1) Vehicles or self-propelled machines or autos that you manufacture, process or warehouse; 2) Vehicles or self-propelled machines, other than autos, that you hold for sale; or 3) Trailers or semi -trailers, except as provided in the Non -Owned Detached Trailers Coverage. d. Dams or dikes; e. Contraband, or property in the course of illegal transportation or trade; f. The cost of excavating, grading, backfilling or filling (except those costs necessary due to repair of buildings insured under this Coverage Form from a Covered Cause of Loss), reclaiming or restoring land or water; g. Water or land whether in its natural state or otherwise (including land on which the property is located), land improvements, growing crops or standing timber; h. Outdoor trees, shrubs, plants and lawns, other than "stock" except as provided in the Outdoor Trees, Shrubs, Plants and Lawns Additional Coverage; SB -146801-1 Ed. 04-14) 2) Outdoor radio or television antennas including satellite dishes) and including their lead-in wiring, masts or towers; Except as provided in the Outdoor Property Coverage Extension; j. Watercraft (including motors, equipment and accessories) while afloat; k. Accounts and bills, except as provided in the Accounts Receivable Coverage Extension; I. "Valuable Papers and Records," except as provided in the Valuable Papers and Records Coverage Extension; m. Property that is covered under another Coverage Form of this or any other policy in which it is more specifically described, except for the excess of the amount due (whether you can collect on it or not) from that other insurance; n. "Fine Arts," except as provided in the Fine Arts Additional Coverage; o. Bullion, gold, silver, platinum and other precious alloys or metals, unless they are used in your 'operations" (theft limitation applies); p. "Electronic data processing equipment' and Electronic media and data" (not including stock"), except as provided in the Electronic Data Processing Equipment, Electronic Media and Data and Electronic Data (EDP Coverage Form) Coverage Extension, the Business Income And Extra Expense Coverage Extension, the Accounts Receivable Coverage Extension or the Targeted Hacker Attack Coverage Extension; Your Business Personal Property coverage is extended to provide excess coverage for loss to the Electronic Data Processing Equipment and Electronic Media and Data (EDP Coverage Form) located only at the described premises and resulting from a covered cause of loss. All exclusions applicable to Business Personal Property apply to this excess coverage. This excess coverage is included in and is not in addition to the limits applicable to your Business Personal Property. q. Outdoor signs, except as provided in the Signs Coverage Extension. 3. Covered Causes of Loss L The following property while outside of the RISKS OF DIRECT PHYSICAL LOSS unless thebuildings: loss is: 1) Bridges, walks, roadways, patios or other a. Excluded in section B. EXCLUSIONS; paved surfaces; or b. Limited in paragraph A.4. Limitations; or SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 2 of 22 Ed. 04-14) SB -146801-1 Ed. 04-14) c. Excluded or limited by other provisions of this c) Photographic or scientific instrument policy. lenses. 4. Limitations c. For loss or damage by theft, the following a. We will not pay for loss of or damage to: types of property are covered only up to the limits shown: 1) The "interior of any building or structure" 1) $2,500 for furs, fur garments, and or to personal property in the building or garments trimmed with fur. structure, caused by rain, snow, sleet or ice whether driven by wind or not, unless: 2) $5,000 for jewelry, watches, watch a) The building or structure first sustains movements, jewels, pearls, precious and actual damage to the roof or walls by semi-precious stones, bullion, gold, silver, wind or hail and then we will pay only interior platinum and other precious alloys or metals. This limit does not apply toforthelosstotheofthejewelryandwatchesworth $500 or lessbuildingorstructure" or the personal per item. property in the building or structure that is caused by rain, snow, sleet, 3) $25,000 for patterns, dies, molds and sand or dust entering the building(s) forms. or structure(s) through openings in the roof or walls made by direct d. We will not pay for any loss or damage action of wind; or caused by any of the following even if they are Covered Causes of Loss if the building b) The loss or damage is caused by or where loss or damage occurs has been results from thawing of snow, sleet or vacant" for more than 60 consecutive days ice on the building or structure. before that loss or damage occurs: 2) Steam boilers, steam pipes, steam 1) Vandalism; engines or steam turbines caused by or 2) Sprinkler leakage, unless you haveresultingfromanyconditionoreventprotectedthesystemagainstfreezing; inside such equipment. But we will pay for loss of or damage to such equipment 3) Building glass breakage; caused by or resulting from an explosion of gasses or fuel within the furnace of any 4) Discharge or leakage of water; fired vessel or within the flues or 5) "Theft"; or passages through which the gasses of combustion pass. 6) Attempted "theft." 3) Hot water boilers or other water heating equipment caused by or resulting from any condition or event inside such boilers or equipment, other than an explosion. b. We will not pay for loss of or damage to the following types of property unless caused by any of the "specified causes of loss" or building glass breakage 1) Live animals, birds or fish, and then only if they are killed or their destruction is made necessary. This limitation does not apply to animals, birds or fish owned by you and held as "stock." 2) Fragile articles such as glassware, statuary, marbles, chinaware and porcelains, if broken. This limitation does not apply to: a) Glass that is part of the exterior or interior of a building or structure; With respect to Covered Causes of Loss other than those listed in 4.d.(1) through 4.d.(6) above, we will reduce the amount we would otherwise pay for the loss or damage by 15%. 5. Additional Coverages Additional Coverages may be attached to this Policy (designation would appear in the attached form(s)). Unless otherwise stated, payments made under these Additional Coverages are in addition to the applicable Limits of Insurance. 6. Coverage Extensions Coverage forms may be attached to this Policy and designated as Coverage Extensions (such designation would appear in the attached form(s)). Unless otherwise stated, payments made under these Coverage Extensions are subject to and not in addition to the applicable Limits of Insurance in this Coverage Form. B. EXCLUSIONS b) Containers or property held for sale; 1. We will not pay for loss or damage caused directlyororindirectlybyanyofthefollowing. Such loss or SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 3 of 22 Ed. 04-14) 0N 0 0 0 0 0 damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. a. Ordinance or Law 1) The enforcement of any ordinance or law: a) Regulating the construction, use or repair of any property; or b) Requiring the tearing down of any property, including the cost of removing its debris. 2) This exclusion applies whether the loss results from: a) An ordinance or law that is enforced even if the property has not been damaged; or b) The increased costs incurred to comply with an ordinance or law in the course of construction, repair, renovation, remodeling or demolition of property, or removal of its debris, following a physical loss to that property. b. Earth Movement 1) Earthquake, including any earth sinking, rising or shifting related to such event; 2) Landslide, including any earth sinking, rising or shifting related to such event; 3) Mine subsidence, meaning subsidence of a man-made mine, whether or not mining activity has ceased; 4) Earth sinking (other than sinkhole collapse), rising or shifting including soil conditions which cause settling, cracking or other disarrangement of foundations or other parts of realty. Soil conditions include contraction, expansion, freezing, thawing, erosion, improperly compacted soil and the action of water under the ground surface. But if Earth Movement, as described in Paragraphs (1) through (4) above, results in fire or explosion, we will pay for the loss or damage caused by that fire or explosion. 5) Volcanic eruption, explosion or effusion. But if volcanic eruption, explosion or effusion results in fire, building glass breakage or volcanic action, we will pay for the loss or damage caused by that fire, or volcanic action. SB -146801-1 Ed. 04-14) Volcanic action means direct loss or damage resulting from the eruption of a volcano when the loss or damage is caused by: a) Airborne volcanic blast or airborne shock waves; b) Ash, dust or particulate matter; or c) Lava flow. All volcanic eruptions that occur within any 168 hour period will constitute a single occurrence. Volcanic action does not include the cost to remove ash, dust or particulate matter that does not cause direct physical loss of or damage to Covered Property. c. Governmental Action Seizure or destruction of property by order of governmental authority. But we will pay for loss or damage caused by or resulting from acts of destruction ordered by governmental authority and taken at the time of a fire to prevent its spread, if the fire would be covered under this policy. d. Nuclear Hazard Nuclear reaction or radiation, or radioactive contamination, however caused. But if nuclear reaction or radiation, or radioactive contamination, results in fire, we will pay for the loss or damage caused by that fire. e. Power Failure or Fluctuation The failure or fluctuation of power or other utility service supplied to the described premises, however caused, if the cause of the failure or fluctuation occurs away from the described premises. But if the failure or fluctuation of power or other utility service results in a Covered Cause of Loss, we will pay for the loss or damage caused by that covered cause of Loss. If. War And Military Action 1) War, including undeclared or civil war; 2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 4 of 22 Ed. 04-14) 3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. g. Water h. 1) "Flood," surface water, waves, tides, tidal waves, overflow of any body of water, or their spray, all whether driven by wind or not; 2) Mudslide or mudflow; 3) Water or sewage that backs up or overflows from a sewer, drain or sump; or 4) Water under the ground surface pressing on, or flowing or seeping through: a) Foundations, walls, floors or paved surfaces; b) Basements, whether paved or not; or c) Doors, windows or other openings. But if Water, as described in Paragraphs 1) through (4), results in fire, explosion or sprinkler leakage, we will pay for the loss or damage caused by that fire, explosion or sprinkler leakage. Neglect Neglect of an insured to use reasonable means to save and preserve property from further damage at and after the time of loss. Collapse of Buildings Collapse of buildings meaning an abrupt falling down or caving in of a building or any part of a building with the result being that the building or part of a building cannot be occupied for its intended purpose. 1) This exclusion does not apply to collapse of buildings if caused only by one or more of the following: a) A "specified cause of loss" or breakage of building glass; b) Decay, insect or vermin damage that is hidden from view, unless the presence of such decay or insect or vermin damage is known to an insured prior to collapse; c) Weight of people or personal property; d) Weight of rain that collects on a roof; or e) Use of defective material or methods in construction, remodeling or SB -146801-1 Ed. 04-14) renovation if the collapse occurs during the course of construction, remodeling or renovation; or f) Use of defective material or methods in construction, remodeling or renovation if the collapse occurs after construction, remodeling or renovation is complete and is caused in part by a cause of loss listed in Paragraphs (a) through (d) above. In the event collapse results in a Covered Cause of Loss, we will only pay for the resulting loss or damage by that Covered Cause of Loss. 2) We will not pay for loss of or damage to the following types of property, if otherwise covered in this Coverage Form under Paragraphs (1)(b) through (1)(f) above, unless the loss or damage is a direct result of the collapse of a building: a) Awnings, gutters and downspouts; b) Outdoor radio or television antennas including microwave or satellite dishes) and their lead-in wiring, masts or towers; c) Fences; d) Piers, wharves and docks; e) Beach or diving platforms or appurtenances; f) Retaining walls; g) Walks, roadway and other paved surfaces; h) Yard fixtures; or i) Outdoor swimming pools. 3) A building or part of a building that: a) Is in imminent danger of abruptly falling down or caving in; or b) Suffers a substantial impairment of structural integrity; is not considered to have collapsed but is considered to be in a state of imminent collapse. 4) With respect to buildings in a state of imminent collapse, we will not pay for loss or damage unless the state of imminent collapse first manifests itself during the policy period and is cause only by one or more of the following which occurs during the policy period: SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 5 of 22 Ed. 04-14) SB -146801-1 Ed. 04-14) SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 6 of 22 Ed. 04-14) a) A "specified cause of loss" or 7) The following causes of loss to personal breakage of glass property: b) Weight of people or personal a) Dampness or dryness of atmosphere; property; b) Changes in or extremes of c) Weight of rain that collects on a roof; temperature; or or c) Marring or scratching. d) Use of defective material or methods d) Changes in flavor, color, texture orinconstruction, remodeling or finish; renovation if the state of imminent collapse occurs during the course of e) Evaporation or leakage; or construction, remodeling or renovation. 8) Contamination by other than "pollutants." j. Malicious Code But if an excluded cause of loss that is listed in Paragraphs (1) through (8) above Any "malicious code." results in a "specified cause of loss," k. System Penetration building glass breakage, or "breakdown" to "covered equipment" (only if otherwise Any "system penetration." a Covered Cause of Loss), we will pay for I. Denial of Service the loss or damage caused by that specified cause of loss, building glass Any "denial of service." breakage or "breakdown" to "covered equipment" (only if otherwise a Covered2. We will not pay for loss or damage caused by or Cause of Loss). resulting from any of the following: e. Steam Apparatus a. Electrical Apparatus Explosion of steam boilers, steam pipes, Artificially generated electrical current, steam engines or steam turbines owned or including electric arcing, that disturbs leased by you, or operated under your control. electrical devices, appliances or wires. But if explosion of steam boilers, steam pipes, But if artificially generated electrical current steam engines or steam turbines results in fire results in fire, we will pay for the loss or or combustion explosion, we will pay for the damage caused by fire. loss or damage caused by that fire or combustion explosion. We will also pay forb. Consequential Loss loss or damage caused by or resulting from Delay, loss of use or loss of market. the explosion of gases or fuel within the furnace of any fired vessel or within the flues c. Smoke, Vapor, Gas or passages through which the gases of Smoke, vapor or gas from agricultural combustion pass. o N smudging or industrial operations. f. Seepage O d. Other Types Of Loss Continuous or repeated seepage or leakage 1) Wear and tear; of water, or the presence of condensation of humidity, moisture or vapor, that occurs over 2) Rust, corrosion, fungus, decay, a period of 14 days or more. deterioration, hidden or latent defect or g. Frozen Plumbinganyqualityinpropertythatcausesitto damage or destroy itself; Water, other liquids, powder or molten 3 Smog;material that leaks or flows from plumbing, heating, air conditioning or other equipment 4) Settling, cracking, shrinking or expansion; except fire protective systems) caused by or resulting from freezing, unless: 5) Nesting or infestation, or discharge or release of waste products or secretions, 1) You do your best to maintain heat in the by insects, birds, rodents or other building or structure; or animals; 2) You drain the equipment and shut off the 6) Mechanical breakdown, including rupture supply if the heat is not maintained. or bursting caused by centrifugal force. SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 6 of 22 Ed. 04-14) h. Dishonesty Dishonest or criminal acts by you, or any of your partners, "members," officers, managers," "employees" (including leased employees), directors, trustees, authorized representatives or anyone to whom you entrust the property for any purpose: 1) Acting alone or in collusion with others; 2) Whether or not occurring during the hours of employment. This exclusion does not apply to acts of destruction to your property, or your Electronic data processing equipment," Electronic media and data," and "Electronic data," by your "employees" (including leased employees); but theft by employees (including leased employees) is not covered, except as provided in the Employee Dishonesty Additional Coverage. i. False Pretense Voluntary parting with any property by you or anyone else to whom you have entrusted the property if induced to do so by any fraudulent scheme, trick, device or false pretense. j. Exposed property Rain, snow, sand, dust, ice or sleet to personal property in the open, except as provided in the Coverage Extension for Outdoor Property. k. Pollution Discharge, dispersal, seepage, migration, release or escape of "pollutants" unless the discharge, dispersal, seepage, migration, release or escape is itself caused by any of the "specified causes of loss." But if the discharge, dispersal, seepage, migration, release or escape of "pollutants" results in a specified cause of loss," we will pay for the loss or damage caused by that "specified cause of loss" Inventory Shortage, mysterious disappearance Property that is missing, where the only evidence of the loss or damage is a shortage disclosed on taking inventory, or other instances where there is no physical evidence to show what happened to the property. This exclusion does not apply to "money" and securities" SB -146801-1 Ed. 04-14) m. Inventory Computation Loss of property or that part of any loss, the proof of which as to its existence or amount is dependent on: 1) Any inventory computation; or 2) A profit and loss computation. n. Transfer of Property The transfer of property to a person or to a place outside the described premises, on the basis of unauthorized instructions. o. Accounting Errors Loss of "money" or "securities" caused by or resulting from accounting or arithmetic errors or omissions. p. Cost of Correction The cost of correcting or making good the damage to personal property attributable to such property being processed, manufactured, tested, repaired, restored, retouched or otherwise being worked on. 3. We will not pay for loss or damage caused by or resulting from any of the following Paragraphs a. through c. But if an excluded cause of loss that is listed in Paragraphs a. through c. results in a Covered Cause of Loss, we will pay for the loss or damage caused by that Covered Cause of Loss. a. Weather Conditions Weather conditions. But this exclusion only applies if weather conditions contribute in any way with a cause or event excluded in Paragraph B.1. above to produce the loss or damage. b. Acts or Decisions Acts or decisions, including the failure to act or decide, of any person, group, organization or governmental body. c. Negligent Work Faulty, inadequate or defective: 1) Planning, zoning, development, surveying, siting; 2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; 3) Materials used in repair, construction, renovation or remodeling; or 4) Maintenance; of part or all of any property on or off the described premises. SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 7 of 22 Ed. 04-14) If an excluded cause of loss that is listed in Paragraphs (1) through (4) above results in a Covered Cause of Loss, we will pay for the resulting loss or damage caused by that Covered Cause of Loss. But we will not pay for: 1) Any cost of correcting or making good the fault, inadequacy or defect itself, including any cost incurred to tear down, tear out, repair or replace any part of any property to correct the fault, inadequacy or defect; or 2) Any resulting loss or damage by a Covered Cause of Loss to the property that has the fault, inadequacy or defect until the fault, inadequacy or defect is corrected. 4. Business Income and Extra Expense Exclusions a. We will not pay for: 1) Any Extra Expense, or increase of Business Income loss, caused by or resulting from: a) Delay in rebuilding, repairing or replacing the property or resuming operations," due to interference at the location of the rebuilding, repair or replacement by strikers or other persons; or b) Suspension, lapse or cancellation of any license, lease or contract. But if the suspension, lapse or cancellation is directly caused by the suspension of 'operations," we will cover such loss that affects your Business Income during the "period of restoration." b. Any other consequential loss. C. Limits of Insurance 1. Unless otherwise stated, the most we will pay for loss or damage in any one occurrence is the applicable Limit of Insurance shown in the Declarations, Schedules, Coverage Forms, or endorsements. 2. Inflation Guard SB -146801-1 Ed. 04-14) 1) The Limit of Insurance that applied on the most recent of the policy inception date, the policy anniversary date, or any other policy change amending the Limit of Insurance, multiplied by 2) The percentage of annual increase shown in the Declarations, expressed as a decimal (example: 5% is .05), multiplied by 3) The number of days since the beginning of the current policy year or the effective date of the most recent policy change amending the Limit of Insurance, divided by 365. Example: If: The applicable Building limit is $100,000 The annual percentage increase is 5% The number of days since the beginning of the policy year (or last policy change) is 146 The amount of increase is 100,000 x .05 x (146/365) _ $2,000 D. DEDUCTIBLES 1. We will not pay for loss or damage in any one occurrence until the amount of loss or damage exceeds the Businessowners Property Coverage Deductible amount shown in the Declarations. We will then pay the amount of loss or damage in excess of the Deductible up to the applicable Limit of Insurance. 2. Regardless of the amount of the Businessowners Property Coverage Deductible, the most we will deduct from any loss or damage under the Building Glass Coverage Extension in any one occurrence is the Building Glass Deductible shown in the Declarations. 3. The Businessowners Property Coverage Deductible does not apply to any of the following if they are included as part of this policy: a. Fire Department Service Charge a. When a percentage for Inflation Guard is b. Business Income and Extra Expense shown in the Declarations, the Limit of Insurance for property to which this coverage c. Arson and Theft Reward; and applies will automatically increase by that d. Accounts Receivable; annual percentage. e. Any other property coverage with a specificb. The amount of increase will be: deductible amount shown in the coverage form or declaration. SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 8 of 22 Ed. 04-14) 4. If more than one deductible applies to loss or damage in any one occurrence, we will apply each deductible separately. But the total of all deductible amounts applied in any one occurrence will not exceed the largest applicable deductible. E. PROPERTY LOSS CONDITIONS 1. Abandonment There can be no abandonment of any property to us. 2. Appraisal If we and you disagree on the amount of loss, either may make written demand for an appraisal of the loss. In this event, each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a. Pay its chosen appraiser; and b. Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. 3. Duties In The Event Of Loss Or Damage a. You must see that the following are done in the event of loss or damage to Covered Property: 1) Notify the police if a law may have been broken. 2) Give us prompt notice of the loss or damage. Include a description of the property involved. 3) As soon as possible, give us a description of how, when and where the loss or damage occurred. 4) Take all reasonable steps to protect the Covered Property from further damage, and keep a record of your expenses necessary to protect the Covered Property, for consideration in the settlement of the claim. This will not increase the Limits of Insurance. However, we will not pay for any loss or damage from a cause of loss that is not a Covered Cause of Loss. Also, if feasible, set the damaged property aside and in the best possible order for examination. SB -146801-1 Ed. 04-14) 5) At our request, give us complete inventories of the damaged and undamaged property. Include quantities, costs, values and amount of loss claimed. 6) As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records. Also permit us to take samples of damaged and undamaged property for inspection, testing an analysis, and permit us to make copies from your books and records. 7) Send us a signed, sworn proof of loss containing the information we request to investigate the claim. You must do this within 60 days after our request. We will supply you with the necessary forms. 8) Cooperate with us in the investigation or settlement of the claim. 9) Resume all or part of your "operations" as quickly as possible. b. We may examine any insured under oath, while not in the presence of any other insured and at such times as may be reasonably required, about any matter relating to this insurance or the claim, including an insured's books and records. In the event of an examination, an insured's answers must be signed. 4. Loss Payment — Building and Personal Property a. In the event of loss or damage covered by this Coverage Form, at our option, we will either: 1) Pay the value of lost or damaged property; 2) Pay the cost of repairing or replacing the lost or damaged property, subject to b. below; 3) Take all or any part of the property at an agreed or appraised value; or 4) Repair, rebuild or replace the property with other property of like kind and quality, subject to b. below. We will determine the value of lost or damaged property, or the cost of its repair or replacement, in accordance with the applicable terms of 4.e. below or any applicable provision which amends or supersedes the value of Covered Property. b. The cost to repair, rebuild or replace does not include the increased cost attributable to SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 9 of 22 Ed. 04-14) SB -146801-1 Ed. 04-14) enforcement of any ordinance or law i) The Limit of Insurance regulating the construction, use or repair of applicable to the lost or any property, except as provided in the damaged property; Ordinance or Law Additional Coverage. ii) The cost to replace the lost c. We will give notice of our intentions within 30 or damaged property with days after we receive the proof of loss. other property: d. We will not pay you more than your financial a) Of comparable material interest in the Covered Property. and quality; and e. We will determine the value of Covered b) Used for the same Property as follows: purpose; or 1) At replacement cost (without deduction iii) The amount actually spent for depreciation), except as provided in that is necessary to repair or 2) through (18) below. replace the lost or damaged a) You may make a claim for loss or property. damage covered by this insurance on If a building is rebuilt at a new an actual cash value basis instead of premises, the cost described in on a replacement cost basis. In the c)(ii) above is limited to the cost event you elect to have loss or which would have been incurred damage settled on an actual cash if the building had been rebuilt at value basis, you may still make a the original premises. claim on a replacement cost basis if d) The cost of repair or replacementyounotifyusofyourintenttodosodoesnotincludetheincreasedwithin180daysafterthelossor cost attributable to enforcementdamage. of any ordinance or law b) We will not pay on a replacement regulating the construction, use cost basis for any loss or damage: or repair of any property. i) Until the lost or damaged 2) If the Declarations indicate that Actual property is actually repaired or Cash Value applies to Buildings or replaced; and Business Personal Property, paragraph 1) above does not apply to the propertyii) Unless the repairs or for which Actual Cash Value is indicated. replacement are made as soon as reasonably possible after the 3) Property of others at the amount you are loss or damage. liable plus the cost of labor, materials, or With respect to tenants' services furnished or arranged by you on improvements and betterment's, the personal property of others, not to exceed following also applies: the replacement cost. a) If the conditions in (b)(i) and 4) The following property at actual cash b)(ii) above are not met, the value: value of tenants' improvements a) Used or second-hand merchandise and betterments will be held in storage or for sale; determined as a proportion of b) Household furnishings; your original cost, as set forth under 4e.(7) below; and c) Personal effects. b) We will not pay for loss or 5) "Fine Arts" as follows: damage to tenants' improvements and betterments if a) If there is a schedule of "fine arts" on others pay for repairs or file which includes a description and replacement. value of the lost or damaged item, we will pay the value as stated in the c) We will not pay more for loss or schedule for that item if there is a damage on a replacement cost total loss to that item. If there is a basis than the least of (i), (ii), or partial loss to an item, we will pay the iii) subject to (d) below: cost of reasonably restoring or repairing that item. SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 10 of 22 Ed. 04-14) b) For "fine arts" without a schedule on file as described in paragraph (a) above, the value of "fine arts" will be the least of the following amounts: i) Market value of the lost or damaged item at the time and place of loss; ii) The cost of reasonably restoring the lost or damaged item; or iii) The cost of replacing that lost or damaged item with property substantially the same. 6) Glass at the cost of replacement with safety glazing material if required by law. 7) Tenants' Improvements and Betterments at: a) Replacement cost if you make repairs promptly. b) A proportion of your original cost if you do not make repairs promptly. We will determine the proportionate value as follows: i) Multiply the original cost by the number of days from the loss or damage to the expiration date of the lease; and ii) Divide the amount determined in i) above by the number of days from the installation of improvements to the expiration of the lease. If your lease contains a renewal option, the expiration of the renewal option period will replace the expiration of the lease in this procedure. c) Nothing, if others pay for repairs or replacement. 8) "Valuable Papers and Records" at the cost of restoration or replacement. To the extent that the contents of the "valuable papers and records" are not restored or replaced, the "valuable papers and records" will be valued at the cost of replacement with blank material of substantially identical type. 9) "Stock" you have sold but not delivered at the selling price less discounts and expenses you otherwise would have had. 10) Property in transit (other than "stock" you have sold) at the amount of invoice, including your prepaid or advanced freight SB -146801-1 Ed. 04-14) charges and other charges which may have accrued or become legally due from you since the shipment. If you have no invoice, the actual cash value will apply. 111) "Money" at its face value. 12)"Securities" at their value at the close of business on the day the loss is discovered. 13)Accounts Receivable as follows: a) If you cannot accurately establish the amount of Accounts Receivable outstanding as of the time of loss, we will: i) Determine the total of the average monthly amounts of Accounts Receivable for the 12 months immediately preceding the month in which the loss occurs; and ii) Adjust that total for any normal fluctuations in the amount for Accounts Receivable for the month in which the loss occurred or for any demonstrated variance from the average for that month. b) If you can accurately establish the amount of Accounts Receivable outstanding, that amount will be used in the determination of loss. c) The following will be deducted from the total amount of Accounts Receivable, however that amount is established: i) The amount of the accounts for which there was no loss; ii) The amount of the accounts that you are able to reestablish or collect; iii) An amount to allow for probable bad debts that you are normally unable to collect; and iv) All unearned interest and service charges. 14)"Electronic Data Processing Equipment" at replacement cost as of the time and place of loss, without deduction for physical deterioration, depreciation, obsolescence or depletion. However, in the event of replacement of "electronic data processing equipment" with identical property is impossible, the replacement cost will be the cost of items that are SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 11 of 22 Ed. 04-14) similar to the damaged or destroyed equipment and intended to perform the same function, but which may include technological advances. Electronic data processing equipment" that is obsolete or no longer used by you will be valued at actual cash value. 115) "Electronic Media and Data" at the cost of the same or similar blank media. 16)"Electronic Data": a) For which duplicates or back-ups do not exist, will be valued at your cost to research, replace or restore the electronic data," but only if the electronic data" is actually replaced or restored. b) For which full duplicates or back-ups exist, will be valued at your cost of labor to copy the "electronic data" from such duplicates or back-ups, but only if the "electronic data" is actually copied. c) For which partial duplicates or back- ups exist, will be valued at your cost of labor to copy the partial "electronic data" from such duplicates or back- ups, and your cost to research, replace or restore the remaining electronic data," but only if the electronic data" is actually copied and replaced or restored. d) In the event that you are not able to copy "electronic data" from back-ups, or replace or restore, "electronic data" will be valued at your cost of labor up to the point in time that you reach that determination. 17)The value of United States Government Internal Revenue taxes and custom duties and refundable state and local taxes paid or fully determined on the following property held for sale will not be considered in determining the value of Covered Property: a) Distilled spirits; b) Wines; c) Rectified products; or d) Beer. SB -146801-1 Ed. 04-14) If. Our payment for loss of or damage to personal property of others will only be for the account of the owners of the property. We may adjust losses with the owners of lost or damaged property, if other than you. If we pay the owners, such payments will satisfy your claims against us for the owners' property. We will not pay the owners more than their financial interest in the Covered Property. g. We may elect to defend you against suits arising from claims of owners of property. We will do so at our expense. h. We will pay for covered loss or damage within 30 days after we receive the sworn proof of loss provided you have complied with all of the terms of this policy; and 1) We have reached agreement with you on the amount of loss; or 2) An appraisal award has been made. At our option, we may make a partial payment toward any claims, subject to the policy provisions and our normal adjustment process. To be considered for partial claim payment, you must submit a partial sworn proof of loss with supporting documentation. Any applicable policy deductibles must be satisfied before any partial payments are made. j. Pair, Sets or Parts Pair or Set. In case of "loss" to any part of a pair or set we may: a) Repair or replace any part to restore the pair or set to its value before the loss"; or b) Pay the difference between the value of the pair or set before and after the loss.,, 2. Parts. In case of "loss" to any part of Covered Property consisting of several parts when complete, we will only pay for the value of the lost or damaged part. k. Commodity Stock We will determine the value of merchandise and raw materials that are bought and sold at an established market exchange. We will determine the value at: 1) The posted market price as of the time and place of loss; 18) Lottery tickets at their initial cost to you (2) Less discounts and expenses youexceptforwinningticketsattheir redeemed value. otherwise would have had. SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 12 of 22 Ed. 04-14) 5. Loss Payment — Business Income and Extra Expense a. If the Declarations indicate that Business Income and Extra Expense applies to Buildings or Business Personal Property, the amount of Business Income loss will be determined based on: 1) The Net Income of the business before the direct physical loss or damage occurred; 2) The likely Net Income of the business if no physical loss or damage occurred, but not including any likely increase in Net Income attributable to an increase in the volume of business as a result if favorable business conditions caused by the impact of the Covered Cause of Loss on customers or on other businesses; 3) The operating expenses, including payroll expenses, necessary to resume operations" with the same quality of service that existed just before the direct physical loss or damage; and 4) Other relevant sources of information, including: a) Your financial records and accounting procedures; b) Bills, invoices and other vouchers; and c) Deeds, liens or contracts. b. The amount of Extra Expense will be determined based on: 1) All reasonable and necessary expenses that exceed the normal operating expenses that would have been incurred by "operations" during the "period of restoration" if no direct physical loss or damage had occurred. We will deduct from the total of such expenses: a) The salvage value that remains of any property bought for temporary use during the "period of restoration," once "operations" are resumed; and SB -146801-1 Ed. 04-14) c. We will reduce the amount of your: 1) Business Income loss, other than Extra Expense, to the extent you can resume your "operations," in whole or in part, by using damaged or undamaged property including merchandise or "stock") at the described premises or elsewhere; or 2) Extra Expense loss to the extent you can return "operations" to normal and discontinue such Extra Expense. d. If you do not resume "operations," or do not resume "operations" as quickly as possible, we will pay based on the length of time it would have taken to resume "operations" as quickly as possible. e. We will pay for covered loss or damage within 30 days after we receive your sworn proof of loss provided you have complied with all of the terms of this policy; and 1) We have reached agreement with you on the amount of loss; or 2) An appraisal award has been made. 6. Vacancy a. Description of Terms 1) As used in this Vacancy Condition, the term building and the term vacant have the meanings set forth in Paragraphs (a) and (b) below: a) When this policy is issued to a tenant, and with respect to that tenant's interest in Covered Property, building means the unit or suite rented or leased to the tenant. Such building is vacant when it does not contain enough business personal property to conduct customary operations. b) When this policy is issued to the owner or general lessee of a building, building means the entire building. Such building is vacant unless at least 31% of its total square footage is: b) Any Extra Expense that is paid for by i. Rented to a lessee or sub -lessee other insurance, except for insurance and used by the lessee or sub - that is written subject to the same lessee to conduct its customary plan, terms, conditions and operations; and/or provisions as this insurance; and ii. Used by the building owner to 2) All reasonable and necessary expenses conduct customary operations. that reduce the Business Income loss that ( 2) Buildings under construction orotherwisewouldhavebeenincurred. renovation are not considered vacant. SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 13 of 22 Ed. 04-14) b. Vacancy Provisions If the building where loss or damage occurs has been vacant for more than 60 consecutive days before that loss or damage occurs: 1) We will not pay for any loss or damage caused by any of the following even if they are Covered Causes of Loss: a) Vandalism; b) Sprinkler leakage, unless you have protected the system against freezing; c) Building glass breakage; d) Water damage; e) Theft; or f) Attempted theft. With respect to Covered Causes of Loss other than those listed in paragraphs (1)(a) through (1)(f) above, we will reduce the amount we would otherwise pay for the loss or damage by 15%. 7. Recovered Property If either you or we recover any property after loss settlement, that party must give the other prompt notice. At your option, you may retain the property. But then you must return to us the amount we paid to you for the property. We will pay the recovery expenses and the expenses to repair the recovered property, subject to the applicable Limit of Insurance. 8. Noncumulative Limit No Limit of Insurance cumulates from policy period to policy period. F. COMMERCIAL PROPERTY CONDITIONS 1. Concealment, Misrepresentation or Fraud This policy is void in any case of fraud by you as it relates to this policy at any time. It is also void if you or any other insured, at any time, intentionally conceal or misrepresent a material fact concerning: a. This policy; b. The Covered Property; c. Your interest in the Covered Property; or d. A claim under this policy. 2. Control of Property SB -146801-1 Ed. 04-14) The breach of any condition of this Coverage Form at any one or more premises will not affect coverage at any premises where, at the time of loss or damage, the breach of condition does not exist. 3. Insurance Under Two or More Coverages If two or more of this policy's coverages apply to the same loss or damage, we will not pay more than the actual amount of the loss or damage. 4. Legal Action Against Us No one may bring a legal action against us under this Coverage Form unless: a. There has been full compliance with all of the terms of this Coverage Form; and b. The action is brought within 2 years after the date on which the direct physical loss or damage occurred. 5. Liberalization If, during your policy period, we adopt any revision that would broaden the coverage under this policy without additional premium the broadened coverage will immediately apply to this policy. The broadened coverage will also apply to the renewal of this policy if such renewal was in process, or was mailed prior to the date we adopted such revision. 6. No Benefit to Bailee No person or organization, other than you, having custody of Covered Property will benefit from this insurance. 7. Other Insurance a. You may have other insurance subject to the same plan, terms, conditions and provisions as the insurance under this Coverage Form. If you do, we will pay our share of the covered loss or damage. Our share is the proportion that the applicable Limit of Insurance under this Coverage Form bears to the Limits of Insurance of all insurance covering on the same basis. b. If you have other insurance covering the same loss or damage, other than that described in Paragraph a. above, we will pay only for the amount of covered loss or damage in excess of the amount due from that other insurance, whether you can collect on it or not. But we will not pay more than the applicable Limit of Insurance. Any act or neglect of any person other than you 8. Policy Period, Coverage Territorybeyondyourdirectionorcontrolwillnotaffectthis insurance. Under this Coverage Form: SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 14 of 22 Ed. 04-14) a. We cover loss or damage you sustain through acts committed or events occurring: 1) During the policy period shown in the Declarations; and 2) Within the coverage territory; and b. The coverage territory is: 1) The United States of America (including its territories and possessions); 2) Puerto Rico; and 3) Canada 9. Transfer of Rights of Recovery Against Others To Us Applicable to the Businessowners Property coverage: If any person or organization to or for whom we make payment under this policy has rights to recover damages from another, those rights are transferred to us to the extent of our payment. That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing. a. Prior to a loss to your Covered Property or Covered Income; or b. After a loss to your Covered Property only if, at the time of loss, that party is one of the following: 1) Someone insured by this insurance; 2) A business firm: a) Owned or controlled by you; or b) That owns or controls you; or 3) Your tenant. This will not restrict your insurance. 10. Coinsurance If a Coinsurance percentage is shown in the Declarations, the following condition applies. a. We will not pay the full amount of any loss if the value of Covered Property at the time of loss multiplied by the Coinsurance percentage shown for it in the Declarations is greater than the Limit of Insurance for the property Instead, we will determine the most we will pay using the following steps: 1) Multiply the value of Covered Property at the time of loss by the Coinsurance Percentage; SB -146801-1 Ed. 04-14) 2) Divide the Limit of Insurance of the property by the figure determined in step 1); 3) Multiply the total amount of the covered loss, before the application of any deductible, by the figure determined in step (2) above; and 4) Subtract the deductible from the figure determined in step (3). We will pay the amount determined in step (4) or the limit of insurance, whichever is less. For the remainder, you will either have to rely on other insurance or absorb the loss yourself. Example No. 1 (Under Insurance): When: The value of the property is $250,000 The coinsurance percent for it is 90% The Limit of Insurance for it is $112,500 The Deductible is $250 The amount of loss is $40,000 Step (1): $250,000 x 90% = $225,000 (the minimum amount of insurance to meet your Coinsurance requirements) Step (2): $112,500/$225,000 = .50 Step (3): $40,000 x .50 = $20,000 Step (4): $20,000 - $250 = $19,750 We will pay no more than $19,750. The remaining $20,250 is not covered. Example No. 2 (Adequate Insurance): When: The value of the property is $250,000 The Coinsurance percentage for it is 90% The Limit of Insurance for it is $225,000 The Deductible is $250 The amount of loss is $40,000 The minimum amount of insurance to meet your Coinsurance requirement is $225,000 250,000 x 90%). Therefore, the Limit of Insurance in this Example is adequate and no penalty applies. SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 15 of 22 Ed. 04-14) SB -146801-1 Ed. 04-14) We will pay no more than $39,750 ($40,000 transferred to us and you will pay your amount of loss minus the deductible of $250). remaining mortgage debt to us. b. Coinsurance does not apply to: f. If we cancel this policy we will give written 1) "Money" and "securities"; notice to the mortgageholder at least: 2) Additional Coverages; 1) 10 days before the effective date of cancellation if we cancel for your non - 3) Coverage Extensions; or payment of premium; or 4) Loss or damage in any one occurrence 2) 30 days before the effective date of totaling less than $2,500. cancellation if we cancel for any other 11. Mortgageholders reason. g• If we elect not to renew this policy, we will a. The term, mortgageholder, includes trustee. give written notice to the mortgageholder at b. We will pay for covered loss of or damage to least 10 days before the expiration date of this buildings or structures to each policy. mortgageholder shown in the Declarations in G. PROPERTY DEFINITIONS their order of precedence, as interests may appear. 1. "Banking Premises" means the interior of that portion of any building which is occupied by a c. The mortgageholder has the right to receive banking institution or similar safe depository. loss payment even if the mortgageholder has started foreclosure or similar action on the 2. "Breakdown" building or structure. a. Means: d. If we deny your claim because of your acts or 1) Failure of pressure or vacuum equipment; because you have failed to comply with the terms of this Coverage Form, the 2) Mechanical failure, including rupture or mortgageholder will still have the right to bursting caused by centrifugal force; or receive loss payment if the mortgageholder: 3) Electrical failure including arcing; 1) Pays any premium due under this Coverage Form at our request if you have That causes physical damage to "covered failed to do so; equipment" and necessitates its repair or replacement; and 2) Submits a signed, sworn proof of loss b. Does not mean: within 60 days after receiving notice from us of your failure to do so; and 1) Malfunction, including but not limited to 3) Has notified us of any change in adjustment, alignment, calibration, ownership or occupancy or substantial cleaning or modification; change in risk known to the 2) Leakage at any valve, fitting, shaft seal, mortgageholder. gland packing, joint or connection; All of the terms of this Coverage Form will 3) Damage to any vacuum tube, gas tube, or then apply directly to the mortgageholder. brush; e. If we pay the mortgageholder for any loss or 4) Damage to any structure or foundation damage and deny payment to you because of supporting the "covered equipment" or your acts or because you have failed to any of its parts; comply with the terms of this Coverage Form: 5) The functioning of any safety or protective 1) The mortgageholder's rights under the device; or mortgage will be transferred to us to the extent of the amount we pay; and 6) The cracking of any part on any internal combustion gas turbine exposed to the 2) The mortgageholder's rights to recover products of combustion. the full amount of the mortgageholder's claim will not be impaired. 3. "Communication Supply Services" At our option, we may pay to the a. Means property supplying communication mortgageholder the whole principal on the services, including telephone, radio, mortgage plus any accrued interest. In microwave or television services to the this event, your mortgage and note will be described premises, such as: SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 16 of 22 Ed. 04-14) SB -146801-1 Ed. 04-14) 1) Communication transmission lines, b. Apparatus; including fiber optic transmission lines; used solely for research, diagnostic, medical, 2) Coaxial cables; and surgical, therapeutic, dental or pathological 3) Microwave radio relays, except satellites purposes. and; 6. "Electronic Data" b. Does not mean overhead transmission lines. a. Means information reduced to an electronic 4. "Covered Equipment" format for processing with and storage in electronic data processing equipment," a. Means the following types of equipment: software and programming records and instructions used for "electronic data 1) Equipment designed and built to operate processing equipment." under internal pressure or vacuum other than weight of contents; b. Any reference to your "electronic data" means electronic data" owned or licensed by you2) Electrical or mechanical equipment that is and stored on your "electronic data used in the generation, transmission or processing equipment." utilization of energy; c. Does not mean "valuable papers and 3) Refrigeration or Air Conditioning systems; records." 4) Fiber optic cable; and 7. "Electronic Media and Data" 5) Hoists and cranes; a. Means physical media on which "electronic b. Does not mean any data" is stored, and the "electronic data" stored thereon, including without limitation, 1) Electronic data processing equipment"; hard or floppy disks, CD-ROMS, tapes, 2) Electronic media and data" or "electronic drives, cells, data processing devices or any data"; other repositories used with electronically controlled equipment. 3) Part of pressure or vacuum equipment that is not under internal pressure of its b. Any reference to your "electronic media and contents or internal vacuum; data" means "electronic media and data" owned by you and stored on your "electronic 4) Insulating or refractory material; data processing equipment." 5) Pressure vessels and piping that are c. Electronic media and data" does not mean buried below ground and require the any "valuable papers & records." excavation of materials to inspect, remove, repair, or replace; 8• "Electronic Data Processing Equipment" 6) Structure, foundation, cabinet or a. Means any of the following equipment: compartment supporting or containing the 1) Computers, facsimile machines, word covered equipment" or part of the processors, multi -functional telephones covered equipment" including pen -stock, and computer servers, and draft tube or well casing; 2) Any component parts and peripherals of 7) Vehicle, aircraft, self-propelled equipment such equipment, including related surge or floating vessel, including any protection devices. equipment mounted on or used solely with any vehicle, aircraft, self-propelled 3) Laptops and personal digital assistants. equipment or floating vessel; 4) "Diagnostic Equipment" 8) Elevator or escalator, but not excluding b. Electronic data processing equipment" does any electrical machine or apparatus not mean equipment used to operate mounted on or used with this equipment; production type of: or 1) Machinery; or9) Equipment or any part of such equipment manufactured by you for sale. 2) Equipment. 5. "Diagnostic Equipment" means any: c. Any reference to your "electronic data processing equipment" means "electronic a. Equipment; or data processing equipment" used in your SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 17 of 22 Ed. 04-14) operations" and controlled and operated by you, and includes any "electronic data processing equipment" controlled or operated by a third party on your behalf. 9. "Employee(s)" means: a. Any natural person: 1) While in your service (and for 30 days after termination of service); and 2) Whom you compensate directly by salary, wages or commissions; and 3) Whom you have the right to direct and control while performing services for you. b. Any natural person employed by an employment contractor while that person is subject to your direction and control and performing services for you excluding, however, any such person while having care and custody of property outside the premises. c. Your directors or trustees while acting as a member of any of your elected or appointed committees to perform on your behalf specific, as distinguished from general, directorial acts. But "employee" does not mean any agent, broker, factor, commission merchant, consignee, independent contractor or representative of the same general character. 10. "Employee Dishonesty" means only dishonest acts, committed by an "employee," whether identified or not, acting alone or in collusion with other persons, except you, a partner, a "member" or a "manager," including the "theft" of Personal Property of Others in your care custody or control by an "employee," with the manifest intent to: a. Cause you, your customers or clients to sustain loss; and also b. Obtain financial benefit (other than salaries, commissions, fees, bonuses, promotions, awards, profit sharing, pensions or other employee benefits earned in the normal course of employment) for: 1) The "employee"; or 2) Any person or organization intended by the "employee" to receive that benefit. 11. "Fine Arts" SB -146801-1 Ed. 04-14) b. Does not mean any glass that is a part of a building or structure. 12. "Flood" means a general and temporary condition of partial or complete inundation of normally dry land areas, whether caused by natural occurrences, acts or omissions of man or any other cause or combination of causes. All flooding in a continuous or protracted event will constitute a single "flood." 13. "Forgery" means the signing of the name of another person or organization with intent to deceive. "Forgery" does not mean a signature which consists in whole or in part of one's own name signed with or without authority, in any capacity for any purpose. 14. "Interior of any building or structure" as used in this policy means all portions of the structure that are within the exterior skin of the structure's walls and roof, including, but not limited to lathe, sand paper, framing, wallboard and tarpaper. 15. "Maintenance Fees" means the regular payment made to you by unit -owners and used to service the common property. 16. "Manager" means a person serving in a directorial capacity for a limited liability company. 17. "Member" means an owner of a limited liability company represented by its membership interest, who also may serve as a "manager." 18. "Money" means currency and coins in current use, bank notes, travelers checks, register checks and money orders held for sale to the public. 19. "Operations" means the type of your business activities occurring at the described premises and tenantability of the described premises. 20. "Period of restoration" means the period of time that: a. Begins with the date of direct physical loss or damage caused by or resulting from any Covered Cause of Loss at the described premises; and b. Ends on the earlier of: 1) The date when the property at the described premises should be repaired, rebuilt or replaced with reasonable speed and similar quality; or a. Means paintings, etchings, pictures, (2) The date when business is resumed at a tapestries, art glass windows, valuable rugs, new permanent location. statuary, marbles, bronzes, antique furniture, rare books, antique silver, porcelains, rare "Period of restoration" does not include any glass, bric-a-brac, and similar property with increased period required due to the historical value, or artistic merit; and enforcement of any law that: SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 18 of 22 Ed. 04-14) a) Regulates the construction, use or repair, or requires the tearing down of any property; or b) Regulates the prevention, control, repair, clean-up or restoration of environmental damage. The expiration date of this policy will not cut short the "period of restoration." 21. "Pollutants" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals, waste, and any unhealthful or hazardous building materials (including but not limited to asbestos and lead products or materials containing lead). Waste includes materials to be recycled, reconditioned or reclaimed. 22. "Power Generating Equipment" a. Means the following types of equipment or apparatus: 1) Pressure; 2) Mechanical; or 3) Electrical; Used in or associated with the generation of electrical power; and b. Does not mean such equipment that is used solely to generate emergency power that is less than or equal to 1000KW 23. "Power Supply Services" a. Means the following types of property supplying electricity, steam or gas to the described premises: 1) Utility generating plants; 2) Switching stations; 3) Substations; 4) Transformers; and 5) Transmission Lines; and b. Does not mean overhead transmission lines. 24. "Production Equipment" a. Means any: 1) Production machinery; or 2) Process machinery that processes, shapes, forms or grinds: i. Raw materials; ii. Materials in process; or SB -146801-1 Ed. 04-14) b. Includes "covered equipment" that is used solely with or forms an integral part of the: 1) Production; 2) Process; or 3) Apparatus. 25. "Rental Value" means Business Income that consist of: a. Net income (Net Profit or Loss before income taxes) that would have been earned or incurred as rental income from tenant occupancy of the premises described in the Declarations as furnished and equipped by you, including the fair rental value of any portion of the described premises which is occupied by you; and b. Continuing normal operating expenses incurred in connection with that premises, including: 1) Payroll; and 2) The amount of charges which are the legal obligation of the tenant(s) but would otherwise be your obligations. 26. "Securities" means negotiable and nonnegotiable instruments or contracts representing either money" or other property and includes: a. Tokens, tickets except lottery tickets, revenue and other non -postage stamps whether or not in current use; and b. Evidences of debt issued in connection with credit or charge cards, which are not of your own issue; but does not include "money." Lottery tickets held for sale are not securities. 27. "Specified causes of loss" means the following: Fire; lightning; explosion; windstorm or hail; smoke; aircraft or vehicles; riot or civil commotion; vandalism; leakage from fire extinguishing equipment; sinkhole collapse; volcanic action; falling objects; weight of snow, ice or sleet; water damage. a. Sinkhole collapse means the sudden sinking or collapse of land into underground empty spaces created by the action of water on limestone or dolomite. This cause of loss does not include: 1) The cost of filling sinkholes; or 2) Sinking or collapse of land into man-made underground cavities. iii. Finished products; and b. Falling objects does not include loss of or damage to: SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 19 of 22 Ed. 04-14) 1) Personal Property in the open; or 2) The interior of a building or structure, or property inside a building or structure, unless the roof or an outside wall of the building or structure is first damaged by a falling object. c. Water damage means: 1) Accidental discharge or leakage of water or steam as the direct result of the breaking apart or cracking of any part of a system or appliance (other than a sump system including its related equipment and parts) containing water or steam; and 2) Accidental discharge or leakage of water or waterborne material as the direct result of the breaking apart or cracking of a water or sewer pipe that is located off the described premises and is part of a municipal potable water supply system or municipal sanitary sewer system, if the breakage or cracking is caused by wear and tear. But water damage does not include loss or damage otherwise excluded under the terms of the Water Exclusion. Therefore, for example, there is no coverage in the situation in which discharge or leakage of water results from the breaking apart or cracking of a pipe which was caused by or related to weather - induced flooding, even if wear and tear contributed to the breakage or cracking. As another example, and also in accordance with the terms of the Water Exclusion, there is no coverage for loss or damage caused by or related to weather -induced flooding which follows or is exacerbated by pipe breakage or cracking attributable to wear and tear. To the extent that accidental discharge or leakage of water falls within the criteria set forth in c.(1) or c.(2) of this definition of specified causes of loss," such water is not subject to the provisions of the Water Exclusion which preclude coverage for surface water or water under the ground surface. 28. "Stock" means merchandise held in storage or for sale, raw materials and in -process or finished goods, including supplies used in their packing or shipping. 29. "Suspension" means: a. The partial or complete cessation of your business activities; or b. That a part or all of the described premises is rendered untenantable. SB -146801-1 Ed. 04-14) 30. "Theft" means any act of stealing. 31. "Vacant" means the following a. When this policy is issued to a tenant, and with respect to that tenant's interest in Covered Property, building means the unit or suite rented or leased to the tenant. Such building is vacant when it does not contain enough business personal property to conduct customary operation. b. When this policy is issued to the owner or general lessee of a building, building means the entire building. Such building is vacant unless at least 31% of its total square footage is: 1) Rented to a lessee or sub -lessee and used by the lessee or sub -lessee to conduct its customary operations; and/or 2) Used by the building owner to conduct customary operations. 32. "Valuable papers and records" means inscribed, printed or written: a. Documents; b. Manuscripts; and c. Records; Including abstracts, books, deeds, drawings, films, maps or mortgages. But "valuable papers and records" does not mean: a. "Money" or securities"; b. "Electronic data"; c. "Electronic media and data"; 33. "Water Supply Services" means the following types of property supplying water to the described premises: a. Pumping stations; and b. Water mains. H. MALICIOUS CODE, SYSTEM PENETRATION AND DENIAL OF SERVICE DEFINITIONS: Denial of Service" means any failure or inability of any person, user, customer, "electronic data processing equipment," computer system or computer network to communicate with, gain access to, or use, any "electronic data processing equipment," computer system, computer network, electronic media and data" or "electronic data" because an excessive volume of data, requests or communications is sent to, received by or processed by such "electronic data processing equipment," computer system or computer network, and depletes the bandwidth, capacity or SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 20 of 22 Ed. 04-14) computational resources thereof, including without limitation, any business interruption caused by the foregoing. 2. "Electronic Data Peril" means: a. b. C. Corruption, unauthorized use, distortion, deletion, damage, destruction or any other harm to, or misappropriation or copying of, electronic data" or information; Interruption, delay, disruption, suspension, loss of functionality of, inaccessibility to, unauthorized access to or inability to use or communicate with, "electronic data processing equipment," "electronic media and data," "electronic data," computer resources, electronic devices, computer system, computer network or equipment; or Misappropriation, transfer or copying of any property, "money," "securities" or "stock," including without limitation, the use of any computer to cause such misappropriation, transfer or copying; 3. "Malicious Code" means any data, computer program, software, firmware or computer code designed to cause or result in, or that does cause or result in (whether designed to do so or not), any electronic data peril," including without limitation, computer viruses, worms or Trojan horses. 4. "Mass Attack Malware" means any "malicious code": a. Capable of replicating or mutating; b. C. I* Propagating, spreading or moving to other electronic data processing equipment," electronic media and data," "electronic data," electronic devices, media, computer systems, equipment or computer networks, including without limitation, by attaching to applications, e-mails, e-mail attachments or otherwise; Designed to exploit a vulnerability that is common to or present on more than one electronic data processing equipment," electronic media and data," "electronic data," electronic devices, media, computer systems, equipment or computer networks; or That infects, is stored upon, exists within or resides on more than one "electronic data processing equipment," "electronic media and data," "electronic data," electronic device, media, computer system, equipment or computer network. SB -146801-1 Ed. 04-14) 5. "Mass System Penetration" means any "system penetration" that: a. Exploits, or is designed to exploit, a vulnerability that is common to or present on more than one "electronic data processing equipment," "electronic media and data," electronic data," electronic devices, media, computer systems, equipment or computer networks; or b. Targets or exploits more than one "electronic data processing equipment," "electronic media and data," "electronic data," electronic device, media, computer system, equipment or computer network. 6. "System Penetration" means any access to or use of any "electronic data processing equipment," "electronic media and data," electronic data," electronic device, computer system, equipment or computer network intended to cause or result in, or that does cause or result in, any "electronic data peril," which is not directly or indirectly enabled by "malicious code" and which is achieved by a person without the use or assistance, directly or indirectly, of "malicious code." 7. "Targeted Hacker Attack" means the corruption, distortion, damaging, deletion or destruction of your "electronic data" resulting from "targeted system penetration" or "targeted malware." 8. "Targeted Malware" means any "malicious code" that: a. Is intended by a hacker to specifically infect, or be stored or reside on, only your "electronic data processing equipment'; b. Is incapable of replicating, mutating, propagating, spreading or moving to other electronic data processing equipment," electronic media and data," "electronic data," electronic devices, media, computer systems or computer networks; c. Does not infect or reside on any other electronic data processing equipment," electronic media and data," "electronic data," computer system, electronic device, or computer network that is not yours; and d. Exploits a vulnerability that is unique to, and present on, only your "electronic data processing equipment," and such vulnerability is not common to or present on any other electronic data processing equipment," computer, electronic device, medium, computer system, equipment or computer network. SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 21 of 22 Ed. 04-14) 9. "Targeted System Penetration" means "system penetration" that is designed to target and exploit, and that does target and exploit, a vulnerability that is unique to, and present on, only your electronic data processing equipment," and such SB -146801-1 Ed. 04-14) vulnerability is not common to or present on any other "electronic data processing equipment," computer, electronic device, medium, computer system, equipment or computer network. SB -146801-1 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 22 of 22 Ed. 04-14) CNA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS INCOME AND EXTRA EXPENSE SB146802E04 Ed. 6-16) This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A. Coverage. Business Income and Extra Expense Business Income and Extra Expense is provided at the premises described in the Declarations when the Declarations show that you have coverage for Business Income and Extra Expense. 1. Business Income a. Business Income means: 1) Net Income (Net Profit or Loss before Income taxes) that would have been earned or incurred, including: a) "Rental Value"; and b) "Maintenance Fees," if you are a condominium association; and 2) Continuing normal operating expenses incurred, including payroll, subject to 90 day limitation if indicated on the Declaration page. b. We will pay for the actual loss of Business Income you sustain due to the necessary "suspension" of your operations" during the "period of restoration." The "suspension" must be caused by direct physical loss of or damage to property at the described premises. The loss or damage must be caused by or result from a Covered Cause of Loss. With respect to loss of or damage to personal property in the open or personal property in a vehicle, the described premises include the area within 1,000 feet of the site at which the described premises are located. c. Your loss of Business Income is covered up to 30 consecutive days when caused as a direct result of damage, by a Covered Cause of Loss, to property adjacent to your premises. d. With respect to the requirements set forth in Paragraph b. above, if you rent, lease or occupy only part of the site at which the described premises are located, the described premises means: 1) The portion of the building which you rent, lease or occupy; and 2) Any area within the building or on the site at which the described premises are located, if that area services, or is used to gain access to, the described premises. e. Property in Transit 1) We will pay for the actual loss of Business Income you sustain and necessary Extra Expense you incur during the "period of restoration" due to direct physical loss of or damage to: a) Your business personal property; or b) Personal property of others in your care, custody or control; while such property in the due course of transit. If caused by such loss or damage to property in the due course of transit, we will also pay for the actual loss of Business Income you sustain during the additional period of coverage provided under the Extended Business Income Additional Coverage. 2) Insurance under this Additional Coverage applies only if the loss or damage to the property in transit is caused by a Covered Cause of Loss. Insurance under this Additional Coverage does not apply to any loss of Business Income or Extra Expense due to loss of or damage to: SB146802E04 (Ed. 6-16) Page 1 of 3 Copyright, CNA All Rights Reserved. CNA SB1( Ed. 6--16) a) Vehicles or self propelled machines (including motor vehicles, trailers, aircraft, watercraft and similar conveyances) unless such vehicles are themselves in the due course of transit in or on another transporting conveyance; b) Property while waterborne, except in regular ferry operations in the course being moved by other means of transportation; c) Property shipped by mail; d) Contraband, or property in the course of illegal transportation or trade; e) Import shipments that have not been unloaded from any importing aircraft or watercraft, or that are under the protection of marine insurance; f) Export shipments once loaded on board exporting aircraft or watercraft, or under the protection of marine insurance; or g) Properly sold by you under conditional sale, trust agreement, installment payment or other deferred payment plan, after delivery to customers. 3) The most we will pay for loss under this Additional Coverage is $10,000 unless a different Limit of Insurance is shown in the Declarations for Property in Transit — Business Income and Extra Expense. 2. Extra Expense a. Extra Expense means reasonable and necessary expenses you incur during the "period of restoration" that you would not have incurred if there had been no direct physical loss of or damage to property caused by or resulting from a Covered Cause of Loss. b. We will pay Extra Expense (other than the expense to repair or replace property) to: 1) Avoid or minimize the "suspension" of business and to continue 'operations" at the described premises or at replacement premises or temporary locations, including relocation expenses and costs to equip and operate the replacement premises or temporary locations; or 2) Minimize the "suspension" of business if you cannot continue "operations." c. We will also pay Extra Expense (including Expediting Expenses) to repair or replace the property, but only to the extent it reduces the amount of loss that otherwise would have been payable under Paragraph 1. Business Income above. 3. Extended Business Income If the necessary "suspension" of your 'operations" produces a Business Income loss payable under Paragraph 1. Business Income above, we will also pay for the actual loss of Business Income you sustain during the period that: a. Begins on the date property is actually repaired, rebuilt or replaced and 'operations are resumed; and b. Ends on the earlier of: 1) The date you could restore your "operations" with reasonable speed, to the level which would generate the Business Income amount that would have existed if no direct physical loss or damage occurred; or 2) Sixty consecutive days after the date determined in paragraph a. above. However, this extended Business Income does not apply to loss of Business Income incurred as a result of unfavorable business conditions caused by the impact of the Covered Cause of loss in the area where the described premises are located. 4. If the Declarations show for Business Income and Extra Expense: a. Actual loss sustained for 12 consecutive months, then we will pay for loss of Business Income and Extra Expense that occurs within 12 consecutive months following the date of direct physical loss or damage; or actual loss sustained for the number of months shown on the Declaration page; or b. Subject to a. above, if a maximum dollar limit is shown on the Declarations page, then we will pay actual loss sustained up to a maximum dollar limit, for the loss of Business Income and Extra Expense. SB146802E04 (Ed. 6-16) Page 2 of 3 Copyright, CNA All Rights Reserved. CNA SB1( Ed. 6--16) 5. "Electronic Data Processing Equipment' and "Electronic Media and Data" a. "Electronic data processing equipment' and "electronic media and data" shall be considered covered property as referenced in this Coverage Part. b. We shall not be liable for any payment for the Extra Expense you incur, and loss of Business Income you sustain, during the first 12 hours following the start of a necessary "suspension" of your "operations" during the "period of restoration" that is caused by direct physical loss of or damage to "electronic data processing equipment' or electronic data and media" at the described premises; or at the premises of a 3rd party vendor who is managing or controlling your "electronic data processing equipment' on your behalf, provided, however, if the Business Income And Extra Expense — 72 Hour Deductible endorsement is part of this policy, the 72 hour deductible stated in that endorsement shall apply with respect to this sub -paragraph 5.b. instead of the 12 hour deductible set forth above. All other terms and conditions of the Policy remain unchanged. SB146802E04 (Ed. 6-16) Page 3 of 3 Copyright, CNA All Rights Reserved. CNA SB -146803-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SEASONALINCREASE This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form: Subject to the Exclusions, Conditions and Limitations of this policy, you may extend this insurance as indicated below. Unless otherwise stated, payments made under the following coverage will not increase the applicable Limits of Insurance. 1. The Limit of Insurance for Business Personal Property shown in the Declarations will automatically increase by 25%, or the amount SB -146803-A Ed. 01/06) shown in the Declarations to provide for seasonal variations. 2. This increase will apply only if the Limit of Insurance shown for Business Personal Property in the Declarations is at least 100% of your average monthly values during the lesser of: a. The 12 months immediately preceding the date of the loss or damage occurs; or b. The period of time you have been in business at the location where the loss or damage occurs, on the date the loss or damage occurs. Page 1 of 1 CNA SB -146804-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 1*970VAN III .1:4;k9N4i%\7 . This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Section A.5. Additional Coverages. Unless otherwise stated, payments made under the following Additional Coverage is in addition to the applicable Limits of Insurance. Arson and Theft Reward 1. We will pay for reasonable expenses you incur for rewards that lead to: a. An arson conviction in connection with a covered fire or explosion loss; or b. A "theft' conviction in connection with a covered "theft' loss. 2. The most we will pay under this Additional Coverage in connection with a particular loss is 5,000. SB -146804-A Page 1 of 1 Ed. 01/06) CNA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CLAIM DATA EXPENSE This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM SB146805B Ed. 6-16) The following coverage is added to your Businessowners Special Property Coverage under Section A.5. Additional Coverages: Unless otherwise stated, payments made under the following Additional Coverage is in addition to the applicable Limit of Insurance. Claim Data Expense 1. We will pay the reasonable and necessary expenses you incur in preparing claim data when we require such data or we request you prepare income statements to show the extent of covered loss or damage. This includes the cost of taking inventories, making appraisals, preparing income statements, and preparing other documentation. 2. Under this Additional Coverage, we will not pay for: a. Any fees, costs or expenses incurred, directed or billed by or payable to: 1) attorneys, public adjusters, loss adjusters, loss consultants or their associates or subsidiaries; or 2) insurance brokers or agents, or their associates or subsidiaries, including related forensic accounting services, without our written consent prior to such expenses being incurred. b. Any costs incurred in connection with Paragraph E.2. Appraisal. 3. The most we will pay for preparation of claim data under this Additional Coverage in any one occurrence is $5,000 regardless of the number of premises involved. All other terms and conditions of the Policy remain unchanged. SB146805B (Ed. 6-16) Page 1 of 1 Copyright, CNA All Rights Reserved. CNA SB -146806-B Ed. 01/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I17:-1N&A0:4kh This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners b. Remove, restore or replace polluted land or Special Property Coverage Form under Paragraph A.5. water. Additional Coverages. 3. Except as provided in Paragraph 4. below, Unless otherwise stated, payments made under the payment for Debris Removal is included within the following Additional Coverage is in addition to the applicable Limit of Insurance shown in the applicable Limit of Insurance. Declarations. The most we will pay under this Debris Removal Additional Coverage is 25% of: We will pay your expense to remove debris of Covered Property, other than outdoor trees, shrubs, plants and lawns as described in the Outdoor Trees, Shrubs, Plants and Lawns Coverage Extension, caused by or resulting from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us within 180 days of the date of direct physical loss or damage 2. Debris Removal does not apply to costs to: a. Extract "pollutants" from land or water; or a. The amount we pay for the direct physical loss or damage to Covered Property; plus b. The deductible in this Coverage Form applicable to that loss or damage. 4. When the debris removal expense exceeds the 25% limitation in Paragraph 3. above or when the sum of the debris removal expense and the amount we pay for the direct physical loss of or damage to Covered Property exceeds the applicable Limit of Insurance, we will pay up to an additional $25,000, or the limit shown in the Declarations, for debris removal expense in any one occurrence, at each described premises. SB -146806-B Page 1 of 1 Ed. 01/08) CNA EMPLOYEE DISHONESTY SB146807E Ed. 6-16) This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.S. Additional Coverages: Unless otherwise stated, payments under the following Additional Coverage are in addition to the applicable Limit of Insurance. Employee Dishonesty 1. We will pay for loss of or damage to Business Personal Property resulting directly from "employee dishonesty." We will pay for loss or damage you sustain through acts committed or events occurring during the Policy Period. Regardless of the number of years this insurance remains in force or the number of premiums paid, no Limit of Insurance cumulates from year to year or period to period. 2. Paragraphs A.2.m., A.2.n., A.2.p., 113.1.1k., 113.2.1h., 113.21, 113.2.n. and 113.2.o. do not apply to this Additional Coverage. 3. We will not pay for loss resulting from the dishonest acts of any "employee" if coverage for that "employee" was either cancelled or excluded from any previous insurance of yours providing "employee dishonesty" coverage. 4. This Additional Coverage is cancelled as to any "employee" immediately upon discovery by: a. You; or b. Any of your partners, "members," "managers," officers, directors or trustees not in collusion with the employee," of any fraudulent dishonest act committed by that "employee" before or after being employed by you. 5. We will pay for covered loss or damage only if discovered no later than one year from the end of the Policy Period. 6. The most we will pay for loss under this Additional Coverage in any one occurrence is the limit shown on the Declarations regardless of the number of premises involved. 7. With respect to this Additional Coverage, occurrence means all loss or damage caused by or involving the same employee(s)" whether the result of a single act or series of acts. N 8. If, during the period of any prior "Employee Dishonesty" insurance, you (or any predecessor in interest) sustained loss or damage that you could have recovered under that insurance, except that the time within which to discover loss or damage has expired, we will pay for it under this Additional Coverage, subject to the following: 0 a. This insurance became effective at the time of cancellation or termination of the prior insurance; and 0 b. The loss or damage would have been covered by this insurance had it been in effect when the acts or events causing the loss or damage were committed or occurred. 9. The insurance provide under paragraph 8. above is part of, not in addition to the Limit of Insurance described in Paragraph 6. above and is limited to the lesser of the amount recoverable under: a. This Additional Coverage, as of its effective date; or b. The prior "Employee Dishonesty" insurance, had it remained in effect. 10. We will not pay for loss or damage under this endorsement until the amount of loss or damage in any one occurrence exceeds $250. We will then pay the amount of loss or damage in excess of the $250 up to the Limit of Insurance. SB146807E (Ed. 6-16): Page 1 of 2 Copyright, CNA All Rights Reserved. CNA SB146807E Ed. 6-16) 11. Under PROPERTY DEFINITIONS, and only for the purpose of the coverage provided by this Employee Dishonesty Additional Coverage, the definition of "employee" is deleted and replaced by the following: Employee(s)" means: a. Any natural person: 1) While in your service (and for 30 days after termination of service); and 2) Whom you compensate directly by salary, wages or commissions; and 3) Whom you have the right to direct and control while performing services for you. b. Any natural person employed by an employment contractor while that person is subject to your direction and control and performing services for you excluding, however, any such person while having custody of property outside the premises. c. Any natural person, whether or not compensated, while performing services for you as a member or chairperson of any committee. d. Your natural person director or trustee while acting as a member of any of your elected or appointed committees to perform on your behalf specific, as distinguished from general, directorial acts. But "employee" does not mean any agent, broker, factor, commission merchant, consignee, independent contractor or representative of the same general character. All other terms and conditions of the Policy remain unchanged. SB146807E (Ed. 6-16): Page 2 of 2 Copyright, CNA All Rights Reserved. CNA SB -146808-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXPEDITING EXPENSES This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.5. Additional Coverages. Unless otherwise stated, payments made under the following Additional Coverage is in addition to the applicable Limits of Insurance. Expediting Expenses 1. In the event of direct physical loss of or damage to Covered Property caused by or resulting from a Covered Cause of Loss, we will pay for the reasonable and necessary additional expenses you incur to make temporary repairs, expedite permanent repairs, or expedite permanent SB -146808-A Ed. 01/06) replacement, at the premises sustaining loss or damage. Expediting expenses include overtime wages and the extra cost of express or other rapid means of transportation. Expediting expenses do not include expenses you incur for the temporary rental of property or temporary replacement of damaged property. 2. With respect to this Additional Coverages, breakdown" to "covered equipment' will not be considered a Covered Cause of Loss, even if otherwise covered elsewhere in this Policy. 3. The most we will pay under this Additional Coverage in any one occurrence is $25,000, regardless of the number of premises involved. Page 1 of 1 CNA SB -146809-C Ed. 07/09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS OWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.5. Additional Coverages. Unless otherwise stated, payments made under the following Additional Coverage is in addition to the applicable Limits of Insurance. Fine Arts 1. When a Limit of Insurance is shown in the Declarations for Building or Business Personal Property at any described premises, we will pay for direct physical loss of or damage to "fine arts" which are owned by: a. You; or b. Others and in your care, custody or control; caused by or resulting from a Covered Cause of Loss, including while on exhibit, or in transit, anywhere within the Coverage Territory. 2. The breakage limitation under Paragraph A.4.b.(2) does not apply to this Additional Coverage. 3. The following exclusions apply to this Additional Coverage: a. We will not pay for loss or damage caused by or resulting from wear and tear, any quality in the property that causes it to damage or destroy itself, gradual deterioration, insects, birds, rodents or other animals; b. We will not pay for loss or damage caused by or resulting from dampness or dryness of atmosphere, or changes in extremes of temperature; SB -146809-C Ed. 07/09) c. We will not pay for loss or damage cause by or resulting from any repairing, restoration or retouching process; d. We will not pay for loss or damage cause by or resulting from faulty packing; e. Paragraph 113.1.b. Earth Movement; f. Paragraph 113.1.c. Governmental Action; g. Paragraph 113.1.d. Nuclear Hazard; h. Paragraph 113.1.f. War and Military Action; i. Paragraph 113.1.g. (1), (2) and (4) Water; j. Paragraph 113.1.1h. Neglect; and k. Paragraph 113.2.g. Frozen Plumbing No other exclusions in Paragraph B. Exclusions apply to this Additional Coverage. However, if any exclusions are added by endorsement to this policy, such exclusions will apply to this Additional Coverage. 4. The most we pay for loss or damage under this Additional Coverage in any one occurrence is 25,000, or the amount shown in the Declarations for "fine arts," whichever is greater. 5. This Additional Coverage does not apply to property: a. While in the custody of the United States Postal Service; b. After delivery to customers. Page 1 of 1 CNA SB -146810-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.5. Additional Coverages. Unless otherwise stated, payments made under this following Additional Coverage is in addition to the applicable Limit of Insurance. SB -146810-A Ed. 01/06) When the fire department is called to save or protect Covered Property from a Covered Cause of loss, we will pay up to $25,000 for your liability for fire department service charges: 1. Assumed by contract or agreement prior to loss; or 2. Required by local ordinance Page 1 of 1 CNA SB -146811-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 1N *2ael III to Sly/ fi x-1111 kh 1:40 k91 Ris]:1_\ aeU This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.5. Additional Coverages. Unless otherwise stated, payments made under the following Additional Coverage is in addition to the Applicable Limits of Insurance. 1. If fire protective equipment discharges accidentally or to control a Covered Cause of Loss, we will pay your cost to: a. Refill or recharge the system with the extinguishing agents that were discharged; and b. Replace or repair faulty valves or controls which caused the discharge. 2. The most we will pay under this Additional Coverage in any one occurrence is $10,000, regardless of the number of premises involved. SB -146811-A Page 1 of 1 Ed. 01/06) N 0 0 0 0 CNA SB -146812-C Ed. 04/10) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners 6. Special Property Coverage Form under Paragraph A.5. Additional Coverages. Unless otherwise stated, payment made under the following Additional Coverage is in addition to the applicable Limits of Insurance. Forgery and Alteration We will pay for loss resulting directly from "forgery" or alteration of, on, or in any check, draft, promissory note, bill of exchange, or similar written promise, order or direction to pay a sum certain money, made or drawn by or drawn upon you, or made or drawn by one acting as an agent or claiming to have been so made or drawn. If, during the period of any prior Forgery or Alteration insurance, you (or any predecessor in interest) sustained loss or damage that you could have recovered under that insurance, except that the time within which to discover loss or damage has expired, we will pay for it under this Additional Coverage provided: a. This insurance became effective at the time of cancellation or termination of the prior insurance; and The loss would have been covered by this insurance had it been in effect when the acts or events causing the loss were committed or occurred. We will consider signatures that are produced or 7. The insurance provided under Paragraph 6. above is reproduced electronically, mechanically or by facsimile part of, and not in addition to the limit described in the same as handwritten signatures. Paragraph 4. above and is limited to the lesser of the amount recoverable under: We will pay for loss that you sustain through acts a. This Additional Coverage up to the applicablecommittedoreventsoccurringduringthePolicyLimitofInsuranceunderthisPolicy, as of itsPeriod. Regardless of the number of years this effective date; orinsuranceremainsinforceorthenumberofpremiums paid, no Limit of Insurance cumulates from year to b. The prior Forgery or Alteration insurance, had it year or period to period. remained in effect. 2. We will not pay for loss resulting from any dishonest or 8. criminal acts committed by your or any of your partners, "employees," "members," "managers," officers, directors or trustees whether acting alone or in collusion with other persons. 3. We will pay for covered loss discovered no later than one year from the end of the Policy Period. 4. The most we will pay for loss under this Additional Coverage in any one occurrence is the limit shown on the Declarations regardless of the number of premises involved. 5. With respect to this Additional Coverage, occurrence means all loss caused by any person, or in which that person is concerned or implicated, either resulting from a single act or any number of such acts, whether the loss involves one or more instruments. If you are sued for refusing to pay any covered instrument described in Paragraph 1. above on the basis that it has been forged or altered, and you have our written consent to defend against the suit, we will pay any reasonable legal expenses that you incur and pay in that defense. The amount we pay for these legal expenses will be part of and not in addition to the limit described in Paragraph 4. above. 9. The following definition is added: Forgery" means the signing of the name of another person or organization with intent to deceive; it does not mean a signature which consists in whole or in part of one's own name signed with or without authority, in any capacity for any purpose. 10. Paragraphs 113.21, and B.2.n. do not apply to this Additional Coverage. SB -146812-C Page 1 of 1 Ed. 04/10) CNA SB -146813-B Ed. 01/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 10Myly[WeAK01111:A1Z91 MIT9106"111 1IN1111141l e]:24 4w1 This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners 2. Special Property Coverage Form under Paragraph A.5. Additional Coverages. Unless otherwise stated, payments made under the following Additional Coverage is in addition to the applicable Limits of Insurance. Newly Acquired or Constructed Property 1. Buildings a. We will pay for direct physical loss of or damage to the following property caused by or resulting from a Covered Cause of Loss: 1) Your: a) New buildings while being built on a premises shown in the Declarations; b) New buildings while being built on newly acquired premises; and i) intended for similar use as a building described in the Declarations; or used as a warehouse c) Materials, equipment, supplies and temporary structures used in connection with such buildings while they are being built; or 2) Buildings you acquire by purchase or lease at any premises, including those premises shown in the Declarations. b. The most we will pay for loss of or damage to newly constructed buildings or newly acquired buildings under this Additional Coverage in any one occurrence is $1,000,000 at each premises. 9 Business Personal Property a. When a Limit of Insurance is shown in the Declarations for Business Personal Property at any described premises, we will pay for direct physical loss of or damage to the following property caused by or resulting from a Covered Cause of Loss: 1) Business Personal Property, including such property that you newly acquire, at a building you acquire by purchase or lease at any premises, including those premises shown in the Declarations; and 2) Business Personal Property that you newly acquire at a described premises. b. The most we will pay for loss of or damage to Business Personal Property under this Additional Coverage in any once occurrence is $250,000 at each premises. Period of Coverage a. With respect to insurance under this Additional Coverage, coverage will end when any of the following first occurs: 1) This policy expires; 2) 180 days expire after you acquire the property or begin to construct the property; 3) You report values to us; or 4) The property is more specifically insured. b. We will charge you additional premium for values reported to us from the date construction begins or you acquire the property. SB -146813-B Page 1 of 1 Ed. 01/08) N 0 0 0 0 CNA SB -146814-B Ed. 03/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ORDINANCE OR LAW This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Section A.5. Additional Coverages. Unless otherwise stated, payments made under the following Additional Coverage is in addition to the applicable Limits of Insurance. 1. In the event of damage by a Covered Cause of Loss to a building that is Covered Property, we will pay for: a. Loss in value of the undamaged portion of the building as a consequence of enforcement of the minimum requirements of any ordinance or law that requires the demolition of undamaged parts of the same building; b. Demolition cost, meaning the cost to demolish and clear the site of undamaged parts of the same building as a consequence of enforcement of the minimum requirements of any ordinance or law that required demolition of such undamaged property; and c. The increased cost of construction, meaning the increased cost to repair, rebuild or reconstruct the property as a consequence of enforcement of the minimum requirements of any ordinance or law. This increased cost of construction coverage applies only if: 1) The building is insured for replacement cost; 2) The building is repaired, rebuilt or reconstructed; and 3) The repaired, rebuilt or reconstructed building is intended for similar occupancy as the current building, unless otherwise required by zoning or land use ordinance or law. 2. The ordinance or law referred to in this Additional Coverage is an ordinance or law that: a. Regulates the demolition, construction or repair of buildings, or establishes zoning or land use requirements at the described premises; and b. Is in force at the time of the loss. 3. We will not pay under this Additional Coverage for: a. Loss due to any ordinance or law that: SB -146814-B Ed. 03/06) 1) You were required to comply with before the loss, even if the building was undamaged; and 2) You failed to comply with; or b. Costs associated with the enforcement of any ordinance or law that requires any insured or other to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of pollutants." 4. Paragraph B.1.a. does not apply to this Additional Coverage. 5. Subject to the limit described in Paragraph 6. below: a. The insurance provided under this Additional Coverage for loss in value to the undamaged portion of the building is limited as follows: 1) If Replacement Cost Coverage applies and the building is repaired or replaced on the same or another premises, we will not pay more than the lesser of: a) The amount you actually spend to repair, rebuild or reconstruct the undamaged portion of the building; or b) The amount it would cost to restore the undamaged portion of the building on the same premises and to the same height, floor area, style and comparable quality of the original undamaged portion of the building; or 2) If Replacement Cost Coverage applies and the building is not repaired or replaced, or if Replacement Cost Coverage does not apply, we will not pay more than the actual cash value of the undamaged portion of the building at the time of loss. b. We will not pay more for demolition costs than the amount you actually spend to demolish and clear the site of the described premises. c. The insurance provided under this Additional Coverage for increased cost of construction is limited as follows: 1) If the building is repaired or replaced at the same premises, or if you elect to Page 1 of 2 Version 1.0) rebuild at another premises, the most we will pay is the increased cost of construction at the same premises; or 2) If the ordinance or law requires relocation to another premises, the most we will pay is the increased cost of construction at the new premises. 6. The most we will pay for loss under this Additional Coverage for the total of all coverages described in: SB -146814-B Ed. 03/06) SB -146814-B Ed. 03/06) a. Paragraph 1.a. above in any one occurrence is the Building Limit at each described premises shown in the Declarations, if this coverage has been selected and is indicated on the Declarations. b. Paragraph 1.b. and 1.c. above in any one occurrence is $25,000 or the limit shown in the Declarations, whichever is greater at each described premises. Page 2 of 2 Version 1.0) CNA SB -146815-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OUTDOOR TREES, SHRUBS, PLANTS AND LAWNS This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Section A.5. Additional Coverages. Unless otherwise stated, payments made under the following Additional Coverage is in addition to the applicable Limits of Insurance. Outdoor Trees, Shrubs, Plants and Lawns 1. We will pay for direct physical loss of or damage to outdoor trees, shrubs, plants (other than "stock" SB -146815-A Ed. 01/06) of trees, shrubs or plants) and lawns located at the described premises caused by or resulting from a Covered Cause of Loss. 2. The most we will pay for loss or damage under this Additional Coverage in any one occurrence is 3,000 at each described premises. 3. Debris removal, because of covered loss or damage to outdoor trees, shrubs, plants and lawns, is included within the limits described in Paragraph 2. above. Page 1 of 1 CNA SB -146816-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ael"II CAlk III IMIN I_1li117_1l1 X 0:4k This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Property Coverage Form under Paragraph A.5. Additional Coverages. Unless otherwise stated, payments made under the following Additional Coverage is in addition to the applicable Limits of Insurance. Pollutant Clean Up and Removal We will pay your necessary and reasonable expense to extract "pollutants" from land or water at the described premises if the discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused by or results from specified causes of loss" that occurs: a. On the described premises; b. To Covered Property; and c. During the policy period 2. The expenses will be paid only if they are reported to us in writing within 180 days of the date on which the "specified cause of loss" occurs. 3. This Additional Coverage does not apply to costs to test for, monitor or assess the existence, concentration or effects of "pollutants." But we will pay for testing which is performed in the course of extracting the "pollutants" from the land or water. 4. The most we will pay under this Additional Coverage is $25,000 for the sum of all covered expenses arising out of all Covered Causes of Loss occurring during each separate 12 month period of this policy beginning with the effective date of this policy. This amount applies regardless of the number of premises involved. SB -146816-A Page 1 of 1 Ed. 01/06) CNA SB -146817-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.5. Additional Coverages. Unless otherwise stated, payments made under the following Additional Coverage is in addition to the applicable Limits of Insurance. Preservation of Property 1. If it is necessary to move Covered Property from the described premises to preserve it from loss or damage by a Covered Cause of Loss, we will pay for: a. Any direct physical loss or damage to this property: 1) While it is being moved; or 2) Temporarily stored at another location only if the loss or damage occurs within 90 days after the property is first moved; and b. The costs incurred to: 1) Remove such property from the described premises; and 2) Return such property to the described premises. SB -146817-A Ed. 01/06) 2. Coverage under this Additional Coverage will end when any of the following first occurs: a. When the policy is amended to provide insurance at the new location; b. The property is returned to the original described premises; c. 90 days expire after the property is first moved; or d. This policy expires. 3. Payments under this Additional Coverage are subject to and not in addition to the applicable Limit of Insurance. Page 1 of 1 CNA SB -146818-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 10:4k Ia#1R_ WAN:W9Za_,9[910to]: M :j Z*7: a::WW1 This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.5. Additional Coverages. Unless otherwise stated, payments made under the following Additional Coverage is in addition to the applicable Limits of Insurance. Temporary Relocation of Property 1. If Covered Property is removed from the described premises and stored temporarily at a location you own, lease or operate while the described SB -146818-A Ed. 01/06) premises is being renovated or remodeled, we will pay for loss or damage to that stored property: a. Caused by or resulting from a Covered Cause of Loss; b. Up to $50,000 at each temporary location; and c. During the storage period of up to 90 consecutive days but not beyond expiration of this policy. 2. This Additional Coverage does not apply if the stored property is more specifically insured. Page 1 of 1 CNA SB -14 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WATER DAMAGE, OTHER LIQUIDS, SOLDER OR MOLTEN MATERIAL DAMAGE This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.5. Additional Coverages. Unless otherwise stated, payments made under the following Additional Coverage is in addition to the applicable Limits of Insurance. Water Damage, Other Liquids, Solder or Molten Material Damage 1. If loss or damage caused by or resulting from covered water or other liquid, solder or molten material damage loss occurs, we will also pay the cost to tear out and replace any part of the building or structure to repair damage to the SB -146819-A Ed. 01/06) system or appliance from which the water or other substance escapes. 2. We will not pay the cost to repair any defect to a system or appliance from which the water, other liquid, solder or molten material escapes. But we will pay the cost to repair or replace damaged parts of fire extinguishing equipment if the damage: a. Results in discharge of any substance from an automatic fire protection system; or b. Is directly caused by freezing. 3. Payments made under this Additional Coverage are subject to and not in addition to the applicable Limit of Insurance. Page 1 of 1 CNA SB -146820-C Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ACCOUNTS RECEIVABLE This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners b. We will not pay for loss that requires an audit Special Property Coverage Form under Paragraph A.6. of records or any inventory computation to Coverage Extensions. prove its factual existence; Unless otherwise stated, payments made under the c. We will not pay for loss caused by or resulting following Coverage Extension is subject to and not in from alteration, falsification, concealment or addition to the applicable Limits of Insurance. destruction of records of accounts receivable Accounts Receivable done to conceal the wrongful giving, taking or withholding of money, securities or other 1. When a Limit of Insurance is shown in the property. But this exclusion applies only to the Declarations for Building or Business Personal extent of wrongful giving, taking or Property at the described premises, you may withholding; extend that insurance to apply to loss, as d. Paragraph 113.1.b. Earth Movement; described in Paragraph 2. below, due to direct physical loss of or damage to your records of e. Paragraph 113.1.c. Governmental Action; accounts receivable (including those on electronic f. Paragraph 113.1.d. Nuclear Hazard; data processing media) caused by or resulting from a Covered Cause of Loss. Credit card g. Paragraph 113.1.f. War and Military Action; company media will be considered accounts receivable until delivered to the credit card h. Paragraph B.1.g. (1), (2), and (4) Water; company. i. Paragraph 113.1.1h. Neglect; and 2. We will pay for: j. Paragraph 113.21 False Pretense; a. All amounts due from your customers that you No other exclusions in Paragraph B. Exclusions were unable to collect; apply to this Coverage Extension. However, if any b. Interest charges on any loan required to offset exclusions are added by endorsement to this amounts you are unable to collect pending our Policy, such exclusions will apply to this Coverage payment of these amounts; Extension. c. Collection expenses in excess of your normal 4. The most we will pay under this Coverage collection expenses that are made necessary Extension for loss of or damage to records of by the loss or damage; and accounts receivable in any one occurrence while in transit or at a premises other than the described d. Other reasonable expenses that you incur to premises is $25,000. re-establish your records of accounts receivable. 5. The most we will pay under this Coverage Extension for loss of or damage to records of 3. The following exclusions apply to this Coverage accounts receivable in any one occurrence at Extension: each described premises is $25,000 or the a. We will not pay for loss caused by or resulting amount shown in the Declarations for Accounts from bookkeeping, accounting or billing errors Receivable, whichever is greater. or omissions; 6. Payments made under this Coverage Extension are in addition to the applicable Limits of Insurance. SB -146820-C Page 1 of 1 Ed. 06/11) CNA SB -146821-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extensions. Unless otherwise stated, payments made under the following Coverage Extension is subject to and not in addition to the applicable Limits of Insurance. Appurtenant Buildings and Structures 1. When a Limit of Insurance is shown in the Declarations for Building at the described premises, you may extend that insurance to apply to direct physical loss of or damage to incidental appurtenant buildings or structures, within 1,000 feet of that described premises, caused by or resulting from a Covered Cause of Loss. 2. When a Limit of Insurance is shown in the Declarations for Business Personal Property at the described premises, you may extend that insurance to apply to direct physical loss of or damage to Business Personal Property within incidental appurtenant buildings or structures within 1,000 feet of that SB -146821-A Ed. 01/06) described premises, caused by or resulting from a Covered Cause of Loss. 3. Incidental appurtenant buildings or structures include: a. Storage buildings; b. Carports; c. Garages; d. Pump houses; or e. Above ground tanks; Which have not been specifically described in the Declarations. 4. The most we will pay for loss or damage under this Coverage Extension in any one occurrence for any combination of loss of or damage to Building and Business Personal Property is $50,000, regardless of the number of described premises involved. 5. Payments made under this Coverage Extension are in addition to the applicable Limits of Insurance. Page 1 of 1 CNA SB -146822-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 1 -.111 [111110[e e_ This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners breakage and damage to glass by chemicals Special Property Coverage Form under Paragraph A.6. accidentally or maliciously applied to glass. If a Coverage Extensions. specific deductible has been selected for building glass as shown on the Declarations we will apply Unless otherwise stated, payments made under the that deductible to any covered loss. If no following Coverage Extension is subject to and not in deductible is selected for building glass, the policy addition to the applicable Limits of Insurance. deductible will be applied to covered building Building Glass glass losses. 1. If: 3. We will also pay for necessary expenses in connection with loss or damage covered in a. You are the building owner; and Paragraphs 1. or 2. above, incurred by you to: b. A Limit of Insurance is shown in the a. Put up temporary plates or board up Declarations for Building at the described openings; premises; b. Repair or replace encasing frames; and you may extend that insurance to apply to direct c. Remove or replace obstructions. physical loss of or damage to all exterior and interior building glass caused by or resulting from 4. The following exclusions apply to this Coverage a Covered Cause of Loss, including glass Extension: breakage and damage to glass by chemicals accidentally or maliciously applied to glass. If a a. We will not pay for loss or damage caused by specific deductible has been selected for building or resulting from: glass as shown on the Declarations we will apply 1) Wear and tear; that deductible to any covered loss. If no deductible is selected for building glass, the policy 2) Hidden or latent defect; deductible will be applied to covered building 3) Corrosion; or glass losses. 2. If: 4) Rust; b. Paragraph B.1.b. Earth Movement; a. You are a tenant; b. A Limit of Insurance shown in the c. Paragraph B.1.c. Governmental Action; Declarations for Building or Business d. Paragraph B.1.d. Nuclear Hazard; Personal Property at the described premises; e. Paragraph B.1.f. War and Military Action; andand c. You are contractually obligated to repair or f. Paragraph B.1.g. Water. replace building glass at the described No other exclusions in Paragraph B. Exclusions premises; apply to this Coverage Extension. However, if any you may extend that insurance to apply to direct exclusions are added by endorsement to this physical loss of or damage to all exterior and Policy, such exclusions will apply to this Coverage interior building glass caused by or resulting from Extension. a Covered Cause of Loss, including glass SB -146822-A Page 1 of 1 Ed. 01/06) SB -146825-C Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners 2. This Coverage Extension does not apply to Special Property Coverage Form under Paragraph A.6. property: Coverage Extensions. a. While in the custody of the United States Unless otherwise stated, payments made under the Postal Service; following Coverage Extension is subject to and not in b. Rented or leased to others; addition to the applicable Limits of Insurance. Business Personal Property Off Premises 1. When a Limit of Insurance is shown in the Declarations for Business Personal Property at the described premises, you may extend that insurance to apply to direct physical loss of or damage to such property caused by or resulting from a Covered Cause of Loss while: a. In the course of transit, more than 1,000 feet from the described premises; b. Temporarily away from the described premises and: 1) At a premises you do not own, lease or operate; or 2) At any fair, trade show or exhibition at a premises you do not own or regularly occupy. SB -146825-C Ed. 06/11) c. After delivery to customers; d. Temporarily at a premises for more than 60 consecutive days, except "money" and securities" at a "banking premises"; e. Otherwise covered under the Fine Arts Additional Coverage; or f. Otherwise covered under the following Coverage Extensions: 1) Accounts Receivable; 2) Electronic Data Processing; 3) Personal Effects; or 4) Valuable Papers and Records. Page 1 of 1 CNA SB -146826-B Ed. 01/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AVA"F_111j9:[07N11C1 This endorsement modifies insurance provided under the following: BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FORM BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extensions. Unless otherwise stated, payments made under the following Coverage Extension is subject to and not in addition to the applicable Limits of Insurance. Civil Authority When the Declarations show that you have prohibits access to the described premises. The civil authority action must be due to direct physical loss of or damage to property at locations, other than described premises, caused by or resulting from a Covered Cause of Loss. 2. The coverage for Business Income will begin 24 hours after the time of that action and will apply for a period of four consecutive weeks after coverage begins. coverage for Business Income and Extra 3. The coverage for Extra Expense will begin Expense, you may extend that insurance to apply immediately after the time of that action and will to the actual loss of Business Income you sustain end when your Business Income coverages ends and reasonable and necessary Extra Expense you for this Coverage Extension. incur caused by action of civil authority that SB -146826-B Page 1 of 1 Ed. 01/08) N 0 0 0 0 0 SB -146827-F Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ELECTRONIC DATA PROCESSING EQUIPMENT AND ELECTRONIC MEDIA AND DATA EDP COVERAGE FORM) This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your 5. The following additional exclusions apply: Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extension: With respect to this Coverage Extension, we will not pay for loss or damage caused directly or Electronic Data Processing indirectly by any of the following. Such loss or damage is excluded regardless of any other cause 1. When a Limit of Insurance is shown in the or event that contributes concurrently or in any Declarations for Electronic Data Processing at the sequence to the loss: described premises, that insurance applies to: a. Direct physical loss of or damage to your electronic data processing equipment" caused by or resulting from a Covered Cause of Loss; and b. Direct physical loss of or damage to your electronic media and data" caused by or resulting from a Covered Cause of Loss. 2. Worldwide coverage is provided under this Coverage Extension. The coverage territory as described in Paragraph F.8.b does not apply to this Coverage Extension. 3. This Coverage Extension does not apply to: a. "Stock"; or b. Property that is leased or rented to others. 4. The following exclusions as described in Section B., Exclusions, of the Businessowners Special Property Coverage Form do not apply to the Insuring Agreement set forth in Paragraph 1.a. or 1.b. of this Coverage Extension: a. Paragraph 1.e.; and b. Paragraph 1.g.(3); and c. Paragraph 2.a. The following exclusion as described in Section B., Exclusions, of the Businessowners Special Property Coverage Form does not apply to the Insuring Agreement set forth in Paragraph 1.a. of this Coverage Extension: Paragraph 2.d.(6). SB -146827-F Ed. 06/11) a. Programming errors or omissions, or incorrect instructions to a machine, including without limitation, incorrect instructions to "electronic data processing equipment' from a user incorrectly operating with, or committing an error using an input device (including, without limitation, a keyboard, mouse or touchpad) and corrupting, distorting, deleting, damaging or destroying "electronic data"; provided, however, that this exclusion shall not apply to an otherwise covered mechanical breakdown of "electronic data processing equipment' under the Insuring Agreement set forth in Paragraph 1.a. of this Coverage Extension. b. Unauthorized viewing, copying or use of Electronic Media and Data" or "Electronic Data" (or any proprietary or confidential information or intellectual property) by any person, even if such activity is characterized as "theft." c. Errors or deficiency in design, installation, maintenance, repair or modification of your electronic data processing equipment," electronic media and data" or "electronic data" or any "electronic data processing equipment," electronic devices, computer system or network to which your "electronic data processing equipment' "electronic media and data" or "electronic data" is connected or dependent; provided, however, that this exclusion shall not apply to an otherwise covered mechanical breakdown of "electronic data processing equipment' under the Insuring Agreement set forth in Paragraph 1.a. of this Coverage Extension. Page 1 of 2 CNA d. Unexplained or indeterminable failure, malfunction or slowdown of a "electronic data processing equipment' "electronic media and data" or "electronic data." 6. The most we will pay under this Coverage Extension for all direct physical loss of or damage to "electronic data processing equipment' and electronic media and data" (combined) in any one occurrence while in transit or at a premises other than the described premises is $25,000, or the limit shown in the Declarations. The most we will pay under this Coverage Extension for loss of or damage to "Electronic Media and Data" while stored at a separate premises from where your original "Electronic Media and Data" are kept, in any one occurrence, is $25,000. 8. The most we will pay under this Coverage Extension for all direct physical loss or damage to electronic data processing equipment" and electronic media and data" (combined) you acquire after the inception date of the policy in any one occurrence is $25,000. Provided, however, with respect to insurance coverage under this Coverage Extension on any such newly acquired "electronic data processing SB -146827-F Ed. 06/11) SB -146827-F Ed. 06/11) equipment' or "electronic media and data," coverage will end on the date and time that any of the following first occurs: a. This policy expires; b. 180 days after you acquire the "electronic data processing equipment' or "electronic media and data"; or c. You report values to us. 9. The most we will pay under this Coverage Extension for all direct physical loss of or damage to "electronic data processing equipment' and electronic media and data" (combined) at the described premises in any one occurrence is the Limit of Insurance shown in the Declarations or 50,000, whichever is greater. 10. A separate Blanket Limit of Insurance applies to electronic data processing equipment" and electronic media and data" at all scheduled premises, if indicated in the declarations as Blanket Electronic Data Processing 11. Payments made under this Coverage Extension are in addition to the applicable Limits of Insurance. Page 2 of 2 CNA SB146828E Ed. 04/14) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extensions. Unless otherwise stated, payments made under the following Coverage Extension are subject to and not in addition to the applicable Limits of Insurance. Equipment Breakdown 1. When a Limit of Insurance is shown in the Declarations for Equipment Breakdown, at the described premises, the limit applies to direct physical loss of or damage to Covered Property at the described premises caused by or resulting from a "breakdown" to "covered equipment." For the purposes of this coverage form, "covered equipment' includes, but is not limited to, the following: a. "Diagnostic Equipment'; b. "Power Generating Equipment'; c. "Production Equipment." With respect to otherwise covered Business Income and Extra Expense, "breakdown" to "covered equipment' will be considered a Covered Cause of Loss. If an initial "breakdown" causes other "breakdowns," all will be considered one "breakdown." All "breakdowns" that manifest themselves at the same time and are the result of the same cause will also be considered one breakdown." 2. Under this Coverage Extension, the following coverages also apply: a. Expediting Expenses 1) In the event of direct physical loss of or damage to Covered Property caused by or resulting from a breakdown" to "covered equipment," we will pay for the reasonable additional expenses you necessarily incur to make temporary repairs to, or expedite the permanent repair or replacement of, the lost or damaged Covered Property. 2) Expediting expenses include overtime wages and the extra cost of express or other rapid means of 0 transportation. 3) The most we will pay under this Coverage Extension for all Expediting Expenses arising out of any one breakdown" is $25,000. This limit is part of and not in addition to the Limit of Insurance that applies to lost or damage Covered Property. b. "Pollutants" 1) In the event of direct physical loss of or damage to Covered Property caused by or resulting from a breakdown" to "covered equipment," we will pay for the additional cost to repair or replace Covered Property because of contamination by "pollutants." This includes the additional expenses to clean up or dispose of such property. Additional costs mean those beyond what would have been required had no pollutants" been involved. 2) The most we will pay under this Coverage Extension for loss or damage to Covered Property caused by contamination by "pollutants" arising out of any one "breakdown" is $25,000. This limit is subject to and not in addition to the Limit of Insurance that applies to lost or damaged Covered Property. SB146828E (Ed. 04/14) Page 1 of 3 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. SB146828E Ed. 04/14) c. Service Interruption When the Declarations show that you have coverage for Business Income and Extra Expense, you may extend that insurance to apply to loss caused by or resulting from a "breakdown" to equipment that is owned, operated or controlled by a local public or private utility or distributor that directly generates, transmits, distributes or provides the following utility services: 1) "Water Supply Services"; 2) "Communication Supply Services"; or 3) "Power Supply Services." d. Data Restoration We will pay for your cost to research, replace and restore "electronic data" and "electronic media and data" that is lost as a result due to a "breakdown" to "Covered Equipment." The most we will pay for loss or expenses under this coverage is $100,000 or the limit shown in the Declarations for Equipment Breakdown Coverage at the described premises, whichever is less. The limit provided for the Data Restoration Coverage is a part of, and does not increase the Limit of Insurance for Equipment Breakdown Coverage. 3. We will not pay under this Coverage Extension for loss or damage caused by or resulting from any of the following tests: a. A hydrostatic, pneumatic or gas pressure test of any boiler or pressure vessel; or b. An insulation breakdown test of any type of electrical equipment. 4. We will not pay under this Coverage Extension for loss or damage caused by or resulting from a change in: a. Temperature; or b. Humidity; as a consequence of "breakdown" to "covered equipment." 5. The following limitations in Paragraph A.4. do not apply to this Coverage Extension: a. Paragraph a.(2); and b. Paragraph a.(3). 6. The following exclusions in Paragraph B. Exclusions do not apply to this Coverage Extension: a. Paragraph 2.a.; b. Paragraph 2.d.(6); and c. Paragraph 2.e. 7. With respect to this Coverage Extension, the following condition is added to Paragraph F. Commercial Property Conditions: Suspension If any "covered equipment' is found to be in or exposed to a dangerous condition, any of our representatives may immediately suspend the insurance provided by this Coverage Form for loss or damage caused by or resulting from a "breakdown" to that "covered equipment." This can be done by delivering or mailing a notice of suspension to: a. Your last known address; or b. The address where the "covered equipment' is located. Once suspended in this way, such insurance can only be reinstated by a written endorsement issued by us. If we suspend your insurance, you will get a pro rata refund of premium for that "covered equipment." But the suspension will be effective even if we have not yet made or offered a refund. SB146828E (Ed. 04/14) Page 2 of 3 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. SB146828E Ed. 04/14) 8. The following Loss Payment Condition is added under EA.e. Loss Payment Building and Personal Property of the Businessowners Special Property Coverage Form: 19) "Covered Equipment' as follows: If Equipment Breakdown Property requires replacement due to an Equipment Breakdown, we will pay your additional cost to replace it with equipment that is better for the environment, safer or more efficient than the equipment being replaced. However, we will not pay more than 125% of what the cost would have been to repair or replace with property of comparable material and quality. This coverage does not increase any of the applicable limits. This coverage does not apply to any property indicated as being valued on an Actual Cash Value basis. If you wish to retrofit air conditioning or refrigeration equipment that utilizes a refrigerant containing CFC chlorofluorocarbon) substances to accept a non -CFC refrigerant, we will consider this better for the environment. Any associated Business Income or Extra Expense will be included, in determining the additional cost, if Business Income and Extra Expense apply to this policy. All other terms and conditions of the Policy remain unchanged. SB146828E (Ed. 04/14) Page 3 of 3 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA SB -146830-B Ed. 01/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Ikh19101 W&91N11:4*V_1011X4011R1i0:4 MAk9]_14 2411:1040 M This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extensions: Unless otherwise stated, payments made under this Coverage Extension are subject to and not in addition to the applicable Limits of Insurance. When a Limit of Insurance is shown in the Declarations for Business Personal Property at the described premises, you may extend that insurance to apply to loss due to the good faith acceptance of: 1. Any U.S. or Canadian post office or express money order, issued or claiming to have been issued by any post office or express company, if the money order is not paid upon presentation; or 2. Counterfeit United States or Canadian paper currency. in exchange for merchandise, "money" or services or as part of a normal business transaction. SB -146830-B Page 1 of 1 Ed. 01/08) SB -146831-B Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NON -OWNED DETACHED TRAILERS This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners 2. We will not pay for any loss or damage that Special Property Coverage Form under Paragraph A.6. occurs: Coverage Extensions. a. While the trailer is attached to any motor Unless otherwise stated, payments made under the vehicle or motorized conveyance, whether or following Coverage Extension is subject to and not in not the motor vehicle or motorized addition to the applicable Limits of Insurance. conveyance is in motion; 1. When a Limit of Insurance is shown in the Declarations for Building or Business Personal Property at the described premises you may extend the insurance that applies to your Business Personal Property to apply to loss or damage to trailers or semi -trailers that you do not own, provided that: a. The trailer is used in your business; b. The trailer is in your care, custody or control at the premises described in the Declarations; and c. You have a contractual responsibility to pay for loss or damage to the trailer. SB -146831-B Ed. 06/11) b. During hitching or unhitching operations, or when a trailer becomes accidentally unhitched from a motor vehicle or motorized conveyance. 3. The most we will pay for loss or damage under this Coverage Extension in any one occurrence is 5,000 regardless of the number of described premises, trailers or semi -trailers involved. 4. This insurance is excess over the amount due whether you can collect on it or not) from any other insurance covering such property. Page 1 of 1 CNA SB -146832-B Ed. 01/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IQN17101_10DI*977111F_ Tlym10MNl_9 QUA NIQ1X972N*3to] MIN9CORI This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FORM The following coverage is added to your Businessowners 2. This Coverage Extension applies only to the Special Property Coverage Form under Paragraph A.6. period that would be required, with reasonable Coverage Extensions. speed, to reconstruct, repair or replace the Unless otherwise stated, payments made under the property to comply with the minimum requirements following Coverage Extension is subject to and not in of the ordinance or law. addition to the applicable Limits of Insurance. 3. This Coverage Extension does not apply to: Ordinance or Law — Increased Period of Restoration 1. When: a. A Covered Cause of Loss occurs to property at the described premises; and b. The Declarations shown that you have coverage for Business Income and Extra Expense; you may extend that insurance to apply to the amount of actual loss of Business Income you sustain and reasonable and necessary Extra Expense you incur during the increased period of suspension" of 'operations" caused by or resulting from the enforcement of any ordinance or law that: 1) Regulates the construction, repair or replacement of any property; 2) Requires the tearing down or replacement of any parts of property not damaged by a Covered Cause of Loss; and 3) Is in force at the time of loss. SB -146832-B Ed. 01/08) a. Loss due to an ordinance or law that: 1) You were required to comply with before the loss, even if the property was undamaged; and 2) You failed to comply with; or b. Costs associated with the enforcement of any ordinance or law that requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to or assess the effects of pollutants." 4. Paragraph 113.1.a., does not apply to this Coverage Extension. 5. The most we will pay for loss under this Coverage Extension in any one occurrence is $25,000 at each described premises. 6. Payments made under this Coverage Extension are in addition to the applicable Limits of Insurance. Page 1 of 1 CNA SB -146833-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extensions. Unless otherwise stated, payments made under the following Coverage Extension is subject to and not in addition to the applicable Limits of Insurance. Outdoor Property 1. When a Limit of Insurance is shown in the Declarations for Building or Business Personal Property at the described premises, you may extend that insurance to apply to direct physical SB -146833-A Ed. 01/06) loss of or damage to the following types of outdoor property at that described premises caused by or resulting from a Covered Cause of Loss: a. Radio or television antennas (including microwave or satellite dishes) and their lead in wiring, masts or towers; or b. Bridges, walks, roadways, patios and other paved surfaces. 2. The most we will pay for loss or damage under this Coverage Extension in any one occurrence is 10,000 at each described premises. Page 1 of 1 CNA SB -146834-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PERSONAL EFFECTS This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extensions. Unless otherwise stated, payments made under the following Coverage Extension is subject to and not in addition to the applicable Limits of Insurance. Personal Effects 1. When a Limit of Insurance is shown in the Declarations for Building or Business Personal Property at the described premises, you may extend that insurance to apply to direct physical loss of or damage to personal effects owned by: a. You; or b. Your officers, partners, "members", managers", "employees", directors or trustees; caused by or resulting from a Covered Cause of Loss. 2. Such property must be located at a described premises. 3. The most we will pay for loss or damage under this Coverage Extension in any one occurrence is 25,000 at each described premises. 4. Payments under this Coverage Extension are in addition to the applicable Limits of Insurance. SB -146834-A Page 1 of 1 Ed. 01/06) CNA SB -146835-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SIGNS This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM Subject to the Exclusions, Conditions and Limitations of this policy, you may extend this insurance as indicated below. Unless otherwise stated, payments made under the following coverage will not increase the applicable Limits of Insurance. SB -146835-A Ed. 01/06) Your Building or Business Personal Property insurance is extended to cover outdoor signs attached to the building or on or within 1,000 feet of the described premises. Page 1 of 1 CNA SB -146836-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPOILAGE - CONSEQUENTIAL LOSS This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extensions. Unless otherwise stated, payments made under the following Coverage Extension is subject to and not in addition to the applicable Limits of Insurance. Spoilage — Consequential Loss 1. When a Limit of Insurance is shown in the Declarations for Business Personal Property at the described premises, you may extend that insurance to apply to consequential loss to your Business Personal Property caused by a change in: a. Temperature; or b. Humidity; caused by or resulting from a Covered Cause of loss to any of the following types of equipment situated within the building at the described premises: a. Refrigerating; b. Cooling; c. Humidifying; d. Air conditioning; e. Heating; f. Generating or converting power; or g. Connections, supply or transmission lines and pipes associated with the above equipment. 2. With respect to this Coverage Extension, breakdown" to "covered equipment' will not be considered a Covered Cause of Loss, even if otherwise covered elsewhere in this Policy. 3. Paragraphs B.2.d.(7)(a) and B.2.d.(7)(b) do not apply to this Coverage Extension. SB -146836-A Page 1 of 1 Ed. 01/06) CNA SB -146837-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extensions. Unless otherwise stated, payments made under the following Coverage Extension is subject to and not in addition to the applicable Limits of Insurance. Theft Damage to Rented Property 1. When a Limit of Insurance is shown in the Declarations for Business Personal Property at the described premises, you may extend that insurance to apply to direct physical loss of or damage to the following caused by or resulting by theft" or attempted "theft": a. That part of a building you occupy, but do not own, which contains Covered Property; and SB -146837-A Ed. 01/06) e. b. Property within such non -owned building used for maintenance or service of such non -owned building. 2. We will not pay under this Coverage Extension for loss or damage: a. Caused by or resulting from fire or explosion; or b. To glass (other than glass building blocks) or to any lettering, ornamentation or burglar alarm tape on glass. 3. This Coverage Extension applies only if you are a tenant and you are contractually obligated to insure this exposure. Page 1 of 1 CNA SB -146838-C Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extensions. Unless otherwise stated, payments made under the following Coverage Extension is subject to and not in addition to the applicable Limits of Insurance. Valuable Papers and Records 1. When a Limit of Insurance is shown in the Declarations for Building or Business Personal Property at the described premises, you may extend that insurance to apply to loss, as described in Paragraph 2. below, due to direct physical loss of or damage to "valuable papers and records" that: a. You own; or b. Are owned by others, but in your care, custody or control; caused by or resulting from a Covered Cause of loss. 2. This Coverage Extension includes the cost to research, replace or restore the lost information on valuable papers and records" for which duplicates do not exist. 3. The following exclusions apply to this Coverage Extension: a. We will not pay for any loss or damage to valuable papers and records" caused by or resulting from any errors or omissions in processing or copying. But if errors or omissions in processing or copying results in fire or explosion, we will pay for the resulting loss or damage caused by that fire or explosion. b. Paragraph 113.1.b. Earth Movement; c. Paragraph 113.1.c. Governmental Action; d. Paragraph 113.1.d. Nuclear Hazard; e. Paragraph 113.1.f. War and Military Action; f. Paragraph 113.1.g. (1), (2) and (4) Water; g. Paragraph 113.1.1h. Neglect; h. Paragraph 113.2.g. Frozen plumbing. No other exclusions in Paragraph B. Exclusions apply to this Coverage Extension. However, if any exclusions are added by endorsement to this Coverage Form, such exclusions will apply to this Coverage Extension. 4. The most we will pay under this Coverage Extension for loss of or damage to "valuable papers and records" in any one occurrence while in transit or at a premises other than the described premises is $25,000. 5. The most we will pay under this Coverage Extension for loss of or damage to "valuable papers and records" in any one occurrence at each described premises is $25,000 or the amount shown in the Declarations for Valuable Papers and Records, whichever is greater. 6. Payments made under this Coverage Extension are in addition to the applicable Limits of Insurance. SB -146838-C Page 1 of 1 Ed. 06/11) CNA SB -146839-F Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM CONCURRENT CAUSATION, EARTH MOVEMENT & WATER EXCLUSION CHANGES The following coverage is added to your Businessowners Special Property Coverage Form: Unless otherwise stated, payments made under the following coverage will not increase the applicable Limits of Insurance. Subject to the Exclusions, Conditions and Limitations of this policy, you may extend this insurance as indicated below. 2. We will pay for loss or damage to covered property caused by water that backs up or overflows from a sewer, drain, sump, or from water that overflows due to the failure of a sump pump, sump pump well, or any other type of system designed to remove subsurface water from the foundation area, subject to the following limitations: a. We will not pay for loss or damage under this Additional Coverage caused by the emanation of water from a sewer or drain, sump, sump pump, sump pump well, or any other type of system designed to remove subsurface water from the foundation area, that itself caused by, or is the result of: SB -146839-F Ed. 06/11) i) "Flood," surface water, waves, tides, tidal waves, overflow of any body of water, or their spray, all whether driven by wind or not; ii) Mudslide or mudflow. b. The most we will pay for direct physical damage is the limit of insurance shown in the Declarations for Sewer or Drain Back Up. With respect to otherwise covered Business Income and Extra Expense, loss or damage to covered property caused by water that backs up or overflows from a sewer, drain, sump, or from water that overflows due to the failure of a sump pump, sump pump well, or any other type of system designed to remove subsurface water from the foundation area, will be considered a Covered Cause of Loss. 3. Exclusion 113.1l.g. (3) of the Businessowners Special Property Coverage Form does not apply to this Additional Coverage. Page 1 of 1 CNA SB -146846-B Ed. 01/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NIMto] Lh1 "Z*7:: 4:4VA: 401197:1"*4khl: 40kI This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The Businessowners Special Property Coverage Form is changed as follows: 1. The following is added to Paragraph A.6.: Customers Property a. When a Limit of Insurance is shown in the Declarations for Business Personal Property at the described premises, you may extend that insurance to apply to direct physical loss of or damage to real and personal property of your customers at or away from their premises while in your care, custody or control. b. Paragraph AA.b.(2) does not apply to this Coverage Extension. c. The following exclusions in Paragraph B. do not apply to this Coverage Extension: 1) Paragraph 2.d.(7)(c) (dealing with marring and scratching); 2) Paragraph 3.c.(3) (dealing with materials used in repair, construction, renovation or remodeling); and SB -146846-B Ed. 01/08) 3) Paragraph 3.c.(4) (dealing with maintenance). d. With respect to this Coverage Extension, Paragraph 113.3.c.(2) is replaced by the following: 2) Design, specifications; e. The most we will pay for loss or damage under this Coverage Extension in any one occurrence is $25,000 or the Limit of Insurance shown in the Declarations for Business Personal Property, whichever is less. f. With respect to this endorsement only, Paragraph D. is replaced by the following; We will not pay for loss or damage in any one occurrence until the amount of loss or damage exceeds $500. We will then pay the amount of covered loss or damage in excess of $500, up to the applicable Limit of Insurance. Page 1 of 1 CNA SB146901 B Ed. 04/14) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TECHNOLOGY SERVICES EXCLUSION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM 1. It is agreed that Exclusion 113.11J. Professional Services is deleted and replaced by the following: j. Professional Services Bodily injury," "property damage," "personal and advertising injury" caused by the rendering or failure to render any professional service. This includes but is not limited to: 1) Legal, accounting or advertising services; 2) Preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; 3) Supervisory, inspection or engineering services; 4) Medical, surgical, dental, x-ray or nursing services treatment, advice or instruction; 5) Any health or therapeutic service treatment, advice or instruction; 6) Any service, treatment, advice or instruction for the purpose of appearance or skin enhancement, hair removal or replacement or personal grooming; 7) Optometry or optical or hearing aid services including the prescribing, preparation, fitting, demonstration or distribution of ophthalmic lenses and similar products or hearing aid devices; 8) Body piercing services; 9) Services in the practice of pharmacy; 10) Veterinary medicine services; and 11) Mortician services 12) Technology Services This exclusion applies even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an insured, if the 'occurrence" which caused the "bodily injury" or property damage," or the offense which caused the "personal and advertising injury," involved the rendering or failure to render any professional service. NV 2. Additional Definitions As respects the coverage provided by this endorsement, "Technology Services" means the following services 0 performed for others: 0 a. Web -site design or consulting services; b. Electronic data processing services; c. Computer programming or consulting services; d. Creation, development, modification, repair, selling, distributing, licensing, franchising or furnishing any computer software, programs, designs, specifications, manuals or instructions; e. Any evaluation, consultation or advice given concerning telecommunications equipment or services; f. Any advice, consultation, evaluation, inspection, supervision, quality control or phone network setup, including central office cabling, done by you or for you on a project on which you serve as a telecommunications equipment or service provider; or g. The failure of any insured to adequately provide internet access or telecommunications services. All other terms and conditions of the Policy remain unchanged. SB 146901 B (Ed. 04/14) Page 1 of 2 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. SB146901 B Ed. 04/14) SB 146901 B (Ed. 04/14) Page 2 of 2 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA SB146902G Ed. 6-16) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. HIRED AUTO AND NON -OWNED AUTO LIABILITY This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COMMON POLICY CONDITIONS SCHEDULE Insurance is provided only with respect to those coverages for which a specific limit is shown COVERAGE LIMIT Hired Auto Liability: $ Non -owned Auto Liability: $ If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) PROVISIONS A. COVERAGE With respect only to the Coverage(s) for which a limit is shown in the SCHEDULE above, the insurance provided under Coverage A.1. Business Liability for "bodily injury" and "property damage" also applies to "bodily injury" or property damage" arising out of the maintenance or use of a: Hired auto" used by you or your "employee" in the course of your business; and/or Non -owned auto" used in the course of your business. Maintenance or use of a "non -owned auto" includes test driving in connection with an "auto business." With respect only to the coverage provided by this endorsement, under Coverages, coverage A.1. Business Liability is amended to: 1. Delete paragraph A.1.b.(1)(b) and replace it with the following: b. This insurance applies: 1) To "bodily injury" and "property damage" only if: b) The "occurrence" occurs during the policy period; and 2. Delete paragraph A.1.b.(2),. B. LIMITS OF INSURANCE With respect only to the coverage provided by this endorsement, SECTION D. Liability And Medical Expenses Limits of Insurance is deleted in its entirety and replaced with the following: D. Limits Of Insurance 1. Regardless of the number of: a. Insureds; b. Claims made or "suits" brought; c. Persons or organizations making claims or bringing "suits"; or d. "Autos," the applicable Hired Auto Liability limit or Non -Owned Auto Liability limit shown in the Declarations is the most we will pay for damages under SECTION A. Coverages because of all "bodily injury" and "property damage" resulting from any one 'occurrence" arising out of the maintenance or use of a "hired auto" or "non -owned auto." SB146902G (Ed. 6-16) Page 1 of 3 Copyright, CNA All Rights Reserved. CNA C. EXCLUSIONS SB146902G Ed. 6-16) With respect only to the insurance provided by this endorsement: 1. Under Exclusions, the paragraph entitled Applicable to Business Liability Coverage is amended to delete all exclusions except exclusions a., b., d., e., If. and i. and to add the following exclusions: This insurance does not apply to: Fellow Employee Bodily injury" to: 1) Any fellow "employee" of the insured arising out of and in the course of employment by the insured or while performing duties related to the conduct of the insured's business; or 2) The spouse, child, parent, brother or sister of that fellow "employee" while as a consequence of Paragraph (1) above. Care, Custody or Control Property Damage" to: 1) Property owned or being transported by, or rented or loaned to the insured; or 2) Property in the care, custody or control of the insured. D. WHO IS AN INSURED With respect only to the insurance provided by this endorsement, Who Is An Insured is replaced by the following: Each of the following is an insured under this insurance to the extent set forth below: 1. You; 2. Subject to paragraph 3.c. below, your "employee" while operating an "auto" hired or rented under a contract or agreement, with your permission, in that "employee's" name, while performing duties related to the conduct of your business. 3. Anyone else including any partner or "executive officer" of yours while using with your permission a "hired auto" or a "non -owned auto" except: a. The owner or lessee (of whom you are a sublessee) of a "hired auto" or the owner or lessee of a "non -owned auto" or any agent or "employee" of any such owner or lessee; b. Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household; c. Your "employee" if the covered "auto" is leased, hired or rented by him or her or a member of his or her household under a lease or rental agreement for a period of 180 days or more; d. Any partner or "executive officer" with respect to any "auto" owned by such partner or officer or a member of his or her household; e. Any partner or "executive officer" with respect to any "auto" leased or rented to such partner or officer or a member of his or her household under a lease or rental agreement for a period of 180 days or more; If. Any person while employed in or otherwise engaged in duties in connection with an "auto business," other than an "auto business" you operate; g. Anyone other than your "employees," partners, a lessee or borrower or any of their "employees," while moving property to or from a "hired auto" or a "non -owned auto"; or 4. Any other person or organization, but only with respect to their liability because of acts or omissions of an insured under 1., 2. or 3. above. E. AMENDED DEFINITION The Definition of "insured contract" in Section F — Definitions is amended by the addition of the following exceptions to paragraph If.: SB146902G (Ed. 6-16) Page 2 of 3 Copyright, CNA All Rights Reserved. CNA SB146902G Ed. 6-16) Paragraph f. does not include that part of any contract or agreement: That pertains to the loan, lease or rental of an "auto" to you or any of your "employees," if the "auto" is loaned, leased or rented with a driver; or That holds a person or organization engaged in the business of transporting property by "auto" for hire harmless for your use of a covered "auto" over a route or territory that person or organization is authorized to serve by public authority. F. ADDITIONAL DEFINITIONS Section F. Definitions is amended by the addition of the following definitions: a. "Auto Business" means the business or occupation of selling, repairing, servicing, storing or parking "autos." b. "Hired auto" means any "auto" you or your "employee" lease, hire, rent or borrow in the course of your business. This does not include: L Any "auto" you lease, hire or rent under a lease or rental agreement for a period of 180 days or more, or iii. Any "auto" you lease, hire, rent or borrow from any of your "employees," partners, stockholders, or members of their households. c. "Non -owned auto" means any "autos" you do not own, lease, hire, rent or borrow that are being used in the course and scope of your business at the time of the "occurrence." This includes "autos" owned by your employees" or partners or members of their households but only while being used in the course and scope of your business at the time of the "occurrence." If you are a sole proprietor, "non -owned auto" means any "autos" you do not own, lease, hire, rent or borrow that are being used in the course and scope of your business or personal affairs at the time of the "occurrence." G. With respect only to the operation of a "hired auto" or "non -owned auto," Paragraph H, of the Businessowners Common Policy Conditions is deleted and replaced with the following: H. Other Insurance 1. Except for any liability assumed under an "insured contract" the insurance provided by this Coverage Form is excess over any other collectible insurance. However, if your business is the selling, servicing, repairing, parking or storage of "autos," the insurance provided by this endorsement is primary when covered "bodily injury" or "property damage" arises out of the operation of a customer's "auto" by you or your "employee." 2. When this Coverage Form and any other Coverage Form or policy covers on the same basis, either excess or primary, we will pay only our share. Our share is the proportion that the Limit of Insurance of our Coverage Form bears to the total of the limits of all the Coverage Forms and policies covering on the same basis. NOO OOOONOOO All other terms and conditions of the Policy remain unchanged. SB146902G (Ed. 6-16) Page 3 of 3 Copyright, CNA All Rights Reserved. CNA SB146916C Ed. 5-17) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COMMON POLICY CONDITIONS A. The Businessowners Special Property Coverage Form is amended as follows: 1. With respect to an 'open policy", the following is added to any provision which uses the term actual cash value: a. In the event of a total loss to a building or structure, actual cash value is calculated as the Limit of Insurance applicable to that building or structure or the fair market value of the building or structure, whichever is less. b. In the event of a partial loss to a building or structure, actual cash value is calculated as b.(1) or b.(2), whichever is less: 1) The amount it would cost to repair, rebuild or replace the property less a fair and reasonable deduction for physical depreciation of the components of the building or structure that are normally subject to repair or replacement during its useful life. Physical depreciation is based upon the condition of the property at the time of loss; 2) The Limit of Insurance applicable to the property. c. In the event of a partial or total loss to Covered Property other than a building or structure, actual cash value is calculated as c.(1) or c.(2), whichever is less: 1) The amount it would cost to repair or replace the property less a fair and reasonable deduction for physical depreciation based upon the condition of the property at the time of loss; 2) The Limit of Insurance applicable to the property. d. An 'open policy" is a policy under which the value of Covered Property is not fixed at policy inception, but is determined at the time of loss in accordance with policy provisions on valuation. 2. Paragraph E.2. Appraisal Property Loss Conditions is replaced by the following: 2. Appraisal If we and you disagree on the value of the property or the amount of loss, either may make written request for an appraisal of the loss. If the request is accepted, each party will select a competent and impartial appraiser. Each party shall notify the other of the appraiser selected within 20 days of the request. The two appraisers will select an umpire. If they cannot agree within 15 days, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a. Pay its chosen appraiser; and b. Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. 3. Paragraph EA.e.(1)(a) of the Loss Payment — Building and Personal Property Property Loss Conditions is deleted. 4. Paragraphs EA.e.(1)(b)(i), EA.e.(1)(b)(ii) and EA.e.(7) of the Loss Payment — Building and Personal Property Property Loss Conditions are deleted and replaced by the following: b) We will not pay on a replacement cost basis for any loss or damage until the lost or damaged property is actually repaired or replaced. Prior to such repair or replacement, we will pay the actual cash value of the lost or damaged property as described in paragraph A.1. of this Endorsement. If the actual cash value does not exhaust the applicable Limit of Insurance, we will then pay the difference between the actual cash value and the replacement cost, provided that the repair or replacement is completed: SB146916C (Ed. 5-17) Page 1 of 5 Copyright, CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. SB146916C Ed. 5-17) i) Within 12 months after we pay the actual cash value; or ii) Within 24 months after we pay the actual cash value if the loss or damage relates to a state of emergency as described in Section 8558 of the Government Code; unless we extend the time period for good cause. Nothing in this paragraph (b) constitutes a waiver of our right to deny the claim for any valid reason or to restrict payment in cases of suspected fraud. 7) Tenants Improvements and betterments at: a) Replacement cost in accordance with the terms set form in paragraph (1)(b) above. b) A proportion of your original cost if the property is not repaired or replaced. We will determine the proportionate value as follows: i) Multiply the original cost by the number of days from the loss or damage to the expiration of the lease; and ii) Divide the amount determined in (i) above by the number of days from the installation of improvements to the expiration of the lease. If your lease contains a renewal option, the expiration of the renewal option period will replace the expiration of the lease in this procedure. c) Nothing if others pay for repairs or replacement. B. The Businessowners Common Policy Conditions are amended as follows: 1. Paragraphs A.2. and A.3. Cancellation are replaced by the following: 2. All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured at the mailing address shown in the policy and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a. 10 days before the effective date of cancellation if we cancel for: 1) Nonpayment of premium; or 2) Discovery of fraud by: N a) Any insured or his or her representative in obtaining this insurance; or 0 b) You or your representative in pursuing a claim under this policy. 0 b. 30 days before the effective date of cancellation if we cancel for any other reason. N 3. All Policies In Effect For More Than 60 Days a. If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following: 1) Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks. 2) Discovery of fraud or material misrepresentation by: a) Any insured or his or her representative in obtaining this insurance; or b) You or your representative in pursuing a claim under this policy. 3) A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. SB146916C (Ed. 5-17) Page 2 of 5 Copyright, CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. SB146916C Ed. 5-17) 4) Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative, which materially increase any of the risks insured against. 5) Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. 6) A determination by the Commissioner of Insurance that the: a) Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or b) Continuation of the policy coverage would: i) Place us in violation of California law or the laws of the state where we are domiciled; or ii) Threaten our solvency. 7) A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. b. We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: 1) 10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or 2) 30 days before the effective date of cancellation if we cancel for any other reason listed in Paragraph 3.a. 2. The following provision is added to Paragraph A. Cancellation: 7. Residential Property This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit, if such coverage is written under one of the following: a. If such coverage has been in effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in Paragraphs b. and c. below. b. We may not cancel this policy solely because the first Named Insured has: 1) Accepted an offer of earthquake coverage; or 2) Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included an earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but fails to pay the earthquake policy premium surcharge authorized by the CEA. c. We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This Restriction c. applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions. 3. Paragraph C. Concealment, Misrepresentation Or Fraud is replaced by the following with respect to loss or damage caused by fire: We do not provide coverage to the insured who, whether before or after a loss, has committed fraud or intentionally concealed or misrepresented any material fact or circumstance concerning: a. This policy; b. The Covered Property; c. That insured's interest in the Covered Property; or SB146916C (Ed. 5-17) Page 3 of 5 Copyright, CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. SB146916C Ed. 5-17) d. A claim under this policy. 4. Paragraph C. Concealment, Misrepresentation Or Fraud is replaced by the following with respect to loss or damage caused by a Covered Cause of Loss other than fire: This policy is void if any insured, whether before or after a loss, has committed fraud or intentionally concealed or misrepresented any material fact or circumstance concerning: a. This policy; b. The Covered Property; c. An insured's interest in the Covered Property; or d. A claim under this policy. 5. The following paragraph is added and supersedes any provisions to the contrary: M. Nonrenewal Subject to the provisions of Paragraphs 2. and 3. below, if we elect not to renew this policy, we will mail or deliver written notice stating the reason for nonrenewal to the first Named Insured shown in the Declarations and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured, and to the producer of record, at the mailing address shown in the policy. 2. Residential Property This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household property contained in a residential unit. We may elect not to renew such coverage for any reason, except that we will not refuse to renew such coverage solely because: a. The first Named Insured has accepted an offer of earthquake coverage. However, the following applies only to insurers who are associate participating insurers as established by Cal. Ins. Code Section 10089.16. We may elect not to renew such coverage after the first Named Insured has accepted an offer of earthquake coverage, if one or more of the following reasons applies: N 1) The nonrenewal is based on sound underwriting principles that relate to the coverages provided by this policy and that are consistent with the approved rating plan and related documents filed with the Department of Insurance as required by existing law; 2) The Commissioner of Insurance finds that the exposure to potential losses will threaten our solvency or place us in a hazardous condition. A hazardous condition includes, but is not limited to, a condition in which we make claims payments for losses resulting from an earthquake that occurred within the preceding two years and that required a reduction in policyholder surplus of at least 25% for payment of those claims; or 3) We have: a) Lost or experienced a substantial reduction in the availability or scope of reinsurance coverage; or b) Experienced a substantial increase in the premium charged for reinsurance coverage of our residential property insurance policies; and the Commissioner has approved a plan for the nonrenewals that is fair and equitable, and that is responsive to the changes in our reinsurance position. b. The first Named Insured has cancelled or did not renew a policy, issued by the California Earthquake Authority that included an earthquake policy premium surcharge. SB146916C (Ed. 5-17) Page 4 of 5 Copyright, CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. SB146916C Ed. 5-17) c. Corrosive soil conditions exist on the premises. 3. We are not required to send notice of nonrenewal in the following situations: a. If the transfer or renewal of a policy, without any changes in terms, conditions, or rates, is between us and a member of our insurance group. b. If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph 1. c. If you have obtained replacement coverage, or if the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d. If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. e. If the first Named Insured requests a change in the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f. If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in Paragraph 1., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25%. All other terms and conditions of the Policy remain unchanged. SB146916C (Ed. 5-17) Page 5 of 5 Copyright, CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA BLANKET ADDITIONAL INSURED AND LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COMMON POLICY CONDITIONS SB146932F Ed. 6-16) I. BLANKET ADDITIONAL INSURED PROVISIONS A. ADDITIONAL INSURED — BLANKET VENDORS Who Is An Insured is amended to include as an additional insured any person or organization (referred to below as vendor) with whom you agreed under a "written contract" to provide insurance, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the 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, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; SB146932F (6-16) Page 1 of 7 Copyright, CNA All Rights Reserved. TABLE OF CONTENTS I. Blanket Additional Insured Provisions A. Additional Insured — Blanket Vendors B. Miscellaneous Additional Insureds C. Additional Provisions Pertinent to Additional Insured Coverage 1. Primary — Noncontributory provision 2. Definition of "written contract." II. Liability Extension Coverages A. Bodily Injury — Expanded Definition B. Broad Knowledge of Occurrence C. Estates, Legal Representatives and Spouses D. Legal Liability — Damage to Premises E. Personal and Advertising Injury — Discrimination or Humiliation F. Personal and Advertising Injury — Broadened Eviction G. Waiver of Subrogation - Blanket I. BLANKET ADDITIONAL INSURED PROVISIONS A. ADDITIONAL INSURED — BLANKET VENDORS Who Is An Insured is amended to include as an additional insured any person or organization (referred to below as vendor) with whom you agreed under a "written contract" to provide insurance, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the 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, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; SB146932F (6-16) Page 1 of 7 Copyright, CNA All Rights Reserved. CNA S ( Ed. 6-16) e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; If. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: 1) The exceptions contained in Subparagraphs d. or If.; or 2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 3. This provision 2. does not apply to any vendor included as an insured by an endorsement issued by us and made a part of this Policy. 4. This provision 2. does not apply if "bodily injury" or "property damage" included within the "products - completed operations hazard" is excluded either by the provisions of the Policy or by endorsement. B. MISCELLANEOUS ADDITIONAL INSUREDS 1. Who Is An Insured is amended to include as an insured any person or organization (called additional insured) described in paragraphs 3.a. through 3.j. below whom you are required to add as an additional insured on this policy under a "written contract.": 2. However, subject always to the terms and conditions of this policy, including the limits of insurance, we will not provide the additional insured with: a. A higher limit of insurance than required by such "written contract"; b. Coverage broader than required by such "written contract" and in no event greater than that described by the applicable paragraph a. through k. below; or c. Coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard." But this paragraph c. does not apply to the extent coverage for such liability is provided by paragraph 3.j. below. Any coverage granted by this endorsement shall apply only to the extent permitted by law. 3. Only the following persons or organizations can qualify as additional insureds under this endorsement: a. Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of: 1) such person or organization's financial control of you; or 2) Premises such person or organization owns, maintains or controls while you lease or occupy these premises; provided that the coverage granted to such additional insureds does not apply to structural alterations, new construction or demolition operations performed by or for such additional insured. SB146932F (6-16) Page 2 of 7 Copyright, CNA All Rights Reserved. CNA SB146932F Ed. 6-16) b. Co-owner of Insured Premises A co-owner of a premises co -owned by you and covered under this insurance but only with respect to the co-owners liability for "bodily injury", "property damage" or "personal and advertising injury" as co-owner of such premises. c. Grantor of Franchise Any person or organization that has granted a franchise to you, but only with respect to such person or organization's liability for "bodily injury", "property damage", or "personal and advertising injury" as grantor of a franchise to you. d. Lessor of Equipment Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by your maintenance, operation or use of such equipment, provided that the "occurrence" giving rise to such bodily injury" or "property damage" or the offense giving rise to such "personal and advertising injury" takes place prior to the termination of such lease. e. Lessor of Land Any person or organization from whom you lease land, but only with respect to liability for "bodily injury", property damage" or "personal and advertising injury" arising out of the ownership, maintenance or use of that specific part of the land leased to you, provided that the "occurrence" giving rise to such "bodily injury" or "property damage" or the offense giving rise to such "personal and advertising injury", takes place prior to the termination of such lease. The insurance hereby afforded to the additional insured does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. f. Lessor of Premises An owner or lessor of premises leased to you, or such owner or lessor's real estate manager, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the ownership, maintenance or use of such part of the premises leased to you, and provided that the "occurrence" giving rise to such "bodily injury" or "property damage" or the offense giving rise to such personal and advertising injury", takes place prior to the termination of such lease. The insurance hereby afforded to the additional insured does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. g. Mortgagee, Assignee or Receiver N A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee, or receiver's liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the ownership, maintenance, or use of a premises by you. This insurance does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. h. State or Political Subdivisions A state or government agency or subdivision or political subdivision that has issued a permit or authorization, but only with respect to such government agency or subdivision or political subdivision's liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of: 1) The following hazards in connection with premises you own, rent, or control and to which this insurance applies: SB146932F (6-16) Page 3 of 7 a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or b) The construction, erection, or removal of elevators; or c) The ownership, maintenance or use of any elevators covered by this insurance; or Copyright, CNA All Rights Reserved. CNA S ( Ed. 6-16) 2) The permitted or authorized operations performed by you or on your behalf. But the coverage granted by this paragraph does not apply to: a) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or government agency or subdivision or political subdivision; or b) "Bodily injury" or "property damage" included within the "products -completed operations hazard." With respect to this provision's requirement that additional insured status must be requested under a written contract", we will treat as a "written contract" any governmental permit that requires you to add the governmental entity as an additional insured. i. Trade Show Event Lessor With respect to your participation in a trade show event as an exhibitor, presenter or displayer, any person or organization .whom you are required to include as an additional insured, but only with respect to such person or organization's liability for "bodily injury", "property damage", or "personal and advertising injury" cause by: a. Your acts or omissions; or b. Acts or omissions of those acting on your behalf; in the performance of your ongoing operations at the trade show premises during the trade show event. j. Other Person or Organization Any person or organization who is not an additional insured under paragraphs a. through i. above. Such additional insured is an insured solely for "bodily injury", "property damage" or "personal and advertising injury" for which such additional insured is liable because of your acts or omissions. The coverage granted by this paragraph does not apply to any person or organization: 1) For "bodily injury," "property damage," or "personal and advertising injury" arising out of the rendering or failure to render any professional services; 2) For "bodily injury" or "property damage" included in the "products -completed operations hazard." But this provision (2) does not apply to such "bodily injury" or "property damage" if: a) It is entirely due to your negligence and specifically results from your work for the additional insured which is the subject to the "written contract"; and b) The "written contract" requires you to make the person or organization an additional insured for such "bodily injury" or "property damage"; or 3) Who is afforded additional insured coverage under another endorsement attached to this policy. C. ADDITIONAL PROVISIONS PERTINENT TO ADDITIONAL INSURED COVERAGE With respect only to additional insured coverage provided under paragraphs A. and B. above: The BUSINESSOWNERS COMMON POLICY CONDITIONS are amended to add the following to the Condition entitled Other Insurance: This insurance is excess of all other insurance available to an additional insured whether primary, excess, contingent or on any other basis. However, if a "written contract" requires that this insurance be either primary or primary and noncontributing, then this insurance will be primary and non-contributory relative solely to insurance on which the additional insured is a named insured. 2. Under Liability and Medical Expense Definitions, the following definition is added: Written contract" means a written contract or agreement that requires you to make a person or organization an additional insured on this policy, provided the contract or agreement: a. Is currently in effect or becomes effective during the term of this policy; and b. Was executed prior to: SB146932F (6-16) Page 4 of 7 Copyright, CNA All Rights Reserved. CNA 1) The "bodily injury" or "property damage"; or 2) The offense that caused the "personal and advertising injury"; for which the additional insured seeks coverage. II. LIABILITY EXTENSION COVERAGES SB146932F Ed. 6-16) It is understood and agreed that this endorsement amends the Businessowners Liability Coverage Form. If any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision, and the changes made by this endorsement to such provision do not apply. A. Bodily Injury— Expanded Definition Under Liability and Medical Expenses Definitions, the definition of "Bodily injury" is deleted and replaced by the following: Bodily injury" means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the physical injury, sickness or disease. B. Broad Knowledge of Occurrence Under Businessowners Liability Conditions, the Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended to add the following: Paragraphs a. and b. above apply to you or to any additional insured only when such "occurrence," offense, claim or "suit" is known to: 1) You or any additional insured that is an individual; 2) Any partner, if you or an additional insured is a partnership; 3) Any manager, if you or an additional insured is a limited liability company; 4) Any "executive officer" or insurance manager, if you or an additional insured is a corporation; 5) Any trustee, if you or an additional insured is a trust; or 6) Any elected or appointed official, if you or an additional insured is a political subdivision or public entity. This paragraph applies separately to you and any additional insured. C. Estates, Legal Representatives and Spouses The estates, heirs, legal representatives and spouses of any natural person insured shall also be insured under this policy; provided, however, coverage is afforded to such estates, heirs, legal representatives and spouses only for claims arising solely out of their capacity as such and, in the case of a spouse, where such claim seeks damages from marital common property, jointly held property, or property transferred from such natural person insured to such spouse. No coverage is provided for any act, error or omission of an estate, heir, legal representative or spouse outside the scope of such person's capacity as such, provided however that the spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership Named Insureds are insureds with respect to such spouses' acts, errors or omissions in the conduct of the Named Insured's business. D. Legal Liability — Damage To Premises Under B. Exclusions, 1. Applicable to Business Liability Coverage, Exclusion k. Damage To Property, is replaced by the following: k. Damage To Property Property damage" to: 1. Property you own, rent or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of SB146932F (6-16) Page 5 of 7 Copyright, CNA All Rights Reserved. CNA S ( Ed. 6-16) 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 premises; 3. Property loaned to you; 4. Personal property in the care, custody or control of the insured; 5. That particular part of any real property on which you or any contractors or subcontractors working directly or indirectly in your behalf are performing operations, if the "property damage" arises out of those operations; or 6. That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraph 2 of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. Paragraphs 1, 3, and 4, of this exclusion do not apply to "property damage" (other than damage by fire or explosion) to premises: 1) rented to you: 2) temporarily occupied by you with the permission of the owner, or 3) to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section D — Liability and Medical Expenses Limits of Insurance. Paragraphs 3, 4, 5, and 6 of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph 6 of this exclusion does not apply to "property damage" included in the "products -completed operations hazard." 2. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the following paragraph is added, and replaces the similar paragraph, if any, beneath paragraph (14) of the exclusion entitled Personal and Advertising injury: Exclusions c, d, e, f, g, h, i, k, I, m, n, and o, do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section D. Liability And Medical Expenses Limits Of Insurance. 3. The first Paragraph under item 5. Damage To Premises Rented To You Limit of the section entitled Liability And Medical Expenses Limits Of Insurance is replaced by the following: The most we will pay under Business Liability for damages because of "property damage" to any one premises, while rented to you or temporarily occupied by you with the permission of the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days, is the Damage to Premises Rented to You limit shown in the Declaration. E. Personal and Advertising Injury — Discrimination or Humiliation 1. Under Liability and Medical Expenses Definitions, the definition of "personal and advertising injury" is amended to add the following: h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: 1) Not done intentionally by or at the direction of: a) The insured; or SB146932F (6-16) Page 6 of 7 Copyright, CNA All Rights Reserved. CNA SB146932F Ed. 6-16) b) Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and 2) Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or person by any insured. 2. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the exclusion entitled Personal and Advertising injury is amended to add the following additional exclusions: 15) Discrimination Relating to Room, Dwelling or Premises Caused by discrimination directly or indirectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured. 16) Employment Related Discrimination Discrimination or humiliation directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person by any insured. 17) Fines or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. 3. This provision (Personal and Advertising Injury — Discrimination or Humiliation) does not apply if Personal and Advertising Injury Liability is excluded either by the provisions of the Policy or by endorsement. F. Personal and Advertising Injury - Broadened Eviction Under Liability and Medical Expenses Definitions, the definition of "Personal and advertising injury" is amended to delete Paragraph c. and replace it with the following: c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room dwelling or premises that a person or organization occupies committed by or on behalf of its owner, landlord or lessor. G. Waiver of Subrogation — Blanket We waive any right of recovery we may have against: a. Any person or organization with whom you have a written contract that requires such a waiver. 0 NV OV All other terms and conditions of the Policy remain unchanged. NOO OOOONOOO SB146932F (6-16) Page 7 of 7 Copyright, CNA All Rights Reserved. CNA SB -146936-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I10f7W_19[970telll_1N This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners b. The percentage of annual increase shown in Special Property Coverage Form: the Declarations, expressed as a decimal Inflation Guard example: 5% is .05); times 1. The limit of Insurance for Building will be c. The number of days since the beginning of increased by the annual percentage shown in the the current policy year or the effective date of Declarations, if you choose this optional coverage. the most recent policy change amending the limit, divided by 365. The limit of Insurance for Business Personal Example: Property will be increased by the annual percentage shown in the Declarations, if you If: the applicable limit is $100,000. choose this optional coverage. The annual increase is 5%. 2. The amount of increase will be: The number of days since the beginning of a. The limit that applied on the most recent of the policy year (or last policy change) is 146. the policy inception date, the policy The amount of increase is: anniversary date, or any other policy change amending the limit; times 100,000 x .05 x 146 / 365 = $2,000. SB -146936-A Page 1 of 1 Ed. 01/06) CNA SB -147028-A Ed. 03/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCEPTIONS TO PERSONAL AND ADVERTISING INJURY EXCLUSION P. ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM Section B, Exclusions, 1. Applicable To Business Liability Coverage - p. Personal and Advertising Injury Liability, subparagraph (9) is deleted and replaced with the following: Personal and advertising injury" 9) Committed by an insured whose business is; a) Advertising, broadcasting, publishing or telecasting: b) Designing or determining content of websites for others; or c) An Internet search, access, content or service provider. However: 1) This exclusion does not apply to Paragraphs 14. a., b. and c. of "personal and advertising injury" under Paragraph F. Liability And Medical Expenses Definition; 2) Subparagraphs 9. (b) and 9.(c) only apply to the insured's operations for others. For the purposes of this exclusion, the placing of frames, borders or links, or advertising, for you or others anywhere on the Internet, is not by itself, considered the business of advertising, broadcasting, publishing or telecasting. SB -147028-A Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Ed. 03/06) (Version 1.0) CNA CHANGES - NOTICE OF CANCELLATION OR MATERIAL COVERAGE CHANGE This endorsement modifies insurance provided under the following: BUSINESSOWNERS COMMON POLICY CONDITIONS SB147052C Ed. 6-16) In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part (other than the reduction of aggregate limits through payment of claims), we agree to mail written notice of cancellation or material change at a minimum of thirty (30) days prior to such cancellation or material change, to: SCHEDULE Name of Desianated Address/Contact Information of Desianated Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following conditions are added: 1. If the policy is cancelled or not renewed, we will give written notice of such cancellation or nonrenewal to the Designated Entity shown in the Schedule above, or in the Declarations, at a minimum of thirty (30) days prior to such cancellation or nonrenewal. Such notice may be delivered or sent by any means of our choosing. The notice to the Designated Entity will state the effective date of cancellation or nonrenewal. However, such notice of cancellation or nonrenewal is solely for the purpose of informing the Designated Entity of the effective date of cancellation or nonrenewal and does not grant, alter, or extend any rights or obligations under this policy. 2. If we cancel or elect not to renew the policy for any reason other than nonpayment of premium, we will give written notice to the Designated Entity shown in the Schedule above, or in the Declarations, at a minimum of thirty 30) days prior to such cancellation or nonrenewal, at the same time notice is given to the first Named Insured. 3. If we cancel or elect not to renew this policy for nonpayment of premium, we will give written notice to the Designated Entity shown in the Schedule above, or in the Declarations. Such notice may be provided before or after the effective date of cancellation or nonrenewal. 4. Failure to give notice in accordance with the terms of this endorsement does not: a. Alter the effective date of policy cancellation, nonrenewal or expiration; b. Render such cancellation or nonrenewal ineffective; c. Grant, alter, or extend any rights or obligations under this policy; or d. Extend the insurance beyond the effective date of cancellation or policy expiration, whichever comes first. All other terms and conditions of the Policy remain unchanged. SB147052C (Ed. 6-16) Page 1 of 1 Copyright, CNA All Rights Reserved. CNA SB -147075-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ECONOMIC AND TRADE SANCTIONS CONDITION The following condition is added to the COMMON POLICY CONDITIONS: ECONOMIC AND TRADE SANCTIONS CONDITION In accordance with laws and regulations of the United States concerning economic and trade embargoes, this policy is void ab initio (void from its inception) with respect to any term or condition of this policy that violates any laws or regulations of the United States concerning economic and trade embargoes including, but not limited to the following: 1. Any insured, or any person or entity claiming the benefits of an insured, who is or becomes a Specially Designated National or Blocked Person or who is otherwise subject to U.S. economic or trade sanctions; 2. Any claim or "suit" that is brought in a Sanctioned Country or by a Sanctioned Country Government, where any action in connection with such claim or suit is prohibited by U.S. economic or trade sanctions; 3. Any claim or "suit" that is brought by any Specially Designated National or Blocked Person or any person or entity who is otherwise subject to U.S. economic or trade sanctions; SB -147075-A Ed. 01/06) 4. Property that is located in a Sanctioned Country or that is owned by, rented to or in the care, custody or control of a Sanctioned Country Government, where any activities related to such property are prohibited by U.S. economic or trade sanctions; or 5. Property that is owned by, rented to or in the care, custody or control of a Specially Designated National or Blocked Person, or any person or entity who is otherwise subject to U.S. economic or trade sanctions. As used in this endorsement a Specially Designated National or Blocked Person is any person or entity that is on the list of Specially Designated Nationals and Blocked Persons issued by the U.S. Treasury Department's Office of Foreign Asset Control (O.F.A.C.) as it may be from time to time amended. As used in this endorsement a Sanctioned Country is any country that is the subject of trade or economic embargoes imposed by the laws or regulations of the United States of America. Page 1 of 1 CNA SB -147079-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. N%\MI_\=1I11111VAWIMIJ69L9701 This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM I. The following provisions are added to the Business Liability Coverage Forms: A. War Exclusion i. under Paragraph B.1., Exclusions — Applicable to Business Liability Coverage is replaced by the following: This insurance does not apply to War. Bodily injury," "property damage," "personal and advertising injury," however caused, arising, directly or indirectly, out of: 1) War, including undeclared or civil war; or 2) Warlike action by a military force, including action in hindering or defending against an actual or expected 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. II. The following provision is added to the Business Liability Coverage Form: A. Exclusion h. under Paragraph B.2., Exclusions — Applicable To Medical Expenses Coverage does not apply. Medical Expenses due to war are now subject to Exclusion g. of Paragraph B.2., since "bodily injury" arising out of war is now excluded under Paragraph B.1., Exclusions — Applicable To Business Liability Coverage. SB -147079-A Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Ed. 01/06) Copyright, Insurance Services Office, Inc., 2003 CNA SB -147080-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - SILICA This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM A. The following exclusion is added to Section B.1. EXCLUSIONS — Applicable to Business Liability Coverage: This insurance does not apply to: 1. "Bodily injury" arising in whole or in part out of the actual, alleged or threatened respiration or ingestion at any time of "silica"; or 2. "Property damage" arising in whole or in part out of the actual, alleged or threatened presence of silica." SB -147080-A Ed. 01/06) 3. This insurance does not apply to "personal and advertising injury" arising in whole or in part out of the actual, alleged or threatened exposure at any time to or the presence of "silica." B. The following definition is added: Silica" means the chemical compound silicon dioxide Si02) in any form, including dust which contains silica." Page 1 of 1 CNA 1 91 1 7 i 1 1 7 l [7 i Z 7 ['L 7 17 [7 SB -147082-E Ed. 04/14) All Coverage Parts included in this policy are subject to the following conditions: A. Cancellation (b) Pay property taxes that are owing 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 5 days before the effective date of cancellation if any one of the following conditions exists at any building that is Covered Property in this policy. 1) The building has been vacant or unoccupied 60 or more consecutive days. This does not apply to: a) Seasonal unoccupancy; or b) Buildings in the course of construction, renovation or addition. Buildings with 65% or more of the rental units or floor area vacant or unoccupied are considered unoccupied under this provision. 2) After damage by a covered cause of loss, permanent repairs to the building: a) Have not started, and b) Have not been contracted for, within 30 days of initial payment of loss. 3) The building has: a) An outstanding order to vacate; b) An outstanding demolition order; or c) Been declared unsafe by governmental authority. 4) Fixed and salvageable items have been or are being removed from the building and are not being replaced. This does not apply to such removal that is necessary or incidental to any renovation or remodeling. 5) Failure to: a) Furnish necessary heat, water, sewer service or electricity for 30 consecutive days or more, except during a period of seasonal unoccupancy; or and have been outstanding for more than one year following the date due, except that this provision will not apply where you are in a bona fide dispute with the taxing authority regarding payment of such taxes. b. 10 days before the effective date of cancellation if we cancel for nonpayment of premium. c. 30 days before the effective date of cancellation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be sufficient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Concealment, Misrepresentation Or Fraud This policy is void in any case of fraud by you as it relates to this policy at any time. It is also void if you or any other insured, at any time, intentionally conceal or misrepresent a material fact concerning: 1. This policy; 2. The Covered Property; 3. Your interest in the Covered Property; or 4. A claim under this policy. D. Examination Of Your Books And Records We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three years afterward. SB -147082-E Page 1 of 3 Ed. 04/14) Includes copyrighted material of Insurance Services Office, Inc., with its permission N 0 0 0 0 E. Inspections And Surveys We have the right but are not obligated to: 1. Make inspections and surveys at any time; 2. Give you reports on the conditions we find; and 3. Recommend changes. Any inspections, surveys, reports or recommendations relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: 1. Are safe or healthful; or 2. Comply with laws, regulations, codes or standards. This condition applies not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. F. Insurance Under Two Or More Coverages If two or more of this policy's coverages apply to the same loss or damage, we will not pay more than the actual amount of the loss or damage. G. Liberalization If, during your policy period, we adopt any revision that would broaden the coverage under this policy without additional premium the broadened coverage will immediately apply to this policy. The broadened coverage will also apply to the renewal of this policy if such renewal was in process or was mailed prior to the date we adopted such revision. H. Other Insurance 1. If you have other insurance covering the same loss or damage, we will pay only for the amount of covered loss or damage in excess of the amount due from that other insurance, whether you can collect on it or not. But we will not pay more than the applicable Limit of Insurance. 2. Business Liability Coverage is excess over: a. Any other insurance that insures for direct physical loss or damage; or b. Any other primary insurance available to you covering liability for damages arising out of the premises or operations for which you have been added as an additional insured. SB -147082-E Ed. 04/14) undertake to do so; but we will be entitled to the insured's rights against all those other insurers. I. Premiums 1. The first Named Insured shown in the Declarations: a. Is responsible for the payment of all premiums; and b. Will be the payee for any return premiums we pay. 2. The premium shown in the Declarations was computed based on rates in effect at the time the policy was issued. On each renewal, continuation or anniversary of the effective date of this policy, we will compute the premium in accordance with our rates and rules then in effect. 3. With our consent, you may continue this policy in force by paying a continuation premium for each successive one-year period. The premium must be: a. Paid to us prior to the anniversary date; and b. Determined in accordance with Paragraph 2. above. Our forms then in effect will apply. If you do not pay the continuation premium, this policy will expire on the first anniversary date that we have not received the premium. 4. Undeclared exposures or change in your business operation, acquisition or use of locations may occur during the policy period that are not shown in the Declarations. If so, we may require an additional premium. That premium will be determined in accordance with our rates and rules then in effect. J. Premium Audit 1. This policy is subject to audit if the Declarations show an Audit Period other than 'Not Auditable.' We will compute the final premium due when we determine your actual exposures. 2. Premium shown in this policy as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period. Audit premiums are due and payable on notice to the first Named Insured. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. 3. When this insurance is excess, we will have no 3. The first Named Insured must keep records of the duty under Business Liability Coverage to defend information we need for premium computation, any claim or "suit" that any other insurer has a and send us copies at such times as we may duty to defend. If no other insurer defends, we will request. SB -147082-E Page 2 of 3 Ed. 04/14) Includes copyrighted material of Insurance Services Office, Inc., with its permission K. Transfer Of Rights Of Recovery Against Others To Us 1. Applicable to Businessowners Property Coverage: If any person or organization to or for whom we make payment under this policy has rights to recover damages from another, those rights are transferred to us to the extent of our payment. That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: a. Prior to a loss to your Covered Property. b. After a loss to your Covered Property only if, at time of loss, that party is one of the following: 1) Someone insured by this insurance; 2) A business firm: a) Owned or controlled by you; or b) That owns or controls you; or 3) Your tenant. You may also accept the usual bills of lading or shipping receipts limiting the liability of carriers. SB -147082-E Ed. 04/14) This will not restrict your insurance. 2. Applicable to Businessowners Liability Coverage If the insured has rights to recover all or part of any payment we have made under this policy, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit' or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. L. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual Named Insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. SB -147082-E Page 3 of 3 Ed. 04/14) Includes copyrighted material of Insurance Services Office, Inc., with its permission N 0 00 0 0 CNA SB -147083-B Ed. 07/09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FUNGI / MOLD / MILDEW / YEAST / MICROBE EXCLUSION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM A. The following exclusion is added to SECTION B.1., EXCLUSIONS — Applicable to Business Liability Coverage: This insurance does not apply to: Fungi and Microbes 1) "Bodily injury" or "property damage" arising out of or relating to, in whole or in part, the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or growth or presence of any "fungi" or "microbes." This exclusion applies regardless of any other cause or event that contributes concurrently or in any sequence to such injury or damage, loss, cost or expense. This exclusion does not apply where your business is food processing, sales, or serving, and the "bodily injury" is caused solely by food poisoning in connection with such processing, sales, or serving. 2) Any loss, cost or expense arising out of or relating to the testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating, or disposing of, or in any way responding to or assessing the effects of fungi" or "microbes" by any insured or by anyone else. 3) "Property damage" arising out of or relating to the actual, alleged or threatened contact with, exposure to, existence of, or growth or presence of any "fungi" or "microbes." B. The following exclusion is added to SECTION B.1.q. & r., EXCLUSIONS — Applicable to Business Liability Coverage / "Personal injury" or "advertising injury": This insurance does not apply to: Fungi and Microbes 1) "Personal injury" or "advertising injury" arising out of or relating to, in whole or in part, the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or growth or presence of any "fungi" or "microbes." 2) Any loss, cost or expense arising out of or relating to the testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating, or disposing of, or in any way responding to or assessing the effects of fungi" or "microbes" by any insured or by anyone else. This exclusion applies regardless of any other cause or event that contributes concurrently or in any sequence to such injury, loss, cost or expense. C. The following definitions are added to SECTION F., DEFINITIONS: Fungi" means any form of fungus, including but not limited to, yeast, mold, mildew, rust, smut or mushroom, and including any spores, mycotoxins, odors, or any other substances, products, or byproducts produced by, released by, or arising out of the current or past presence of fungi. But "fungi" does not include any fungi intended by the insured for consumption. Microbe(s)" means any non -fungal microorganism or non -fungal, colony -form organism that causes infection or disease. "Microbe" includes any spores, mycotoxins, odors, or any other substances, products, or byproducts produced by, released by, or arising out of the current or past presence of microbes. But microbe" does not mean microbes that were transmitted directly from person to person. SB -147083-B Incorporates materials copyrighted by Insurance Services Office, reprinted with their permission. Page 1 of 1 Ed. 07/09) CNA SB -147084-004 Ed. 04-12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Ifill I I'Ll 14 STIMA• Z I • z l valo-J91:1 i This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM A. Section Ill EXCLUSIONS, is amended to add the following provision: m. Fungi, Wet Rot, Dry Rot and Microbes Presence, growth, proliferation, spread or any activity of "fungi," wet or dry rot, or "microbes." This exclusion does not apply when "fungi," wet or dry rot or "microbes" result from fire or lightning. B. Section B.2.d., Subsections (2) and (7), EXCLUSIONS/Other Types of Loss, are deleted in its entirety and replaced as follows: 2) Rust, or other corrosion, decay, deterioration, hidden or latent defect or any quality in property that causes it to damage or destroy itself; 7) The following causes of loss: a) Dampness or dryness of atmosphere; b) Changes in or extremes of temperature; or c) Marring or scratching. C. The following is added to Section A. Coverage, Paragraph 5. of the Additional Coverages section: Additional Coverage — Limited Coverage for Fungus," Wet Rot, Dry Rot and Microbes The coverage described below in paragraphs C.2. and C.6. of this Limited Coverage endorsement only applies when the "fungus," wet or dry rot or microbes is the result of Covered Causes of Loss other than fire or lightning that occur during the policy period and only if all reasonable means were used to save and preserve the property from further damage at the time of and after that occurrence. 2. We will pay for loss or damage by "fungus," wet or dry rot or microbes. As used in this Limited Coverage, the term loss or damage means: a. Direct physical loss or damage to Covered Property caused by "fungus," wet or dry rot or microbes, including the cost of removal of the fungus," wet or dry rot or microbes. b. The cost to tear out and replace any part of the building or other property as needed to gain access to the "fungus," wet or dry rot or microbes; and SB -147084-004 (Ed. 04-12) Page 1 of 2 c. The cost of testing performed after removal, repair, replacement or restoration of the damaged property is completed, provided there is a reason to believe that "fungus," wet or dry rot or microbes are present. 3. The coverage described under paragraph C.2. of this Limited Coverage endorsement is limited to 25,000, unless a different limit is shown in the Declarations. Regardless of the number of claims, this limit is the most we will pay for the total of all loss or damage arising out of all occurrences of Covered Causes of Loss (other than fire or lightning) which take place in a 12 month period starting with the beginning of the present annual policy period). With respect to a particular occurrence of loss which results in "fungus," wet or dry rot or microbes, we will not pay more than a total of $25,000 (unless a different limit is shown in the Declarations), even if the "fungus," wet or dry rot or microbes continues to be present or active, or recurs, in a later policy period. 4. The coverage provided under this Limited Coverage does not increase the applicable Limit of Insurance on any Covered Property. If a particular occurrence results in loss or damage by fungus," wet or dry rot or microbes, and other loss or damage, we will not pay more, for the total of all loss or damage, than the applicable Limit of Insurance on the affected Covered Property. If there is covered loss or damage to Covered Property, not caused by "fungus," wet or dry rot or microbes, loss payment will not be limited by the terms of this Limited Coverage, except to the extent that "fungus," wet or dry rot or microbes causes an increase in the loss. Any such increase in the loss will be subject to the terms of this Limited Coverage. 5. The terms of this Limited Coverage do not increase or reduce the coverage provided under the Additional Coverages Section of the Special Property Coverage Forms. 6. The following paragraphs, 6.a. or 6.b. applies to the Business Income and Extra Expense coverage and only if the suspension (slowdown or cessation) of 'operations" satisfies all terms and conditions of the applicable Business Income and Copyright, CNA All Rights Reserved. Extra Expense coverage. The coverage provided under this Limited Coverage is part of and does not increase the applicable Limit of Insurance on the Business Income and Extra Expense coverage. a. If the loss which resulted in "fungus," wet or dry rot or microbes does not in itself necessitate a suspension of 'operations," but such suspension is necessary due to loss or damage to property caused by "fungus," wet or dry rot or microbes, then our payment under Business Income and/or Extra Expense is limited to the amount of loss and/or expense sustained in a period of not more than 30 days. The days need not be consecutive. b. If a covered suspension of 'operations" was caused by loss or damage other than fungus," wet or dry rot or microbes but remediation of "fungus," wet or dry rot or microbes prolongs the "period of restoration," we will pay for loss and/or expense sustained during the delay (regardless of when such a delay occurs during the "period of restoration"), but such coverage is limited to 30 days. The days need not be consecutive. D. Under this policy, we will not pay under the Ordinance or Law Coverage for: 1. Loss or expense sustained due to the enforcement of any ordinance or law which All other terms and conditions of the Policy remain unchanged. SB -147084-004 (Ed. 04-12) Page 2 of 2 SB -147084-004 Ed. 04-12) requires the demolition, repair, replacement, reconstruction, remodeling or remediation of property due to the presence, growth, proliferation, spread or any activity of "fungus," wet or dry rot or microbes; or 2. The costs associated with the enforcement of any ordinance or law which requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "fungus," wet or dry rot or microbes. E. Section G., DEFINITIONS, is amended to add the following two (2) definitions: Fungi" means any form of fungus, including but not limited to, yeast, mold, mildew, rust, smut or mushroom, and including any spores, mycotoxins, odors, or any other substances, products, or byproducts produced by, released by, or arising out of the current or past presence of "fungi." But "fungi" does not include any "fungi" intended by the insured for consumption. Microbe(s)" means any non -fungal micro-organism or non -fungal, colony -form organism that causes infection or disease. "Microbe" includes any spores, mycotoxins, odors, or any other substances, products, or byproducts produced by, released by, or arising out of the current or past presence of "microbes." Copyright, CNA All Rights Reserved. CNA SB -147086-B Ed. 04/10) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LOSS PAYABLE CLAUSES This endorsement modifies insurance provided under the following: BUSINESSOWNERS POLICY SCHEDULE* Provision Applicable Prem. Description Loss Payee (Indicate Paragraph No. of Property (Name & Address) A, B, C or D) REFER TO LOSS PAYEE SCHEDULE Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations. The following is added to the Businessowners Special have the right to receive loss payment if the Property Coverage Form LOSS PAYMENT Loss Condition, Loss Payee: as shown in the Declarations or by an "A," "B" "C," or "D" (1) Pays any premium due under this policyintheSchedule: at our request if you have failed to do so; A. LOSS PAYABLE CLAUSE For Covered Property in which both you and a Loss Payee shown in the Schedule or in the Declarations have an insurable interest, we will: 1. Adjust losses with you; and 2. Pay any claim for loss or damage jointly to you and the Loss Payee, as interests may appear. B. LENDER'S LOSS PAYABLE CLAUSE 1. The Loss Payee shown in the Schedule or in the Declarations is a creditor (including a mortgageholder or trustee) with whom you have entered a contract for the sale of Covered Property, whose interest in that Covered Property is established by such written contracts as: a. Warehouse receipts; b. A contract for deed; c. Bills of lading; or d. Financing statements. 2. For Covered Property in which both you and a Loss Payee have an insurable interest: a. We will pay for covered loss or damage to each Loss Payee in their order of precedence, as interests may appear. b. The Loss Payee has the right to receive loss payment even if the Loss Payee has started foreclosure for similar action on the Covered Property. c. If we deny your claim because of your acts or because you have failed to comply with the terms of this policy, the Loss Payee will still SB -147086-B Ed. 04/10) 2) Submits a signed, sworn proof of loss within 60 days after receiving notice from us of your failure to do so; and 3) Has notified us of any change in ownership, occupancy or substantial change in risk known to the Loss Payee. All of the terms of the Businessowners Special Property Coverage Form will then apply directly to the Loss Payee. d. If we pay the Loss Payee for any loss or damage and deny payment to you because of your acts or because you have failed to comply with the terms of this policy: 1) The Loss Payee's rights will be transferred to us to the extent of the amount we pay; and 2) The Loss Payee's right to recover the full amount of the Loss Payee's claim will not be impaired. At our option, we may pay to the Loss Payee the whole principal on the debt plus any accrued interest. In this event, you will pay your remaining debt to us. 3. If we cancel this policy, we will give written notice to the Loss Payee at least: a. 10 days before the effective date of cancellation if we cancel for your nonpayment of premium; or b. 30 days before the effective date of cancellation if we cancel for any other reason. Page 1 of 2 L 4. If we do not renew this policy, we will give written notice to the Loss Payee at least 10 days before the expiration date of this policy. CONTRACT OF SALE CLAUSE 1. The Loss Payee shown in the Schedule or in the Declarations is a person or organization you have entered a contract with for the sale of Covered Property. 2. For Covered Property in which both you and the Loss Payee have an insurable interest, we will: a. Adjust losses with you; and b. Pay any claim for loss or damage jointly to you and the Loss Payee, as interests may appear. SB -147086-B Ed. 04/10) SB -147086-B Ed. 04/10) 3. The following is added to the OTHER INSURANCE Businessowners Common Policy Condition: For Covered Property that is the subject of a contract of sale, the word "you" includes the Loss Payee. D. BUILDING OWNER LOSS PAYABLE CLAUSE 1. The Loss Payee shown in the Schedule or in the Declarations is the owner of the described building, in which you are a tenant. 2. We will adjust losses to the described building with the Loss Payee. Any loss payment made to the Loss Payee will satisfy your claims against us for the owner's property. 3. We will adjust losses to tenant's improvements and betterments with you, unless the lease provides otherwise. Page 2 of 2 CNA SB -147088-A-04 Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - ASBESTOS This endorsement modifies insurance provided under the following: BUSINESSOWNERS POLICY This insurance does not apply to: 1) "Bodily injury", "property damage", "personal injury" or advertising injury" arising out of the actual, alleged or threatened exposure at any time to asbestos; or 2) Any loss, cost or expense that may be awarded or incurred: a) by reason of a claim or "suit' for any such injury or damage; or b) in complying with a governmental direction or request to test for, monitor, clean up, remove, contain or dispose of asbestos. Asbestos means the mineral in any form whether or not the asbestos was at any time: 1) airborne as a fiber, particle or dust; 2) contained in, or formed a part of a product, structure or other real or personal property; 3) carried on clothing; 4) inhaled or ingested; or 5) transmitted by any other means. SB -147088-A-04 Page 1 of 1 Ed. 01/06) CNA SB -147089-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYMENT - RELATED PRACTICES EXCLUSION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM The following exclusion is added to Section B. EXCLUSIONS of the Businessowners Liability Coverage Form: This insurance does not apply to: r. "Bodily injury" or "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) Employment-related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation or discrimination directed at that person; or 2) The spouse, child, parent, brother or sister of that person as a consequence of "bodily injury" or "personal and advertising injury" to that person at whom any of the employment- related practices described in paragraphs (1), 2) or (3) above is directed. This exclusion applies: a. Whether the insured may be liable as an employer or in any other capacity; and b. To any obligation to share damages with or repay someone else who must pay damages because of the injury. SB -147089-A Includes copyrighted material of the Insurance Services Office, Inc., with its permission. Page 1 of 1 Ed. 01/06) Copyright, Insurance Services Office, Inc., 1996 30 CNA SB-30( Ed. 04/01 ) BUSINESSOWNERS LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we," us" and 'bur" refer to the company providing the insurance. The word "insured" means any person or organization qualifying as such under Section C. — Who Is An Insured. Other words and phrases that appear in quotation marks have special meaning. Refer to SECTION F — LIABILITY DEFINITIONS. A. Coverages 1. Business Liability (Bodily Injury, Property Damage, Personal and Advertising Injury) We will pay those sums that the insured becomes legally obligated to pay as damages because of "bodily injury," "property damage" or "personal and advertising injury" to which this insurance applies. We will have the right and duty to defend the insured against any suit" seeking those damages. However, we will have no duty to defend the insured against any "suit' seeking damages for "bodily injury," "property damage" or "personal and advertising injury," to which this insurance does not apply. We may at our discretion, investigate any 'occurrence" or any offense and settle any claim or "suit' that may result. But: 1) The amount we will pay for damages is limited as described in Section D — Liability And Medical Expenses Limits Of Insurance; and 2) Our right and duty to defend ends when we have used up the applicable limit of insurance in the payment of judgments or settlements or medical expenses to which this insurance applies. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Coverage Extension — Supplementary Payments. b. This insurance applies: 1) To "bodily injury" and "property damage" only if: a) The "bodily injury" or "property damage" is caused by an occurrence" that takes place in the coverage territory"; b) The "bodily injury" or "property damage" occurs during the policy period; and c) Prior to the policy period, no insured listed under Paragraph C.1. Who Is An Insured and no "employee" authorized by you to give or receive notice of an 'occurrence" or claim, knew that the "bodily injury" or property damage" had occurred, in whole or in part. If such a listed insured or authorized "employee" knew, prior to the policy period, that the "bodily injury" or "property damage" occurred, then any continuation, change or resumption of such "bodily injury" or "property damage" during or after the policy period will be deemed to have been known before the policy period. 2) To "personal and advertising injury" caused by an offense arising out of your business, but only if the offense was committed in the "coverage territory" during the policy period. c. "Bodily injury" or "property damage" which occurs during the policy period and was not, prior to the policy period, known to have occurred by any insured listed under Section C.1. Who Is An Insured or any "employee" authorized by you to give or receive notice of an 'occurrence" or claim, includes any continuation, change or resumption of "bodily injury" or "property damage" after the end of the policy period. d. "Bodily injury" or "property damage" will be deemed to have been known to have occurred at the earliest time when any insured listed under Section C.1. Who Is An Insured or any "employee" authorized by you to give or receive notice of an 'occurrence" or claim: 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"; or SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 16 Ed. 04/14) N0 0 0 0 3) Becomes aware by any other means that bodily injury" or "property damage" has occurred or has begun to occur. e. Damages because of "bodily injury" include damages claimed by any person or organization for care, loss of services or death resulting at any time from the "bodily injury." f. Coverage Extension — Supplementary Payments 1) In addition to the Limit of Insurance of Liability we will pay, with respect to any claim we investigate or settle, or any suit" against an insured we defend: a) All expenses we incur. b) Up to $1,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which Business Liability Coverage for "bodily injury" applies. We do not have to furnish these bonds. c) The cost of bonds to release attachments, but only for bond amounts within our Limit of Insurance. We do not have to furnish these bonds. 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 $250 a day because of time off from work. SB -300000-D Ed. 04/14) 2) If we defend an insured against a "suit" and an indemnitee of the insured is also named as a party to the "suit," we will defend that indemnitee if all of the following conditions are met: a) The "suit" against the indemnitee seeks damages for which the insured has assumed the liability of the indemnitee in a contract or agreement that is an "insured contract"; b) This insurance applies to such liability assumed by the insured; c) The obligation to defend, or the cost of the defense of, that indemnitee, has also been assumed by the insured in the same "insured contract"; d) The allegations in the "suit" and the information we know about the occurrence" are such that no conflict appears to exist between the interests of the insured and the interests of the indemnitee: e) The indemnitee and the insured ask us to conduct and control the defense of that indemnitee against such "suit" and agree that we can assign the same counsel to defend the insured and the indemnitee; and f) The indemnitee: i) Agrees in writing to: e) All court costs taxed against the i. Cooperate with us in the insured in the "suit." However, these investigation, settlement or payments do not include attorneys' defense of the "suit"; fees or attorney expenses taxed ii. Immediately send us copiesagainsttheinsured. of any demands, notices, f) Prejudgment interest awarded summonses or legal papers against the insured on that part of the received in connection with judgment we pay. If we make an offer the "suit"; to pay the Limit of Insurance, we will iii. Notify any other insurernotpayanyprejudgmentinterestwhosecoverageisavailablebasedonthatperiodoftimeafterthe offer. to the indemnitee; and g) All interest on the full amount of any iv. Cooperate with us with judgment that accrues after entry of respect to coordinating other the judgment and before we have applicable insurance paid, offered to pay, or deposited in available to the indemnitee; court the part of the judgment that is and within our Limit of Insurance. ii) Provides us with written These payments will not reduce the authorization to: Limits of Insurance. SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 2 of 16 Ed. 04/14) i. Obtain records and other information related to the suit"; and ii. Conduct and control the defense of the indemnitee in such "suit." 3) So long as the above conditions are met, attorneys' fees incurred by us in the defense of that indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Notwithstanding the provisions of Paragraph B.1.b.(2) Exclusions in Section B - EXCLUSIONS, such payments will not be deemed to be damages for "bodily injury" and "property damage" and will not reduce the limits of insurance. Our obligation to defend an insured's indemnitee and to pay for attorneys' fees and necessary litigation expenses as Supplementary Payments ends when: a) We have used up the applicable limit of insurance in the payment of judgments or settlements; or b) The conditions set forth above, or the terms of the agreement described in f. above are no longer met. 2. Medical Expenses a. We will pay medical expenses as described 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: a) The accident takes place in the coverage territory" and during the policy period; b) The expenses are incurred and reported to us within one year of the date of the accident; and c) The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require. SB -300000-D Ed. 04/14) 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 prosthetic devices; and 3) Necessary ambulance, hospital, professional nursing and funeral services. B. Exclusions 1. Applicable To Business Liability Coverage This insurance does not apply to: a. Expected Or Intended Injury Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" resulting from the use of reasonable force to protect persons or property. b. Contractual Liability Bodily injury" or "property damage" for which the insured is obligated to pay 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 agreement; or 2) Assumed in a contract or agreement that is an "insured contract," provided the bodily injury" or "property damage" occurs subsequent to the execution of the contract or agreement. Solely for the purposes of liability assumed in an insured contract," reasonable attorney fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of "bodily injury" or "property damage," provided: a) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same "insured contract"; and b) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. b. We will make these payments regardless of c. Liquor Liability fault. These payments will not exceed the Bodily injury" or "property damage" for which any insured may be held liable by reason of: SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 3 of 16 Ed. 04/14) 0 0 0 0 0 SB -300000-D Ed. 04/14) 1) Causing or contributing to the intoxication migration, release or escape of of any person; pollutants": 2) The furnishing of alcoholic beverages to a a) At or from any premises, site or person under the legal drinking age or location which is or was at any time under the influence of alcohol; or owned or occupied by, or rented or 3) Any statute, ordinance or regulation loaned to, any insured. However, this relating to the sale, gift, distribution or use subparagraph does not apply to: of alcoholic beverages. i) "Bodily injury" if sustained within This exclusion applies even if the claims a building and caused by smoke, fumes, vapor or soot from allege negligence or other wrongdoing in: equipment used to heat, cool or a) The supervision, hiring, employment, dehumidify the building or training or monitoring of others by an equipment that is used to heat insured; or water for personal use by the buildings occupants or their b) Providing or failing to provide guests; transportation with respect to any person that may be under the influence of alcohol ii) "Bodily injury" or "property damage" for which you may be This exclusion applies only if you are in the held liable, if you are a contractor business of manufacturing, distributing, and the owner or lessee of such selling, serving or furnishing alcoholic premises, site or location has beverages. been added to your policy as an d. Workers' Compensation And Similar Laws additional insured with respect to your ongoing operations Any obligation of the insured under a workers' performed for that additional compensation, disability benefits or insured at that premises, site or unemployment compensation law or any location and such premises, site similar law. or location is not and never was owned or occupied by, or rentede. Employer's Liability or loaned to, any insured, other Bodily Injury" to: than that additional insured; or 1) An "employee" of the insured arising out iii) "Bodily injury" or "property of and in the course of: damage" arising out of heat, smoke or fumes from a "hostile a) Employment by the insured; or fire"; b) Performing duties related to the b) At or from any premises, site or conduct of the insured's business; or location which is or was at any time 2) The spouse, child, parent, brother or used by or for any insured or others sister of that "employee" as a for the handling, storage, disposal, consequence of (1) above. processing or treatment of waste; This exclusion applies: c) Which are or were at any time transported, handled, stored, treated, 1) Whether the insured may be liable as an disposed of, or processed as waste employer or in any other capacity; and by or for: 2) To any obligation to share damages with i) Any insured; or or repay someone else who must pay damages because of the injury. ii) Any person or organization for whom you may be legally This exclusion does not apply to liability responsible; or assumed by the insured under an "insured contract. d) At or from any premises, site or location on which any insured or any If. Pollution contractors or subcontractors working 1) "Bodily injury" or "property damage" directly or indirectly on any insured's arising out of the actual, alleged or behalf are performing operations if threatened discharge, dispersal, seepage, the pollutants are brought on or to the premises, site or location in SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 4 of 16 Ed. 04/14) SB -300000-D Ed. 04/14) connection with such operations by a. Request, demand, order or statutory such insured, contractor or or regulatory requirement that any subcontractor. However, this insured or others test for, monitor, subparagraph does not apply to: clean up, remove, contain, treat, i) "Bodily injury" or "property detoxify or neutralize, or in any way damage" arising out of the respond to, or assess the effects of, escape of fuels, lubricants or pollutants , or other operating fluids which are b. Claim or "suit" by or on behalf of a needed to perform the normal governmental authority for damages electrical, hydraulic or because of testing for, monitoring, mechanical functions necessary cleaning up, removing, containing, for the operation of "mobile treating, detoxifying or neutralizing, or equipment" or its parts, if such in any way responding to, or fuels, lubricants or other assessing the effects of, "pollutants." operating fluids escape from a vehicle part designed to hold, However, this paragraph does not apply store or receive them. This to liability for damages because of exception does not apply if the property damage" that the insured would bodily injuryor property have in the absence of such request, damage" arises out of the demand, order or statutory or regulatory suit" intentional discharge, dispersal requirement or such claim or by or or release of the fuels, lubricants on behalf of a governmental authority. or other operating fluids, or if g. Aircraft, Auto Or Watercraft such fuels, lubricants or other operating fluids are brought on or Bodily injury" or "property damage" arising to the premises, site or location out of the ownership, maintenance, use or with the intent that they be entrustment to others of any aircraft, "auto" or discharged, dispersed or watercraft owned or operated by or rented or released as part of the loaned to any insured. Use includes operation operations being performed by and "loading or unloading." such insured, contractor or This exclusion applies even if the claims subcontractor; allege negligence or other wrongdoing in the ii) "Bodily injury" or "property supervision, hiring, employment, training or damage" sustained within a monitoring of others by an insured, if the building and caused by the occurrence" which caused the "bodily injury" release of gases, fumes or or "property damage" involved the ownership, vapors from materials brought maintenance, use or entrustment to others of into that building in connection any aircraft, "auto" or watercraft that is owned with operations being performed or operated by or rented or loaned to any by you or on your behalf by a insured. contractor or subcontractor; or This exclusion does not apply to: iii) "Bodily injury" or "property 1) An aircraft that is: damage" arising out of heat, smoke or fumes from a "hostile a) Hired, chartered, or loaned with a fire." paid crew; but e) At or from any premises, site or b) Not owned by any insured; location on which any insured or any 2) A watercraft while ashore on premises contractors or subcontractors working you own or rent; directly or indirectly on any insured's behalf are performing operations if 3) A watercraft you do not own that is: the operations are to test for, monitor, a) Less than 51 feet long; andcleanup, remove, contain, treat, detoxify or neutralize, or in any way b) Not being used to carry persons or respond to, or assess the effects of, property for a charge; pollutants." 4) Parking an "auto" on, or on the ways next 2) Any loss, cost or expense arising out of to, premises you own or rent, provided any: SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 5 of 16 Ed. 04/14) the "auto" is not owned by or rented or loaned to you or the insured; 5) Liability assumed under any "insured contract" for the ownership, maintenance or use of aircraft or watercraft; or 6) "Bodily injury" or "property damage" arising out of the operation of any of the following equipment: a) Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; and b) Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment. h. Mobile Equipment Bodily injury" or "property damage" arising out of: 1) The transportation of "mobile equipment" by an "auto" owned or operated by or rented or loaned to any insured; or 2) The use of "mobile equipment" in, or while in practice for, or while being prepared for, any prearranged racing, speed, demolition or stunting activity. SB -300000-D Ed. 04/14) 6) Any service, treatment, advice or instruction for the purpose of appearance or skin enhancement, hair removal or replacement or personal grooming; 7) Optometry or optical or hearing aid services including the prescribing, preparation, fitting, demonstration or distribution of ophthalmic lenses and similar products or hearing aid devices; 8) Body piercing services; 9) Services in the practice of pharmacy; 10)Veterinary medicine services; 11)Mortician services; and 12)Services rendered in connection with the creation and/or development, modification, or repair of "software," including, but not limited to design, specifications, system or "software" configuration and consultation. This exclusion applies even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an insured, if the occurrence" which caused the "bodily injury" or "property damage," or the offense which caused the "personal and advertising injury," involved the rendering or failure to render any professional service. i. War k. Damage To Property Bodily injury" or "property damage" due to Property damage" to: war, whether or not declared, or any act or condition incident to war. War includes civil 1) Property you own, rent or occupy, war, insurrection, rebellion or revolution. This including any costs or expenses incurred exclusion applies only to liability assumed by you, or any other person, organization under a contract or agreement. or entity, for repair, replacement, j. Professional Services enhancement, restoration or maintenance 0 of such property for any reason, including o "Bodily injury," "property damage," "personal prevention of injury to a person or and advertising injury" caused by the damage to another's property; rendering or failure to render any professional 2) Premises you sell, give away or abandon, service. This includes but is not limited to: if the "property damage" arises out of any 1) Legal, accounting or advertising services; part of those premises; 2) Preparing, approving, or failing to prepare 3) Property loaned to you; or approve maps, drawings, opinions, 4) Personal property in the care, custody orreports, surveys, change orders, designs control of the insured; or specifications; 3) Supervisory, inspection or engineering (5) That particular part of real property on which you or any contractor or services; subcontractor working directly or 4) Medical, surgical, dental, x-ray or nursing indirectly on your behalf is performing services treatment, advice or instruction; operations, if the "property damage" 5) Any health or therapeutic service arises out of those operations; or treatment, advice or instruction; SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 6 of 16 Ed. 04/14) 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 exclusion 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. A separate limit of insurance applies to Damage To Premises Rented To You as described in Paragraph D. Liability And Medical Expenses Limit 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 exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to "property damage" included in the products — completed operations hazard." Damage To Your Product Property damage" to "your product" arising out of it or any part of it. m. Damage To Your Work Property damage" to "your work" arising out of it or any part of it and included in the products — completed operations hazard." This exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. n. Damage To Impaired Property Or Property Not Physically Injured Property damage" to "impaired property" or property that has not been physically injured, arising out of: 1) A defect, deficiency, inadequacy or dangerous condition in "your product" or your work"; or 2) A delay or failure by you or anyone acting on your behalf to perform a contract or agreement in accordance with its terms. SB -300000-D Ed. 04/14) o. Recall Of Products, Work Or Impaired Property Damages claimed for any loss, cost or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal or disposal of: 1) "Your product"; 2) "Your work"; or 3) "Impaired property"; if such product, work or property is withdrawn or recalled from the market or from use by any person or organization because of a known or suspected defect, deficiency, inadequacy or dangerous condition in it. p. Personal And Advertising Injury Personal and advertising injury": 1) 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"; 2) Arising out of oral or written publication of material, if done by or at the direction of the insured with knowledge of its falsity; 3) Arising out of oral or written publication of material whose first publication took place before the beginning of the policy period; 4) Arising out of a criminal act committed by or at the direction of any insured; 5) For which the insured has assumed liability in a contract or agreement. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement; 6) Arising out of a breach of contract, except an implied contract to use another's advertising idea in your "advertisement"; 7) Arising out of the failure of goods, products or services to conform with any statement of quality or performance made in your "advertisement"; 8) Arising out of the wrong description of the price of goods, products or services stated in your "advertisement"; This exclusion does not apply to the loss of (9) Committed by an insured whose business use of other property arising out of sudden is: and accidental physical injury to "your product" or "your work" after it has been put to (a) Advertising, broadcasting, publishing its intended use. or telecasting; SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 7 of 16 Ed. 04/14) b) Designing or determining content of web -sites for others; or c) An Internet search, access, content or service provider. However, this exclusion does not apply to Paragraphs 14.a., b. and c. of "personal and advertising injury" under Paragraph F. Liability And Medical Expenses Definitions. For the purposes of this exclusion, the placing of frames, borders or links, or advertising, for you or others anywhere on the Internet, by itself, is not considered the business of advertising, broadcasting, publishing or telecasting. 10)Arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of pollutants" at any time. 111) With respect to any loss, cost or expense arising out of any: a) Request, demand or order that any insured or others test for, monitor, clean-up, remove, contain, treat, detoxify or neutralize or in any way respond to, or assess the effects of, pollutants"; or b) Claim or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing or in any way responding to, or assessing the effects of, "pollutants." 12)Arising out of an electronic chatroom or bulletin board the insured hosts, owns or over which the insured exercises control. 13)Arising out of the infringement of copyright, patent, trademark, trade secret or other intellectual property rights. However, this exclusion does not apply to infringement, in your "advertisement," of copyright, trade dress or slogan. 14)Arising out of the unauthorized use of another's name or product in your e-mail address, domain name or metatags, or any other similar tactics to mislead another's potential customers. SB -300000-D Ed. 04/14) Damage To Premises Rented To You Limit of Insurance applies to this coverage as described in Paragraph D. Liability And Medical Expenses Limits of Insurance. q. 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. As used in this exclusion, 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 controlled equipment. 2. Applicable To Medical Expenses Coverage We will not pay expenses for "bodily injury": a. To any insured, except "volunteer workers." b. To a person hired to do work for or on behalf of any insured or a tenant of any insured. c. To a person injured on that part of premises you own or rent that the person normally occupies. d. To a person, whether or not an "employee" of any insured, if benefits for the "bodily injury" are payable or must be provided under a workers' compensation or disability benefits law or a similar law. e. To a person injured while taking part in athletics. f. Included within the "products — completed operations hazard." g. Excluded under Business Liability Coverage. h. Due to war, whether or not declared, or any act or condition incident to war. War includes civil war, insurrection, rebellion or revolution. 3. Applicable To Both Business Liability Coverage And Medical Expenses Coverage — Nuclear Energy Liability Exclusion This insurance does not apply: a. Under Business Liability Coverage, to "bodily injury" or "property damage": Exclusions c., d., e., f., g., h., i., k., I., m., n. (1) With respect to which an insured under and o. in Section II — Liability do not apply to the policy is also an insured under a damage by fire or explosion to premises while nuclear energy liability policy issued by rented to you, or temporarily occupied by you the Nuclear Energy Liability Insurance with permission of the owner. A separate Association, Mutual Atomic Energy SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 8 of 16 Ed. 04/14) SB -300000-D Ed. 04/14) Liability Underwriters or Nuclear 1) By-product material" has the meaning Insurance Association of Canada, or given it in the Atomic Energy Act of 1954 would be an insured under any such or in any law amendatory thereof; policy but for its termination upon exhaustion of its limit of liability; or 2) Hazardous properties" include radioactive, toxic or explosive properties; 2) Resulting from the "hazardous properties" nuclear 3) Nuclear facility" means: of material" and with respect to which: a) Any "nuclear reactor"; a) Any person or organization is b) Any equipment or device designed or required to maintain financial used for: protection pursuant to the Atomic Energy Act of 1954, or any law i) Separating the isotopes of amendatory thereof; or uranium or plutonium; b) The insured is, or had this policy not ii) Processing or utilizing "spent been issued would be, entitled to fuel"; or indemnity from the United States of iii) Handling, processing or America, or any agency thereof, packaging "waste"; under any agreement entered into by the United States of America, or any c) Any equipment or device used for the agency thereof, with any person or processing, fabricating or alloying of organization. special nuclear material" if at any time the total amount of such material b. Under Medical Expenses Coverage, to in the custodyof the insured at the expenses incurred with respect to "bodilyPPY premises where such equipment or injury" resulting from the "hazardous device is located consists of or properties" of "nuclear material" and arising contains more than 25 grams of out of the operation of a "nuclear facility" by plutonium or uranium 233 or any any person or organization. combination thereof, or more than c. Under Business Liability Coverage, to "bodily 250 grams of uranium 235; injury" or "property damage" resulting from the d) Any structure, basin, excavation, hazardous properties" of the nuclear premises or place prepared or used material"; if: for the storage or disposal of "waste"; 1) The "nuclear material": and includes the site on which any of the a) Is at any "nuclear facility" owned by, foregoing is located, all operations or operated by or on behalf of, an conducted on such site and all premises insured; or used for such operations; b) Has been discharged or dispersed 4) Nuclear material" means "source therefrom; material," "special nuclear material" or byproduct material"; 2) The "nuclear material" is contained in spent fuel" or "waste" at any time 5) Nuclear reactor" means an apparatus possessed, handled, used, processed, designed or used to sustain nuclear stored, transported or disposed of by or fission in a self-supporting chain reaction on behalf of an insured; or or to contain a critical mass of fissionable material; 3) The "bodily injury" or "property damage" arises out of the furnishing by an insured 6) Property damage" includes all forms of of services, materials, parts or equipment radioactive contamination of property. in connection with the planning, 7) Source material" has the meaning given construction, maintenance, operation or it in the Atomic Energy Act of 1954 or inuseofany "nuclear facility"; but if such any law amendatory thereof; facility is located within the United States of America, its territories or possessions 8) Special nuclear material" has the or Canada, this Exclusion (3) applies only meaning given it in the Atomic Energy Act to "property damage" to such "nuclear of 1954 or in any law amendatory thereof; facility" and any property thereat. g) Spent fuel" means any fuel element or d. As used in this exclusion: fuel component, solid or liquid, which has SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 9 of 16 Ed. 04/14) been used or exposed to radiation in a nuclear reactor"; 10) "Waste" means any waste material a) Containing "by-product material" other than the tailings or wastes produced by the extraction or concentration of uranium or thorium from any one processed primarily for its "source material" content; and b) Resulting from the operation by any person or organization of any nuclear facility" included under Paragraph (a) and (b) of the definition of "nuclear facility." C. Who Is An Insured 1. If you are designated in the Declarations as a. An individual, you and your spouse are insureds, but only with respect to the 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 insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. d. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers 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 performing 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) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these SB -300000-D Ed. 04/14) employees" or "volunteer workers" are insureds for: 1) "Bodily injury" or "personal and advertising injury": a) To you, to your partners or members if you are a partnership or joint venture), to your members (if you are a limited liability company), or to a co -"employee" while 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" as a consequence of Paragraph (a) above; c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (a) or (b); or d) Arising out of his or her providing or failing to provide professional health care services. 2) "Property damage" to property: a) Owned, occupied or used by, b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by you, any of your "employees," "volunteer 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 organization while acting as your real estate manager. c. Any person or organization having proper temporary custody of your property if you die, but only: 1) With respect to liability arising out of the maintenance or use of that property; and 2) Until your legal representative has been appointed. d. Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this policy. SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 10 of 16 Ed. 04/14) 3. With respect to "mobile equipment' registered in your name under any motor vehicle registration law, any person is an insured while driving such equipment along a public highway with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability arising out of the operation of the equipment, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an insured with respect to: a. "Bodily injury" to a co -"employee" of the person driving the equipment; or b. "Property damage" to property owned by, rented to, in the charge of or occupied by you or the employer of any person who is an insured under this provision. 4. Any organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership of majority interest, will 3. qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage 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. Bodily Injury and Property Damage coverage does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Personal and Advertising Injury coverage does not apply to "personal injury" or advertising injury" arising out of an offense committed before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. D. Liability And Medical Expenses Limits Of Insurance 1. The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits." 2. The most we will pay for: SB -300000-D Ed. 04/14) a. Injury or damages under the "products completed operations hazard" arising from all occurrences" during the policy period is the Products -Completed Operations Aggregate Limit shown in the Declarations. b. All other injury or damages, including medical expenses, arising from all 'occurrences" during the policy period is the General Aggregate Limit shown in the Declarations. This General Aggregate Limit applies separately to each of your "locations" owned by or rented to you. Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway or right-of-way of a railroad. This aggregate Limit does not apply to property damage" to premises rented to you arising out of fire, lightning or explosion. Subject to item 2. above, the most we will pay for the sum of all damages because of all "bodily injury," "property damage" and medical expenses arising out of any one 'occurrence" is the Liability and Medical Expense Limit shown in the Declarations. The most we will pay for all medical expenses because of "bodily injury" sustained by any one person is the Medical Expenses Limit shown in the Declarations. 4. Subject to item 2. above, the most we will pay for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization is the Personal and Advertising Injury Limit shown in the Declarations. 5. The most we will pay under Business Liability Coverage for damages because of "property damage" to premises rented to you, or in the case of fire, while rented to you or temporarily occupied by you with permission of the owner, is the Damage To Premises Rented To You Limit shown in the Declarations. The Damage to Premises Rented To You Limit applies to all damage proximately caused by the same event, whether such damage results from fire, lightning, or explosion or any combination of the three. If more than one limit of insurance under this policy and any endorsements attached thereto applies to any claim or "suit," the most we will pay under this policy and the endorsements is the single highest limit of liability of all coverages applicable to such claim or "suit." However, this paragraph does not apply to the Medical Expenses limit set forth in paragraph 3. above. SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 11 of 16 Ed. 04/14) The Limits of this policy apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. E. Businessowners Liability Conditions 1. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this policy. 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: 1) How, when and where the "occurrence" or offense took place; 2) The names and addresses of any injured persons and witnesses; and 3) The nature and location of any injury or damage arising out of the "occurrence" 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 received; and 2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. You and any other involved insured must: 1) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit"; 2) Authorize us to obtain records and other information; 3) Cooperate with us in the investigation, or settlement of the claim or defense against the "suit"; and SB -300000-D Ed. 04/14) damage to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. 3. Financial Responsibility Laws a. When this policy is certified as proof of financial responsibility for the future under the provisions of any motor vehicle financial responsibility law, the insurance provided by the policy for "bodily injury" liability and property damage" liability will comply with the provisions of the law to the extent of the coverage and limits of insurance required by that law. b. With respect to "mobile equipment" to which this insurance applies, we will provide any liability, uninsured motorists, underinsured motorists, no-fault or other coverage required by any motor vehicle law. We will provide the required limits for those coverages. 4. Legal Action Against Us No person or organization has a right under this policy: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this policy unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this policy or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. 5. Separation Of Insureds Except with respect to the Limits of Insurance in this policy, and any rights or duties specifically assigned in this policy to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and 4) Assist us, upon our request, in the b. Separately to each insured against whom enforcement of any right against any claim is made or "suit" is brought. person or organization that may be liable to the insured because of injury or SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 12 of 16 Ed. 04/14) 6. Unintentional Failure to Disclose Hazards It is agreed that based on our reliance on your representations as to existing hazards, if unintentionally you should fail to disclose all such hazards at the inception date of your policy, we shall not deny any coverage under this Coverage Form because of such failure. F. Liability And Medical Expenses Definitions 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material 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, products or services for the purposes of attracting customers or supporters is considered an advertisement. 2. "Auto" means a land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment. But "auto" does not include "mobile equipment." 3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. 4. "Coverage territory" means: a. The United States of America (including its territories and possessions), Puerto Rico and Canada; b. International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in Paragraph 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 Paragraph a. above; 2) The activities of a person whose home is in the territory described in Paragraph a. above, but is away for a short time on your business; or 3) "Personal and advertising injury" offenses that take place through the Internet or similar electronic means of communication; provided the insured's responsibility to pay damages is determined in a "suit" on the SB -300000-D Ed. 04/14) merits in the territory described in Paragraph a. above or in a settlement we agree to. 5. "Employee" includes a "leased worker." Employee" does not include a "temporary worker." 6. "Executive officer" means a person holding any of the officer positions created by your charter, constitution, by-laws or any other similar governing document. 7. "Hostile fire" means one which becomes uncontrollable or breaks out from where it was intended to be. 8. "Impaired property" means tangible property, other than "your product" or "your work," that cannot be used or is less useful because: a. It incorporates "your product" or "your work" that is known or thought to be defective, deficient, inadequate or dangerous; or b. You have failed to fulfill the terms of a contract or agreement; if such property can be restored to use by: 1) The repair, replacement, adjustment or removal of "your product" or "your work"; or 2) Your fulfilling the terms of the contract or agreement. 9. "Insured contract" means: 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 to premises while rented to you or temporarily occupied by you with permission of the owner is not an insured contract": b. A sidetrack agreement; c. Any easement or license agreement, except 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 agreement pertaining to your business (including 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" or "property damage" to a third person or organization. Tort liability means a liability that would be SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 13 of 16 Ed. 04/14) imposed by law in the absence of any contract or agreement. Paragraph If. does not include that part of any contract or agreement: 1) That indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road beds, tunnel, underpass or crossing; 2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: a) Preparing, approving or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or c) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in Paragraph (2) above and supervisory, inspection or engineering services. 10. "Leased worker" means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm, to perform duties related to the conduct of your business. "Leased worker" does not include a "temporary worker." 0 11. "Loading or unloading" means the handling of 0 property: a. After it is moved from the place where it is accepted for movement into or onto an aircraft, watercraft or "auto"; b. While it is in or on an aircraft, watercraft or auto"; or c. While it is being moved from an aircraft, watercraft or "auto" to the place where it is finally delivered; SB -300000-D Ed. 04/14) 12. "Mobile equipment" means any of the following types of land vehicles, including any attached machinery or equipment: a. Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; b. Vehicles maintained for use solely on or next to premises you own or rent; c. Vehicles that travel on crawler treads; d. Vehicles, whether self-propelled or not, on which are permanently mounted: 1) Power cranes, shovels, loaders, diggers or drills; or 2) Road construction or resurfacing equipment such as graders, scrapers or rollers; e. Vehicles not described in Paragraphs a., b., c. or d. above that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types: 1) Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment; or 2) Cherry pickers and similar devices used to raise or lower workers; If. Vehicles not described in Paragraphs 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 construction 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 but "loading or unloading" does not include the (3) Air compressors, pumps and generators, movement of property by means of a mechanical including spraying, welding, building device, other than a hand truck, that is not cleaning, geophysical exploration, lighting attached to the aircraft, watercraft or "auto." and well servicing equipment. 13. "Occurrence" means an accident, including continuous or repeated exposure to substantially the same general harmful conditions. SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 14 of 16 Ed. 04/14) 14. "Personal and advertising injury" means injury, including consequential "bodily injury," arising out of one or more of the following offenses: a. False arrest, detention or imprisonment; b. Malicious prosecution; c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies, committed by or on behalf of its owner, landlord or lessor; d. Oral or written publication, in any manner, of material that slanders or libels a person or organization or disparages a person'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." 15. "Pollutants" mean any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed 16. "Products — completed operations hazard": a. Includes all "bodily injury" and "property damage" occurring away from premises you own or rent and arising out of "your product" or "your work" except: 1) Products that are still in your physical possession; or 2) Work that has not yet been completed or abandoned. However, "your work" will be deemed completed at the earliest of the following times: a) When all of the work called for in your contract has been completed. b) When all of the work to be done at the job site has been completed if your contract calls for work at more than one job site. c) When that part of the work done at the job site has been put to its intended use by any other person or organization other than another contractor or subcontractor working on the same project. Work that may need service, maintenance, correction, repair or SB -300000-D Ed. 04/14) replacement, but which is otherwise complete, will be treated as completed. The "bodily injury" or "property damage" must occur away from premises you own or rent, unless your business includes the selling, handling or distribution of "your product" for consumption on premises you own or rent. b. Does not include "bodily injury" or "property damage" arising out of: 1) The transportation of property, unless the injury or damage arises out of a condition in or on a vehicle not owned or operated by you, and that condition was created by the "loading or unloading" of that vehicle by any insured; or 2) The existence of tools, uninstalled equipment or abandoned or unused materials. 17. "Property damage" means: a. Physical injury to tangible property, including 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 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. As used in this definition, electronic data means information, facts or programs stored as, 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 controlled equipment. 18. "Software" means: a. Electronic data processing, recording or storage media such as films, tapes, cards, discs, drums or cells; and b. Data and programming records used for electronic data processing or electronically controlled equipment stored on such media; and c. Written or printed data, such as programs, routines, and symbolic languages, essential to the operation of computers; and d. Documents containing information on the operation and maintenance of computers. SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 15 of 16 Ed. 04/14) 19. "Suit' means a civil proceeding in which damages because of "bodily injury," "property damage," personal and advertising 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; or b. Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent. 20. "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. 21. "Volunteer worker" means a person who is not your "employee," and who donates his or 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 compensation by you or anyone else for their work performed for you. 22. "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 SB -300000-D Ed. 04/14) c) A person or organization whose business or assets you have acquired; and 2) Containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products. b. Includes: 1) Warranties or representations made at any time with respect to the fitness, 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. 23. "Your work": a. Means: 1) Work or operations performed by you or on your behalf; and 2) Materials, parts or equipment furnished in connection with such work or operations. b. Includes: 1) Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of your work"; and 2) The providing of or failure to provide warnings or instructions. SB -300000-D Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 16 of 16 Ed. 04/14) CNA SB -300092-A Ed. 01/06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 1»:;*9701_W_\0117_\11MC-496910Lid 10 pill WAWIf"W"IL970 IkhIk9 11 This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM The insurance does not apply to "personal and advertising injury" and none of the references to "personal and advertising injury" in the policy apply. This exclusion does not apply to "personal and advertising injury" arising out of the following offenses: a. False arrest, detention or imprisonment b. Malicious prosecution; or c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that the person occupies, committed by or on behalf of its owner, landlord or lessor. SB -300092-A Page 1 of 1 Ed. 01/06) N 0 0 00 CNA SB -300129-B Ed. 01/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extensions. Unless otherwise stated, payments made under this Coverage Extension are subject to and not in addition to the applicable Limits of Insurance. Targeted Hacker Attack 1. We will pay up to the Limits of Insurance indicated in Paragraphs 9. and 10. below, for the following: a. Corruption, distortion, deletion, damage or destruction of your "electronic data" caused by or resulting from a "targeted hacker attack." b. Subject to paragraph 8. below, actual loss of Business Income you sustain due to the necessary "suspension" of your "operations" during the "period of restoration." The suspension" must be caused by the necessary interruption or suspension of your "electronic data processing equipment" resulting from a "targeted hacker attack" that corrupts, distorts, deletes, damages or destroys your "electronic data." c. Subject to paragraph 8. below, with respect to a suspension" of your "operations" as described in paragraph 1.b. above, the "extra expense" (other than the expense to repair or replace property) to: 1) Avoid or minimize the "suspension" of business and to continue "operations"; or 2) Minimize the "suspension" of business if you cannot continue "operations." 2. Worldwide coverage is provided under this Coverage Extension. The coverage territory as described in Paragraph F.8.b does not apply to this Coverage Extension. 3. This Coverage Extension does not apply to: a. "Stock"; or b. Property that is licensed, leased or rented to others. 4. The following exclusions as described in Section B., Exclusions, of the Businessowners Special Property Coverage Form do not apply to this Coverage Extension: a. Paragraph 1.j.; and SB -300129-B Ed. 01/08) b. Paragraph 1.k. 5. The following additional exclusions apply: With respect to this Coverage Extension, we will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. a. Programming errors or omissions, or incorrect instructions to a machine, including without limitation, incorrect instructions to "electronic data processing equipment" from a user incorrectly operating with, or committing an error using, an input device (including, without limitation, a keyboard, mouse or touchpad) and corrupting, distorting, deleting, damaging or destroying electronic data." Misappropriation, theft, copying, transfer or unauthorized viewing of any property, proprietary or confidential information, "money," "securities," stock," "electronic data processing equipment" electronic media and data" or "electronic data" including without limitation, the use of any computer to cause such misappropriation, transfer or copying. c. Errors or deficiency in design, installation, maintenance, repair or modification of your electronic data processing equipment," electronic media and data" or "electronic data" or any "electronic data processing equipment," electronic devices, computer system or network to which your "electronic data processing equipment" electronic media and data" or "electronic data" is connected or dependent; provided, however, this exclusion shall not apply with respect to any such error or deficiency in design, installation, maintenance, repair or modification that is exploited as part of an otherwise covered " targeted hacker attack." d. Unexplained or indeterminable failure, malfunction or slowdown of a "electronic data processing equipment" "electronic media and data" or electronic data." e. Suspension, interruption, delay, disruption, loss of functionality of, inaccessibility to, or inability to use or communicate with, any "electronic data Page 1 of 2 Version 1.0) SB -300129-B Ed. 01/08) 7. For purposes of this Coverage Extension only, the definition for "period of restoration" as set forth in the 10 Businessowners Special Property Coverage Form is changed to the following (the definition shall remained unchanged with respect to all other parts of the policy): Period of restoration" means the period of time that: a. Begins on the date and time of the necessary interruption or suspension of your "electronic data processing equipment"; and SB -300129-B Ed. 01/08) The most we will pay in the aggregate under this Coverage Extension and the policy for all "extra expense" and loss of "business income" (combined) during each separate 12 month period of this policy beginning with the effective date of this policy is 25,000. Page 2 of 2 Version 1.0) processing equipment," "electronic media and b. Ends on the date and time that the necessary data," "electronic data," computer resource, interruption or suspension of your "electronic data electronic device, computer system, computer processing equipment" ends, or would have network or equipment. ended had you acted with due diligence and f. Mass attack malware." dispatch. g. Mass system penetration." Provided, however, that "period of restoration" shall not mean more than, or exceed, thirty (30) days. The 6. The following definitions apply to this Coverage expiration date of this policy will not cut short the Extension: period of restoration." a. Business Income means: 8. We shall not be liable for any payment for the "extra expense" you incur, and loss of Business Income you 1) Net Income (Net Profit or Loss before Income sustain, during the first 12 hours following the date and taxes) that would have been earned or time the necessary interruption or suspension of your incurred, including; and electronic data processing equipment" begins; 2) Continuing normal operating expenses provided, however, if the "business income and extra incurred, including payroll. expense" — 72 Hour Deductible endorsement is part of this policy, the "12 hours" reference in this paragraph b. Extra Expense means reasonable and necessary shall be changed to 72 hours" and the 72 hour expenses you incur during the "period of deductible stated in that endorsement shall apply with restoration" that you would not have incurred if respect to this Coverage Extension. there had been no necessary interruption or suspension of your "electronic data processing 9• The most we will pay in the aggregate under this equipment" resulting from a "targeted hacker Coverage Extension and the policy for all corruption, attack" that corrupts, distorts, deletes, damages or distortion, deletion, damage, destruction or any other destroys your "electronic data." Provided, harm to "electronic data" (combined) caused by or however, that Extra Expense shall not mean the resulting from a "targeted hacker attack," during each costs you incur to copy, research, replace or separate 12 month period of this policy beginning with restore "electronic data." the effective date of this policy, is $25,000 or the limit shown on the Declaration page. 7. For purposes of this Coverage Extension only, the definition for "period of restoration" as set forth in the 10 Businessowners Special Property Coverage Form is changed to the following (the definition shall remained unchanged with respect to all other parts of the policy): Period of restoration" means the period of time that: a. Begins on the date and time of the necessary interruption or suspension of your "electronic data processing equipment"; and SB -300129-B Ed. 01/08) The most we will pay in the aggregate under this Coverage Extension and the policy for all "extra expense" and loss of "business income" (combined) during each separate 12 month period of this policy beginning with the effective date of this policy is 25,000. Page 2 of 2 Version 1.0) N 0 0 0 0 CNA SB -300441 -A Ed. 01/07) THIS IS A CLAIMS MADE COVERAGE FORM. PLEASE READ ALL PROVISIONS AND CONTACT YOUR AGENT IF YOU HAVE ANY QUESTIONS. THIS INSURANCE APPLIES ONLY TO "WRONGFUL ACTS" THAT OCCUR BETWEEN THE RETROACTIVE DATE AND THE END OF THE "POLICY PERIOD." THIS INSURANCE APPLIES ONLY TO CLAIMS" FIRST MADE AGAINST THE INSURED AFTER THE INCEPTION DATE AND BEFORE THE END OF THE POLICY PERIOD" OR ANY APPLICABLE EXTENDED REPORTING PERIOD AND REPORTED TO US IN ACCORDANCE WITH THE PROVISIONS OF THIS FORM. UPON TERMINATION OF YOUR POLICY AN AUTOMATIC EXTENDED REPORTING PERIOD WILL BE PROVIDED, AND A SUPPLEMENTAL EXTENDED REPORTING PERIOD WILL BE AVAILABLE. Various provisions in this Coverage Form restrict coverage. Read the entire Coverage Form carefully to determine rights, duties and what is and is not covered. Throughout this Coverage Form the terms "you" and "your" refer to the Named Insured shown in the Declarations, and any other person or organization qualifying as a Named Insured under this policy." The terms "we," "us" and 'bur" refer to the Stock Insurance Company named on the Declarations providing this insurance. The word "insured" means any person or organization 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 III — Definitions. SECTION I — INSURING AGREEMENTS for under paragraph 1.11). — Supplementary Payments A. Coverage B. Defense We will pay those sums in excess of the deductible and subject to the limits of liability that the Insured becomes legally obligated to pay as "damages" because of a claim resulting from a "wrongful act' provided: 1. The "wrongful act' takes place in the "coverage territory"; The "wrongful act' did not occur before the Retroactive Date, if any, shown in the Declarations nor after the end of the "policy period"; and A "claim" arising out of a "wrongful act' is first made against an insured, during the "policy period" or Extended Reporting Period, if applicable and is reported to us in accordance with Section VIII, Conditions, paragraph C, Duties in the event of a "Claim"; and 4. Prior to the inception date of this Coverage Form: a. The Insured did not give notice to a prior insurer of a "related claim"; b. The Insured did not give notice to a prior insurer of any such "wrongful act' or interrelated wrongful act." No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided SB -300441 -A Ed. 01/07) We have the right and duty to defend all "suits," even if the allegations are groundless, false or fraudulent. We shall have the right to appoint counsel and to make such investigation and defense of a "suit' as we deem necessary. Alternatively we may, at our option, give our written consent to the defense of any such suit" to the insured. Our obligation to defend any suit" or pay any "damages" and "defense expenses" for any "claim" shall be completely fulfilled and extinguished if the limit of insurance has been exhausted by payment of "damages" or "defense expenses." C. Consent To Settle We shall not settle a "claim" without your written consent . If you refuse to consent to a settlement or compromise recommended by us, and acceptable to the claimant, then the applicable limit of insurance under this Coverage Form shall be reduced to the amount for which the "claim" could have been settled plus all "defense expenses" incurred up to the time we made our recommendation. D. Supplementary Payments We will pay, with respect to any "claim" or "suit' we investigate or settle, or any "suit' against an insured we defend all "defense expenses." These payments Page 1 of 6 are included within and reduce the Limits of Insurance. SECTION II — WHO IS AN INSURED A. If you are designated in the Declarations as: 1. A partnership or joint venture, you are an insured. Your partners or members are also insureds. 2. A limited liability company, you are an insured. Your members and managers are also insureds. 3. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your directors, officers and trustees are also insureds. B. Your "plans" and their employees, directors, officers and trustees are also insureds. D. Your employees are also insureds, unless otherwise excluded in this policy. E. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if no other similar insurance applies to that organization. You must notify us of such acquisition or formation as soon as practicable. However, coverage under this provision: 1. Is afforded only until the 90th day after you acquire or form the organization, or until the end of the "policy period," whichever is earlier; and 2. Does not apply to an offense committed before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. SECTION III — DEFINITIONS The following defined words shall have the same meaning throughout this Coverage Form, whether expressed in the singular or the plural. A. "Claim" means: 1. A "suit"; or 2. A written demand for monetary or non -monetary damages made against an insured, arising out of a "wrongful act," B. "Coverage territory" means: 1. The United States of America (including its territories or possessions) and Puerto Rico; or 2. All parts of the world if the "insured's" responsibility to pay "damages" is determined in a SB -300441 -A Ed. 01/07) SB -300441 -A Ed. 01/07) suit" on the merits brought in the territory described in Paragraph 1. above or in a settlement of a "claim" that we agree to. C. "Damages" means sums, settlements, judgments including any award of pre -judgment and post- judgment interest) for which you are legally obligated to pay on account of a covered "claim." "Damages" shall not include: 1. Any taxes, sanctions, criminal or civil fines, or penalties imposed by law other than: a. The five percent or less or the twenty percent or less penalty imposed upon an insured as a Fiduciary under Section 502(1) or 502(1) of ERISA; b. Those civil fines or penalties imposed under 42 USC 1320d -5(a) the Health Insurance Portability and Accountability Act of 1996 provided however that our maximum limit of insurance for all such fines and penalties shall be $10,000 in the aggregate, regardless of the number of "claims" made or Insureds covered under this Coverage Form. This sublimit of insurance is part of and not in addition to the limit of insurance set forth on the Declarations. 2. Any amount for which an "insured person" is absolved from payment by reason of any covenant, agreement or court order; 3. Any matters deemed uninsurable under the law pursuant to which this Policy is construed. Notwithstanding anything to the contrary above, damages" shall include punitive or exemplary damages, if insurable, to the fullest extent permitted by any applicable law. Where you reasonably determine that punitive, exemplary or multiple damages are insurable under any applicable law, we shall not challenge that determination of insurability. D. "Defense expenses" means all fees charged by attorneys designated by us, or by you, with our written consent and all other reasonable and necessary fees, costs and expenses resulting from the investigation, adjustment, defense and appeal of a "claim" if incurred by us or you with our written consent, including the costs of appeal, attachment or similar bonds. We have no obligation to provide such bonds. Defense Expenses" shall not include salaries, wages, fees, overhead or benefit expenses associated with the directors, officers, and employees of yours. E. "Domestic Partner" means any person qualifying as such under any federal, state or local laws or under your employee benefit plans. F. "ERISA or any Similar Act" means the Employee Retirement Income Security Act of 1974, as Page 2 of 6 SB -300441 -A Ed. 01/07) amended, or any similar common or statutory law of identified on any list of hazardous substances issued the United States, Canada or their states, territories or by the United States Environmental Protection provinces or any other jurisdiction anywhere in the Agency or any state or local or foreign counterpart. world. Pollutants" also means, without limitation, any solid, G. "Executive officer" means your chairperson, chief liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, executive officer, president, chief financial officer and chemicals or waste (including materials to bein-house general counsel; recycled, reconditioned or reclaimed), as well as any H. "Insured Persons" means all of those natural person air emission, odor, waste water, oil or oil products, insureds who are your partners, trustees, members, infectious or medical waste, asbestos, or asbestos managers, "executive officers," directors and products or any noise. employees 0. Related claims" mean all claims arising out of a I. "Interrelated Wrongful Acts" means any "wrongful single "wrongful act" or arising out of "interrrelated acts" which are logically or causally connected by wrongful acts." reason of any common fact, circumstance, situation, P. Suit" means a formal civil, criminal, administrative, transaction or event. or regulatory proceeding or investigation or an J "Pension Plan" means any employee pension arbitration against an "insured," including any appeal benefit plan as defined in 29 U.S.C. §1002 subject to therefrom. regulation under "ERISA or any Similar Act." "Pension Q. Wrongful act" means any actual or alleged error, plan" shall not include an excess benefit plan as misstatement, misleading statement, act, omission, defined in 29 U.S.C. §1002 or an employee stock neglect or breach of duty by the insureds in theownershipplanasdefinedin26U.S.C. §4975. discharge of their duties in their capacities, or solely K. "Plan" means: by reason of their status as fiduciaries or administrators (as defined in "ERISA or any similara. Any "welfare plan" which was, is now, or act") of any "plan," including, without limitation: hereafter becomes, sponsored solely by you, or sponsored jointly by you and a labor organization, i) Counseling employees, beneficiaries or "plan" solely for the benefit of your employees; participants with respect to any "plans"; b. Any "pension plan" which was, on or prior to the ii) Providing interpretations with respect to any effective date of this Policy, sponsored solely by plan"; you, or sponsored jointly by you and a labor iii) Handling records in connection with any "plan"; organization, solely for the benefit of your employees; iv) Enrolling, terminating or canceling employees c. Any "pension plan" which, after the effective date under any "plan"; or of this Policy, becomes sponsored solely by you, v) Otherwise performing or failing to perform "ERISA n or jointly by you and a labor organization, solely or any similar act" obligations relating to any for the benefit of your employees, if and to the N plan." extent coverage with respect such "pension plan" SECTION IV- EXTENDED REPORTING PERIODoisaffordedpursuanttoSectionXIV.1 of the o General Terms &Conditions of this Policy; or A. If the first Named Insured cancels or non -renews this 0 d. Any government -mandated insurance for workers' Coverage Form or if we decide not to offer any compensation, unemployment, social security or renewal terms for this Coverage Form, the first disability benefits for employees of Named Named Insured shall have the right to purchase, upon Company or any Subsidiary. payment of an additional premium not to exceed 200% of the annual premium for this coverage, an L. "Welfare Plan" means any employee welfare benefit extension of this Coverage Form for a period of 12 plan as defined in 29 U.S.C. §1002 subject to months immediately following the end of the "policy regulation under ERISA or any Similar Act. Welfare period," but only with respect to any "wrongful act" Plan shall not include an excess benefit plan as committed before the earlier of the end of the "policy defined in 29 U.S.C. §1002. period"; M. "Policy Period" means the period from the effective This period shall be referred to as the Extended date of this Coverage Form to the expiration date Reporting Period. stated on the Declarations, or its earlier cancellation g As a condition precedent to the right to purchase thedate. Extended Reporting Period, the total premium for this N. "Pollutants" means any substance exhibiting Coverage Form must have been paid. The right to hazardous characteristics as, is or may be defined or purchase the Extended Reporting Period shall end SB -300441 -A Page 3 of 6 Ed. 01/07) unless we receive written notice and full payment of the premium for such period within 30 days after the end of the "policy period." C. If the Extended Reporting Period is purchased, the entire premium shall be deemed fully earned at its commencement without any obligation by us to return any portion thereof. D. There is no separate or additional limit of insurance for the Extended Reporting Period. SECTION V- LIMIT OF INSURANCE Your rights and ours are stated in the attached Single Limit of Insurance Endorsement For Employment Practices/Fiduciary Liability Coverage Forms SECTION VI - EXCLUSIONS A. Exclusions Applicable to Damages and Defense Expenses We will not be liable to pay any "damages" or defense expenses" under this Coverage Form in connection with any "claim" made against an insured: 1. Bodily Injury/Property Damage For any actual or alleged bodily injury (including death), sickness, disease of any person, or damage to or destruction of any tangible property including loss of use; 2. Violation of Law For any actual or alleged violation of any law governing workers' compensation, unemployment insurance, social security, disability benefits or any other similar federal, state or local statutory or regulatory law or common law anywhere in the world except the Consolidated Omnibus Budget Reconciliation Act of 1985 or the Health Insurance Portability and Accountability Act of 1996 or any amendments to such laws or any rules or regulations promulgated under such laws. 3. Pollution Based upon, directly or indirectly arising out of or in any way involving: any nuclear reaction, radiation or contamination, or any actual, alleged or threatened discharge, release, escape, or disposal of, or exposure to, "pollutants"; any request, direction or order that any of the insureds test for, monitor, clean up, remove, contain, treat, detoxify, neutralize or in any way respond to or assess the effect of "pollutants" or nuclear reaction, radiation or contamination, or any voluntary decision to do so; or any actual or alleged property damage, or bodily injury, sickness, disease or death of any person resulting from any of the aforementioned matters. SB -300441 -A Ed. 01/07) SB -300441 -A Ed. 01/07) 4. Prior Wrongful Acts of Subsidiaries For: a) Any "wrongful act" by an insured of any of your subsidiaries, or by such subsidiary occurring before the date such entity became a subsidiary, or b) Any other "wrongful act," whenever occurring, which, together with a "wrongful act" described in (a) above, would constitute interrelated wrongful acts." 5. Assumed Liability Based upon, directly or indirectly arising out of or in any way involving the insured's assumption of the liability of others in any oral or written contract or agreement, unless such liability would have attached to an Insured in the absence of such agreement. B. Exclusions Applicable to Non -Monetary Relief We will not be liable to pay any "damages" under this Coverage Form that represent: 1. The return or reversion to you of any contribution or asset of any "plan"; 2. Any costs incurred by an insured to comply with any order for remedial, preventive, injunctive or other non -monetary relief, or to comply with an agreement to provide such relief; 3. Benefits due or to become due under any "plan," or benefits which would be due under any "plan" if such "plan" complied with all applicable law, except to the extent that: i. An "insured person" is legally obligated to pay such benefits as a personal obligation, and ii. Recovery for the benefits is based upon a covered "wrongful act"; or 4. An employer's contributions owed to a "plan" and other amounts for which the insureds are legally obligated to pay by reason of the failure to collect such contributions. SECTION VII — CONDITIONS A. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's" estate will not relieve us of our obligations under this policy. B. Duties In The Event Of A "Claim" 1. If, during the "policy period' or any Extended Reporting Period, if applicable, any "claim" is first made against the "insured," the insured shall, as a condition precedent to our obligations under this Coverage Form, give us written notice as Page 4 of 6 0 0 0 0 0 soon as practicable but in no event later than ninety (90) days after the end of the "policy period" or the Extended Reporting Period, if applicable. 2. You must: a. Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the "claim"; b. Authorize us to obtain records and other information; and Cooperate with us in the investigation or settlement of the "claim" or defense of the suit." No insured shall voluntarily make a payment, assume any obligation, or incur any expense without our written consent. C. Duties in the Event of A "Wrongful Act" That May Result In A "Claim" If, during the "policy period," you first become aware of a specific "wrongful act" which may reasonably give rise to a future "claim," and during the "policy period" give written notice to us of: 1. The names of any potential claimants and a description of the "wrongful act" which forms the basis of their potential "claim"; 2. The identity of the specific insureds allegedly responsible for such specific "wrongful act"; 3. The consequences which have resulted or may result from such specific "wrongful act"; 4. The nature of the potential monetary damages which may be sought in consequence of such specific "wrongful act"; and 5. The circumstances by which you first became aware of such specific "wrongful act"; Then any "claim" otherwise covered pursuant to this Coverage Form which is subsequently made and which arises out of such "wrongful act" shall be deemed to have been first made and reported to us by you at the time we received such written notice. No coverage is provided for fees and expenses incurred prior to the time such notice results in a "claim." D. When a "Claim" is Deemed Made A "claim" shall be deemed made: In the case of a civil, criminal, administrative or regulatory proceeding or arbitration, on the earliest of the date of service upon or other receipt by the insured of a complaint, indictment, notice of charge or similar document against the insured in such proceeding or arbitration; SB -300441 -A Ed. 01/07) SB -300441 -A Ed. 01/07) 2. In the case of an investigation, on the earliest of the date of service upon or other receipt by the insured of a written notice or subpoena from the investigating authority identifying such "insured person" as an individual against whom a formal proceeding may be commenced; 3. In the case of a written demand for monetary damages or non monetary relief, upon the insured's receipt of such written demand. E. Other Insurance The Other Insurance clause, Section H. of the Common Policy Conditions is deleted and replaced with the following: If any "damages" and "defense expenses" resulting from any "claim" are insured under any other policies, this Coverage Form shall apply only to the extent the damages" and "defense expenses" exceed the amount paid under such other insurance, whether such other insurance is stated to be primary, contributory, excess, contingent or otherwise, unless such other insurance is written only as specific excess insurance over this Coverage Form. F. Section IV. Estates, Legal Representatives and Spouses/Domestic Partners Section L. of the Common Policy Conditions, Transfer Of Your Rights And Duties Under This Policy, is deleted in its entirety and replaced as follows: The estates, heirs, legal representatives, assigns, spouses and any "domestic partner" of "insured persons" shall be considered insureds under this Coverage Form; provided, however, coverage is afforded to such estates, heirs, legal representatives, assigns and spouses only for a "claim "arising solely out of their status as such and, in the case of a spouse or "domestic partner," where such "claim" seeks damages from marital community property, jointly held property or property transferred from the insured person" to the spouse or "domestic partner." No coverage is provided for any act, error or omission of an estate, heir, legal representative, assign, spouse or "domestic partner." All terms and conditions of this Coverage Form, including without limitation the deductible applicable to "damages" and "defense expenses" incurred by the "insured person" shall also apply to "damages" and "defense expenses" incurred by such estates, heirs, legal representatives, assigns, spouses and "domestic partners." G. No Action Against Us 1. No action shall be taken against us unless, as a condition precedent, there shall have been full compliance with all the provisions of this Coverage Form nor until the amount of your obligation to pay shall have been finally determined either by final and nonappealable Page 5 of 6 judgment against you after trial or by written agreement by you, the claimant and us. 2. No person or organization shall have any right under this Coverage Form to join us a party to any "suit' against you to determine your liability, nor shall we be impleaded by you or your legal representatives in any such "suit." H. 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 Form those rights are transferred to us. The insured must do nothing after a "claim" is made to impair them. At our request, the insured will bring "suit' or transfer those rights to us and help us enforce them. In no event shall the insured be entitled to recoup from recoveries any amount to satisfy any deductible until after all amounts which we are required to pay or do pay under this Coverage Form are reimbursed to us. I. Transfer Of Duties When Limit Of Insurance Is Exhausted 1. If we conclude that, based on "claims" which have been reported to us and to which this insurance may apply, the limit of insurance is likely to be exhausted in the payment of damages" or "defense expenses," we will notify the first named insured, in writing, to that effect; 2. When the limit of insurance has actually been exhausted by payments of "damages" or defense expenses," we will: a. Notify the first "named insured" in writing, as soon as practicable, that such limit has been exhausted and that our obligations under this Coverage Form shall be deemed completely fulfilled and extinguished; b. Initiate, and cooperate in, the transfer of control, to any appropriate insured, of all open "claims" to you; and c. Take such steps, as we deem appropriate, to avoid a default in, or continue the defense of, such "claims" until such transfer is SB -300441 -A Ed. 01/07) SB -300441 -A Ed. 01/07) completed, provided you are cooperating in completing such transfer. 3. Upon receipt of such notice, you, must: a. Cooperate in the transfer of control of claims"; and b. Arrange for the defense of such "claim" within such time period as agreed to between you and us. Arrangements for the defense of such "claim" must be made as soon as practicable. 4. We will take no action with respect to defense for any "claim" if such "claim" is reported to us after the applicable limit of insurance is exhausted. It becomes the your responsibility to arrange defense for such "claim." 5. You will reimburse us as soon as practicable for expenses we incur in taking those steps we deem appropriate in accordance with Paragraph 2. above. 6. The exhaustion of the applicable limit of insurance and the resulting end of our duty to defend will not be affected by our failure to comply with any of the provisions of this Condition. J. Named Insured Authorization The insureds agree that the first named insured will act on behalf of all insureds with respect to giving of all notice to us (except notices provided in Section VII. Paragraph B and C), the receipt of notices from us, the payment of the premiums, the receipt of any return premiums that may become due under this Coverage Form, and the acceptance of endorsements. K. Assignment of Interest Assignment of interest under this Coverage Form shall not bind us unless its consent is endorsed to this Coverage Form. L. Common Policy Conditions Unless otherwise stated in this Coverage Form, all of the terms and conditions of the Businessowners Common Policy Conditions shall be included and incorporated into this Coverage Form. Page 6 of 6 CNA SB -30 01/07) SINGLE LIMIT OF INSURANCE ENDORSEMENT FOR EMPLOYMENT PRACTICES/FIDUCIARY LIABILITY COVERAGE FORMS In consideration of the premium paid for this Policy, it is hereby understood and agreed that the following endorsement is applicable to the Employment Practices Liability and Fiduciary Liability Coverage Forms: SINGLE LIMIT OF INSURANCE/DEDUCTIBLE A. The Employment Practices/Fiduciary Liability single limit of insurance shown in the Declarations and subject to the provisions of the Employment Practices Liability and Fiduciary Liability Coverage Forms is the total amount we will pay as "damages" and "defense expenses" under both the Employment Practices Liability and Fiduciary Liability Coverage Forms combined, regardless of the number of insureds, claims" made or persons or entities making "claims" under such Coverage Forms. If "related claims" are subsequently made against the insured and reported to us, all such "related claims," whenever made, shall be considered a single "claim" first made and reported to us within the "policy period" in which the earliest of the "related claims" was first made and reported to us. B. L The Employment Practices/Fiduciary Liability single limit of insurance shown in the Declarations shall be our maximum aggregate limit of insurance for all damages" and "defense expenses" under the Employment Practices Liability and Fiduciary Liability Coverage Forms combined, regardless of the number of: 1. Insureds; 2. "Claims"; 3. "Damages" or "defense expenses" incurred; or D 4. Claimants; Our obligations under both the Employment Practices Liability and Fiduciary Liability Coverage Forms, shall be completely fulfilled and extinguished if the Employment Practices/Fiduciary Liability single limit of insurance is exhausted by payment of "damages" or defense expenses." We will pay "damages" and "defense expenses" in excess of the EPL Deductible shown on the Declarations, up to the applicable Employment Practices/Fiduciary Liability single limit of insurance. SB -300449-A Ed. 01/07) Example No. 1 EPL Deductible: $5,000 Employment Practices/Fiduciary Single Limit of Insurance: $100,000 Damages" and "Defense Expenses": $75,000 The EPL Deductible will be subtracted from the amount of "damages" and "defense expenses" in calculating the amount payable: 75,000 - $5,000 = $70,000 Amount Payable Example No. 2 EPL Deductible: $5,000 Employment Practices/Fiduciary Single Limit of Insurance: $100,000 Damages" and "Defense Expenses": $120,000 The EPL Deductible will be subtracted from the amount of "damages" and "defense expenses" 120,000 - $5,000 = $115,000). Since the amount of the "damages" and "defense expenses" minus the EPL Deductible exceeds the Employment Practices/Fiduciary Liability single limit of insurance, the policy will pay the full Employment Practices/Fiduciary Liability Single Limit of Insurance ($100,000). Subject to Paragraph E. below, we may pay any part or all of the EPL Deductible amount to effect settlement of any "claim" and, upon notification of the action taken, you shall promptly reimburse us for such part of the EPL Deductible amount as has been paid by us. E.. No deductible applies with respect to any "claim" against any "insured person" if you are not permitted to advance "defense expenses" or to indemnify such insured person" for "damages" by reason of: 1. Financial insolvency; or 2. A good faith determination by you that such payment is not permitted under the broadest construction of applicable law Page 1 of 1 CNA SB -300450-A Ed. 01/07) THIS IS A CLAIMS MADE COVERAGE FORM. PLEASE READ ALL PROVISIONS AND CONTACT YOUR AGENT IF YOU HAVE ANY QUESTIONS. THIS INSURANCE APPLIES ONLY TO "WRONGFUL ACTS" THAT OCCUR BETWEEN THE RETROACTIVE DATE AND THE END OF THE "POLICY PERIOD." THIS INSURANCE APPLIES ONLY TO CLAIMS" FIRST MADE AGAINST THE INSURED AFTER THE INCEPTION DATE AND BEFORE THE END OF THE POLICY PERIOD" OR ANY APPLICABLE EXTENDED REPORTING PERIOD AND REPORTED TO US IN ACCORDANCE WITH THE PROVISIONS OF THIS FORM. UPON TERMINATION OF YOUR POLICY AN AUTOMATIC EXTENDED REPORTING PERIOD WILL BE PROVIDED, AND A SUPPLEMENTAL EXTENDED REPORTING PERIOD WILL BE AVAILABLE. Various provisions in this Coverage Form restrict coverage. Read the entire Coverage Form carefully to determine rights, duties and what is and is not covered. Throughout this Coverage Form the terms "you" and "your" refer to the Named Insured shown in the Declarations, and any other person or organization qualifying as a Named Insured under this policy." The terms "we," "us" and 'bur" refer to the Stock Insurance Company named on the Declarations providing this insurance. The word "insured" means any person or organization 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 III Definitions. SECTION I - INSURING AGREEMENTS No other obligation or liability to pay sums or perform A. Coverage acts or services is covered unless explicitly provided for under paragraph 1.11). -Supplementary Payments We will pay those sums in excess of the deductible and subject to the limits of liability that the Insured becomes legally obligated to pay as "damages" because of a "claim" resulting from a "wrongful employment practice" provided: 1. The "wrongful employment practice" takes place in the "coverage territory"; 2. The "wrongful employment practice" did not occur before the Retroactive Date, if any, shown in the Declarations nor after the end of the "policy period"; and 3. A "claim" arising out of a "wrongful employment practice" is first made against an insured, during the "policy period" or Extended Reporting Period, if applicable and is reported to us in accordance with Section VIII, Conditions, paragraph C, Duties in the event of a "Claim"; and 4. Prior to the inception date of this Coverage Form a. the Insured did not give notice to a prior insurer of a "related claim"; b. the Insured did not give notice to a prior insurer of any such "wrongful employment practice" or "interrelated wrongful employment practice." B. Defense We have the right and duty to defend all "suits," even if the allegations are groundless, false or fraudulent. We shall have the right to appoint counsel and to make such investigation and defense of a "suit' as we deem necessary. Alternatively we may, at our option, give our written consent to the defense of any such "suit' to the insured. Our obligation to defend any "suit' or pay any "damages" and "defense expenses" for any claim" shall be completely fulfilled and extinguished if the limit of insurance has been exhausted by payment of "damages" or "defense expenses." C. Consent To Settle We shall not settle a "claim" without your written consent. If you refuse to consent to a settlement or compromise recommended by us, and acceptable to the claimant, then the applicable limit of insurance under this Coverage Form shall be reduced to the amount for which the "claim" could have been settled plus all "defense expenses" incurred up to the time we made our recommendation. D. Supplementary Payments We will pay, with respect to any "claim" or "suit' we investigate or settle, or any "suit' against an insured we defend all "defense expenses." These payments are included within and reduce the Limits of Insurance. SB -300450-A Page 1 of 7 Ed. 01/07) SECTION II — WHO IS AN INSURED A. If you are designated in the Declarations as: 1. A partnership or joint venture, you are an insured. Your partners or members are also insureds. 2. A limited liability company, you are an insured. Your members and managers are also insureds. 3. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are also insureds. B. Your "employees" are also insureds, unless otherwise excluded in this policy. C. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if no other similar insurance applies to that organization. You must notify us of such acquisition or formation as soon as practicable. However, coverage under this provision: 1. Is afforded only until the 90th day after you acquire or form the organization, or until the end of the policy period, whichever is earlier; and 2. Does not apply to an offense committed before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. D. SECTION III — DEFINITIONS The following defined words shall have the same meaning throughout this Coverage Form, whether expressed in the singular or the plural. A. B Claim" means a "suit" or written demand for monetary damages against an insured and made by or on behalf of a natural person who is an "employee" or applicant for employment for a "wrongful employment practice." Coverage territory" means: 1. The United States of America (including its territories or possessions) and Puerto Rico; or 2. All parts of the world if the insured's responsibility to pay "damages" is determined in a "suit" on the merits brought in the territory described in Paragraph 1. above or in a settlement of a "claim" that we agree to. C. "Damages" means sums (including back pay and front pay), settlements, judgments (including any award of pre -judgment and post -judgment interest) for which you are legally obligated to pay on account of a covered "claim." "Damages" shall not include: SB -300450-A Ed. 01/07) E. F. A SB -300450-A Ed. 01/07) 1. criminal or civil fines or penalties imposed by law; 2. taxes; 3. liquidated or the multiple portion of any multiplied damages, amounts which may be deemed uninsurable under the law pursuant to which this policy shall be construed; 4. compensation earned by the claimant in the course of employment but unpaid by the Insured, including salary, wages, commissions, bonus or incentive compensation; 5. any amounts for which an Insured is liable due to breach of any written contract of employment; 6. amounts representing medical or insurance premiums or benefit claim payments; 7. any amount for which an Insured is absolved from payment by reason of any covenant, agreement or court order; or 8. future salary, wages or commissions of a claimant who is hired, promoted or reinstated to employment pursuant to a settlement of, order in, or other resolution of any "claim" Notwithstanding anything to the contrary above, damages" shall include punitive or exemplary damages, if insurable, to the fullest extent permitted by any applicable law. Where you reasonably determine that punitive, exemplary or multiple damages are insurable under any applicable law, we shall not challenge that determination of insurability. Defense expenses" means all fees charged by attorneys designated by us, or by you, with our written consent and all other reasonable and necessary fees, costs and expenses resulting from the investigation, adjustment, defense and appeal of a "claim" if incurred by us or you with our written consent, including the costs of appeal, attachment or similar bonds. We have no obligation to provide such bonds. "Defense Expenses" shall not include salaries, wages, fees, overhead or benefit expenses associated with the directors, officers, and employees of yours. Domestic Partner" means any person qualifying as such under any federal, state or local laws or under your employee benefit plans. EEOC Proceeding" means an investigative proceeding before the Equal Employment Opportunity Commission or an adjudicatory or investigative proceeding before any similar federal, state or local government body whose purpose is to address wrongful employment practices." Employee" means all of your past, present or future full-time or part-time employees, including seasonal and temporary employees and employees leased or loaned to you. "Employee" does not include an independent contractor. Page 2 of 7 H. "ERISA or any Similar Act" means the Employee Retirement Income Security Act of 1974, as amended, or any similar common or statutory law of the United States, Canada or their states, territories or provinces or any other jurisdiction anywhere in the world. I. "Executive officer" means your chairperson, chief executive officer, president, chief financial officer and in-house general counsel, and, the director of human resources or equivalent position; J. "Insured Persons" means all of those natural person insureds who are your partners, members, managers, executive officers," directors and "employees" K. "Interrelated Wrongful Employment Practices" means any "wrongful employment practices" which are logically or causally connected by reason of any common fact, circumstance, situation, transaction or event. Policy Period" means the period from the effective date of this Coverage Form to the expiration date stated on the Declarations, or its earlier cancellation date. M. "Pollutants" means any substance exhibiting hazardous characteristics as, is or may be defined or identified on any list of hazardous substances issued by the United States Environmental Protection Agency or any state or local or foreign counterpart. "Pollutants" also means, without limitation, any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals or waste (including materials to be recycled, reconditioned or reclaimed), as well as any air emission, odor, waste water, oil or oil products, infectious or medical waste, asbestos, or asbestos products or any noise. N. "Related claims" mean all claims arising out of a single "wrongful employment practice" or arising out of interrelated wrongful employment practices." 0. "Suit" means a formal civil, administrative, or regulatory proceeding (including an "EEOC Proceeding") or investigation or an arbitration against an insured, including any appeal therefrom. P. "Wrongful Employment Practice" means any actual or alleged error, misstatement, misleading statement, act, omission, neglect or breach of duty committed or attempted by the "insured persons" in their capacity as such or by you constituting or related to 1. Wrongful dismissal or discharge or termination of employment, whether actual or constructive; 2. Employment-related misrepresentation; SB -300450-A Ed. 01/07) SB -300450-A Ed. 01/07) 3. Violation of any federal, state or local laws whether common-law or statutory) concerning employment or discrimination in employment, including the Americans with Disabilities Act of 1992, the Civil Rights Act of 1991, the Age Discrimination in Employment Act of 1967, Title VII of the Civil Rights Act of 1964 and the Civil Rights Act of 1866; 4. Sexual harassment or other unlawful harassment in the work place; 5. Wrongful deprivation of career opportunity or failure to employ or promote; 6. Wrongful discipline of "employees"; 7. Retaliation against "employees" for the exercise of any legally protected right or for engaging in any legally protected activity; 8. Negligent evaluation of "employees"; 9. Failure to adopt adequate workplace or employment policies and procedures; 10. Employment-related defamation or invasion of privacy; or 11. Employment-related wrongful infliction of emotional distress. SECTION IV— EXTENDED REPORTING PERIOD A. If the first Named Insured cancels or non -renews this Coverage Form or if we decide not to offer any renewal terms for this Coverage Form, the first Named Insured shall have the right to purchase, upon payment of an additional premium not to exceed 200% of the annual premium for this coverage, an extension of this Coverage Form for a period of 12 months immediately following the end of the "policy period," but only with respect to any "wrongful employment practice" committed before the earlier of the end of the policy period"; This period shall be referred to as the Extended Reporting Period. B. As a condition precedent to the right to purchase the Extended Reporting Period, the total premium for this Coverage Form must have been paid. The right to purchase the Extended Reporting Period shall end unless we receive written notice and full payment of the premium for such period within 30 days after the end of the "policy period." C. If the Extended Reporting Period is purchased, the entire premium shall be deemed fully earned at its commencement without any obligation by us to return any portion thereof. D. There is no separate or additional limit of insurance for the Extended Reporting Period. Page 3 of 7 SECTION V - LIMIT OF INSURANCE Your rights and ours are stated in the attached Single Limit of Insurance Endorsement For Employment Practices/Fiduciary Liability Coverage Forms SECTION VI - EXCLUSIONS A. Exclusions Applicable to Damages and Defense Expenses We will not be liable to pay any "damages" or "defense expenses" under this Coverage Form in connection with any "claim" made against an insured: 1. Bodily Injury/Property Damage For any actual or alleged bodily injury (including death), sickness, disease of any person, or damage to or destruction of any tangible property including loss of use except that this exclusion shall not apply to allegations of emotional distress, humiliation or mental anguish; 2. Violation of Law Based upon, directly or indirectly arising out of, or in any way involving any actual or alleged violation of: a. (i) "ERISA or any Similar Act," (ii) the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended, or (iii) any other federal, state or local statutory law or common law anywhere in the world governing any employee benefit program, policy, plan or arrangement of any type, including but not limited to laws governing retirement or pension benefit programs, welfare plans, insurance plan, employee stock option ownership or employee stock purchase plans or deferred compensation programs; b. Any law governing workers' compensation, unemployment insurance, social security, disability benefits or any other similar federal, state or local statutory or regulatory law or common law anywhere in the world; c. The Occupational Safety and Health Act of 1970 (OSHA), as amended, or any other federal, state or local statutory or regulatory law or common law anywhere in the world governing workplace safety and health; d. The Fair Labor Standards Act (except the Equal Pay Act), as amended, or any other federal, state or local statutory law or common law anywhere in the world governing wage, hour and payroll policies; e. The Workers' Adjustment and Retraining Notification Act, Public Law 100-379 (1988), as amended, or any other federal, state or local statutory or regulatory law or common SB -300450-A Ed. 01/07) SB -300450-A Ed. 01/07) law anywhere in the world governing an employer's obligation to notify or bargain with others in advance of any facility closing or mass layoff. f. The National Labor Relations Act, as amended, or any other federal, state or local statutory or regulatory law or common law anywhere in the world governing employees' rights and the employers duties with respect to unions, bargaining, strikes, boycotts, picketing, lockouts or collective activities. However, this exclusion shall not apply to any claim" alleging retaliation or wrongful dismissal or discharge or termination of employment whether actual or constructive, because of a claimant's exercise of a right pursuant to any such laws; 3. Pollution Based upon, directly or indirectly arising out of or in any way involving: any nuclear reaction, radiation or contamination, or any actual, alleged or threatened discharge, release, escape, or disposal of, or exposure to, "pollutants"; any request, direction or order that any of the insureds test for, monitor, clean up, remove, contain, treat, detoxify, neutralize or in any way respond to or assess the effect of "pollutants" or nuclear reaction, radiation or contamination, or any voluntary decision to do so; or any actual or alleged property damage, or bodily injury, sickness, disease or death of any person resulting from any of the aforementioned matters. However, this exclusion shall not apply to any "claim" alleging retaliation or wrongful dismissal or discharge or termination of employment whether actual or constructive, because of a claimant's exercise of a right pursuant to any such laws; 4. Prior Wrongful Acts of Subsidiaries For: a) Any "wrongful employment practice" by an insured of any of your subsidiaries, or by such subsidiary occurring before the date such entity became a subsidiary, or b) Any other "wrongful employment practice," whenever occurring, which, together with a wrongful employment practice" described in a) above, would constitute "interrelated wrongful employment practices." 5. Assumed Liability Based upon, directly or indirectly arising out of or in any way involving the insured's assumption of the liability of others in any oral or written contract or agreement, unless such liability would have attached to an Insured in the absence of such agreement; Page 4 of 7 B. Exclusions Applicable to Non -Monetary Relief We will not be liable to pay any "damages" under this Coverage Form that represent 1. The cost of any non -monetary relief, including without limitation any costs associated with compliance with any injunctive relief of any kind or nature imposed by any judgment or settlement; 2. The costs associated with providing any reasonable accommodations required by, made as a result of, or to conform with the requirements of the Americans With Disabilities Act and any amendments thereto or any similar federal, state or local statute, regulation, or common laws; 3. Amounts determined to be owing under an express contract with or express severance obligation of yours; however, this exclusion shall not apply if and to the extent that liability would have attached to such insured in the absence of the express contract with or obligation of yours ; or 4. Medical or insurance benefits to which the claimant allegedly was entitled or would have been entitled had you provided the claimant with a continuation or conversion of insurance. SECTION VII — CONDITIONS A. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's" estate will not relieve us of our obligations under this policy. B. Duties In The Event Of A "Claim" 1. If, during the "policy period' or any Extended Reporting Period, if applicable, any "claim" is first made against the "insured," the insured shall, as a condition precedent to our obligations under this Coverage Form, give us written notice as soon as practicable but in no event later than ninety (90) days after the end of the "policy period" or the Extended Reporting Period, if applicable. 2. You must: a. Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the "claim": b. Authorize us to obtain records and other information; and c. Cooperate with us in the investigation or settlement of the "claim" or defense of the suit." 3. No insured shall voluntarily make a payment, assume any obligation, or incur any expense without our written consent. SB -300450-A Ed. 01/07) SB -300450-A Ed. 01/07) C. Duties in the Event of A "Wrongful Employment Practice" That May Result In A "Claim" If, during the "policy period," you first become aware of a specific "wrongful employment practice" which may reasonably give rise to a future "claim," and during the policy period" give written notice to us of: 1. The names of any potential claimants and a description of the "wrongful employment practice" which forms the basis of their potential "claim"; 2. The identity of the specific insureds allegedly responsible for such specific "wrongful employment practice"; 3. The consequences which have resulted or may result from such specific "wrongful employment practice"; 4. The nature of the potential monetary damages which may be sought in consequence of such specific "wrongful employment practice"; and 5. The circumstances by which you first became aware of such specific "wrongful employment practice"; Then any "claim" otherwise covered pursuant to this Coverage Form which is subsequently made and which arises out of such "wrongful employment practice" shall be deemed to have been first made and reported to us by you at the time we received such written notice. No coverage is provided for fees and expenses incurred prior to the time such notice results in a "claim." D. When a "Claim" is Deemed Made A "claim" shall be deemed made: 1. In the case of a civil, administrative or regulatory proceeding or arbitration, on the earliest of the date of service upon or other receipt by the insured of a complaint, or similar document against the insured in such proceeding or arbitration; 2. In the case of an investigation, on the earliest of the date of service upon or other receipt by the insured of a written notice or subpoena from the investigating authority identifying such "insured person" as an individual against whom a formal proceeding may be commenced; 3. In the case of a written demand for monetary damages, upon the insured's receipt of such written demand. E. Other Insurance The Other Insurance clause, Section H. of the Common Policy Conditions is deleted and replaced with the following: Page 5 of 7 If any "damages" and "defense expenses" resulting from any "claim" are insured under any other policies, this Coverage Form shall apply only to the extent the damages" and "defense expenses" exceed the amount paid under such other insurance, whether such other insurance is stated to be primary, contributory, excess, contingent or otherwise, unless such other insurance is written only as specific excess insurance over this Coverage Form. F. Section IV. Estates, Legal Representatives and Spouses/Domestic Partners Section L. of the Common Policy Conditions, Transfer Of Your Rights And Duties Under This Policy, is deleted in its entirety and replaced as follows: The estates, heirs, legal representatives, assigns, spouses and any "domestic partner" of "insured persons" shall be considered insureds under this Coverage Form; provided, however, coverage is afforded to such estates, heirs, legal representatives, assigns and spouses only for a "claim "arising solely out of their status as such and, in the case of a spouse or "domestic partner," where such "claim" seeks damages from marital community property, jointly held property or property transferred from the "insured person" to the spouse or "domestic partner." No coverage is provided for any act, error or omission of an estate, heir, legal representative, assign, spouse or domestic partner." All terms and conditions of this Coverage Form, including without limitation the deductible applicable to "damages" and "defense expenses" incurred by the "insured person" shall also apply to "damages" and "defense expenses" incurred by such estates, heirs, legal representatives, assigns, spouses and "domestic partners." G. No Action Against Us 1. No action shall be taken against us unless, as a condition precedent, there shall have been full compliance with all the provisions of this Coverage Form nor until the amount of your obligation to pay shall have been finally determined either by final and nonappealable judgment against you after trial or by written agreement by you, the claimant and us. 2. No person or organization shall have any right under this Coverage Form to join us a party to any suit" against you to determine your liability, nor shall we be impleaded by you or your legal representatives in any such "suit." H. 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 Form those rights are transferred to us. The insured must do nothing after a "claim" is made to impair them. At our SB -300450-A Ed. 01/07) SB -300450-A Ed. 01/07) request, the insured will bring "suit' or transfer those rights to us and help us enforce them. In no event shall the insured be entitled to recoup from recoveries any amount to satisfy any deductible until after all amounts which we are required to pay or do pay under this Coverage Form are reimbursed to us. I. Transfer Of Duties When Limit Of Insurance Is Exhausted 1. If we conclude that, based on "claims" which have been reported to us and to which this insurance may apply, the limit of insurance is likely to be exhausted in the payment of "damages" or defense expenses," we will notify the first named insured, in writing, to that effect; 2. When the limit of insurance has actually been exhausted by payments of "damages" or "defense expenses," we will: a. Notify the first named insured in writing, as soon as practicable, that such limit has been exhausted and that our obligations under this Coverage Form shall be deemed completely fulfilled and extinguished; b. Initiate, and cooperate in, the transfer of control, to any appropriate insured, of all open claims" to you; and c. Take such steps, as we deem appropriate, to avoid a default in, or continue the defense of, such "claims" until such transfer is completed, provided you are cooperating in completing such transfer. 3. Upon receipt of such notice, you must: a. Cooperate in the transfer of control of claims"; and b. Arrange for the defense of such "claim" within such time period as agreed to between you and us. Arrangements for the defense of such claim" must be made as soon as practicable. 4. We will take no action with respect to defense for any "claim" if such "claim" is reported to us after the applicable limit of insurance is exhausted. It becomes your responsibility to arrange defense for such "claim." 5. You will reimburse us as soon as practicable for expenses we incur in taking those steps we deem appropriate in accordance with Paragraph 2. above. 6. The exhaustion of the applicable limit of insurance and the resulting end of our duty to defend will not be affected by our failure to comply with any of the provisions of this Condition. Page 6 of 7 J. Named Insured Authorization The insureds agree that the first named insured will act on behalf of all insureds with respect to giving of all notice to us (except notices provided in Section VII. Paragraph B and C), the receipt of notices from us, the payment of the premiums, the receipt of any return premiums that may become due under this Coverage Form, and the acceptance of endorsements. SB -300450-A Ed. 01/07) SB -300450-A Ed. 01/07) K. Assignment of Interest Assignment of interest under this Coverage Form shall not bind us unless its consent is endorsed to this Coverage Form. L. Common Policy Conditions Unless otherwise stated in this Coverage Form, all of the terms and conditions of the Business Owners Common Policy Conditions Endorsement shall be included and incorporated into this Coverage Form. Page 7 of 7 N 00 0 0 CNA S BEd 07o ) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONCURRENT CAUSATION, EARTH MOVEMENT & WATER EXCLUSION CHANGES This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM A. Section B. EXCLUSIONS the first paragraph of B.1. is deleted in its entirety and replaced by the following: 1. We will not pay for loss or damage directly or indirectly caused by or resulting from any of the following regardless of: (a) the causes of the excluded event; or (b) other causes of the loss; or c) any other causes or events, whether or not insured under this Policy, which may have contributed concurrently or in any sequence with the excluded event to produce the loss; or (d) whether the event occurred suddenly or gradually, involved isolated or widespread damage, arose from natural or external forces or acts or omissions of man, or occurred as a result of any combination of any of the following: B. Section B. EXCLUSIONS exclusion 113.1.b. Earth Movement deleted in its entirety and replaced by the following: b. Earth Movement 1) Earthquake, including any earth sinking, rising or shifting related to such event; 2) Landslide, including any earth sinking, rising or shifting related to such event; 3) Mine subsidence, meaning subsidence of a man-made mine, whether or not mining activity has ceased; 4) Earth sinking (other than sinkhole collapse), rising or shifting, including soil conditions which cause settling, cracking or other disarrangement of foundations or other parts of realty. Soil conditions include contraction, expansion, freezing, thawing, erosion, improperly compacted soil and the action of water under the ground surface. Also, Earth Movement, as described in (1) through 4) applies to acts or omissions of man or any other cause or combination of causes listed above. But if Earth Movement, as described in (1) through (4) above, results in fire or explosion, and such resulting loss or damage is not otherwise excluded, we will pay for the loss or damage caused by that fire or explosion. 5) Volcanic eruption, explosion or effusion. But if volcanic eruption, explosion or effusion results in fire, building glass breakage or Volcanic Action, and such resulting loss or damage is not otherwise excluded, we will pay for the loss or damage caused by that fire, building glass breakage or Volcanic Action. Volcanic action means direct loss or damage resulting from the eruption of a volcano when the loss or damage is caused by: a) Airborne volcanic blast or airborne shock waves; b) Ash, dust or particulate matter; or c) Lava flow. All volcanic eruptions that occur within any 168 hour period will constitute a single occurrence. Volcanic action does not include the cost to remove ash, dust or particulate matter that does not cause direct physical loss or damage to the Covered Property. C. Section B. EXCLUSIONS exclusion 113.1.g. Water is deleted in its entirety and replaced by the following: g. Water 1) "Flood," surface water, waves, tides, tidal waves, overflow of any body of water, including release of water held by a dam, levy or dike or by a water or flood control device, or their spray, all whether driven by wind or not; 2) Mudslide or mudflow; 3) Water or sewage that backs up or overflows from a sewer, drain or sump; or 4) Water under the ground surface pressing on, or flowing or seeping through: a) Foundations, walls, floors or paved surfaces; b) Basements, whether paved or not; or c) Doors, windows or other openings. But if water, as described in g.(1) through g.(4) above, results in fire, explosion, or sprinkler leakage not otherwise excluded, we will pay for the loss or damage caused by that fire, explosion, or sprinkler leakage. SB -300456-A Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 Ed. 07/07) D. Wherever the word "flood" appears in the Commercial Property Coverage Part, it is amended to a defined term, as per the following, and is added to the Definitions section of each applicable coverage part. Flood" means a general and temporary condition of partial or complete inundation of normally dry land SB -300456-A Ed. 07/07) areas, whether caused by natural occurrences, acts or omissions of man or any other cause or combination of causes. All flooding in a continuous or protracted event will constitute a single flood. SB -300456-A Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 Ed. 07/07) N 0 0 0 0 CNA SB -300596-A Ed. 01/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IDENTITY THEFT/RECOVERY SERVICES ENDORSEMENT IDENTITY THEFT/RECOVERY CASE MANAGEMENT SERVICE AND EXPENSE REIMBURSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following changes apply to the Businessowners authorized representative of an "identity recovery Special Property Coverage Form: insured," whether acting alone or in collusion with others. However, this exclusion shall not apply to A. IDENTITY RECOVERY COVERAGE the interests of an "insured" who has no The following is added to Paragraph 5. Additional knowledge of or involvement in such fraud, Coverages: dishonesty or criminal act. We will provide the Case Management Service and Expense Reimbursement Coverage indicated below if all of the following requirements are met: There has been an "identity theft' involving the personal identity of an "identity recovery insured" under this policy; and 2. Such "identity theft' is first discovered by the identity recovery insured" during the policy period for which this Identity Recovery coverage is applicable; and 3. Such "identity theft' is reported to us as soon as practicable but in no event later than 60 days after it is first discovered by the "identity recovery insured." If all three of the requirements listed above have been met, then we will provide the following to the "identity recovery insured": 1. Case Management Service Services of an "identity recovery case manager" as needed to respond to the "identity theft"; and 2. Expense Reimbursement Reimbursement of necessary and reasonable identity recovery expenses" incurred as a direct result of the "identity theft." This coverage is additional insurance. B. EXCLUSIONS The following additional exclusions are added to Section B. - Exclusions and apply to this coverage: We do not cover loss or expense arising from any of the following: 1. Theft of a professional or business identity. 2. Any fraudulent, dishonest or criminal act by an identity recovery insured," or any person aiding or abetting an "identity recovery insured," or by any SB -300596-A Ed. 01/08) 3. Loss other than "identity recovery expenses." 4. An "identity theft' that is first discovered by the identity recovery insured" prior to or after the policy period for which this coverage applies. This exclusion applies whether or not such "identity theft' began or continued during the period of coverage. 5. An "identity theft' that is not reported to us within 60 days after it is first discovered by the "identity recovery insured." 6. An "identity theft' that is not reported in writing to the police. C. LIMITS OF INSURANCE 1. Case Management Service is available as needed for any one "identity theft' for up to 12 consecutive months from the inception of the service. Expenses we incur to provide Case Management Service do not reduce the amount of limit available for Expense Reimbursement coverage. 2. Expense Reimbursement coverage is subject to a limit of $25,000 annual aggregate per "identity recovery insured." Regardless of the number of claims, this limit is the most we will pay for the total of all loss or expense arising out of all identity thefts" to any one "identity recovery insured" which are first discovered by the "identity recovery insured" during a 12 -month period starting with the beginning of the present annual policy period. If an "identity theft' is first discovered in one policy period and continues into other policy periods, all loss and expense arising from such "identity theft' will be subject to the aggregate limit applicable to the policy period when the "identity theft' was first discovered. a. Legal costs as provided under paragraph d. of the definition of "identity recovery expenses" are part of, and not in addition to the Expense Reimbursement coverage limit. Page 1 of 3 b. Lost Wages and Child and Elder Care Expenses as provided under paragraphs e. and f. of the definition of "identity recovery insured" are jointly subject to a sublimit of 250. per day, not to exceed $5,000. in total. This sublimit is part of, and not in addition to the Expense Reimbursement coverage limit. Coverage is limited to lost wages and expenses incurred within 12 months after the first discovery of the "identity theft' by the identity recovery insured." c. Mental Health Counseling as provided under paragraph g. of the definition of "identity recovery expenses" is subject to a sublimit of 1,000. This sublimit is part of, and not in addition to the Expense Reimbursement coverage limit. Coverage is limited to counseling that takes place within 12 months after the first discovery of the "identity theft' by the "identity recovery insured." D. DEDUCTIBLE Case Management Service is not subject to a deductible. Expense Reimbursement coverage is subject to a deductible of $250. Any one "identity recovery insured" shall be responsible for only one deductible under this Identity Recovery Coverage during any one policy period. E. CONDITIONS The following additional conditions are added to Section F. — Commercial Property Conditions and apply to this coverage: 1. Assistance and Claims For assistance, the "identity recovery insured" should call the Identity Recovery Help Line at 1- 877 -CNA -ASAP (1-877-262-2727) CNA Claims. The Identity Recovery Help Line can provide the identity recovery insured" with: a. Information and advice for how to respond to a possible "identity theft"; and b. Instructions for how to submit a service request for Case Management Service and/or a claim form for Expense Reimbursement Coverage. In some cases, we may provide Case Management services at our expense to an identity recovery insured" prior to a determination that a covered "identity theft' has occurred. Our provision of such services is not an admission of liability under the policy. We reserve the right to deny further coverage or service if, after investigation, we determine that a covered identity theft" has not occurred. SB -300596-A Ed. 01/08) SB -300596-A Ed. 01/08) As respects Expense Reimbursement coverage, the "identity recovery insured" must send to us within 60 days after our request, receipts, bills or other records that support his or her claim for identity recovery expenses." 2. Services The following conditions apply as respects any services provided by us or our designees to any identity recovery insured" under this endorsement: a. Our ability to provide helpful services in the event of an "identity theft' depends on the cooperation, permission and assistance of the identity recovery insured." b. All services may not be available or applicable to all individuals. For example, "identity recovery insureds" who are minors or foreign nationals may not have credit records that can be provided or monitored. Service in Canada will be different from service in the United States and Puerto Rico in accordance with local conditions. c. We do not warrant or guarantee that our services will end or eliminate all problems associated with an "identity theft' or prevent future "identity thefts." 3. Computer Security It is the responsibility of each "identity recovery insured" to use and maintain his or her computer system security, including personal firewalls, anti- virus software and proper disposal of used hard drives. F. DEFINITIONS With respect to the provisions of this endorsement only, the following definitions are added to Section G. Property Definitions: 1. "Identity Recovery Case Manager" means one or more individuals assigned by us to assist an identity recovery insured" with communications we deem necessary for re-establishing the integrity of the personal identity of the "identity recovery insured." This includes, with the permission and cooperation of the "identity recovery insured," written and telephone communications with law enforcement authorities, governmental agencies, credit agencies and individual creditors and businesses. 2. "Identity Theft" means the fraudulent use of the social security number or other method of identifying an "identity recovery insured." This includes fraudulently using the personal identity of an "identity recovery insured" to establish credit accounts, secure loans, enter into contracts or commit crimes. Page 2 of 3 Identity theft" does not include the fraudulent use of a business name, d/b/a/ or any other method of identifying a business activity. Identity theft" does not include the unauthorized use of a valid credit card, credit account or bank account. However, "identity theft' does include the fraudulent alteration of account profile information, such as the address to which statements are sent. 3. "Identity Recovery Expenses" means the following when they are reasonable and necessary expenses that are incurred in the United States or Canada as a direct result of an identity theft": a. Costs for re -filing applications for loans, grants or other credit instruments that are rejected solely as a result of an "identity theft." b. Costs for notarizing affidavits or other similar documents, long distance telephone calls and postage solely as a result of your efforts to report an "identity theft' or amend or rectify records as to your true name or identity as a result of an "identity theft." c. Costs for up to twelve (12) credit reports from established credit bureaus dated within 12 months after your knowledge or discovery of an "identity theft." d. Legal Costs Fees and expenses for an attorney approved by us for: 1) Defending any civil suit brought against an "identity recovery insured" by a creditor or collection agency or entity acting on behalf of a creditor for non- payment of goods or services or default on a loan as a result of an "identity theft"; and0 N 2) Removing any civil judgment wrongfully entered against an "identity recovery insured" as a result of the "identity theft." SB -300596-A Ed. 01/08) SB -300596-A Ed. 01/08) e. Lost Wages Actual lost wages of the "identity recovery insured" for time reasonable and necessarily taken away from work and away from the work premises. Time away from work includes partial or whole work days. Actual lost wages may include payment for vacation days, discretionary days, floating holidays and paid personal days. Actual lost wages does not include sick days or any loss arising from time taken away from self employment. Necessary time off does not include time off to do tasks that could reasonable have been done during non -working hours. f. Child and Elder Care Expenses Actual costs for supervision of children or elderly or infirm relatives or dependents of the identity recovery insured" during time reasonable and necessarily taken away from such supervision. Such care must be provided by a professional care provider who is not a relative of the "identity recovery insured." g. Mental Health Counseling Actual costs for counseling from a licensed mental health professional. Such care must be provided by a professional care provider who is not a relative of the "identity recovery insured." 4. "Identity Recovery Insured" means the following: a. The owner of the entity insured under this policy who meets any of the following criteria: 1) A sole proprietor of the insured entity; 2) A partner in the insured entity; or 3) An individual having an ownership position of 20% or more of the insured entity. Page 3 of 3 CNA SB -300849-A Ed. 07/09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM A. The following exclusion is added to Section B. B. The following exclusion is added to Section B. EXCLUSIONS of the Businessowners Liability EXCLUSIONS, Paragraph p. Personal And Advertising Coverage Form: Injury: 2. Exclusions This insurance does not apply to: q. Recording And Distribution Of Material Or Information In Violation Of Law Bodily injury" or "property damage" arising directly or indirectly out of any action or omission that violates or is alleged to violate: 1) The Telephone Consumer Protection Act TCPA), including any amendment of or addition to such law; 2) The CAN -SPAM Act of 2003, including any amendment of or addition to such law; 3) The Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law, including the Fair and Accurate Credit Transaction Act (FACTA); or 4) Any federal, state or local statute, ordinance or regulation, other than the TCPA, CAN -SPAM Act of 2003 or FCRA and their amendments and additions, that addresses, prohibits, or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information. 2. Exclusions This insurance does not apply to: 15) Recording And Distribution Of Material Or Information In Violation Of Law Personal and advertising injury" arising directly or indirectly out of any action or omission that violates or is alleged to violate: 1) The Telephone Consumer Protection Act TCPA), including any amendment of or addition to such law; 2) The CAN -SPAM Act of 2003, including any amendment of or addition to such law; 3) The Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law, including the Fair and Accurate Credit Transaction Act (FACTA); or 4) Any federal, state or local statute, ordinance or regulation, other than the TCPA, CAN -SPAM Act of 2003 or FCRA and their amendments and additions, that addresses, prohibits, or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information. SB -300849-A Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Ed. 07/09) N 00 0 0 CNA TECHNOLOGY ERRORS & OMISSIONS LIABILITY COVERAGE FORM SB300879C Ed. 06-16) THIS INSURANCE IS WRITTEN ON A "CLAIMS" MADE BASIS AND PROVIDES COVERAGE FOR THOSE "CLAIMS" WHICH ARE THE RESULT OF "WRONGFUL ACTS" HAPPENING SUBSEQUENT TO THE RETROACTIVE DATE STATED ON THE DECLARATIONS AND WHICH ARE FIRST MADE AGAINST THE INSURED DURING THE POLICY PERIOD. NO COVERAGE EXISTS FOR "CLAIMS" MADE AGAINST AN INSURED AFTER THE END OF THE POLICY PERIOD UNLESS, AND TO THE EXTENT, AN EXTENDED REPORTING PERIOD APPLIES. "DEFENSE COSTS" REDUCE THE LIMIT OF INSURANCE AND ARE SUBJECT TO A DEDUCTIBLE. Various provisions in this coverage form restrict coverage. Read the entire coverage form carefully to determine rights, duties and what is and is not covered. Throughout this coverage form the words "you" and "your" refer to the Named Insured shown in the Declarations, or other person or organization qualifying as a Named Insured under this coverage form. The words "we," "us" and "our" refer to the Company providing this insurance. The word "Insured" means any person or organization qualifying as such under Section II, WHO IS AN INSURED. Other words and phrases that appear in quotation marks have special meaning. Refer to Section VIII, DEFINITIONS. I. COVERAGE 1. Insuring Agreement A. We will pay those sums that the Insured becomes legally obligated to pay as "damages" because of a covered "claim" by reason of a "wrongful act" by the Insured or by someone for whom the Insured is legally responsible. B. Vicarious Liability Coverage Any entity you are required by written contract to include as an insured for liability of such entity for an Insured's "wrongful act" is insured under this Policy but solely to the extent that a "claim" is made against it for a "wrongful act," of an Insured and only so long as the written contract is entered into before such "wrongful act" occurs. Any coverage afforded by this Section is subject always to all of the Policy's terms and conditions, provided however: 1) there is no coverage afforded to such entity for its "wrongful acts;" and 2) nothing herein confers any rights or duties to such entity under this Policy, other than as provided in this Section. C. Assumed Liability You are insured for the tort liability (liability that would be imposed by law in the absence of any contract or agreement) of another party that you assume in a written contract or agreement and which is incurred by such third party as a result of your "wrongful act", provided the "wrongful act" gives rise to a "claim" and occurs subsequent to the execution of such contract or agreement. Solely for the purposes of liability assumed by you in such contract or agreement, reasonable attorney fees and necessary litigation expenses incurred by or for a party other than an Insured are deemed to be "damages", provided: 1) liability to such party for, or for the cost of, that party's defense has also been assumed in such contract or agreement; and 2) such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which "damages" to which this insurance applies are alleged. Any coverage afforded by this Section is subject always to all of the Policy's terms and conditions. D. How This Insurance Applies We will pay in accordance with paragraphs A., B. and C. above only if: 1) The "wrongful act" takes place in the "coverage territory;" SB300879C Ed.(06-16) Copyright, CNA All Rights Reserved. Page 1 of 12 S308 CNA (Ed006 6) 2) The "wrongful act" occurs after the Retroactive Date shown in the Declarations and prior to the end of the policy period; 3) A "claim" is first made against an Insured during the policy period or any applicable Extended Reporting Period and reported to us, in accordance with Section IV, CONDITIONS, paragraph 2, Duties in the Event of a "Claim;" and 4) Prior to the inception date of this Coverage Form or the first such Coverage Form issued and continuously renewed by us, of which this Coverage Form is a renewal, whichever is earlier, a. no "executive officer" knew of any circumstances which might have resulted in a "claim;" and b. the "wrongful act," or any "related wrongful act" has not been the subject of any notice given under any prior coverage form. Subject to any applicable limit of insurance, we will also pay "defense costs" in connection with such covered "claim" in accordance with paragraph E. below. E. Defense 1) Defense We have the right and duty to defend all "claims," even if the allegations are groundless, false or fraudulent. We shall have the right to appoint counsel and to make such investigation and defense of a claim" as we deem necessary. Alternatively we may, at our option, give our written consent to the defense of any such "claim" by the Insureds. If a "claim" is subject to an arbitration proceeding or mediation proceeding, we shall be entitled to exercise all of the Insured's rights in the choice of arbitrators or mediators and in the conduct of an arbitration or mediation proceeding involving such "claim." Our obligation to defend any "claim" or pay any "damages" or "defense costs," shall be completely fulfilled and extinguished if the limit of insurance has been exhausted. The Insureds shall not admit liability, consent to any judgment, agree to any settlement or make any settlement offer without our advance written consent, such consent not to be unreasonably withheld. We shall not be liable for any "damages" or "defense costs" to which we have not consented. The Insureds agree that they shall not knowingly take any action which increases our exposure for "damages" or defense costs" under this Policy. 2) Valuation All premiums, limits, retentions, "damages" and other amounts under this policy are expressed and payable in United States of America currency. If any judgment, settlement or any part of "damages" is expressed or calculated in any other currency, payment of such "damages" due under this Policy will be made in the currency of the United States of America, at the rate of exchange published in The Wall Street Journal on the date our obligation to pay such "damages" is established, or, if not published on that date, on the date of next publication. F. Mediation If, prior to institution of arbitration proceedings or service of suit or within 60 days of the institution of such proceedings or service of suit, you agree to use a process of non binding intervention by a neutral third party to resolve any "claim" reported to us, and if such "claim" is resolved through such process, we will reduce the deductible applicable to such "claim" by fifty percent or ten thousand dollars ($10,000.00), whichever is less. G. Pre -"Claim" Assistance Until the date a "claim" is made, we may pay for all costs or expenses we incur, at our sole discretion as a result of investigating a potential "claim" that an Insured reports in accordance with Section IV. CONDITIONS, paragraph 3., Duties in the Event of a Potential "Claim." Should a potential "claim" be investigated pursuant to this Section, and that potential "claim" later becomes a covered "claim" under this Coverage Form, then the limits of insurance and the deductible applicable to such "claim" shall apply to such "claim." H. Expenses of the Insured In addition to the Limit of Insurance, we will pay, with respect to any "claim," all reasonable expenses incurred by the Insured at our request to assist us in the investigation or defense of the "claim," including actual loss of earnings up to $1000.00 a day because of time off from work. SB300879C Ed.(06-16) Copyright, CNA All Rights Reserved. Page 2 of 12 CNA SB300879C Ed. 06-16) These payments will not reduce the limits of insurance nor erode any deductible. Multiple Claims More than one "claim" involving the same "wrongful act' or "related wrongful acts" shall be considered as one claim" which shall be deemed made on the earlier of: 1) the date on which the earliest such "claim" was first made; or 2) the first date valid notice was given by you to us under this coverage form or under any prior coverage form of any "wrongful act' or any "related wrongful act." 2. Exclusions The insurance does not apply to any "claim:" Assumed Liability based upon or arising out of any assumption of the liability of others under any contract or agreement, except that this exclusion does not apply to liability arising under Section I. COVERAGE, paragraph 1. Insuring Agreement, part B. Vicarious Liability Coverage or part C. Assumed Liability; Bodily Injury/Property Damage for any actual or alleged: bodily injury (including death), sickness, disease, emotional distress, mental anguish, of any person, or "property damage;" Claims by Insureds by or on behalf of any Insured in any capacity provided, however that this Exclusion shall not apply to: A. any "claim" that is in the form of a crossclaim, third -party claim or otherwise for contribution or indemnity, which is part of and results directly from a "claim" which is not otherwise excluded under this Coverage Form; or B. any "claim" brought or maintained by or on behalf of a bankruptcy or insolvency trustee, examiner, liquidator, receiver or rehabilitator for you or any assignee of such trustee, examiner, liquidator, receiver or rehabilitator; Deliberate Acts/Commingling or Misappropriation of Funds based upon or arising out of any actual or alleged: dishonest, fraudulent, criminal or malicious act or omission; commingling, misappropriation or misuse of funds; or intentional wrongdoing or knowing violation of any contract or agreement by you or on your behalf if a final judgment, ruling or other finding of fact in any proceeding establishes that such act, omission, commingling, misappropriation, misuse or intentional wrongdoing was committed. We will not defend any criminal act which was the subject of a criminal prosecution in which the Insured was found guilty or pleaded guilty, nolo contendere or no contest. Criminal proceedings are not covered under this Policy regardless of the allegations made against any Insured. For purposes of determining the applicability of this Exclusion: NO A. the facts pertaining to and knowledge possessed by any natural person Insured shall not be imputed to any other natural person Insured; and B. only facts pertaining to and knowledge possessed by any "executive officer" shall be imputed to you; ERISA or any Similar Act for any actual or alleged violation of the responsibilities, obligations or duties imposed upon fiduciaries by "ERISA or any Similar Act;" Governmental Actions by or on behalf of any federal, state or local government, including, but not limited to: A. the Federal Trade Commission; or B. the Federal Communications Commission; Except if such "claim" is brought by or on behalf of such government in its capacity as your customer; SB300879C Ed.(06-16) Copyright, CNA All Rights Reserved. Page 3 of 12 CNA SB300879C Ed. 06-16) Owned Entity by any entity not named in the Declarations if, at the time of the "wrongful act" giving rise to such "claim:" A. any Insured controlled, owned, operated or managed such entity; or B. any Insured was a director, officer or "employee" of such entity. For the purpose of this exclusion, a 10% or more owner of the voting stock of a publicly held corporation or a 50% or more owner of the voting stock of a privately held corporation shall be deemed to own such entity; Patent Infringement/Trade Secrets based upon or arising out of actual or alleged misappropriation or infringement of patent or trade secret; Pollution/Nuclear based upon, directly or indirectly arising out of or in any way involving: any nuclear reaction, radiation or contamination, or any actual, alleged or threatened discharge, release, escape, or disposal of, or exposure to, pollutants"; any request, direction or order that any of the Insureds test for, monitor, clean up, remove, contain, treat, detoxify, neutralize or in any way respond to or assess the effect of "pollutants" or nuclear reaction, radiation or contamination, or any voluntary decision to do so; or any actual or alleged "property damage," or bodily injury, sickness, disease or death of any person, or financial loss to you, your security holders, or your creditors resulting from any of the aforementioned matters; Professional Capacity based on or arising out of a "wrongful act" in the Insured's capacity as: A. a lawyer; B. an accountant; C. an architect or engineer;; D. a civil or structural engineer; E. a third party administrator or actuary; F. an insurance agent, broker, company, consultant or representative; or G. a real estate agent or broker; or in the Insured's provision of "medical services." As used herein, "medical services" means dental, medical, mental, nursing, surgical, imaging or other similar services performed by a medical intern, resident, technician, nurse, physician or other medical professional, or the furnishing of food, beverages or medications in connection with such services, or the postmortem handling of bodies; Proprietary Injury"/"Personal Injury" for any actual or alleged "proprietary injury;" or "personal injury;" Price Discounts/Games of Chance based upon or arising out of price discounts, prizes, awards, lotteries, sweepstakes, contests or games of chance; Securities Claims based upon or arising out of: A. the filing of any registration statement under the Securities Acts of 1933, or the Securities Exchange Act of 1934, any State Blue Sky Law, or any other state or local securities law; or B. the Securities Act of 1933, the Securities and Exchange Act of 1934, rules or regulations of the Securities Exchange Commission under either or both acts, similar securities laws or regulations of state, or any laws of any state relating to any transaction arising out of, involving, or relating to the public offering of securities; Unfair Competition/Antitrust Claims/RICO Claims based upon or arising out of: A. unfair competition, dilution, deceptive trade practices, civil actions for consumer fraud; SB300879C Ed.(06-16) Copyright, CNA All Rights Reserved. Page 4 of 12 S308 CNA (Ed006 6) B. charges of price fixing, monopolization or restraint of trade; C. any actual or alleged violation of: 1) the Federal Trade Commission Act; 2) the Sherman Act, the Clayton Act, or any federal statutory provision regarding anti-trust, monopoly, price fixing, price discrimination, predatory pricing or restraint of trade; 3) the Racketeer Influenced and Corrupt Organizations Act; or 4) any rules or regulations promulgated under or in connection with the above statutes, or any similar provision of any state, federal or local statutory law or common law; D. false or deceptive advertising or misrepresentation in advertising; Unsolicited Communication based upon or arising out of: A. any actual or alleged violation of any federal or state anti -spam statute or regulation, including the CAN - SPAM Act of 2003, as amended; or B. any actual or alleged violation of any federal or state statute or regulation prohibiting the dissemination of unsolicited electronic communications to multiple third parties, including any violation of the Telephone Consumer Protection Act of 2001, as amended; Withdrawal/Recall for any costs or expenses incurred by any Insured, or others: A. for the recall, removal, disposal or withdrawal of "your products" or any products which incorporate "your product" or "your work;" or B. to repair, replace, upgrade, supplement, improve, or complete "your product," or any products which incorporate "your product" or "your work." However, this exclusion shall not apply to "claims" for the loss of use of "your product." Wrongful Employment Practice/ Discrimination/Harassment based upon or arising out of any actual or alleged employment practice, discrimination, humiliation, harassment or misconduct that includes, but is not be limited to, "claims" based upon an individual's race, creed, color, age, sex, national origin, religion, handicap, marital status or sexual preference. NV II. WHO IS AN INSURED You are an Insured. In addition, the following persons or entities are Insureds: 0 1. any person who, during the policy period, is your partner, officer, director, member, "manager" or "employee" but, with respect to "your work," only when such services are performed on your behalf; 2. any of your former partners, officers, directors, members, "managers" or "employees" but with respect to "your work," only for such services performed on your behalf at the time of such affiliation; 3. any independent contractor, but only while acting within the scope of a contract and only with respect to "claims" alleging "damages" resulting from "your products" or "your work;" 4. any entity, other than a joint venture or partnership, not listed as Named Insureds on the Declarations, if, at the effective date of this Policy, you owned a 51% controlling ownership interest in such entity; 5. If, after the effective date of this Policy: 1. you create or acquire an entity, or 2. you merge with another entity such that you are the surviving entity, then such entity, and any subsidiaries, partners, officers, directors, members, "managers" or "employees" of such organization who otherwise would thereby become an Insured, shall be automatically covered under this Policy, subject to its terms and conditions, provided, however coverage does not apply to any "wrongful acts" committed before you acquired or formed the entity. SB300879C Ed.(06-16) Copyright, CNA All Rights Reserved. Page 5 of 12 CNA III. LIMITS OF INSURANCE AND DEDUCTIBLE SB300879C Ed. 06-16) 1. The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: A. Insureds; B. "claims" made; or C. persons or organizations making "claims." 2. The Aggregate Limit shown in the Declarations is the most we will pay for the sum of "damages" and "defense costs" for all "claims" to which this insurance applies. 3. Subject to 2. above, the Each Claim Limit shown in the Declarations is the most we will pay for all "damages" and defense costs" for any one "claim" to which this insurance applies. 4. Each payment we make for "damages" or "defense costs" reduces the Limits of Insurance. 5. We shall not be obligated to pay any "damages" or "defense expenses" or defend any "claim" after the applicable Limit of Insurance (as specified in the Declarations) has been exhausted by payment of "damages" or "defense costs," or any combination thereof. 6. Deductible Our obligation under this coverage to pay "damages" and "defense costs" applies only to the sums in excess of any deductible amount stated in the Declarations. The deductible amount is applicable to each "claim." The deductible amount will be the amount stated in the Declarations for each "claim." We may pay any part or all of the deductible amount to effect settlement of any "claim" and, upon notification, you shall promptly reimburse us for such deductible amount as has been paid by us. The Limits of Insurance of this Coverage Form apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. IV. 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 Form. 2. Duties in the Event of a "Claim" A. The Insured must, as a condition precedent to our obligations under this Policy, give us written notice of any claim" as soon as reasonably practicable after the Chief Executive Officer, Chief Financial Officer, President or Risk Manager learns of such "claim," but in no event later than ninety (90) days following the end of the policy period or any renewal policy period in a continuous, uninterrupted series of renewals. B. The Insured must: 1) immediately forward all documents received in connection with the "claim" to us; 2) fully cooperate with us or our designee in the investigation, the making of settlements, the conduct of suits or other proceedings, or enforcing any right of contribution or indemnity against another who may be liable to the Insured in connection with a "claim;" 3) attend depositions, hearings and trials; 4) assist in securing and giving evidence obtaining the attendance of witnesses; and 5) refuse, except at the Insured's own cost, to admit any liability, assume any "damages," voluntarily make any payments, or incur any "defense costs." SB300879C Ed.(06-16) Copyright, CNA All Rights Reserved. Page 6 of 12 CNA 3. Duties in the Event of a Potential "Claim" SB300879C Ed. 06-16) If, during the policy period, the Insured becomes aware of a "wrongful act" that may reasonably be expected to be the basis of a "claim" against the Insured, and provides us with a written notice stating the reasons for anticipating a "claim," with full particulars, including but not limited to: A. the specific "wrongful act;" B. the dates and persons involved; C. the identities of anticipated or possible claimants; D. the circumstances by which you first became aware of the potential "claim." then any "claim" that is subsequently made against an Insured and reported to us shall be deemed to have been made at the time such written notice was received by us. 4. Legal Action Against Us No person or organization has a right under this Coverage Form: A. To join us as a party or otherwise bring us into a "claim" against an Insured; or B. To sue us under this Coverage Form unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an Insured obtained after an actual trial, but we will not be liable for "damages" that are not payable under the terms of this Coverage Form or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the Insured and the claimant or the claimant's legal representative. 5. Representations By accepting this Coverage Form you agree: A. The statements contained in the application for this Coverage Form are accurate and complete; and, B. We have issued this Coverage Form in reliance upon your representations. 6. When We Do Not Renew If we decide not to renew this Coverage Form, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. 7. Economic and Trade Sanctions In accordance with laws and regulations of the United States concerning economic and trade embargoes, this policy is void from its inception with respect to any term or condition that violates any laws or regulations of the United States concerning economic and trade embargoes including, but not limited to the following: 0NO A. Any Insured, or any person or entity claiming the benefits of an Insured, who is or becomes a Specially Designated National or Blocked Person or who is otherwise subject to U.S. economic or trade sanctions; B. Any claim that is brought in a Sanctioned Country or by a Sanctioned Country Government, where any action in connection with such claim is prohibited by U.S. economic or trade sanctions; C. Any claim that is brought by any Specially Designated National or Blocked Person or any person or entity who is otherwise subject to U.S. economic or trade sanctions; D. Property that is located in a Sanctioned Country or that is owned by, rented to or in the care, custody or control of a Sanctioned Country Government, where any activities related to such property are prohibited by U.S. economic or trade sanctions; or E. Property that is owned by, rented to or in the care, custody or control of a Specially Designated National or Blocked Person, or any person or entity that is otherwise subject to U.S. economic or trade sanctions. As used in this Policy a Specially Designated National or Blocked Person is any person or entity that is on the list of Specially Designated Nationals and Blocked Persons issued by the U.S. Treasury Department's Office of Foreign Asset Control (O.F.A.C.) as it may be from time to time amended. SB300879C Ed.(06-16) Copyright, CNA All Rights Reserved. Page 7 of 12 CNA SB300879C Ed. 06-16) As used in this Policy a Sanctioned Country is any country that is the subject of trade or economic embargoes imposed by the laws or regulations of the United States of America. V. EXTENDED REPORTING PERIODS 1. We will provide one or more Extended Reporting Periods, as described below, if: A. This Coverage Form is canceled or not renewed by either party for any reason except non-payment of the premium; or B. We renew or replace this Coverage Form with insurance that: 1) Has a Retroactive Date later than the date shown in the Declarations of this Coverage Form; or 2) Does not apply to "damages" on a "claims" -made basis. 2. Extended Reporting Periods do not extend the policy period or change the scope of coverage provided. They apply only to "claims" made against an insured and reported to us during the Extended Reporting Period for wrongful acts" that occur after the Retroactive Date shown in the Declarations and before the end of the policy period. Once in effect, Extended Reporting Periods may not be canceled. 3. An Automatic Extended Reporting Period is automatically provided without additional charge. This period starts with the end of the policy period and lasts for 90 days after the policy period. "Claims" first made against an insured and reported to us during the Automatic Extended Reporting Period in accordance with Section IV., paragraph 2. Duties in the Event of a "Claim," will be deemed to have been reported on the ending date of this policy. The Automatic Extended Reporting Period will not reinstate or increase the Limits of Insurance. The Automatic Extended Reporting Period does not apply to "claims" that are covered under any subsequent insurance you purchase, or that would be covered but for exhaustion of the amount of insurance applicable to such "claims." 4. A Supplemental Extended Reporting Period is available, but only by an endorsement and for an extra charge. This supplemental period, if purchased, will run concurrently with the automatic Extended Reporting Period set forth in paragraph 3. above. You must give us a written request for the endorsement within 90 days after the end of this policy period. The Supplemental Extended Reporting Period will not go into effect unless you pay the additional premium promptly when due. The additional premium for the Supplemental Extended Reporting Period is a percentage of the total policy premium for this coverage part attributable to the policy period in effect upon such cancellation or nonrenewal. For a one year extension, the premium equals seventy five percent (75%) of such total policy premium; for a two year extension, the additional premium equals one hundred and twenty five percent (125%) of such total policy premium; and for a three year extension, the additional premium equals one hundred and fifty percent (150%) of such total policy premium. The Supplemental Extended Reporting Period will not reinstate or increase the Limits of Insurance. We will determine the additional premium in accordance with our rules and rates. VI. "TAKEOVER" OF FIRST NAMED INSURED In the event of a "takeover" of the first Named Insured, coverage under this Policy shall continue until this Policy is otherwise terminated, but only with respect to "wrongful acts" that take place before the effective date of the takeover," unless: 1. we are notified in writing of the "takeover" prior to the "takeover" effective date and we agree in writing to provide coverage for "wrongful acts" occurring on or after such effective date, and 2. you accept any special terms, conditions, exclusions or additional premium charge required by us. VII. ESTATES The estates, heirs, legal representatives and any "domestic partner" of a natural person Insured shall be insured under this Policy; provided, however, coverage is afforded to such estates, heirs, legal representatives and "domestic partners" only for a "claim" arising solely out of their status as such and, in the case of a "domestic partner," where such "claim" seeks "damages" from marital community property, jointly held property or property transferred from such Insured to the "domestic partner." No coverage is provided for any act, error or omission of an estate, heir, legal representative or "domestic partner." All terms and conditions of this Policy, including without limitation the deductible, SB300879C Ed.(06-16) Copyright, CNA All Rights Reserved. Page 8 of 12 CNA SB300879C Ed. 06-16) applicable to "damages" or "defense costs" incurred by the Insured shall also apply to "damages" and "defense costs" incurred by such estates, heirs, legal representatives, assigns and "domestic partners." VIII. DEFINITIONS Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products, or services for the purpose of attracting customers or supporters. For the purposes of this definition: 1. Notices that are published include material placed on the Internet or on similar electronic means of communication; and 2. Regarding web -sites, only that part of a web -site that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. Claim" means: 1. a written demand for monetary damages or non -monetary relief (including demands for injunctive or declaratory relief) against an Insured alleging a "wrongful act," which "claim" shall be deemed made on the date of the Insureds' receipt of such written demand; or 2. a written request received by the Insured to toll or waive a statute of limitations in connection with a "claim" as defined in paragraph 3. below. Such "claim" shall be deemed made on the date of the Insureds' receipt of such written request; 3. a civil proceeding in a court of law or equity or any alternative dispute resolution proceeding; against an Insured, alleging a "wrongful act," including any appeal therefrom. Such "claim" shall be deemed made on the earliest of the date of service upon or other receipt by any Insured of a complaint, written notice of subpoena, or similar document of service in such proceeding, or arbitration. However, a "claim" does not include any criminal proceeding, criminal administrative or criminal regulatory proceeding or criminal investigation or informal civil investigation. Coverage territory" means anywhere in the world. Damages" means awards, settlements, judgments (including any award of pre -judgment and post -judgment interest on a covered judgment) and "defense costs" for which any Insured is legally obligated to pay on account of a covered claim." However, "damages" does not include: 1. any amount for which an Insured is absolved from payment by reason of any covenant, agreement or court order; 2. any matters which are uninsurable under the law pursuant to which this Policy shall be construed; 3. civil or criminal fines, penalties, taxes, sanctions or forfeitures, imposed on an Insured whether pursuant to law, statute, regulation; 4. fees, costs and expenses paid or incurred or charged by any Insured, no matter whether claimed as restitution of specific funds, financial loss, set-off or paid in the form of service credits or other non-cash consideration by the Insured; 5. liquidated damages pursuant to a written contract or agreement in excess of the Insured's liability caused by the wrongful act;" 6. funds, monies, or securities that an Insured transferred or failed to transfer; 7. the cost of any non -monetary relief, including without limitation any costs associated with compliance with any injunctive relief of any kind or nature imposed by any judgment or settlement; or 8. the fees, costs and expenses, including refund of any money, incurred to comply with a warranty or guarantee. Notwithstanding paragraph 2. above, "damages" shall include (subject to this Policy's other terms, conditions and limitations), punitive and exemplary damages and the multiplied portion of multiplied awards. Enforceability of this paragraph shall be governed by such applicable law that most favors coverage for such punitive, exemplary and multiplied amounts. As used herein, "applicable law" means the law of any of the following jurisdictions: A. where the "claim" seeking such "damages" is brought or where such "damages" are awarded or imposed; B. where the "wrongful act" giving rise to the "claim" occurred; SB300879C Ed.(06-16) Copyright, CNA All Rights Reserved. Page 9 of 12 CNA SB300879C Ed. 06-16) C. where the Insureds, subject to such "damages," are incorporated, have their principal place of business or reside; or D. where we are incorporated or have our principal place of business. Defense Costs" means: 1. all fees charged by attorneys designated by us; 2. all reasonable and necessary: A. fees charged by attorneys designated by you with our written consent; and B. fees, costs and expenses resulting from the investigation, adjustment, defense and appeal of a "claim" if incurred by us, or by an Insured with our written consent, including the costs of appeal, attachment or similar bonds. We have no obligation to provide such bonds. However, "defense costs" does not include salaries, wages, fees, overhead or benefit expenses associated with your directors, officers, employees, nor do "defense costs" include any fees or expenses of any third party contractors hired by an Insured to assist in any defense related activity. Domestic Partner" means any spouse and any person qualifying as a domestic partner under any federal, state or local laws or under your employee benefit plans. Employee" means all your past, present or future full-time or part-time employees, including seasonal and temporary employees and employees leased or loaned to you. "Employee" does not include any independent contractor. ERISA or any Similar Act" means the Employee Retirement Income Security Act of 1974, as amended or any similar common or statutory law of the United States, Canada or their states, territories or provinces or any other jurisdiction anywhere in the world. Executive Officer" means any of your past, present or future: 1. duly elected or appointed directors, officers, trustee governors or "managers;" 2. management committee members if you are a joint venture; or 3. officials, if you are organized and operated in a "foreign jurisdiction," who are holding a position that is equivalent to an executive officer position listed in 1. above. Foreign Jurisdiction" means any jurisdiction, other than the United States or any of its territories or possessions. Manager" means any manager, member of the Board of Managers or equivalent "executive officer" of yours if you are a limited liability company. Management Control" means: 1. owning interests representing more than 50% of the voting, appointment or designation power for the selection of a majority of the Board of Directors of a corporation; the management committee members of a joint venture; or the members of the management board of a limited liability company; or 2. having the right, pursuant to written contract or your by-laws, charter, operating agreement or similar documents, to elect, appoint or designate a majority of the Board of Directors of a corporation; the management committee of a joint venture; or the management board of a limited liability company. Occurrence" means an accident, including continuous or repeated exposure to substantially the same general harmful conditions. Personal Injury" means injury, including consequential "bodily injury," arising out of one or more of the following offenses: 1. False arrest, detention or imprisonment; 2. Malicious prosecution; 3. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies, committed by or on behalf of its owner, landlord or lessor; 4. Oral or written publication, in any manner, of material that slanders or libels a person or organization or disparages a person's or organization's goods, products or services; or SB300879C Ed.(06-16) Copyright, CNA All Rights Reserved. Page 10 of 12 S308 CNA (Ed006 6) 5. Oral or written publication, in any manner, of material that violates a person's right of privacy. Pollutants" means any substance exhibiting hazardous characteristics as is or may be defined or identified on any list of hazardous substances issued by the United States Environmental Protection Agency or any state, local or foreign counterpart. "Pollutants" also means, without limitation, any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals or waste (including materials to be recycled, reconditioned or reclaimed), as well as any air emission, odor, waste water, oil or oil products, infectious or medical waste, asbestos, or asbestos products or any noise. Property Damage" means: 1. physical injury to tangible property, including 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 2. loss of use of tangible property that is not physically damaged which is caused by an "occurrence;" however, this paragraph 2. shall not apply to telecommunication services. Tangible property does not include electronic data. As used in this exclusion, 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 controlled equipment. Proprietary Injury" means: 1. plagiarism or misappropriation of ideas; 2. infringement or misappropriation of copyright, title, slogan, trademark, trade name, trade dress, service mark or service name, including, infringement of copyright on software, computer code and computer firmware; 3. infringement or interference with the rights of publicity; 4. the use of another's advertising idea in your "advertisement;" or 5. infringement of another's copyright, trade dress or slogan in your "advertisement." Related Wrongful Acts" means any "wrongful acts" which are logically or causally connected by reason of any common fact, circumstance, situation, transaction or event. Takeover" means: 1. the acquisition by another entity or person, or group of entities or persons acting in concert, of: A. the "management control" of the first Named Insured; or B. assets of first Named Insured resulting in the ownership of more than 50% of the total consolidated assets of the first Named Insured as of the date of the first Named Insured's most recent audited consolidated financial statement prior to such acquisition; the merger of the first Named Insured into another entity such that first Named Insured is not the surviving entity; or 3. the consolidation of the first Named Insured with another entity. Wrongful Act" means any actual or alleged act, error, omission, neglect or breach of duty:" 1. committed solely in the conduct of "your work," or 2. resulting in the failure of "your product" to perform the function or serve the purpose intended. Your product" 1. means: A. any goods or products, other than real property, manufactured, sold, handled, distributed or disposed of by: 1) you; 2) others trading under your name; or 3) a person or organization whose business or assets you have acquired; and SB300879C Ed.(06-16) Copyright, CNA All Rights Reserved. Page 11 of 12 CNA SB300879C Ed. 06-16) B. containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products. 2. includes: A. warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your product;" and B. the providing of or failure to provide warnings or instructions. Your work" 1. means: A. work or operations performed by you or on your behalf; and B. materials, parts or equipment furnished in connection with such work or operations. 2. includes: A. warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your work;" and B. the providing of or failure to provide warnings or instructions. IN WITNESS WHEREOF, we have caused this Coverage Form to be executed by our Chairperson and Secretary, but this Coverage Form shall not be binding upon us unless completed by the attachment of the declarations and executed by our duly authorized representative. Chairman Secretary SB300879C Ed.(06-16) Copyright, CNA All Rights Reserved. Page 12 of 12 CNA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INFORMATION RISK ENDORSEMENT NETWORK SECURITY AND PRIVACY INJURY LIABILITY) This endorsement modifies insurance provided under the following: TECHNOLOGY ERRORS & OMISSIONS LIABILITY COVERAGE FORM SB300881 D Ed. 6-16) Information Risk Sublimits of Insurance and Deductible Sublimit of Insurance: Deductible: Privacy Regulation Proceeding" Sublimit of Insurance: $300000 2500 Privacy Event Expense" Sublimit of Insurance: $300000 2500 Network Extortion Expense" Sublimit of Insurance: $300000 2500 I. Section I, COVERAGE, Paragraph 1. Insuring Agreement, Part A. is amended to add the following at the end: 1. We will pay those sums that the Insured becomes legally obligated to pay as "damages" because of: A. Network Security Liability any covered "claim" for: 1) the unscheduled and unplanned inability of an authorized user to gain access to the "network;" 2) the unauthorized destruction or alteration of any third -party's information residing on the "network;" or 3) the suspension or interruption of the "network;" by reason of a "wrongful act" by the Insured or by someone for whom the Insured is legally responsible; B. Privacy Injury Liability any covered "claim" for: 1) any unauthorized disclosure of, inability to access, inaccuracy in, or the Insured's failure to prevent unauthorized access to, "nonpublic personal information;" or, 2) the Insured's failure to implement and maintain procedures designed to protect "nonpublic personal information" from unauthorized use or disclosure, in violation of: a. your "privacy policy;" or, b. any federal, state, foreign or other law, statute or regulation governing the confidentiality, integrity, or accessibility of non-public personal information, including but not limited to the Health Insurance Portability and Accountability Act of 1996, Gramm -Leach -Bliley Act, Children's Online Privacy Protection Act, the EU Data Protection Act, or the Fair and Accurate Credit Transactions Act; and, 3) any unauthorized disclosure of or an Insured's failure to prevent unauthorized access to "nonpublic corporate information;" by reason of a "wrongful act" by the Insured or by someone for whom the Insured is legally responsible; C. Privacy Regulation Proceeding any covered "privacy regulation proceeding" (including "privacy regulation fines") by reason of a "wrongful act" by the Insured or by someone for whom the Insured is legally responsible; provided that: a) The "wrongful act" takes place in the "coverage territory;" b) The "wrongful act" occurs after the Retroactive Date shown in the Declarations and prior to the end of the policy period; SB300881 D (Ed. 6-16) Page 1 of 5 Copyright, CNA All Rights Reserved. 30 CNA S ( Ed06-1 ) c) A "claim" is first made against an Insured during the policy period and reported to us, in accordance with Section IV, CONDITIONS, Paragraph 2, Duties in the Event of a "Claim;" and d) Prior to the inception date of this Coverage Form or the first such Coverage Form issued and continuously renewed by us, of which this Coverage Form is a renewal, whichever is earlier, a. no "executive officer" knew of any circumstances which might have resulted in a "claim;" and b. the "wrongful act," or any "related wrongful act' has not been the subject of any notice given under any prior coverage form. Subject to any applicable limit of insurance, we will also pay "defense costs" in connection with such covered claim." 2. Supplemental Liability Coverage A. Privacy Event Expense If the "privacy event expense" reimbursement coverage has been purchased, as indicated above, we will pay the Insured for "privacy event expenses," in excess of any deductible and up to the applicable limit of liability, it incurs in response to a "privacy event', provided that all "privacy event expenses" must be: a. reported to us, in accordance with Section IV, CONDITIONS, Paragraph 2, Duties in the Event of a Claim;" b. incurred within twelve months following the date that the Insured reports the event to us; and, c. consented to in advance in writing by us (such consent not to be unreasonably withheld). B. Network Extortion Expense If the "network extortion expense" Reimbursement coverage has been purchased, as indicated above, we will pay the Insured for "network extortion expenses," in excess of any deductible and up to the applicable limit of liability, it incurs to directly respond to a "network extortion" made during the policy period; provided, that all network extortion expenses" must be: 1) reported to us, in accordance with Section IV, CONDITIONS, Paragraph 2, Duties in the Event of a Claim;" 2) incurred within twelve months of the date that the Insured reports the "network extortion" to us; and, 3) consented to in writing by us (such consent not to be unreasonably withheld). II. Solely with respect to the coverage provided by this endorsement, Section I. COVERAGE, Paragraph 2. Exclusions, the Bodily Injury/Property Damage, Claims by Insureds and Governmental Actions exclusions are deleted in their entirety and replaced with the following: Bodily Injury/Property Damage based upon or arising out of any actual or alleged: bodily injury (including death), sickness, disease, emotional distress, mental anguish, of any person, or "property damage," except that this exclusion shall not apply to the wrongful infliction of emotional distress or mental anguish arising under Insuring Agreement 2. Privacy Injury Liability; Claims by Insureds by or on behalf of any Insured in any capacity provided, except that this exclusion shall not apply to: A. any "claim" that is in the form of a cross claim, third -party claim or otherwise for contribution or indemnity which is part of and results directly from a "claim" which is not otherwise excluded under this Coverage Form; or B. any "claim" brought or maintained by or on behalf of a bankruptcy or insolvency trustee, examiner, liquidator, receiver or rehabilitator for you or any assignee of such trustee, examiner, liquidator, receiver or rehabilitator; C. any "claim" brought by an Insured, other than you, for privacy injury; SB300881 D (Ed. 6-16) Page 2 of 5 Copyright, CNA All Rights Reserved. 30 CNA S ( Ed06-1 ) Governmental Actions based upon or arising out of any action or order by any domestic or foreign law enforcement, administrative, regulatory or judicial body or other governmental authority, to ban, limit or restrict access to, or provide access to, or intercept, confiscate, monitor or analyze, the "network" or any data, software or other information stored or processed on, or transmitted to or from, the "network," whether authorized by the Insured or not, including without limitation, interception, monitoring, or analysis by the NSA, CIA or FBI, or under the Foreign Intelligence Surveillance Act, the USA Patriot Act or any other domestic or foreign law, regulation or order. III. Solely with respect to the coverage provided by this endorsement, Section I. COVERAGE, Paragraph 2. Exclusions, is amended to include the following additional exclusion: The insurance does not apply to any "claim:" Software based upon or arising out of the inability to use or lack of performance of software programs that result from the Insured's modification of software programs in violation of any software license agreement, including but not limited to, violation of license provisions regarding modifications that invalidate a warranty; Video Game Property based upon or arising out of any theft or unlawful exchange of computer or video game currency, points, earnings, awards or other such intangible property. IV. Solely with respect to the coverage provided by this endorsement, Section I. COVERAGE, Paragraph 2. Exclusions, the exclusion for Patent Infringement/Trade Secrets is deleted in its entirety and replaced with the following: Patent Infringement based upon or arising out of actual or alleged misappropriation or infringement of patent; V. Section III. LIMITS OF INSURANCE AND DEDUCTIBLE is amended to include the following sublimits of liability: A. The coverage provided by this endorsement shall not be construed to increase the Limit of Insurance set forth on the Declarations. The amounts set forth in the table above are sublimits of Insurance which further reduce, and in no way increase, the applicable each "claim" and Aggregate Limits of Insurance set forth on the Declarations. B. Subject to the Aggregate Limit shown in the Declarations, the amount set forth in the table above, if any for privacy regulation proceedings," is the most we will pay for the sum of "damages" and "defense costs" for all privacy regulation proceedings" to which this insurance applies. C. Subject to the Aggregate Limit shown in the Declarations, the amount set forth in the table above, if any, for privacy event expenses" and "network extortion expenses" is the most we will pay for all "privacy event expense" and "network extortion expenses" to which this insurance applies. VI. Solely with respect to the coverage provided by this endorsement, Section VIII. DEFINITIONS, the definition of claim," and "wrongful act" are deleted in their entirety and replaced with the following: N Claim" means: A. a written demand for monetary damages or non -monetary relief (including demands for injunctive or declaratory relief) against an Insured alleging a "wrongful act," which "claim" shall be deemed made on the date of the Insureds' receipt of such written demand; or B. a "privacy regulation proceeding," against an Insured, alleging a "wrongful act," including any appeal therefrom. Such "claim" shall be deemed made on the earliest of the date of service upon or other receipt by any Insured of a complaint, written notice of subpoena, or similar document of service in such proceeding, or arbitration; C. a written request received by the Insured to toll or waive a statute of limitations in connection with a "claim" as defined in paragraph A. and B., which "claim" shall be deemed made on the date of the Insureds' receipt of such written request; However, a "claim" does not include any criminal proceeding or criminal or civil investigation. Nor does "claim" include any regulatory proceeding except if the regulatory proceeding is a "privacy regulation proceeding." Wrongful Act" means any actual or alleged act, error, omission, neglect or breach of duty. SB300881 D (Ed. 6-16) Page 3 of 5 Copyright, CNA All Rights Reserved. CNA SB300881 D Ed. 6-16) VII. Solely with respect to the coverage provided by this endorsement, Section VIII. DEFINITIONS, the definition of damages," is amended to add the following at the end: Damages" shall include "privacy regulation fines." VIII. Solely with respect to the coverage provided by this endorsement, Section VIII. DEFINITIONS, is amended to add the following new definitions: Denial of Service Attack" means an attack executed over one or more networks or the Internet, which attack is specifically designed and intended to disrupt the operation of a network and render a network inaccessible to authorized users. Network" means a party's local or wide area network owned or operated by or on behalf of or for the benefit of that party; provided, however, "network" shall not include the internet, telephone company networks, or other public infrastructure network (collectively "public infrastructure network") unless such public infrastructure network is operated and controlled exclusively by you. Nonpublic Corporate Information" means proprietary trade secret information owned by a third -party that is in your care, custody or control by operation of law or pursuant to a contractual obligation that requires you to maintain the confidentiality of such proprietary trade secret information. Nonpublic Personal Information" means two or more elements of information not available to the general public from which an individual may be identified, including without limitation, an individual's name, address, telephone number, social security number, account relationships, account numbers, account balances, and account histories. Network Extortion" means a third party demand to you for money or securities in exchange for: 1. the return of your confidential information or the confidential information of others in your care, custody or control; 2. not disclosing your confidential information or confidential information in your care, custody or control to unauthorized recipients; 3. not publicizing that your "network" will be or has been impaired, compromised or destroyed; 4. not impairing, altering or destroying your "network" or website; provided that the "executive officers" reasonably believe that the third party's demand is credible and that there is imminent and probable danger that the third party can execute on its demand. Network Extortion Expense" means all reasonable and necessary expenses incurred by you in order to directly respond to a "network extortion," including the payment of money or securities demanded by a third party, provided, that the payment of money or securities demanded by a third party must be made in conjunction with, and at the direct direction of, any law enforcement agency conducting an investigation of the "network extortion." Privacy Event" means any act, error or omission which, in the reasonable opinion of an "executive officer" did cause or is reasonably likely to result in the unauthorized disclosure or unauthorized use of "nonpublic personal information" or "nonpublic corporate information." Privacy Event Expenses" means all reasonable and necessary fees, costs and expenses incurred by you and consented to by us: A. to provide voluntary notification to individuals or entities whose "nonpublic personal information" or "nonpublic corporate information' may have been subject to a "privacy event"; B. to directly effect compliance with a "security breach law" including notification to individuals or entities who are required to be notified; C. to hire a computer forensics firm to investigate the existence and cause of a "privacy event" and to determine the extent such "nonpublic personal information" or "nonpublic corporate information" has been or may have been disclosed; D. to hire an attorney or expert to negotiate with regulators and determine the applicability of and the actions necessary to comply with "security breach notice laws"; E. to minimize harm to your reputation from a "privacy event", including but not limited to the costs to set up a call center or provide a credit monitoring service for those impacted by a "privacy event"; or SB300881 D (Ed. 6-16) Page 4 of 5 Copyright, CNA All Rights Reserved. CNA S ( Ed. 6-16) F. to remediate any deficiencies that gave rise to the "privacy event." Privacy Regulation Fines" means civil fines, sanctions or penalties imposed under any "privacy regulation proceeding" for a violation of any "security breach notice law" or any law, statute or regulation governing the confidentiality, integrity or accessibility of "nonpublic personal information" or "nonpublic corporate information" such fines are insurable under applicable law. Privacy Regulation Proceeding" means a civil, administrative or regulatory proceeding against an Insured by a federal, state or foreign governmental authority alleging a violation of any "security breach notice law" or any law, statute or regulation governing the confidentiality, integrity or accessibility of "nonpublic personal information" or nonpublic corporate information." Privacy Policy" means your policies in written or electronic form that: A. govern the collection, dissemination, confidentiality, integrity, accuracy or availability of "nonpublic personal information;" and, B. you provide to those customers, employees or others who provide you with "nonpublic personal information." Security Breach" means the failure of your "network" hardware, software, or firmware, the function or purpose of which is to: A. identify and authenticate parties prior to accessing your "network;" B. control access to your "network" or monitor and audit such access; C. protect against malicious code; D. defend against "denial of service attacks" or co-option of your "network" to perpetrate a "denial of service attack" against others; or, E. ensure confidentiality, integrity and authenticity of information on your "network." Security Breach Notice Law" means any statute or regulation that requires an entity storing "nonpublic personal information" to provide notice to specified individuals of any actual or potential "security breach" with respect to such nonpublic personal information." All other terms and conditions of the Policy remain unchanged. SB300881 D (Ed. 6-16) Page 5 of 5 Copyright, CNA All Rights Reserved. CNA SB -14 01/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS INCOME AND EXTRA EXPENSE - DEPENDENT PROPERTY This endorsement modifies insurance provided under the following: BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FORM BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extensions. Unless otherwise stated, payments made under the following Coverage Extension is subject to and not in addition to the applicable Limits of Insurance. Business Income and Extra Expense — Dependent Property 1. When the Declarations show that you have coverage for Business Income and Extra Expense, you may extend that insurance to apply to the actual loss of Business Income you sustain and reasonable and necessary Extra Expense you incur due to the "suspension" of your 'operations" during the "period of restoration." The suspension" must be caused by direct physical loss or damage at the premises of a Dependent Property, caused by or resulting from a Covered Cause of Loss. 2. Dependent Property means property operated by other whom you depend on to: a. Deliver materials or services (other than water supply services," "communication supply services" or "power supply services") to you, or to others for your account Contributing Locations); b. Accept your products or services (Recipient Locations); c. Manufacture products for delivery to your customers under contract of sale Manufacturing Locations); or d. Attract customers to your business (Leader Locations). 3. With respect to this Coverage Extension, the period of restoration": a. Begins 24 hours after the time of direct physical loss or damage caused by or SB -146823-B Ed. 01/08) resulting from any Covered Cause of Loss at the premises of the Dependent Property; b. Ends on the date when the property at the premises of the Dependent Property should be repaired, rebuilt or replaced with reasonable speed and similar quality; and c. Does not include any increased period required due to the enforcement of any ordinance or law that: 1) Regulates the construction, use or repair, or requires the tearing down of any property; or 2) Requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of pollutants." 4. This Coverage Extension: a. Applies to Dependent Property premises located within the Coverage Territory; and b. Does not apply when you have more specific insurance under any other policy. 5. We will reduce the amount of your Business Income loss, other than Extra Expense, to the extent you can resume 'operations" in whole or in part, by using any other available: a. Source of materials; or b. Outlet for your products. 6. The most we will pay for Business Income and Extra Expense under this Coverage Extension is 10,000, or the limit shown in the Declarations, whichever is higher, regardless of the number of described premises or number of Dependent Properties involved. 7. Payments made under this Coverage Extension are in addition to the applicable Limits of Insurance. Page 1 of 1 CNA SB -146824-B Ed. 01/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS INCOME AND EXTRA EXPENSE - NEWLY ACQUIRED LOCATIONS This endorsement modifies insurance provided under the following: BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FORM BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM The following coverage is added to your Businessowners Special Property Coverage Form under Paragraph A.6. Coverage Extensions. Unless otherwise stated, payments made under the following Coverage Extension is subject to and not in addition to the applicable Limits of Insurance. Business Income and Extra Expense — Newly Acquired Premises 1. When the Declarations show that you have coverage for Business Income and Extra Expense, you may extend that insurance to apply to the actual loss of Business Income and necessary Extra Expense you incur due to the suspension" of your 'operations" during the period of restoration." The "suspension" must be caused by or resulting from a Covered Cause of Loss at any premises you newly acquire by purchase or lease (other than at fairs, trade shows or exhibitions). SB -146824-B Ed. 01/08) 2. The most we will pay under this coverage for the sum of Business Income and Extra Expense incurred is $250,000 at each location. 3. Insurance under this extension for each newly acquired location will end when any of the following first occurs: a. This policy expires; b. 90 days expire after you acquire or begin to construct the property; c. You report the location to us; d. The Business Income or Extra Expense is more specifically insured. We will charge you additional premium for locations reported from the date you acquire the property. 4. Payments made under this Coverage Extension are in addition to the applicable Limits of Insurance. Page 1 of 1 CNA Policy Holder Notice e . EXCLUSION APPLICABLE TO ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION This Notice does not form part of your policy. No coverage is provided by this Notice nor can it be construed to replace any provision of your policy. You should read your policy and review your Declarations page for complete information on the coverages you are provided. If there is any conflict between the Policy and this Notice, THE PROVISIONS OF THE POLICY SHALL PREVAIL. Carefully read your policy, including the endorsements attached to your policy. This Notice provides information concerning the following new endorsement which applies to your renewal policy being issued by us: CNA79203XX Exclusion — Access Or Disclosure Of Confidential Or Personal Information And Data -Related Liability — With Limited Bodily Injury Exception Under this endorsement, coverage is excluded for damages arising out of any access to or disclosure of confidential or personal information. With respect to liability for "bodily injury" or "property damage," the exclusion of damages arising out of any access to or disclosure of confidential or personal information is a reinforcement of coverage intent. But this endorsement also broadens coverage in that it adds an exception for damages because of "bodily injury" arising out of certain loss of or inability to access electronic data, so long as such "bodily injury" does not also arise out of any access to or disclosure of confidential or personal information. With respect to liability for "personal and advertising injury," to the extent that any access or disclosure of confidential or personal information results in an oral or written publication that violates a person's right of privacy, this may result in a reduction in coverage. CNA79240XX (06-14) Copyright, CNA Includes copyrighted materials of Insurance Services Office Page 1 of 1 used with their permission. CNA FOR OUR CNA CONNECT POLICYHOLDERS POLICY LIMITATION DISCLOSURE NOTICE HIRED • AND NON -OWNED• LIABILITY COVERAGE•. No Coverage is provided by this policyholder notice, nor can it be construed to replace any provisions of your policy. You should read your policy and review your declarations page for complete information on the coverage you are provided. If there is any conflict between the policy and this summary, the provisions of the policy shall prevail. Please read your policy, the endorsements attached to your policy and this notice carefully. CHANGES TO YOUR POLICY: The Hired Auto and Non -Owned Auto Liability Coverage Form has been updated as follows: To further clarify coverage intent when Hired Auto and Non -Owned Auto is Excess or Primary, Paragraph G. has been added. G. With respect to the operation of a "hired auto" and "non -owned auto," Paragraph H, of the Businessowners Common Policy Conditions is deleted and replaced with the following: H. Other Insurance 1. Except for any liability assumed under an "insured contract" the insurance provided by this Coverage Form is excess over any other collectible insurance. However, if your business is the selling, servicing, repairing, parking or storage of autos," the insurance provided by this endorsement is primary when covered bodily injury" or "property damage" arises out of the operation of a customer's auto" by you or your "employee." 2. When this Coverage Form and any other Coverage form or policy covers on the same basis, either excess or primary, we will pay only our share. Our share is 0 the proportion that the Limit of Insurance of our Coverage Form bears to the total of the limits of all the Coverage Forms and policies covering on the same basis. 0 SB -301 000-A Copyright, Insurance Services Office, Inc., 2004 Page 1 of 1 Ed. 04/10) CNA 333 S Wabash Chicago, Illinois 60604 Policy NumberFrom Policy Period To Coverage Is Provided By Agency B6021537469 06/02/18 06/02/19 Valley Forge Insurance Company 069154244 Named Insured And Address Agent INET, Inc. IVES INSURANCE SERVICES, INC. 1050 ROSECRANS ST STE G 2850 WOMBLE RD, STE. 103 SAN DIEGO, CA 92106 SAN DIEGO, CA 92106 PAYMENT PLAN SCHEDULE ** THE BILLING FOR THIS POLICY WILL BE FORWARDED TO YOU DIRECTLY FROM CNA. THIS PREMIUM WILL BE INVOICED BY CNA ON A SEPARATE STATEMENT ACCORDING TO THE PAYMENT OPTION YOU SELECT. ISSUE DATE 04/18/18 ACOKO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD YYW) L..i' 04/30/2019 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Robert Tartre Ives Insurance Services, Inc. PHONE FAX Ext): (619)2245337 Arc No: (619)223-47162850WombleRoad, Suite 103 JL MAN 6021537469 ADDRESS: robert@ivesins.com San Diego, CA 92106 EACH OCCURRENCE 2,000,000 License #: OG13604 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: CNA Insurance INSURED INSURER B: The Hartford Insurance Company DAMAGE TO RENTED PREMISES (Ea occurrence) INET, Inc. MED EXP (Any one person) DBA IPARQ INSURER C 1050 Rosecrans St Ste G INSURER D: San Diego, CA 92106 INSURER E : 2,000,000 INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 19 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 LTR TYPE OF INSURANCE ADDLSUBRPOLICY IVSD WVD POLICY NUMBER EFF MM DDYWY POLICYMMDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 6021537469 06/02/2018 06/02/2019 EACH OCCURRENCE 2,000,000 CLAIMS -MADE [XI OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) 300,000 MED EXP (Any one person) 10,000 PERSONAL &ADV INJURY 2,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 4,000,000GEN'L X POLICY a PRO- JECT L_ LOC PRODUCTS - COMP/OP AGG 4,000,000 OTHER: AUTOMOBILE LIABILITY 6021537469 06/02/2018 06/02/2019 BINEDAEOaacccident)S LE LIMIT 1,000,000 BODILY INJURY (Per person) ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE Per accidentXHIREDNON -OWNED AUTOS ONLY X AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATEEXCESSLIABHCLAIMS-MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEF7E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE- EA EMPLOYEMandatoryinNH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT A IT/Professional Liab 6021537469 06/02/2018 06/02/2019 Aggregate 1,000,000 B Crime Bond 72TP0294464-18 02/04/2018 02/04/2019 Employee Theft 1 mm DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate holder is additional insured per blanket Al endorsement Primary and Non -Contributory wording included Waiver of Subrogation Included CERTIFICATE HOLDER CANCELLATION 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by RJT on April 30, 2019 at 01:12PM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Bremerton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Risk Management ACCORDANCE WITH THE POLICY PROVISIONS. 345 6th Street, Suite 100 AUTHORIZED REPRESENTATIVE Bremerton, WA 98337 Rd l t T&C RJT) 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by RJT on April 30, 2019 at 01:12PM INETINC-01 NSEVERSON co ro,,, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/1/2019 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE FAX A/C, No, Ext): (A/C, No): AP Intego Insurance Group, LLC 1601 Trapelo Rd Suite 280 Waltham, MA 02451 E-MAILsupport@apintego.com INSURERS AFFORDING COVERAGE NAIC # INSURERA : Travelers*** 99999 INSURED INSURER B : GEN'L INSURER 7iNetIncDBAIPARQ INSURER D : 1050 Rosecrans Street Suite G San Diego, CA 92106 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER- REVISION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRLTR TYPE OF INSURANCE ADDLINSD SUBRWVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS AUTHORIZED REPRESENTATIVE COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES Ea occurrence GEN'L MED EXP (Any oneperson) PERSONAL & ADV INJURY AGGREGATE LIMIT APPLIES PER: jECT [::] LOCPOLICYEl JO OTHER: GENERAL AGGREGATE PRODUCTS - COMP/OPAGG AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident BODILY INJURY Perperson) BODILY INJURY Per accident PROPERTY DAMAGE Per accident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A UB4J201589 5/28/2018 5/28/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE- EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of BremertonCity THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 345 6th Street STE 100 Bremerton, WA 98337 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SAFETY SERVICES Notice to policy recipient: If you are not the person directly responsible for the accident prevention activities for your company, please direct this Safety Services notice to the person that is directly responsible for them. SAFETY IS OUR CONCERN Thank you for purchasing your insurance from one of the writing companies owned or managed by The Travelers Companies, Inc. We appreciate your business and welcome the opportunity to be of service. An important part of that service concerns safety and accident prevention. Travelers Risk Control department has the experience, resources and capabilities to provide a range of safety services, including site surveys, phone consultations, as well as provide access to numerous safety-related materials. We have experience in a variety of industries, some of which include manufacturing, wholesale and retail businesses, service organizations, technology -related business, oil and gas -based business, and the public sector. Following are some examples of available safety services: Accident Prevention — Our staff can help you identify present and potential hazards in your operations, premises and equipment, and recommend measures for reducing or eliminating these hazards. Analysis of Accident Causes — Although you investigate and keep records of accidents, we are available to assist if needed. Safety Consultations — Our Consultants can help you with special problems such as ergonomics and human factors. Industrial Hygiene/Health Services — We have the facilities and resources to answer your questions concerning job related industrial hygiene/health issues and to measure exposure to industrial hygiene hazards. Safety Literature and Digital Media — We can provide you with top-notch safety-related literature, CDs, DVDs, and videos to assist in your loss control efforts. Also, we can direct you to several vendors who are able to provide additional safety materials, including brochures, pamphlets and digital media. Safety Training — We offer face-to-face classroom courses, as well as distance learning programs that explore the risks our policyholders face and ways for them to control losses. Return -To -Work Coordination — We can assist you with several aspects of the post injury management process. Please note: For ALL loss control assistance requests, please contact your local office directly, which is listed on one of the following pages. These services are available upon request. See the remainder of this document for the Travelers' Risk Control office nearest you. These phone numbers should not be used for questions regarding your policy or claims. SAFETY IS YOUR CONCERN At Travelers, we are committed to doing all we can to help protect your business. As our customer, you have access to hundreds of safety materials specific to industry, size and complexity to help control hazards and reduce risks of illness or injury — with more than 700 focusing on workers' compensation issues. Take advantage of the Risk Control website at travelers.com/riskcontrol. Examples of what you will find include: Safety checklists, sample programs. You will find hundreds of resources in our Education Center including schedules of live classroom sessions and online webinars — more then 90 training options for workers' compensation alone. Alerts and newsletters that can be sent directly to you, to stay informed of the latest safety trends and regulatory topics. These resources can help you improve your workplace safety practices. We like to think of it as protection beyond the policy. Contact Us For more information, please visit travelers. com/riskcontrol. WUNT31315 Page 1 of 4 2014 The Travelers Indemnity Company. All rights reserved. Please call these numbers FOR SAFETY SERVICES ONLY For all other inquiries please contact your agent, underwriter or claim representative ALABAMA CALIFORNIA IDAHO Birmingham San Diego Sacramento, CA 3000 Riverchase Galleria 9325 Sky Park Court, Ste. 220 11070 White Rock Rd, Suite 130 Ste. 600 San Diego, CA 92123 Rancho Cordova, CA 95670 Birmingham, AL 35244 Risk Control: (949) 224-5789 Risk Control: (916) 852-5245 615) 660-6036 Claim: (800) 727-3995 Claims: 1-800-238-6214 ALASKA CALIFORNIA ILLINOIS Portland, OR Walnut Creek Chicago 4000 SW Kruse Place, Suite 100 225 Lennon Lane, Ste. 105 200 North LaSalle Street Lake Oswego, OR 97035 P.O. Box 8090 Suite 2200 503) 534-4276 Walnut Creek, CA 94596-8090 Chicago, IL 60601 Risk Control: (925) 945-4193 630) 961-8074 Claims: (800) 842-7354 Claims: 800-842-6172 ARIZONA COLORADO ILLINOIS Phoenix Denver Naperville 2401 W Peoria Ave., Suite 130 6060 S. Willow Dr. #300 215 Shuman Boulevard Phoenix, AZ 85029 Greenwood Village, CO 80111 P.O. Box 3208 Risk Control: (720) 200-835 720) 200-8355 Naperville, IL 60566 Claims: 720-200-8100 630) 961-8074 Claims: 800-842-6172 ARKANSAS CONNECTICUT INDIANA St. Louis, MO Hartford Indianapolis 940 West Port Plaza, Suite 270 300 Windsor Street Suite 300 St. Louis, MO 63146 Hartford, CT 06120 280 East 96th Street Risk Control: (314) 579-8282 860) 954-3741 Indianapolis, IN 46240 Claims: (860) 954-5190 317) 818-0174 Claims: 800-238-6210 CALIFORNIA DELAWARE IOWA Diamond Bar Philadelphia, PA Des Moines 21688 Gateway Center Drive 10 Sentry Parkway, Suite 300 7101 Vista Dr. P.O. Box 6512 Blue Bell, PA 19422 West Des Moines, IA 50266-9313 Diamond Bar, CA 91765-8512 215) 274-1610 651)-310-7834 Risk Control: (949) 224-5789 Claims: 1-800-368-3562 Claims: 800-255-5072 Claims: (909) 612-3000 CALIFORNIA DISTRICT OF COLUMBIA KANSASGlendaleWashington, DC Kansas City655N. Central Avenue, #1600 14200 Park Meadow Dr. 7465 West 132ndGlendale, CA 91203 Chantilly, VA 20151 Overland Park, KS 66213RiskControl: (949) 224-5789 571) 287-6285 314) 579-8282Claims: (909) 612-3000 Claims: 1-800-368-3562 CALIFORNIA FLORIDA KENTUCKY Irvine Orlando Louisville 3333 Michelson Dr. City Blvd. W 2420 Lakemont Dr Suite 150 Suite 1000 Orlando, FL 32814 303 N Hurstbourne Pkwy Irvine, CA 92612 678) 317-8210 Louisville, KY 40222 Risk Control: (949) 224-5789 Claims: 407-388-2400 248) 312-7301 Claims: 800-238-6210 CALIFORNIA GEORGIA LOUISIANA Los Angeles Atlanta New Orleans 888 South Figueroa St., Ste. 500 1000 Windward Concourse 3838 N. Causeway, Suite 2700 Los Angeles, CA 90017 Alpharetta, GA 30005 Metairie, LA 70002 Risk Control: (949) 224-5789 678) 317-8210 P.O. Box 61479 Claims: (909) 612-3000 Claims: 800-238-6214 New Orleans, LA 70161-1479 504) 832-7562 Claims: 800-842-2556 CALIFORNIA HAWAII MAINE Sacramento Irvine, CA Portland, ME 11070 White Rock Road, Suite 130 3333 Michelson Drive City Blvd. W 207 Larrabee Road, Suite 3 Rancho Cordova, CA 95670 Suite 1000 Westbrook, ME 04092 Risk Control: (916) 852-5245 Irvine, CA 92612 207) 857-2021 Claims: (800) 727-3995 949) 224-5789 WUNT31315 Page 2 of 4 2014 The Travelers Indemnity Company. All rights reserved. WUNT3B15 Page 3 of 4 2014 The Travelers Indemnity Company. All rights reserved. Please call these numbers FOR SAFETY SERVICES ONLY For all other inquiries please contact your agent, underwriter or claim representative MARYLAND Missouri Workers' NEW YORK Blue Bell, PA Compensation Plan (MWCP) Jericho -Long Island 10 Sentry Parkway, Suite 300 1000 Walnut Street Two Jericho Plaza Blue Bell, PA 19422 Kansas City, MO 64199 Jericho, NY 11753 215)274-1610 816)391-1123 516) 933-3932 Claims: 1-800-368-3562 Claims: 800-842-2475 MASSACHUSETTS MONTANA NEW YORK Boston Sacramento, CA New York 100 Summer Street, Suite 201A 11070 White Rock Rd, Suite 130 485 Lexington Ave. Boston, MA 02110 Rancho Cordova, CA 95670 New York, NY 10017-2630 781) 817-8370 Risk Control: (916) 852-5245 516) 933-3932 Claims: 800-832-7839 Claims: (800) 727-3995 Claims: 1-800-842-2475 MASSACHUSETTS NEBRASKA NEW YORK Hudson Omaha Rochester 1 Cabot Road 11516 Miracle Hills Dr., St. 400 75 Town Centre Drive Suite 250 Omaha, NE 68154 P.O. Box 23235 Hudson, MA 01749 651) 310-7834 Rochester, NY 14692-3235 781) 817-8370 Claims: 800-255-5072 315) 424-7231 Claims: 800-832-7839 Claims: 1-800-842-2475 MASSACHUSETTS NEVADA NEW YORK Braintree Las Vegas Syracuse 350 Granite Street 7450 Arroyo Crossing Pkwy 440 South Warren Street Suite 1201 Suite 200 P.O. Box 4963 Braintree, MA 02184 Las Vegas, NV 89113 Syracuse, NY 13221-4963 781) 817-8370 Risk Control: (720) 200-8355 315) 424-7231 Claims: 800-832-7839 Claims: 702-479-4200 Claims: 800-842-2475 MICHIGAN NEW HAMPSHIRE NORTH CAROLINA Grand Rapids Portland, ME Charlotte 3777 Sparks Ave. SE, Ste. 200 207 Larrabee Road, Suite 3 11440 Carmel Commons Blvd. P.O. Box 3010 Westbrook, ME 04092 P.O. Box 473500 Grand Rapids, MI 49501-0323 207) 857-2021 Charlotte, NC 28247-3500 248) 312-7301 704) 540-3209 Claims: 800-238-6210 Claims: (704) 544-3500 MICHIGAN NEW JERSEY NORTH CAROLINA Troy Morristown Raleigh 1301 W. Long Lake Rd., Ste. 300 445 South Street 4504 Emperor Blvd. Troy, MI 48098 Morristown, NJ 07960 Durham, NC 27703 248) 312-7301 973) 631-7015 704) 540-3209 Claims: 800-238-6210 Claims: 1-800-842-2475 Claims: (704) 544-3500 MINNESOTA NEW JERSEY NORTH DAKOTA St. Paul Marlton St. Paul, MN 385 Washington St., MC 104P Lake Center Exec Park Building 30 385 Washington St., MC 104P St. Paul, MN 55102 Suite 110 St. Paul, MN 55102 651) 310-7834 Marlton, NJ 08053 651) 310-7834 Claims: 800-842-3073 856) 703-2323 Claims: 800-842-3073 Claims: 800-842-2475 MISSISSIPPI NEW MEXICO OHIO Jackson Phoenix Cincinnati 1080 River Oaks Dr 2401 W Peoria Ave., Suite 130 Baldwin Center, Suite 500 Ste B-200 Phoenix, AZ 85029 625 Eden Park Drive Flowood, MS 39232 720) 200-8355 Cincinnati, OH 45202 615) 660-6036 Claims: 602-861-8600 412) 338-3069 Claims: 1-800-342-4064 Claims: 800-238-6210 MISSOURI NEW YORK OHIO St. Louis Albany Cleveland 940 West Port Plaza, Suite 270 900 Watervliet -Shaker Road 6150 Oak Tree Blvd., Suite 400 St. Louis, MO 63146 Albany, NY 12205 Independence, OH 44131 314) 579-8282 315)424-7231 412)338-3069 Claims: 800-842-9621 Claims: 800-842-2475 Claims: 800-238-6210 Kansas City NEW YORK OKLAHOMA St. Louis Buffalo Tulsa 940 West Port Plaza, Suite 270 60 Lakefront Blvd. 9820 East 41 st St., Suite 401 St. Louis, MO 63146 P.O. Box 242 P.O Box 3510 314) 579-8282 Buffalo, NY 14240-0242 Tulsa, OK 74101 Claims: 800-255-5072 315)424-7231 314)579-8282 Claims: 800-842-2475 WUNT3B15 Page 3 of 4 2014 The Travelers Indemnity Company. All rights reserved. Please call these numbers FOR SAFETY SERVICES ONLY For all other inquiries please contact your agent, underwriter or claim representative OREGON SOUTH DAKOTA VIRGINIA Portland St. Paul, MN Richmond 4000 SW Kruse Place, Suite 100 385 Washington St. 9954 Mayland Drive, Suite 6100 Lake Oswego, OR 97035 St. Paul, MN 55102 Richmond, VA 23233 Risk Control: (916) 852-5245 651) 310-7834 571) 287-6285 Claims: 800-698-6883 Claims: 800-842-3073 Claims: (804) 330-6000 PENNSYLVANIA TENNESSEE Washington, DC Philadelphia Franklin 14200 Park Meadow Dr. 10 Sentry Parkway, Suite 300 6640 Carothers Pkwy, Suite 300 Chantilly, VA 20151 Blue Bell, PA 19422 Franklin, TN 37067 571) 287-6285 215) 274-1610 615) 660-6036 Claims: 800-368-3562 Claims: 800-832-0606 Claims: (615) 660-6000 PENNSYLVANIA TEXAS WASHINGTON Pittsburgh Dallas Seattle 800 Two Chatham Center 1301 E Collins Blvd., Suite 300 1501 4th Avenue, Suite 400 Pittsburgh, PA 15219-2505 Richardson, TX 75081 Seattle, WA 98101 412) 338-3069 214) 570-6675 Risk Control: (916) 852-5245 Claims: (412) 338-3000 Claims: 214-570-6000 PENNSYLVANIA TEXAS WEST VIRGINIA Reading Houston Charleston, WV 1105 Berkshire Blvd. 4650 Westway Park Blvd., Suite 350 119 Virginia St. W. P.O. Box 13426 Houston, TX 77041 Charleston, WV 25302 Wyomissing, PA 19612-3426 281) 606-8534 412) 338-3069 215) 274-1610 Claims: 800-235-3610 Claims: (443) 353-1000 Claims: 800-832-0606 RHODE ISLAND UTAH WISCONSIN Braintree Denver, CO Milwaukee 350 Granite Street 6060 S. Willow Drive #300 13935 Bishops Drive, Suite 200 Suite 1201 Greenwood Village, CO 80111 Brookfield, WI 53005 Braintree, MA 02184 720) 200-8306 262) 825-9203 781) 817-8370 Claims: 800-453-3025 Claims: 800-842-6172 Claims: 800-832-7839 SOUTH CAROLINA VERMONT WYOMING Charlotte Hartford, CT Denver, CO 11440 Carmel Commons Blvd. 300 Windsor Street 6060 S. Willow Drive #300 P.O. Box 473500 Hartford, CT 06120 Greenwood Village, CO 80111 Charlotte, NC 28247-3500 860) 954-5190 Risk Control: (720) 200-8355 704) 540-3209 Claims: 704-544-3500 WUNT31315 Page 4 of 4 2014 The Travelers Indemnity Company. All rights reserved. POLICYHOLDER NOTICE SHORT RATE CANCELATION CALIFORNIA INSURANCE CODE SECTION 481 CA Insurance Code Section 481 requires that where an insurance policy includes a provision to refund premium on anything other than a pro rata basis, including the assessment of cancellation fees, the insurer must disclose that fact to the policyholder in writing prior to, or concurrent with, the proposal or quote prior to each renewal. The disclosure must include the actual or maximum fees or penalties to be applied. The WCIRB also created a Short Rate Cancelation Endorsement which complements the disclosure requirement. This requirement applies to in- surance policies issued or renewed on or after January 1, 2012. In order to respond to this insurance code requirement we have created this Policyholder Notice to disclose our use of short rate calculations as described in the California Short Rate Cancelation Endorsement included in the policy. W041IN11211-1112 Page 1 of 1 TRAVELERSJW Report Claims Immediately by Calling* 1-800-238-6225 Speak directly with a claim professional 24 hours a day, 365 days a year Unless Your Policy Requires Written Notice or Reporting WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY A Custom Insurance Policy Prepared for: INET INC IPARQ 1050 ROSECRANS STREET SUITE G SAN DIEGO CA 92106 TRAVELERSJ ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE V INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (IJUB-4J20158-9-18) RENEWAL OF (IJUB-4J20158-9-17) INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA lim INSURED: INET INC IPARQ 1050 ROSECRANS STREET SUITE G SAN DIEGO CA 92106 Insured is A CORPORATION NCCI CO CODE: 13 57 9 PRODUCER: AP INTEGO INS GROUP LLC 375 WOODCLIFF DR 1ST FL STE 102 FAIRPORT NY 14450 Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 05-28-18 to 05-28-19 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: AZ CA IA ID B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 1000000 Each Accident Bodily Injury by Disease: $ 1000000 Policy Limit Bodily Injury by Disease: $ 1000000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: AL AR CO CT DC DE FL GA HI IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI WV D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 04-13-18 HJ OFFICE: PAYROLL 70A PRODUCER: AP INTEGO INS GROUP LLC X9275 TRAVELERSJ ONE TOWER SQUARE HARTFORD, CT 06183 CLASSIFICATION SCHEDULE: CLASSIFICATIONS SIC -CODE: 7371 CODE NO WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE V INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (IJUB-4J20158-9-18) PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL REMUNERATION REMUNERATION PREMIUM SEE EXTENSION OF INFORMATION PAGE - SCHEDULE(S) NAICS: 541511 STANDARD TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ 1213 PREMIUM DISCOUNT NONE 0900-04 EXPENSE CONSTANT 160 TERRORISM 138 CAT (OTHER THAN CERT ACTS OF TERRORISM) 20 TOTAL ESTIMATED PREMIUM 1531 TAXES AND SURCHARGES 32 DEPOSIT AMOUNT DUE 1563 Minimum Premium: $ 500 EMPLOYERS LIABILITY MINIMUM: $ 120 OTHER MINIMUMS ARE INDICATED ON THE APPLICABLE SCHEDULE(S) DATE OF ISSUE: 04-13-18 HJ OFFICE: PAYROLL 70A PRODUCER: AP INTEGO INS GROUP LLC X9275 COUNTERSIGNED -AGENT TRAVELERSJ ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE -SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (IJUB-4J20158-9-18) INSURER: THE STANDARD FIRE INSURANCE COMPANY INSURED'S NAME: INET INC IPARQ CLASSIFICATION LOCATION 001 01 FEIN 371566208 ENTITY CD 001 INET INC 129 W DEL RIO DR TEMPE, AZ 85282 SIC CODE: 7371 NAICS: 541511 IPARQ SALESPERSONS OR COLLECTORS - OUTSIDE AZ MANUAL PREMIUM $ 234 PREMIUM BASIS ESTIMATED TOTAL ANNUAL CODE REMUNERATION 3&M 83640 COMPANY DEVIATION CREDIT(9037) 40.00% $ 1.10% EMPL. LIAB. INCREASED LIMITS(9812) EXPERIENCE MODIFICATION: NONE MODIFIED PREMIUM TOTAL ESTIMATED ANNUAL STANDARD PREMIUM TERRORISM (9740) CAT(OTHER THAN CERT ACTS OF TERRORISM) 9741 TOTAL ESTIMATED PREMIUM DEPOSIT AMOUNT DUE 15245 -AZ RATES ESTIMATED PER $100 OF ANNUAL REMUNERATION PREMIUM 28 234 94 2 NONE 142 8 8 158 158 DATE OF ISSUE: 04-13-18 HJ SCHEDULE NO: 1 OF MORE TRAVELERSJ ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE -SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (IJUB-4J20158-9-18) INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INSURED'S NAME: INET INC IPARQ CLASSIFICATION LOCATION 001 01 FEIN 371566208 ENTITY CD 001 INET INC 1050 ROSECRANS STREET SUITE G SAN DIEGO, CA 92106 SIC CODE: 7371 NAICS: 541511 IPARQ COMPUTER PROGRAMMING OR SOFTWARE DEVELOPMENT -ALL EMPLOYEES -INCLUDING CLERICAL OFFICE EMPLOYEES AND OUTSIDE SALESPERSONS CA MANUAL PREMIUM $ 532 PREMIUM BASIS ESTIMATED TOTAL ANNUAL CODE REMUNERATION 8859 591600 EXPERIENCE MODIFICATION: NONE MODIFIED PREMIUM $ TOTAL ESTIMATED ANNUAL STANDARD PREMIUM EXPENSE CONSTANT(0900) TERRORISM (9740) 2.00% CIGA SURCHARGE 1.96% USER / FRAUD / UEBT / SIBT / OSH / LEC TOTAL ESTIMATED PREMIUM DEPOSIT AMOUNT DUE 080 006 13579 -CA RATES ESTIMATED PER $100 OF ANNUAL REMUNERATION PREMIUM 09 532 NONE 532 160 118 16 16 842 842 DATE OF ISSUE: 04-13-18 HJ SCHEDULE NO: 2 OF MORE TRAVELERSJ ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE -SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (IJUB-4J20158-9-18) INSURER: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT INSURED'S NAME: INET INC IPARQ CLASSIFICATION LOCATION 001 01 FEIN 371566208 ENTITY CD 001 INET INC 260 PADDOCK CIR IOWA CITY, IA 52240 SIC CODE: 7371 NAICS: 541511 IPARQ SALESPERSONS OR COLLECTORS - OUTSIDE IA MANUAL PREMIUM $ 276 PREMIUM BASIS ESTIMATED TOTAL ANNUAL CODE REMUNERATION 3&M 54060 COMPANY DEVIATION CREDIT(9037) - 15.00% $ 1.10% EMPL. LIAB. INCREASED LIMITS(9812) ADD FOR INCREASED LIMITS MINIMUM (9848) EXPERIENCE MODIFICATION: NONE MODIFIED PREMIUM TOTAL ESTIMATED ANNUAL STANDARD PREMIUM TERRORISM (9740) CAT(OTHER THAN CERT ACTS OF TERRORISM) 9741 TOTAL ESTIMATED PREMIUM DEPOSIT AMOUNT DUE 12637 -IA RATES ESTIMATED PER $100 OF ANNUAL REMUNERATION PREMIUM 51 276 41 3 113 NONE 351 5 5 361 361 DATE OF ISSUE: 04-13-18 HJ SCHEDULE NO: 3 OF MORE TRAVELERSJ WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE -SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (IJUB-4J20158-9-18) INSURER: THE CHARTER OAK FIRE INSURANCE COMPANY ID MANUAL PREMIUM $ 186 1.10% EMPL. LIAB. INCREASED LIMITS(9812) $ EXPERIENCE MODIFICATION: NONE MODIFIED PREMIUM TOTAL ESTIMATED ANNUAL STANDARD PREMIUM TERRORISM (9740) CAT(OTHER THAN CERT ACTS OF TERRORISM) 9741 TOTAL ESTIMATED PREMIUM DEPOSIT AMOUNT DUE DATE OF ISSUE: 04-13-18 HJ 2 NONE 188 7 7 202 202 SCHEDULE NO: 4 OF LAST 15318 -ID INSURED'S NAME: INET INC IPARQ PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 001 01 FEIN 371566208 ENTITY CD 001 STATE UNEMPLOYMENT IDENTIFIER: 3715662080 INET INC 2135 N MIDDLEFIELD RD BOISE, ID 83704 SIC CODE: 7371 NAICS: 541511 IPARQ COMPUTER SYSTEM DESIGNERS OR PROGRAMMERS: EXCLUSIVELY OFFICE 8810 66300 28 186 ID MANUAL PREMIUM $ 186 1.10% EMPL. LIAB. INCREASED LIMITS(9812) $ EXPERIENCE MODIFICATION: NONE MODIFIED PREMIUM TOTAL ESTIMATED ANNUAL STANDARD PREMIUM TERRORISM (9740) CAT(OTHER THAN CERT ACTS OF TERRORISM) 9741 TOTAL ESTIMATED PREMIUM DEPOSIT AMOUNT DUE DATE OF ISSUE: 04-13-18 HJ 2 NONE 188 7 7 202 202 SCHEDULE NO: 4 OF LAST TRAVELERSJ WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 00 01 (A) POLICY NUMBER: (IJUB-4J20158-9-18) LISTING OF ENDORSEMENTS EXTENSION OF INFO PAGE We agree that the following listed endorsements form a part of this policy on its effective date. WC 00 00 01 A 001 WC 00 00 01 A 001 WC 00 00 01 A 001 WC 00 00 01 A 001 WC 00 04 14 00 001 WC 00 04 22 B 001 WC 00 04 24 00 001 WC 02 06 01 A 001 WC 99 03 C3 00 001 WC 99 03 F3 00 001 WC 99 03 99 00 001 WC 00 04 21 D 001 WC 00 04 19 00 001 WC 02 04 01 C 001 WC 04 03 01 B 001 WC 04 03 17 B 001 WC 04 03 60 B 001 WC 04 04 21 00 001 WC 04 04 22 00 001 WC 04 06 01 A 001 WC 04 03 45 A 001 INFORMATION PAGE INFORMATION PAGE 2 EXTENSION OF INFORMATION PAGE - SCHEDULE ENDORSEMENT LISTING NOTIFICATION OF CHANGE IN OWNERSHIP ENDT TERRORISM RISK INS PROG REAUTH ACT ENDT AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT AZ CANCELLATION AND NONRENEWAL ENDT SPECIAL PROVISIONS ENDT CA LIMITS OF LIABILITY ENDT CA WORKERS' COMP NOTICE OF NON -RENEWAL CATASTROPHE (0/T CERT ACTS OF TERR) ENDT PREMIUM DUE DATE ENDORSEMENT AZ ALCOHOL & DRUG FREE WK PLACE PREM END POLICY AMENDATORY ENDORSEMENT -CALIFORNIA EMPLOYEE INSD BY GENERL EMPLYER EXCLUDED EMPLOYERS' LIAB COV AMENDATORY ENDT-CA OPTIONAL PREMIUM INCREASE ENDT CA CALIFORNIA SHORT -RATE CANCELATION ENDT CA CANCELATION ENDT COMPREHENSIVE PERSONAL LIAB POL EXCL DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of LAST WC 00 00 00 (C) Ed. 1-15) The Travelers Insurance Companies Each a Stock Insurance Company) Hartford, Connecticut WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject PART ONE to all terms of this policy, we agree with you as WORKERS COMPENSATION INSURANCE follows: A. How This Insurance Applies GENERAL SECTION A. The Policy This policy includes at its effective date the In- formation Page and all endorsements and sched- ules listed there. It is a contract of insurance be- tween you (the employer named in Item 1 of the Information Page) and us (the insurer named on the Information Page). The only agreements re- lating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B. Who is Insured You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured, but only in your capacity as an employer of the partnership's employees. C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page. It includes any amendments to that law which are in effect dur- ing the policy period. It does not include any fed- eral workers or workmen's compensation law, any federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits. D. State State means any state of the United States of America, and the District of Columbia. E. Locations This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it cov- ers all other workplaces in Item 3.A. states unless you have other insurance or are self-insured for such workplaces. This workers compensation insurance applies to bodily injury by accident or bodily injury by dis- ease. Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the policy period. 2. Bodily injury by disease must be caused or aggravated by the conditions of your em- ployment. The employee's last day of last exposure to the conditions causing or aggra- vating such bodily injury by disease must occur during the policy period. B. We Will Pay We will pay promptly when due the benefits re- quired of you by the workers compensation law. C. We Will Defend We have the right and duty to defend at our ex- pense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to investigate and settle these claims, proceedings or suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. D. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: 1. reasonable expenses incurred at our request, but not loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this in- surance; and 5. expenses we incur. Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. Page 1 of 6 E. Other Insurance We will not pay more than our share of benefits and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is paid. If any insurance or self- insurance is exhausted, the shares of all remain- ing insurance will be equal until the loss is paid. F. Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required be- cause: 1. of your serious and willful misconduct; 2. you knowingly employ an employee in viola- tion of law; 3. you fail to comply with a health or safety law or regulation; or 4. you discharge, coerce or otherwise discrimi- nate against any employee in violation of the workers compensation law. If we make any payments in excess of the bene- fits regularly provided by the workers compensa- tion law on your behalf, you will reimburse us promptly. G. Recovery From Others We have your rights, and the rights of persons entitled to the benefits of this insurance, to re- cover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. H. Statutory Provisions These statements apply where they are required by law. 1. As between an injured worker and us, we have notice of the injury when you have no- tice. 2. Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our duties under this insurance after an injury oc- curs. 3. We are directly and primarily liable to any person entitled to the benefits payable by this insurance. Those persons may enforce our duties; so may an agency authorized by law. Enforcement may be against us or against you and us. WC 00 00 00 (C) Ed. 1-15) 4. Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this pol- icy that are not in conflict with that law. 5. This insurance conforms to the parts of the workers compensation law that apply to: a. benefits payable by this insurance; b. special taxes, payments into security or other special funds, and assessments payable by us under that law. 6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your duties under this policy. PART TWO EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies This employers liability insurance applies to bod- ily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or inci- dental to your work in a state or territory listed in Item 3.A. of the Information Page. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or aggravated by the conditions of your em- ployment. The employee's last day of last exposure to the conditions causing or aggra- vating such bodily injury by disease must occur during the policy period. 5. If you are sued, the original suit and any re- lated legal actions for damages for bodily in- jury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. B. We Will Pay We will pay all sums that you legally must pay as damages because of bodily injury to your em- ployees, provided the bodily injury is covered by this Employers Liability Insurance. Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. Page 2 of 6 WC 00 00 00 (C) Ed. 1-15) The damages we will pay, where recovery is per- employee, or any personnel practices, poli- mitted by law, include damages: cies, acts or omissions; 1. For which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages claimed against such third party as a result of injury to your employee; 2. For care and loss of services; and 3. For consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and 4. Because of bodily injury to your employee that arises out of and in the course of em- ployment, claimed against you in a capacity other than as employer. C. Exclusions This insurance does not cover: 1. Liability assumed under a contract. This ex- clusion does not apply to a warranty that your work will be done in a workmanlike manner; 2. Punitive or exemplary damages because of bodily injury to an employee employed in vio- lation of law; 3. Bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your execu- tive officers; 4. Any obligation imposed by a workers com- pensation, occupational disease, unemploy- ment compensation, or disability benefits law, or any similar law; 5. Bodily injury intentionally caused or aggra- vated by you; 6. Bodily injury occurring outside the United States of America, its territories or posses- sions, and Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries; 7. Damages arising out of coercion, criticism, demotion, evaluation, reassignment, disci- pline, defamation, harassment, humiliation, discrimination against or termination of any 8. Bodily injury to any person in work subject to the Longshore and Harbor Workers' Com- pensation Act (33 U.S.C. Sections 901 et seq.), the Nonappropriated Fund Instrumen- talities Act (5 U.S.C. Sections 8171 et seq.), the Outer Continental Shelf Lands Act (43 U.S.C. Sections 1331 et seq.), the Defense Base Act (42 U.S.C. Sections 1651-1654), the Federal Mine Safety and Health Act (30 U.S.C. Sections 801 et seq. and 901-944), any other federal workers or workmen's com- pensation law or other federal occupational disease law, or any amendments to these laws; 9. Bodily injury to any person in work subject to the Federal Employers' Liability Act (45 U.S.C. Sections 51 et seq.), any other federal laws obligating an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amendments to those laws; 10. Bodily injury to a master or member of the crew of any vessel, and does not cover puni- tive damages related to your duty or obliga- tion to provide transportation, wages, mainte- nance, and cure under any applicable mari- time law; 11. Fines or penalties imposed for violation of federal or state law; and 12. Damages payable under the Migrant and Seasonal Agricultural Worker Protection Act 29 U.S.C. Sections 1801 et seq.) and under any other federal law awarding damages for violation of those laws or regulations issued thereunder, and any amendments to those laws. D. We Will Defend We have the right and duty to defend, at our ex- pense, any claim, proceeding or suit against you for damages payable by this insurance. We have the right to investigate and settle these claims, proceedings and suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. Page 3 of 6 E. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend: 1. Reasonable expenses incurred at our re- quest, but not loss of earnings; 2. Premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. Litigation costs taxed against you; 4. Interest on a judgment as required by law until we offer the amount due under this in- surance; and 5. Expenses we incur. F. Other Insurance We will not pay more than our share of damages and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insur- ance and self-insurance will be equal until the loss is paid. G. Limits of Liability Our liability to pay for damages is limited. Our limits of liability are shown in Item 3.13. of the In- formation Page. They apply as explained below. 1. Bodily Injury by Accident. The limit shown for bodily injury by accident — each accident" is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in any one accident. A disease is not bodily injury by accident unless it results directly from bodily injury by accident. 2. Bodily Injury by Disease. The limit shown for bodily injury by disease — policy limit" is the most we will pay for all damages covered by this insurance and arising out of bodily injury by disease, regardless of the number of em- ployees who sustain bodily injury by disease. The limit shown for "bodily injury by disease — each employee" is the most we will pay for all damages because of bodily injury by disease to any one employee. WC 00 00 00 (C) Ed. 1-15) Bodily injury by disease does not include dis- ease that results directly from a bodily injury by accident. 3. We will not pay any claims for damages after we have paid the applicable limit of our liabil- ity under this insurance. H. Recovery From Others We have your rights to recover our payment from anyone liable for an injury covered by this insur- ance. You will do everything necessary to protect those rights for us and to help us enforce them. I. Actions Against Us There will be no right of action against us under this insurance unless: 1. You have complied with all the terms of this policy; and 2. The amount you owe has been determined with our consent or by actual trial and final judgment. This insurance does not give anyone the right to add us as a defendant in an action against you to determine your liability. The bankruptcy or insol- vency of you or your estate will not relieve us of our obligations under this Part. PART THREE OTHER STATES INSURANCE A. How This Insurance Applies 1. This other states insurance applies only if one or more states are shown in Item 3.C. of the Information Page. 2. If you begin work in any one of those states after the effective date of this policy and are not insured or are not self-insured for such work, all provisions of the policy will apply as though that state were listed in Item 3.A. of the Information Page. 3. We will reimburse you for the benefits re- quired by the workers compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them. 4. If you have work on the effective date of this policy in any state not listed in Item 3.A. of the Information Page, coverage will not be af- forded for that state unless we are notified within thirty days. Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. Page 4 of 6 B. Notice Tell us at once if you begin work in any state listed in Item 3.C. of the Information Page. PARTFOUR YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be cov- ered by this policy. Your other duties are listed here. 1. Provide for immediate medical and other ser- vices required by the workers compensation law. 2. Give us or our agent the names and ad- dresses of the injured persons and of wit- nesses, and other information we may need. 3. Promptly give us all notices, demands and legal papers related to the injury, claim, pro- ceeding or suit. 4. Cooperate with us and assist us, as we may request, in the investigation, settlement or defense of any claim, proceeding or suit. 5. Do nothing after an injury occurs that would interfere with our right to recover from others. 6. Do not voluntarily make payments, assume obligations or incur expenses, except at your own cost. PART FIVE PREMIUM A. Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and clas- sifications. We may change our manuals and ap- ply the changes to this policy if authorized by law or a governmental agency regulating this insur- ance. B. Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classifications. These classifications were as- signed based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classi- fications, rates and premium basis by endorse- ment to this policy. WC 00 00 00 (C) Ed. 1-15) C. Remuneration Premium for each work classification is deter- mined by multiplying a rate times a premium ba- sis. Remuneration is the most common premium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy period for the services of: 1. all your officers and employees engaged in work covered by this policy; and 2. all other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers com- pensation obligations. D. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers com- pensation law is not valid. E. Final Premium The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, pre- mium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classi- fications covered by this policy. If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise: 1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. 2. If you cancel, final premium will be more than pro rata; it will be based on the time this pol- icy was in force, and increased by our short - rate cancelation table and procedure. Final premium will not be less than the minimum premium. Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. Page 5 of 6 F. Records You will keep records of information needed to compute premium. You will provide us with cop- ies of those records when we ask for them. G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provi- sion. PART SIX CONDITIONS A. Inspection We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any per- son to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or stan- dards. Insurance rate service organizations have the same rights we have under this provision. WC 00 00 00 (C) Ed. 1-15) B. Long Term Policy If the policy period is longer than one year and sixteen days, all provisions of this policy will ap- ply as though a new policy were issued on each annual anniversary that this policy is in force. C. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within thirty days after your death, we will cover your legal repre- sentative as insured. D. Cancelation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect. 2. We may cancel this policy. We must mail or deliver to you not less than ten days advance written notice stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancelation notice. 4. Any of these provisions that conflict with a law that controls the cancelation of the insur- ance in this policy is changed by this state- ment to comply with the law. E. Sole Representative The insured first named in Item 1 of the Informa- tion Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancelation. IN WITNESS WHEREOF, the company has caused this policy to be signed by its President and Secre- tary at Hartford, Connecticut and countersigned on the Information page by a duly authorized agent of the company. Secretary President Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. Page 6 of 6 TRAVELERSJ WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 0414 (00) POLICY NUMBER: (IJUB-4J20158-9-18) NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT Experience rating is mandatory for all eligible insureds. The experience rating modification factor, if any, applicable to this policy, may change if there is a change in your ownership or in that of one or more of the entities eligible to be combined with you for experience rating purposes. Change in ownership includes sales, purchases, other transfers, mergers, consolidations, dissolutions, formations of a new entity and other changes provided for in the applicable experience rating plan manual. You must report any change in ownership to us in writing within 90 days of such change. Failure to report such changes within this period may result in revision of the experience rating modification factor used to determine your premium. DATE OF ISSUE: 04-13-18 ST ASSIGN: W TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 00 04 22 (B) POLICY NUMBER: (IJUB-4J20158-9-18) TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extend- ed by the Terrorism Risk Insurance Program Reauthorization Act of 2015. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, defini- tions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act .If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amend- ments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2015. Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. Insurer Deductible" means, for the period beginning on January 1, 2015, and ending on December 31, 2020, an amount equal to 20% of our direct earned premiums, during the immediately preceding calendar year. Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses exceed: a. $100,000,000, with respect to such Insured Losses occurring in calendar year 2015, the United States Gov- ernment would pay 85% of our Insured Losses that exceed our Insurer Deductible. DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of 2 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. W TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 00 04 22 (B) POLICY NUMBER: (IJUB-4J20158-9-18) b. $120,000,000, with respect to such Insured Losses occurring in calendar year 2016, the United States Gov- ernment would pay 84% of our Insured Losses that exceed our Insurer Deductible. c. $140,000,000, with respect to such Insured Losses occurring in calendar year 2017, the United States Gov- ernment would pay 83% of our Insured Losses that exceed our Insurer Deductible. d. $160,000,000, with respect to such Insured Losses occurring in calendar year 2018, the United States Gov- ernment would pay 82% of our Insured Losses that exceed our Insurer Deductible. e. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019, the United States Gov- ernment would pay 81 % of our Insured Losses that exceed our Insurer Deductible. f. $200,000,000, with respect to such Insured Losses occurring in calendar year 2020, the United States Gov- ernment would pay 80% of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium 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 Insured Insurance Company Policy No. Countersigned by Endorsement No. Premium $ DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 2 of 2 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. TRAVELERSJW ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 04 24 (00) POLICY NUMBER: (IJUB-4J20158-9-18) AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT Part Five —Premium, Section G. (Audit) of the Workers Compensation and Employers Liability Insurance Policy is revised by adding the following: If you do not allow us to examine and audit all of your records that relate to this policy, and/or do not provide audit information as requested, we may apply an Audit Noncompliance Charge. The method for determining the Audit Noncompliance Charge by state, where applicable, is shown in the Schedule below. If you allow us to examine and audit all of your records after we have applied an Audit Noncompliance Charge, we will revise your premium in accordance with our manuals and Part 5 — Premium, E. (Final Premium) of this policy. Failure to cooperate with this policy provision may result in the cancellation of your insurance coverage, as specified under the policy. Note: For coverage under state — approved workers compensation assigned risk plans, failure to cooperate with this policy provision may affect your eligibility for coverage. Schedule State(s) Basis of Audit Noncompliance Charge Maximum Audit Noncompliance Charge Multiplier All states except AK, AZ, CA, FL, HI, Estimated annual premium Multiplier varies based on number of IN, KS, LA, MA, MO, MT, ND, NY, consecutive policy periods in which you OH, OK, PA, TX, WA, WI, WY failed to comply with the Audit provision: First policy period: 40% Second consecutive policy period: 80% Third (or more) consecutive policy period(s): 100% AZ, HI, KS, OK, WI Estimated annual premium 200% 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 Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by DATE OF ISSUE: 04 -13 -18 STATE OF ASSIGN: Page 1 of 1 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. W TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 02 06 01 (A) POLICY NUMBER: (IJUB-4J20158-9-18) ARIZONA CANCELLATION AND NONRENEWAL ENDORSEMENT This endorsement applies because Arizona is shown in Item 3.A. of the Information Page. Part Six— Conditions, Section D. (Cancellation), of the policy is replaced by the following: D. Cancellation and Nonrenewal 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. If you cancel or fail to renew this policy, we must promptly notify the Industrial Commission of Arizona. 3. We may cancel this policy if you fail to pay premium when due, or when one or both of the parties to a profes- sional employer agreement terminate the agreement. 4. If we cancel or nonrenew this policy, we must mail or deliver to you and the Industrial Commission of Arizona at least 30 days' notice of the cancellation or nonrenewal. Mailing that notice to you at your mailing address shown in Item 1. of the Information Page will be sufficient to prove notice. If we nonrenew this policy and fail to give you notice of nonrenewal, coverage will not extend beyond the policy period. 5. The policy period will end on the day and hour stated in the cancellation or nonrenewal notice. 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 Insured Insurance Company Policy No. Countersigned by EndorsementNo. Premium DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of 1 0 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. TRAVELERS JW WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 C3 (00) — 001 POLICY NUMBER: (IJUB-4J20158-9-18) SPECIAL PROVISIONS ENDORSEMENT STATE APPLICABILITY The listed endorsements are only applicable in the following states WC 00 04 14 (00)-001 NOTIFICATION OF CHANGE IN OWNERSHIP ENDT APPLIES TO STATE(S): AZ ID IA WC 00 04 19 (00)-001 MULTI -STATE PREMIUM DUE DATE ENDORSEMENT APPLIES TO STATE(S): ID IA WC 00 04 21 ( D)-001 CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORIS APPLIES TO STATE(S): AZ CA ID IA WC 00 04 22 ( B)-001 TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION A APPLIES TO STATE(S): AZ CA ID IA WC 00 04 24 (00)-001 AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT APPLIES TO STATE(S): AZ ID IA WC 02 04 01 ( C)-001 ARIZONA ALCOHOL AND DRUG-FREE WORKPLACE PREM APPLIES TO STATE(S): AZ WC 02 06 01 ( A)-001 ARIZONA CANCELLATION AND NONRENEWAL ENDORSEMENT APPLIES TO STATE(S): AZ WC 04 03 01 ( B)-001 CA POLICY AMENDATORY ENDORSEMENT -CALIFORNIA APPLIES TO STATE(S): CA WC 04 03 17 ( B)-001 EMPLOYEE INS BY GENERAL EMPLYER EXCLUDED APPLIES TO STATE(S): CA WC 04 03 45 ( A)-001 COMPREHENSIVE PERSONAL LIABILITY POLICY EXCLUSION APPLIES TO STATE(S): CA WC 04 03 60 ( B)-001 EMPLOYERS' LIABILITY COVERAGE AMENDATORY ENDORSEME APPLIES TO STATE(S): CA WC 04 04 21 (00)-001 OPTIONAL PREMIUM INCREASE ENDORSEMENT - CALIFORNIA APPLIES TO STATE(S): CA WC 04 04 22 (00)-001 CALIFORNIA SHORT -RATE CANCELATION ENDORSEMENT APPLIES TO STATE(S): CA WC 04 06 01 ( A)-001 CA CANCELATION ENDT APPLIES TO STATE(S): CA WC 99 03 C3 (00)-001 SPECIAL PROVISIONS ENDORSEMENT APPLIES TO STATE(S): AZ CA ID IA 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 Insured Insurance Company Policy No. Countersigned by Endorsement No. Premium $ DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of MORE TRAVELERS _ WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 C3 (00) — 001 POLICY NUMBER: (IJUB-4J20158-9-18) SPECIAL PROVISIONS ENDORSEMENT STATE APPLICABILITY The listed endorsements are only applicable in the following states: WC 99 03 F3 (00)-001 CALIFORNIA LIMITS OF LIABILITY ENDORSEMENT APPLIES TO STATE(S): CA WC 99 03 99 (00)-001 CA NOTICE OF NON -RENEWAL APPLIES TO STATE(S): CA DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 2 of LAST Order # WC 99 03 C3 SA TRAVELERSJW ONE TOWER SQUARE WORKERS COMPENSATION HARTFORD, CT 06183 AND EMPLOYERS LIABILITY INSURANCE POLICY ENDORSEMENT WC 99 03 F3 (00) POLICY NUMBER: (IJUB-4J20158-9-18) CALIFORNIA LIMITS OF LIABILITY ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. The limits of our liability under Part Two of the policy are: Bodily Injury by Accident $1,000,000 or the amount shown in Item 3.13. of the Information Page, whichever is greater, each accident Bodily Injury by Disease $1,000,000 or the amount shown in Item 3.13. of the Information Page, whichever is greater, policy limit Bodily Injury by Disease $1,000,000 or the amount shown in Item 3.13. of the Information Page, whichever is greater, each employee This change applies to the insurance this policy provides for California operations only. 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 Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by DATEOF ISSUE: 04-13-18 ST ASSIGN: Page 1 of 1 TRAVELERSJ WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 99 (00) POLICY NUMBER: (IJUB-4J20158-9-18) CALIFORNIA WORKERS' COMPENSATION NOTICE OF NON -RENEWAL Section 11664 of the California Insurance Code which becomes operative November 30, 1994 requires us in most instances to provide you with a notice of non -renewal. Except as specified in paragraphs 1 through 6 below, if we elect to non -renew your policy, we are required to deliver or mail to you a written notice stating the reason or reasons for the non -renewal of the policy. The notice is required to be sent to you no earlier than 120 days before the end of the policy period and no later than 30 days before the end of the policy period. If we fail to provide you the required notice, we are required to continue the coverage under the policy with no change in the premium rate until 60 days after we provide you with the required notice. We are not required to provide you with a notice of non -renewal in any of the following situations: 1. Your policy was transferred or renewed without a change in its terms or conditions or the rate on which the premium is based to another insurer or other insurers who are members of the same insurance group as us. 2. The policy was extended for 90 days or less and the required notice was given prior to the extension. 3. You obtained replacement coverage or agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. 4. The policy is for a period of no more than 60 days and you were notified at the time of issuance that it may not be renewed. 5. You requested a change in the terms or conditions or risks covered by the policy within 60 days prior to the end of the policy period. 6. We made a written offer to you at least 30 days, but not more than 120 days, prior to the end of the policy period to renew the policy at a changed premium rate. DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of 1 W TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 00 04 21 ( D) POLICY NUMBER: (IJUB-4J20158-9-18) CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in the event of a Catastrophe (other than Certified Acts of Terrorism) as that term is defined below. Your policy provides coverage for workers compensation losses caused by a Catastrophe (other than Certified Acts of Terrorism). This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 B), attached to this policy. For purposes of this endorsement, the following definitions apply: Catastrophe (other than Certified Acts of Terrorism): Any single event, resulting from an Earthquake, Noncertified Act of Terrorism, or Catastrophic Industrial Accident, which results in aggregate workers compensation losses in excess of $50 million. Earthquake: The shaking and vibration at the surface of the earth resulting from underground movement along a fault plane or from volcanic activity. Noncertified Act of Terrorism: An event that is not certified as an Act of Terrorism by the Secretary of Treasury pursuant to the Terrorism Risk Insurance Act of 2002 (as amended) but that meets all of the following criteria: a. It is an act that is violent or dangerous to human life, property, or infrastructure; b. The act results in damage within the United States, or outside of the United States in the case of the premises of United States missions or air carriers or vessels as those terms are defined in the Terrorism Risk Insur- ance Act of 2002 (as amended); and c. It is an act that has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Govern- ment by coercion. Catastrophic Industrial Accident: A chemical release, large explosion, or small blast that is localized in nature and affects workers in a small perimeter the size of a building. The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe other than Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium 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 Insured Insurance Company DATE OF ISSUE: 04-13-18 Policy No. ST ASSIGN: Countersigned by Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. Endorsement No. Premium $ Page 1 of 1 TRAVELERSJ WORKERS COMPENSATION ONE TOWER SQUARE AND HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 0419 (00) POLICY NUMBER: (IJUB-4J20158-9-18) PREMIUM DUE DATE ENDORSEMENT This endorsement is used to amend: Section D. of Part Five of the policy is replaced by this provision. PART FIVE PREMIUM D. Premium is amended to read: You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. The due date for audit and retrospective premiums is the date of the billing. DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of 1 TRAVELERSJ WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 02 04 01 ( C) POLICY NUMBER: (IJUB-4J20158-9-18) ARIZONA ALCOHOL - AND DRUG-FREE WORKPLACE PREMIUM CREDIT ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Arizona is shown in Item 3.A. of the Policy Information Page. This endorsement provides notice that premium for your policy may be affected by the Arizona Alcohol -and Drug -Free Workplace Premium Credit Program. You may qualify for a 5% premium credit if you have established and maintain a qualifying alcohol -and drug-free workplace program in accordance with Title 23, Chapter 2, Article 14 of Arizona Statutes. We will determine your eligibility for this premium credit after total premium has been paid for the policy period and may be revised at the time your final premium audit is processed. The determination that you have a qualifying program must be made each year that you receive the premium credit. To implement a premium credit program, the following guidelines must be established: 1. Insurers offering the premium credit program may apply a 5% premium credit to qualifying employers. 2. To receive the premium credit, you must: a. Provide a written statement to the insurer prior to or within 30 days after the beginning of the policy ef- fective date each year, certifying that the business has implemented a program meeting the require- ments of Title 23, Chapter 2, Article 14. b. At any time during the term of the policy, provide additional information to the insurer, as required, to confirm that a qualifying program has been established and is being maintained. c. Comply with the alcohol and drug testing policy requirements in accordance with Title 23, Chapter 2, Ar- ticle 14. d. Conduct alcohol and drug testing of prospective employees. e. Conduct alcohol and drug testing of an employee after the employee has been injured. f. Allow us to have access to the alcohol and drug testing results under d. and e. above. 3. The determination that you have established and maintain a qualifying program must be made during each policy term that you receive the premium credit. 4. Your certification and any other information relied upon by the insurer in granting the premium credit must be kept in the insurer's underwriting files and made available to the Department of Insurance upon request. 5. The premium credit may be applied after total premium has been paid for the policy period and may be revised at final audit to the employer's policy. The credit is applicable as a supplement to deviated rates and is applied in a multiplicative manner, after the application of the experience modification, and before the ap- plication of the premium discount and expense constant. DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of 2 TRAVELERSJ WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 02 04 01 ( C) POLICY NUMBER: (IJUB-4J20158-9-18) 6. You must reimburse the premium credit if it is determined that you were not in compliance with the provi- sions of the program. 7. Minimum premium policies are eligible for this premium credit. 8. Residual market employers are eligible to apply for this premium credit. 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 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 2 of 2 W TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 04 03 01 ( B) POLICY NUMBER: (IJUB-4J20158-9-18) POLICY AMENDATORY ENDORSEMENT - CALIFORNIA It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Information Page is subject to the following provisions: 1. Minors Illegally Employed — Not Insured. This policy does not cover liability for additional compensation imposed on you under Section 4557, Division IV, Labor Code of the State of California, by reason of injury to an employee under sixteen years of age and illegally employed at the time of injury. 2. Punitive or Exemplary Damages — Uninsurable. This policy does not cover punitive or exemplary dam- ages where insurance of liability therefor is prohibited by law or contrary to public policy. 3. Increase in Indemnity Payment — Reimbursement. You are obligated to reimburse us for the amount of increase in indemnity payments made pursuant to Subdivision (d) of Section 4650 of the California Labor Code, if the late indemnity payment which gives rise to the increase in the amount of payment is due less than seven (7) days after we receive the completed claim form from you. You are obligated to reimburse us for any increase in indemnity payments not covered under this policy and will reimburse us for any increase in indemnity payment not covered under the policy when the aggregate total amount of the reimbursement payments paid in a policy year exceeds one hundred dollars ($100). If we notify you in writing, within 30 days of the payment, that you are obligated to reimburse us, we will bill you for the amount of increase in indemnity payment and collect it no later than the final audit. You will have 60 days, following notice of the obligation to reimburse, to appeal the decision of the insurer to the Depart- ment of Insurance. 4. Application of Policy. Part One, "Workers Compensation Insurance", A, "How This Insurance Applies", is amended to read as follows: This workers compensation insurance applies to bodily injury by accident or disease, including death result- ing therefrom. Bodily injury by accident must occur during the policy period. Bodily injury by disease must be caused or aggravated by the conditions of your employment. Your employee's exposure to those conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5. Rate Changes. The premium and rates with respect to the insurance provided by this policy by reason of the designation of California in Item 3 of the Information Page are subject to change if ordered by the Insurance Commissioner of the State of California pursuant to Section 11737 of the California Insurance Code. 6. Long Term Policy. If this policy is written for a period longer than one year, all the provisions of this policy shall apply separately to each consecutive twelve-month period or, if the first or last consecutive period is less than twelve months, to such period of less than twelve months, in the same manner as if a separate pol- icy had been written for each consecutive period. 7. Statutory Provision. Your employee has a first lien upon any amount which becomes owing to you by us on account of this policy, and in the case of your legal incapacity or inability to receive the money and pay it to the claimant, we will pay it directly to the claimant. 8. Part Five, "Premium", E, "Final Premium", is amended to read as follows: The premium shown on the Information Page, schedules, and endorsements is an estimate. The final pre- mium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of 2 2011 Workers- Compensation Insurance Rating Bureau of California. All rights reserved. W TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 04 03 01 ( B) POLICY NUMBER: (IJUB-4J20158-9-18) the balance to you. The final premium will not be less than the highest minimum premium for the classifica- tions covered by this policy. If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise: a. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. b. If you cancel, final premium may be more than pro rata; it will be based on the time this policy was in force, and may be increased by our short -rate cancelation table and procedure. Final premium will not be less than the pro rata share of the minimum premium. It is further agreed that this policy, including all endorsements forming a part thereof, constitutes the entire contract of insurance. No condition, provision, agreement, or understanding not set forth in this policy or such endorsements shall affect such contract or any rights, duties, or privileges arising therefrom. 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 Policy No. Endorsement No. Insured Insurance Company Countersigned by DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 2 of 2 2011 Workers' Compensation Insurance Rating Bureau of California. All rights reserved. TRAVELERSJW ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 0317 (B) POLICY NUMBER: (IJUB-4J20158-9-18) ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE Employee Insured by General Employer Excluded The insurance under this policy is limited as follows: It is AGREED that, anything in this policy to the contrary notwithstanding, this policy DOES NOT INSURE: NO LIABILITY FOR Any liability you may have as the special employer of an employee who is not on EMPLOYEE INSURED BY your payroll at the time of injury, based upon your representation that: (1) you have GENERAL EMPLOYER entered into a valid and enforceable agreement pursuant to Labor Code Section 3602(d) with the employee's general employer under which the general employer agrees to secure the payment of compensation for such employee and (2) the general employer has obtained workers' compensation coverage for the employee. This policy will be deemed unlimited to the extent that any of the following requirements are not met: (1) the employer actually obtains coverage for the excluded liability and (2) such coverage remains in effect for the term of this policy. Nothing in this endorsement shall be held to vary, alter, waive or extend any of the terms, conditions, agreements, or limitations of this policy other than as above stated. Nothing elsewhere in this policy shall be held to vary, alter, waive or limit the terms, conditions, agreements or limitations in this endorsement. It is further agreed that "remuneration" when used as a premium basis for such insurance as is afforded by this policy shall not include the remuneration of any person excluded from coverage in accordance with the foregoing. FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER, LARGE FINES AND OTHER SUBSTANTIAL PENALTIES Labor Code Section 3710.1, et seq.). DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of 2 TRAVELERSJ ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 0317 (B) POLICY NUMBER: (IJUB-4J20158-9-18) 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 Insured Insurance Company Policy No. Countersigned by Endorsement No. Premium $ DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 2 of 2 WORKERS COMPENSATION TRAVELERSJ AND EMPLOYERS LIABILITY POLICY ONE TOWER SQUARE ENDORSEMENT WC 04 03 60 ( B) HARTFORD, CT 06183 POLICY NUMBER: (IJUB-4J20158-9-18) EMPLOYERS' LIABILITY COVERAGE AMENDATORY ENDORSEMENT CALIFORNIA The insurance afforded by Part Two (Employers' Liability Insurance) by reason of designation of California in item 3 of the information page is subject to the following provisions: A. "How This Insurance Applies," is amended to read as follows: A. How This Insurance Applies This employers' liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury means a physical injury, including resulting death. 1. The bodily injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or incidental to your work in California. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The em- ployee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5. If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. C. The "Exclusions" section is modified as follows (all other exclusions in the "Exclusions" section remain as is): 1. Exclusion 1 is amended to read as follows: 1. liability assumed under a contract. 2. Exclusion 2 is deleted. 3. Exclusion 7 is amended to read as follows: damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, termination of employ- ment, or any personnel practices, policies, acts or omissions. 4. The following exclusions are added: 1. bodily injury to any member of the flying crew of any aircraft. 2. bodily injury to an employee when you are deprived of statutory or common law defenses or are subject to penalty because of your failure to secure your obligations under the workers' compensation law(s) appli- cable to you or otherwise fail to comply with that law. 3. liability arising from California Labor Code Section 2810.3 which relates to labor contracting. 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 Insured Insurance Company DATE OF ISSUE: 04-13-18 Policy No. Countersigned by ST ASSIGN: 2014 Workers' Compensation Insurance Rating Bureau of California. All Rights Reserved. EndorsementNo. Premium Page 1 of 1 W TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 04 04 21 (00) POLICY NUMBER: (IJUB-4J20158-9-18) OPTIONAL PREMIUM INCREASE ENDORSEMENT — CALIFORNIA You must provide us, or our authorized representative, access to records necessary to perform a payroll verifica- tion audit. If you fail to provide access within 90 days after expiration of the policy, you are liable to pay a total premium equal to 3 times our current estimate of the annual premium for your policy. In addition, if you fail to provide access after our third request within a 90 day or longer period, you are also liable for our costs in at- tempting to perform the audit unless you provide a compelling business reason for your failure. We will contact you to schedule appointments during normal business hours. We will notify you of your failure to provide access by mailing a certified, return -receipt document stating the increased premium and the total amount of our costs incurred in our attempt(s) to perform an audit. In addition to any other obligations under this contract, 30 days after you receive the notification, you will be obligated to pay the total premium and costs referenced above. If, thereafter, you provide access to your records within three years after the policy expires, or within another mutually agreed upon time, and we succeed in performing the audit to our satisfaction, we will revise your total premium and the costs due to reflect the results of the audit. 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 Policy No. Endorsement No. Insured Insurance Company Countersigned By DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of 1 TRAVELERSJW ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 04 22 (00) POLICY NUMBER: (IJUB-4J20158-9-18) CALIFORNIA SHORT -RATE CANCELATION ENDORSEMENT It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Information Page is subject to the following provisions: If you cancel the policy and a disclosure was provided in accordance with Section 481(c) of the California Insurance Code, final premium will be based on the time this policy was in force and increased by the short -rate cancelation table below: Short Rate Cancelation Table Days in Policy Period Short Rate Percentages Factors to Apply to Earned Premium for Period Policy in Effect Days in Policy Period Short Rate Percentages Factors to Apply to Earned Premium for Period Policy in Effect Days in Policy Period Short Rate Percentages Factors to Apply to Earned Premium for Period Policy in Effect 1 5% 18.2482 46 23% 1.8250 91 35% 1.4038 2 6 10.9489 47 23 1.7861 92 36 1.4283 3 7 8.5158 48 24 1.8250 93 36 1.4129 4 7 6.3869 49 24 1.7877 94 36 1.3979 5 8 5.8394 50 24 1.7520 95 37 1.4216 6 8 4.8662 51 24 1.7176 96 37 1.4068 7 9 4.6924 52 25 1.7548 97 37 1.3923 8 9 4.1058 53 25 1.7216 98 37 1.3781 9 10 4.0552 54 25 1.6899 99 38 1.4010 10 10 3.6496 55 26 1.7255 100 38 1.3870 11 11 3.6496 56 26 1.6947 101 38 1.3733 12 11 3.3455 57 26 1.6650 102 38 1.3598 13 12 3.3689 58 26 1.6362 103 39 1.3820 14 12 3.1283 59 27 1.6704 104 39 1.3688 15 13 3.1630 60 27 1.6425 105 39 1.3557 16 13 2.9653 61 27 1.6156 106 40 1.3774 17 14 3.0056 62 27 1.5895 107 40 1.3645 18 14 2.8386 63 28 1.6222 108 40 1.3519 19 15 2.8818 64 28 1.5969 109 40 1.3395 20 15 2.7377 65 28 1.5723 110 41 1.3605 21 16 2.7812 66 29 1.6038 111 41 1.3482 22 16 2.6547 67 29 1.5799 112 41 1.3362 23 17 2.6980 68 29 1.5566 113 41 1.3243 24 17 2.5856 69 29 1.5341 114 42 1.3447 25 17 2.4821 70 30 1.5643 115 42 1.3330 26 18 2.5270 71 30 1.5423 116 42 1.3215 27 18 2.4334 72 30 1.5208 117 43 1.3414 28 18 2.3465 73 30 1.5000 118 43 1.3301 29 18 2.2656 74 31 1.5291 119 43 1.3189 30 19 2.3117 75 31 1.5087 120 43 1.3079 31 19 2.2371 76 31 1.4888 121 44 1.3273 32 19 2.1672 77 32 1.5169 122 44 1.3164 33 20 2.2121 78 32 1.4974 123 44 1.3057 34 20 2.1471 79 32 1.4785 124 44 1.2951 35 20 2.0857 80 32 1.4600 125 45 1.3140 36 20 2.0278 81 33 1.4870 126 45 1.3036 37 21 2.0716 82 33 1.4689 127 45 1.2933 38 21 2.0171 83 33 1.4512 128 46 1.3117 39 21 1.9654 84 34 1.4774 129 46 1.3016 40 21 1.9162 85 34 1.4600 130 46 1.2916 41 22 1.9585 86 34 1.4430 131 46 1.2817 42 22 1.9119 87 34 1.4264 132 47 1.2996 43 22 1.8674 88 35 1.4517 133 47 1.2899 44 23 1.9079 89 35 1.4354 134 47 1.2802 45 23 1.8655 90 35 1.4194 135 47 1.2708 2011 Workers' Compensation Insurance Rating Bureau of California. All rights reserved DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of 3 TRAVELERSJW ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 04 22 (00) POLICY NUMBER: (IJUB-4J20158-9-18) Days in Policy Period Short Rate Percentages Factors to Apply to Earned Premium for Period Policy in Effect Days in Policy Period Short Rate Percentages Factors to Apply to Earned Premium for Period Policy in Effect Days in Policy Period Short Rate Percentages Factors to Apply to Earned Premium for Period Policy in Effect 136 48% 1.2882 181 60% 1.2099 226 70% 1.1305 137 48 1.2788 182 60 1.2033 227 70 1.1255 138 48 1.2696 183 61 1.2167 228 70 1.1206 139 49 1.2867 184 61 1.2101 229 71 1.1317 140 49 1.2775 185 61 1.2035 230 71 1.1267 141 49 1.2684 186 61 1.1970 231 71 1.1219 142 49 1.2595 187 61 1.1906 232 71 1.1170 143 50 1.2762 188 62 1.2037 233 72 1.1279 144 50 1.2674 189 62 1.1974 234 72 1.1231 145 50 1.2586 190 62 1.1910 235 72 1.1183 146 50 1.2500 191 62 1.1848 236 72 1.1136 147 51 1.2663 192 63 1.1977 237 72 1.1089 148 51 1.2578 193 63 1.1914 238 73 1.1195 149 51 1.2493 194 63 1.1853 239 73 1.1149 150 52 1.2653 195 63 1.1792 240 73 1.1102 151 52 1.2569 196 63 1.1732 241 73 1.1056 152 52 1.2487 197 64 1.1858 242 74 1.1161 153 52 1.2405 198 64 1.1798 243 74 1.1115 154 53 1.2562 199 64 1.1739 244 74 1.1070 155 53 1.2481 200 64 1.1680 245 74 1.1025 156 53 1.2401 201 65 1.1804 246 74 1.0980 157 54 1.2554 202 65 1.1745 247 75 1.1083 158 54 1.2475 203 65 1.1687 248 75 1.1038 159 54 1.2396 204 65 1.1630 249 75 1.0994 160 54 1.2319 205 65 1.1573 250 75 1.0950 161 55 1.2469 206 66 1.1694 251 76 1.1052 162 55 1.2392 207 66 1.1638 252 76 1.1008 163 55 1.2316 208 66 1.1582 253 76 1.0964 164 55 1.2241 209 66 1.1526 254 76 1.0921 165 56 1.2388 210 67 1.1645 255 76 1.0878 166 56 1.2313 211 67 1.1590 256 77 1.0979 167 56 1.2240 212 67 1.1535 257 77 1.0936 168 57 1.2384 213 67 1.1481 258 77 1.0893 169 57 1.2311 214 67 1.1428 259 77 1.0851 170 57 1.2238 215 68 1.1544 260 77 1.0810 171 57 1.2167 216 68 1.1491 261 78 1.0908 172 58 1.2308 217 68 1.1438 262 78 1.0866 173 58 1.2237 218 68 1.1385 263 78 1.0825 174 58 1.2167 219 69 1.1500 264 78 1.0784 175 58 1.2097 220 69 1.1448 265 79 1.0881 176 59 1.2236 221 69 1.1396 266 79 1.0840 177 59 1.2167 222 69 1.1345 267 79 1.0800 178 59 1.2098 223 69 1.1294 268 79 1.0759 179 60 1.2235 224 70 1.1406 269 79 1.0719 180 60 1.2167 225 70 1.1356 270 80 1.0815 2011 Workers' Compensation Insurance Rating Bureau of California. All rights reserved DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 2 of 3 TRAVELERSJW ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 04 22 (00) POLICY NUMBER: (IJUB-4J20158-9-18) Days in Policy Period Short Rate Percentages Factors to Apply to Earned Premium for Period Policy in Effect Days in Policy Period Short Rate Percentages Factors to Apply to Earned Premium for Period Policy in Effect Days in Policy Period Short Rate Percentages Factors to Apply to Earned Premium for Period Policy in Effect 271 80% 1.0775 316 90% 1.0396 361 100% 1.0111 272 80 1.0735 317 90 1.0363 362 100 1.0083 273 80 1.0696 318 90 1.0330 363 100 1.0055 274 81 1.0790 319 90 1.0298 364 100 1.0027 275 81 1.0751 320 91 1.0380 365 100 1.0000 276 81 1.0712 321 91 1.0347 277 81 1.0673 322 91 1.0315 278 81 1.0635 323 91 1.0283 279 82 1.0728 324 92 1.0364 280 82 1.0689 325 92 1.0332 281 82 1.0651 326 92 1.0301 282 82 1.0614 327 92 1.0269 283 83 1.0705 328 92 1.0238 284 83 1.0667 329 93 1.0318 285 83 1.0630 330 93 1.0286 286 83 1.0593 331 93 1.0255 287 83 1.0556 332 93 1.0224 288 84 1.0646 333 94 1.0303 289 84 1.0609 334 94 1.0272 290 84 1.0572 335 94 1.0242 291 84 1.0536 336 94 1.0211 292 85 1.0625 337 94 1.0181 293 85 1.0589 338 95 1.0259 294 85 1.0553 339 95 1.0229 295 85 1.0517 340 95 1.0198 296 85 1.0481 341 95 1.0169 297 86 1.0569 342 95 1.0139 298 86 1.0534 343 96 1.0216 299 86 1.0498 344 96 1.0186 300 86 1.0463 345 96 1.0156 301 86 1.0429 346 96 1.0127 302 87 1.0515 347 97 1.0203 303 87 1.0480 348 97 1.0174 304 87 1.0446 349 97 1.0145 305 87 1.0411 350 97 1.0116 306 88 1.0497 351 97 1.0087 307 88 1.0462 352 98 1.0162 308 88 1.0429 353 98 1.0133 309 88 1.0395 354 98 1.0105 310 88 1.0361 355 98 1.0076 311 89 1.0445 356 99 1.0150 312 89 1.0412 357 99 1.0122 313 89 1.0379 358 99 1.0094 314 89 1.0346 359 99 1.0065 315 90 1.0429 360 99 1.0038 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 Insured Insurance Company Policy No. Countersigned by 2011 Workers' Compensation Insurance Rating Bureau of California. All rights reserved DATE OF ISSUE: 04-13-18 ST ASSIGN: Endorsement No. Premium $ Page 3 of 3 TRAVELERSJ WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 06 01 (A) POLICY NUMBER: (IJUB-4J20158-9-18) CALIFORNIA CANCELATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the information page. The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions: CANCELATION 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect. 2. We may cancel this policy for one or more of the following reasons: a. Non-payment of premium; b. Failure to report payroll; c. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us; e. Material misrepresentation made by you or your agent; f. Failure to cooperate with us in the investigation of a claim; g. Failure to comply with Federal or State safety orders; h. Failure to comply with written recommendations of our designated loss control representatives; i. The occurrence of a material change in the ownership of your business; j. The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss; k. The occurrence of any change in your business or operation that requires additional or different classification for premium calculation; I. The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties. 3. If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items (g) through (1), we will give you 30 days advance written notice; however, we agree that in the event of cancelation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. 4. The policy period will end on the day and hour stated in the cancelation notice. DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of 1 TRAVELERS JW WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 04 03 45 (A) POLICY NUMBER: (IJUB-4J20158-9-18) ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE Comprehensive Personal Liability Policy Exclusion The insurance under this policy is limited as follows: It is AGREED that, anything in this policy to the contrary notwithstanding, this policy DOES NOT INSURE: THIS POLICY DOES Any liability you may have for any injury to any employee(s) who is covered for workers' NOT INSURE ANY compensation benefits on a policy also affording comprehensive personal liability insurance EMPLOYEE(S) which has been issued to this insured. COVERED BY A COMPREHENSIVE PERSONAL LIABILITY POLICY Nothing in this endorsement shall be held to vary, alter, waive or extend any of the terms, conditions, agreements, or limitations of this policy other than as above stated. Nothing elsewhere in this policy shall be held to vary, alter, waive or limit the terms, conditions, agreements, or limitations of this endorsement It is further agreed that "remuneration" when used as a premium basis for such insurance as is afforded by this policy shall not include the remuneration of any person excluded from coverage in accordance with the foregoing. FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER, LARGE FINES, AND OTHER SUBSTANTIAL PENALTIES Labor Code Section 3710.1, et seq.) 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 Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by DATE OF ISSUE: 04-13-18 ST ASSIGN: Page 1 of 1 If Your Employee Is Injured At Work Prompt reporting of work-related injuries and illnesses and the use of Travelers national Medical Net- work Providers can achieve better outcomes and lower your overall workers compensation claim costs! Whenever an Employee suffers a work-related injury or illness, the Employer should: 1. Seek appropriate medical care for the Employee. 2. If the injury or illness is acute, the Employer should always send the Employee to the nearest medical emergency department. 3. If the injury or illness is not acute, the Employer may suggest that the Employee seek treatment from the nearest Medical Network Provider. Medical Network Providers understand work-related illnesses and injuries, are credentialed to help assure quality care, and cooperate to achieve a medically appropriate return to work for the Employee. Medical Network Providers (hospitals, initial care clinics, specialists, testing, therapy, etc.) are available in all 50 States and the District of Columbia. Even before an illness or injury occurs, it may be helpful for the Employer to build a relationship with a convenient Medical Network Clinic or Hospital that will provide initial treatment for ill or injured Employees. 4. The Employee's Supervisor should gather pertinent facts about the work-related illness or injury and may use the Worksheet For Workers' Compensation Telephone Reporting provided by Travelers as a guide. 5. As soon as possible, the Employer should report all work-related illnesses or injuries to Travelers by, using Travelers business insurance online reporting web site at travelers.com dialing our toll free number, 1-800-238-6225. If needed at that time, Travelers Customer Service Repre- sentative can provide the name of a convenient Medical Network Provider. Prompt reporting of work- related illnesses and injuries is key in helping to reduce total claim costs. At the conclusion of the phone call, the Travelers Customer Service Representative will provide a claim number that should be retained for the Employer's reference and also provided to the ill or injured Employee. The card below contains information that may be helpful in reporting work-related illnesses and injuries to Travelers and should be kept in a convenient location for use by the Employer when needed. TRAVELERS/ J WC Claim Reporting Promptly report your work-related injuries to Travelers: Travelers.com 800-238-6225 Learn about Travelers unique Claim Services and find a convenient medical network provider by logging on to Travelers.com. To get to Travelers website, select Business Insurance from the home page. Then choose Workers' Compensation & Managed Care Claim Management from the menu of services in the left margin. Finally, click on Preferred Provider Network to search for a Medical Network Provider near you. WUNC61308 Page 1 of 1 IMPORTANT NOTICE - NEW, UNCOLLECTED OR UNCONTEMPLATED SURCHARGES NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANY PROVISION OF YOUR POLICY. YOU SHOULD REVIEW YOUR ENTIRE POLICY CAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TO DETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. The insurer is responsible for the collection of any surcharge related to the policy premium in accordance with state laws or regulations. While surcharges are commonly known at the time of policy issuance, there are instances when a state amends existing, or institutes new, surcharge rates after policy issuance. The insured is responsible to reimburse the insurer when billed for the amount of any surcharge. WUND1C17 © 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 TRAVELERSJW PRIVACY NOTICE THE TRAVELERS INSURANCE COMPANIES PRIVACY POLICY Thank you for selecting THE TRAVELERS INSURANCE COMPANIES as your workers compensation insurer. At THE TRAVELERS INSURANCE COMPANIES a subsidiary of Travelers, we recognize that privacy is important to you. That is why we are committed to protecting your privacy through the adoption of the following privacy principles: Collection Of Information We collect, retain, and use information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, only where we believe that it will help or is necessary to provide you products and services or otherwise conduct our business. We collect nonpublic personal financial information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, from the following sources: information we receive from you or through your agent or broker on applications or other forms; information we receive from or about you in the process of adjusting claims; information about your other transactions, including risk control and other consulting services, with us, our affiliates or other third parties; information about your coverages and loss activity with other carriers; and information we receive from a consumer reporting agency. Such information includes identifying information such as policyholder, participant, beneficiary or claimant name, address, and social security number; financial information such as income, payment history, or credit history; and, under certain circumstances, health information such as information about an illness, disability, or injury. It could also include information on claims with other insurance companies and us and the condition and mainte- nance of your property. Disclosure Of Information We usually do not disclose nonpublic personal information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, without your consent. However, in some circumstances we may disclose information to others without your prior authorization. The most common disclosures are to the following persons: our affiliated property and casualty insurance companies; state insurance departments, for their regulation of our business; other government authorities; our agents and brokers as necessary to conduct our business; organizations that perform underwriting and claims investigations; another insurance company to which you have applied for a policy or submitted a claim; insurance support agencies, law enforcement agencies and our reinsurers; and any other third party, as permitted or required by law. Most importantly, THE TRAVELERS INSURANCE COMPANIES does not and will not disclose or sell nonpublic personal information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, to anyone for marketing purposes. WUNNAB09 Page 1 of 2 Confidentiality And Security We restrict access to nonpublic personal information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, to those who need it to serve your insurance needs and to maintain and improve customer service. We maintain physical, electronic, and procedural safeguards that comply with federal and state laws and regulations to guard your nonpublic personal information. Disclosure and Protection of Former Customers' Information We may disclose all the personal information we have collected, as described above. However, even if you no longer have a customer relationship with us, we will continue to follow our privacy policies and practices to protect your information. Changes In Privacy Policy We may choose to modify our policy regarding the treatment of personal information at any time. Before we do so, we will notify you and provide an updated privacy notice. WUNNAB09 Page 2 of 2 IMPORTANT NOTICE - INDEPENDENT AGENT AND BROKER COMPENSATION NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANY PROVISION OF YOUR POLICY. YOU SHOULD REVIEW YOUR ENTIRE POLICY CAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TO DETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. For information about how Travelers compensates independent agents and brokers, please visit www.travelers.com, call our toll-free telephone number 1-866-904-8348, or request a written copy from Marketing at One Tower Square, 2GSA, Hartford, CT 06183. WUNNDD08 PN T4 54 01 08 Page 1 of 1 IMPORTANT NOTICE - COPYRIGHT NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANY PROVISION OF YOUR POLICY. YOU SHOULD REVIEW YOUR ENTIRE POLICY CAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TO DETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. The National Council on Compensation Insurance and certain state workers compensation bureaus require a copyright notice on policy forms that contain their copyrighted material. This Important Notice addresses this copyright notice requirement for any policy form included in this policy that does not separately contain a copyright notice. For all policy forms other than the workers compensation bureau forms of the states identified below: Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission. 1983- 2018 National Council on Compensation Insurance, Inc. All Rights Reserved For the workers compensation bureau policy forms of the following states: DELAWARE: 2018 Delaware Compensation Rating Bureau MICHIGAN: Includes copyright material of the National Council on Compensation Insurance, Inc. and the Michigan Workers' Compensation Placement Facility, used with their permission. MINNESOTA: 1992- 2018 Minnesota Workers' Compensation Insurers Association, Inc. All Rights Reserved. NEW JERSEY: Compensation Rating and Inspection Bureau NEW YORK: 1987- 2018 New York Compensation Insurance Rating Board PENNSYLVANIA: 2018 Pennsylvania Compensation Rating Bureau WUNN11318 © The Travelers Indemnity Company. All rights reserved. Page 1 of 1 IMPORTANT Policy Audit Information Dear Policyholder: This policy is issued with an estimated premium based upon information provided through your Producer. This premium is subject to adjustment at the end of the policy period. At that time, you may receive a request for information in the mail or a premium auditor may contact you to review the necessary records. The information developed is needed to determine the final earned premium for this policy. Record Maintenance In order to facilitate audit service, it is necessary to maintain proper records and have them available at the proper time. Based on the nature of your business, some of the following data will be necessary to complete the audit: 1. General Ledger, Financial Statements 2. Payroll Records, Time Books, State Unemployment Returns, FICA Returns, Individual Earnings Records -Monthly totals separated by type of work and overtime. 3. Cash Receipts, Sales Journal 4. Cash Disbursements Journal - Including subcontractors. casual labor and material costs. 5. Certificates of Insurance IMPORTANT COVERAGE NOTE: If you utilize subcontractors whose legal status is that of sole proprietor/partner, we may charge premium for these persons as provided under Part 5 of the policy contract even though certificates of insurance may exist. Please contact your producer if you have any questions regarding your Workers' Compensation coverage needs. Work in Other States Please advise your Producer if employees are hired for work in states other than those listed in Item 3. of your policy. This will enable your producer to consider your need for coverage in accordance with state laws. We appreciate the opportunity to serve you. If you have any questions about the enclosed policy or any insurance matters please contact your producer or your Company representative. WUNN7F00 ARIZONA WORK EXPOSURE TO BODILY FLUIDS HIV & AIDS) Dear Policyholder: The Arizona Industrial Commission requires Employers to post Immediately Adjacent to the "Notice To Employees" an English language notice entitled "Work Exposure To Fluids". For those Employers who have a Spanish speaking work force the "Work Exposure To Fluids" is also printed in Spanish. In addition, the Employer must also supply their Employees the Reporting Forms (Sample Attached) needed to report such exposures to bodily fluids. The Employer may secure a supply of these Reporting Forms from the Industrial Commission of Arizona. W02M1A18 PN 04 99 02 B Ed. 5-02) POLICYHOLDER NOTICE CALIFORNIA WORKERS' COMPENSATION INSURANCE RATING LAWS Pursuant to Section 11752.8 of the California Insurance Code, we are providing you with an explanation of the California workers' compensation rating laws. 1. We establish our own rates for workers' compensation. Our rates, rating plans, and related information are filed with the insurance commissioner and are open for public inspection. 2. The insurance commissioner can disapprove our rates, rating plans, or classifications only if he or she has determined after public hearing that our rates might jeopardize our ability to pay claims or might create a mo- nopoly in the market. A monopoly is defined by law as a market where one insurer writes 20% or more of that part of the California workers' compensation insurance that is not written by the State Compensation Insur- ance Fund. If the insurance commissioner disapproves our rates, rating plans, or classifications, he or she may order an increase in the rates applicable to outstanding policies. 3. Rating organizations may develop pure premium rates that are subject to the insurance commissioner's ap- proval. A pure premium rate reflects the anticipated cost and expenses of claims per $100 of payroll for a given classification. Pure premium rates are advisory only, as we are not required to use the pure premium rates developed by any rating organization in establishing our own rates. 4. We must adhere to a single, uniform experience rating plan. If you are eligible for experience rating under the plan, we will be required to adjust your premium to reflect your claim history. A better claim history generally results in a lower experience rating modification; more claims, or more expensive claims, generally result in a higher experience rating modification. The uniform experience rating plan, which is developed by the insur- ance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. 5. A standard classification system, developed by the insurance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. The standard classification system is a method of recognizing and separating policyholders into industry or occupational groups according to their similarities and/or differences. We can adopt and apply the standard classification system or develop and ap- ply our own classification system, provided we can report the payroll, expenses, and other costs of claims in a way that is consistent with the uniform statistical plan or the standard classification system. 6. Our rates and classifications may not violate the Unruh Civil Rights Act or be unfairly discriminatory. 7. We will provide an appeal process for you to appeal the way we rate your insurance policy. The process re- quires us to respond to your written appeal within 30 days. If you are not satisfied with the result of your ap- peal, you may appeal our decision to the insurance commissioner. CALIFORNIA WORKERS' COMPENSATION INSURANCE NOTICE OF NONRENEWAL Section 11664 of the California Insurance Code requires us, in most instances, to provide you with a notice of nonrenewal. Except as specified in paragraphs 1 through 6 below, if we elect to nonrenew your policy, we are required to deliver or mail to you a written notice stating the reason or reasons for the nonrenewal of the policy. The notice is required to be sent to you no earlier than 120 days before the end of the policy period and no later than 30 days before the end of the policy period. If we fail to provide you the required notice, we are required to continue the coverage under the policy with no change in the premium rate until 60 days after we provide you with the required notice. We are not required to provide you with a notice of nonrenewal in any of the following situations: 1. Your policy was transferred or renewed without a change in its terms or conditions or the rate on which the premium is based to another insurer or other insurers who are members of the same insurance group as us. 2. The policy was extended for 90 days or less and the required notice was given prior to the extension. 2002 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. W04NBA02 Page 1 of 2 PN 0499 02 B Ed. 5-02) 3. You obtained replacement coverage or agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. 4. The policy is for a period of no more than 60 days and you were notified at the time of issuance that it may not be renewed. 5. You requested a change in the terms or conditions or risks covered by the policy within 60 days prior to the end of the policy period. 6. We made a written offer to you to renew the policy at a premium rate increase of less than 25 percent. A) If the premium rate in your governing classification is to be increased 25 percent or greater and we intend to renew the policy, we shall provide a written notice of a renewal offer not less than 30 days prior to the policy renewal date. The governing classification shall be determined by the rules and regulations estab- lished in accordance with California Insurance Code Section 11750.3(c). B) For purposes of this Notice, "premium rate" means the cost of insurance per unit of exposure prior to the application of individual risk variations based on loss or expense considerations such as scheduled rating and experience rating. This notice does not change the policy to which it is attached. 2002 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. W04NBA02 Page 2 of 2 PN 04 99 01 F POLICYHOLDER NOTICE YOUR RIGHT TO RATING AND DIVIDEND INFORMATION Information Available to You A. Information Available from Us —The Travelers Companies 1) General questions regarding your policy should be directed to: TRAVELERS P.O. Box 6512 21688 Gateway Center Drive Diamond Bar, CA 91765 Telephone: 1-909-612-3609 Fax: 1-909-612-3629 Website: www.travelers.com 2) Dividend Calculation. If this is a participating policy (a policy on which a dividend may be paid), upon payment or non-payment of a dividend, we shall provide a written explanation to you that sets forth the basis of the dividend calculation. The explanation will be in clear, understandable language and will express the dividend as a dollar amount and as a percentage of the earned premium for the policy year on which the dividend is calculated. 3) Claims Information. Pursuant to Sections 3761 and 3762 of the California Labor Code, you are entitled to receive information in our claim files that affects your premium. Copies of documents will be supplied at your expense during reasonable business hours. For claims covered under this policy, we will estimate the ultimate cost of unsettled claims for statistical purposes eighteen months after the policy becomes effective and will report those estimates to the Workers' Compensation Insurance Rating Bureau of California (WCIRB) no later than twenty months after the policy becomes effective. The cost of any settled claims will also be reported at that time. At twelve-month intervals thereafter, we will update and report to the WCIRB the estimated cost of any unsettled claims and the actual final cost of any claims settled in the interim. The amounts we report will be used by the WCIRB to compute your experience modification if you are eligible for experience rating. B. Information Available from the Workers' Compensation Insurance Rating Bureau of California 1) The WCIRB is a licensed rating organization and the California Insurance Commissioner's designated statistical agent. As such, the WCIRB is responsible for administering the California Workers' Compensation Uniform Statistical Reporting Plan -1995 (USRP) and the California Workers' Compensation Experience Rating Plan -1995 (ERP). Contact information for the WCIRB is: WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attention: Customer Service. You may also contact WCIRB Customer Service at 1-888-229-2472, by fax at 415-778-7272, or via the Internet at the WCIRB's website: http://www.wcirb.com. The regulations contained in the USRP and the ERP are available for public viewing through the WCIRB's website. 2) Policyholder Information. Pursuant to California Insurance Code (CIC) Section 11752.6, upon written request, you are entitled to information relating to loss experience, claims, classification assignments, and policy contracts as well as rating plans, rating systems, manual rules, or other information impacting your premium that is maintained in the records of the WCIRB. Complaints and Requests for Action requesting policyholder information should be forwarded to: WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attention: Custodian of Records. The Custodian of Records can be reached by telephone at 415-777-0777 and by fax at 415-778-7272. 3) Experience Rating Form. Each experience rated risk may receive a single copy of its current Experience Rating Form free of charge by completing a Policyholder Rate Sheet Request Form on the WCIRB's website at http://www.wcirb.com/ratesheet. The Experience Rating Form will include a Loss -Free Rating, which is the experience modification that would have been calculated if $0 (zero) W04NBG15 Page 1 of 3 2015 Workers' Compensation Insurance Rating Bureau of California. All Rights Reserved. PN 04 99 01 F actual losses were incurred during the experience period. This hypothetical rating calculation is provided for informational purposes only. II. Dispute Process You may dispute our actions or the actions of the WCIRB pursuant to CIC Sections 11737 and 11753.1. A. Our Dispute Resolution Process. If you are aggrieved by our decision adopting a change in a classification assignment that results in increased premium, or by the application of our rating system to your workers' compensation insurance, you may dispute these matters with us. If you are dissatisfied with the outcome of the initial dispute with us, you may send us a written Complaint and Request for Action as outlined below.] You may send us a written Complaint and Request for Action requesting that we reconsider a change in a classification assignment that results in an increased premium and/or requesting that we review the manner in which our rating system has been applied in connection with the insurance afforded or offered you. Written Complaints and Requests for Action should be forwarded to: TRAVELERS 1109 White Rock Road Rancho Cordova, CA 95670-6001 Phone: 1-800-328-2189 Website: www.Travelers.com TRAVELERS P.O. Box 6512 21688 Gateway Center Drive Diamond Bar, CA 91765 Phone: 1-909-612-3629 Fax: 1-909-612-3629 Website: www.Travelers.com After you send your Complaint and Request for Action, we have 30 days to send you a written notice indicating whether or not your written request will be reviewed. If we agree to review your request, we must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If we decline to review your request, if you are dissatisfied with the decision upon review, or if we fail to grant or reject your request or issue a decision upon review, you may appeal to the insurance commissioner as described in paragraph II.C., below. B. Disputing the Actions of the WCIRB. If you have been aggrieved by any decision, action, or omission to act of the WCIRB, you may request, in writing, that the WCIRB reconsider its decision, action, or omission to act. You may also request, in writing, that the WCIRB review the manner in which its rating system has been applied in connection with the insurance afforded or offered you. For requests related to classification disputes, the reporting of experience, or coverage issues, your initial request for review must be received by the WCIRB within 12 months after the expiration date of the policy to which the request for review pertains, except if the request involves the application of the Revision of Losses rule. For requests related to your experience modification, your initial request for review must be received by the WCIRB within 6 months after the issuance, or 12 months after the expiration date, of the experience modification to which the request for review pertains, whichever is later, except if the request for review involves the application of the Revision of Losses rule. If the request involves the Revision of Losses rule, the time to state your appeal may be longer. (See Section VI, Rule 14 of the ERP). You may commence the review process by sending the WCIRB a written Inquiry. Written Inquiries should be sent to: WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attention: Customer Service. Customer Service can be reached by telephone at 1-888-229-2472, and by fax at 415-778-7272. If you are dissatisfied with the WCIRB's decision upon an Inquiry, or if the WCIRB fails to respond within 90 days after receipt of the Inquiry, you may pursue the subject of the Inquiry by sending the WCIRB a written Complaint and Request for Action. After you send your Complaint and Request for Action, the WCIRB has 30 days to send you written notice indicating whether or not your written request will be reviewed. If the WCIRB agrees to review your request, it must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If the WCIRB declines to review your request, if you are dissatisfied with the decision upon review, or if the WCIRB fails to grant or reject your request or issue a decision upon review, you may appeal to the insurance commissioner as described in paragraph II.C., below. Written Complaints and Requests for Action should be forwarded to: WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attention: W04NBG15 Page 2 of 3 2015 Workers' Compensation Insurance Rating Bureau of California. All Rights Reserved. PN 04 99 01 F Complaints and Reconsiderations. The WCIRB's telephone number is 1-888-229-2472, and the fax number is 415-371-5204. C. California Department of Insurance — Appeals to the Insurance Commissioner. If, after you follow the appropriate dispute resolution process described above, we or the WCIRB decline to review your request, if you are dissatisfied with the decision upon review, or if we or the WCIRB fail to grant or reject your request or issue a decision upon review, you may appeal to the insurance commissioner pursuant to CIC Sections 11737, 11752.6, 11753.1 and Title 10, California Code of Regulations, Section 2509.40 et seq. You must file your appeal within 30 days after we or the WCIRB send you the notice rejecting review of your Complaint and Request for Action or the decision upon your Complaint and Request for Action. If no written decision regarding your Complaint and Request for Action is sent, your appeal must be filed within 120 days after you sent your Complaint and Request for Action to us or to the WCIRB. The filing address for all appeals to the insurance commissioner is: Administrative Hearing Bureau California Department of Insurance 45 Fremont Street, 22nd Floor San Francisco, California 94105 You have the right to a hearing before the insurance commissioner, and our action, or the action of the WCIRB, maybe affirmed, modified, or reversed. III Resources Available to You in Obtaining Information and Pursuing Disputes A. Policyholder Ombudsman. Pursuant to California Insurance Code Section 11752.6, a policyholder ombudsman is available at the WCIRB to assist you in obtaining and evaluating the rating, policy, and claims information referenced in I.A. and I.B., above. The ombudsman may advise you on any dispute with us, the WCIRB, or on an appeal to the insurance commissioner pursuant to Section 11737 of the Insurance Code. The address of the policyholder ombudsman is WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attention: Policyholder Ombudsman. The policyholder ombudsman can be reached by telephone at 415-778-7159 and by fax at 415-371-5288. B. California Department of Insurance — Information and Assistance. Information and assistance on policy questions can be obtained from the Department of Insurance Consumer HOTLINE, 1 -800 -927 - HELP (4357) or http://www.insurance.ca.gov. For questions and correspondence regarding appeals to the Administrative Hearing Bureau, see the contact information in paragraph II.C. This notice does not change the policy to which it is attached. W04NBG15 Page 3 of 3 2015 Workers' Compensation Insurance Rating Bureau of California. All Rights Reserved. POLICYHOLDER NOTICE CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA) SURCHARGE Companies writing property and casualty insurance business in California are required to participate in the California Insurance Guarantee Association. If a company becomes insolvent, the California Insurance Guarantee Association settles unpaid claims and assesses each insurance company for its fair share. California law requires all companies to surcharge policies to recover these assessments. If your policy is surcharged, "CA Surcharge" or "CA Surcharge (CIGA) Surcharge)" with an amount will be displayed on your premium notice. This notice does not change the policy to which it is attached. PN 04 99 04 (00) W04NDCO2 TRAVELERS!' Your Workers' Compensation Benefits CALIFORNIA This form should be given to all newly hired employees in the State of California. Its content applies to industrial injuries on or after January 1, 2013. Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers' compensation benefits or pay- ments is guilty of a felony. You may be entitled to workers' compensation benefits if you are injured or become ill because of your job, or are a victim of a workplace crime. Workers' compensation covers most work-related physical or mental injuries and illness- es. An injury or illness can be caused by one event (such as hurting your back in a fall) or by repeated exposures to a harmful condition (such as hurting your wrist from doing the same motion over and over). Workers' compensation benefits include: Medical Care: Doctor visits, hospital services, physical therapy, lab tests, x-rays, and medicines that are reasonably necessary to treat your injury. You should never see a bill. Physical therapy, occupational therapy and chiropractic visits may be limited to 24 each. Temporary Disability Benefits: Payments if you lose wages while recovering. For most injuries, temporary disability benefits are limited to 104 weeks within 5 years from your date of injury. Filing a timely Employment Development Department claim may result in additional state disability benefits when TTD benefits are terminated, delayed or denied. Permanent Disability Benefits: Payments if your injury causes a permanent disability. Once your injury stabilizes, your treating physician may find permanent disability, depending upon your level of recovery. The amount of perma- nent disability found by your doctor will be rated by your claims administrator according to your age and occupation in order to determine the percentage and corresponding dollar amount of permanent disability due. These amounts are set by state law. You have the right to obtain a state disability rating or appeal a rating. Supplemental Job Displacement Vouchers: If your injury causes you to miss time from work and results in permanent disability, you may receive a supplemental job displacement voucher if your employer has not offered modified, alternative or regular employment within 60 days of receipt of the doctor's medical report indicating you have made a maximum medical recovery. The voucher is for reimbursement of education -related costs and is capped at 6,000.00, If you receive a voucher as a result of your injury, you have two years from the date you are furnished the voucher or five years from your date of injury (whichever occurs later), to request reimbursement for qualifying expenditures. Death Benefits: Paid to dependents of a worker who dies from a work-related injury or illness. Burial expenses are also provided, with the maximum amount allowed dependent upon the date of injury. Return to Work Program: If you experience a permanent earnings loss as a result of your injury and your permanent disability benefits are determined to be disproportionately low, you may qualify for additional monies from the Depart- ment of Industrial Relation's Return to Work Fund. Contact the Department of Industrial Relations at: www.dir.ca.gov/ to learn more about this additional benefit. Temporary disability, permanent disability, and death benefits are all payable at a rate based on 2/3 of your average weekly wage, and subject to state minimum and maximum amounts in effect on your date of injury. These benefits are paid every two weeks while you are eligible. Voluntary, off duty, recreational, social or athletic activities may not be covered under workers' compensa- tion. W04NE116 travelers.com Page 1 of 6 The Travelers Indemnity Company and its property casualty affiliates. One Tower Square, Hartford, CT 06183 2016 The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The T. -......I___ 1-1...v—:1.1 iL... II 0 ......J .. a L....-..... a. / 7 [7.... 4n On— If you get hurt: Get Medical Care. If you need first aid, contact your employer. If you need emergency care, call for help immediately. Report Your Injury. Report the injury immediately to your supervisor. Don't delay. There are time limits. If you wait too long, you may lose your right to benefits. Your employer is required to provide you a claim form within one working day after learning about your injury, and must also authorize treatment within one working day after you have returned a signed and completed copy of the form. The statute of limitations for filing a workers' compensation claim is one year from the date of injury or, if resulting from repeated exposures, one year from when you realized or should have realized that your job caused the injury. See Your Treating Physician. Your primary treating physician is the doctor with overall responsibility for treating your injury or illness. He or she is charged with maintaining the continuity of your care, as well as initiating referrals to specialists. If your employer has an approved Medical Provider Network (MPN), they may be able to limit your choices of treating physicians retain medical control, and require you to treat with an MPN physician from the onset. (An MPN is a selected network of healthcare providers who provide treatment to workers injured on the job. See your employer for more information on your MPN.) Otherwise, your employer has the right to select the physician who will treat you for the first 30 days. If your employer does not have an approved MPN and you wish to change doctors in the first 30 days after reporting your claim, your claims administrator must select a new physician within five days of your request. If you have provided your employer with the name of your personal physician before your injury and have group health insurance at the time of injury, you may see your personal physician for treatment even if your employer has an approved MPN. Your personal physician must be a general practitioner or a board-certified or board -eligible internist, pediatrician, obstetrician- gynecologist, family practitioner, or multi -specialty medical group of doctors of medicine or osteopathy, and must have treated you and maintained your medical history and records before your work injury and must also agree to treat you for a work-related injury or illness. If your employer does not have an approved MPN and you gave your employer the name of your personal chiropractor or acupuncturist in writing before you were injured, you may switch to the chiropractor or acupuncturist upon request. If you still need medical care after 30 days, you may be able to switch to a doctor of your own choice. For your convenience, optional forms to predesignate your personal physician or multi -specialty medical group of doctors of medicine or osteopathy are attached to this document. Also attached, are forms to predesignate your personal acupuncturist or chiropractor if your employer does not have a medical provider network in place. By law, chiropractors are not allowed to be the treating physician after 24 visits. Discrimination: It is illegal for your employer to punish or fire you for having a work injury or illness, for filing a claim, or testifying in another person's workers' compensation case. If your employer has been found to discriminate, you may be entitled to job reinstatement with back pay, increased compensation, and costs and expenses. You may also have additional rights under the Americans with Disabilities Act (ADA) or the Fair Employment and Housing Act FEHA). For additional information, contact FEHA at (800) 884-1684 or the Equal Employment Opportunity Commis- sion (EEOC) at (800) 669-3362. You can get free information from a state Division of Workers' Compensation Information & Assistance Officer. Hear recorded information and a list of local offices by calling toll-free (800) 736- 7401 or learn more online at: http://www.dir.ca.gov. If medical care is not being provided by your employer you have several options. First, contact your claims administra- tor to find out the status of your claim. If you have given your employer a completed and signed claim form but your claim has been delayed for investigation, your employer is still required to authorize treatment, up to $10,000.00, during the delay. If the claim has not been accepted yet and your medical costs have exceeded the statutory 10,000.00 cap, you can go to your group health plan for care, find a doctor, clinic or hospital that will bill the claims administrator directly, or use public health services. You have the right to disagree with decisions affecting your claim. If you have a disagreement, contact your claims administrator first to see if you can resolve it. W04NE116 travelers.com Page 2of6 The Travelers Indemnity Company and its property casualty affiliates. One Tower Square, Hartford, CT 06183 2016 The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The T. -......I___ 1-1...v—:1.1 iL... II 0 ......J .. a L....-..... a. / 7 [7.... 4n On— Your Workers' Compensation Insurance Company is Travelers Property Casualty Company of America. You can also look up your insurance carrier at the WCIRB online lookup: https://www.caworkcompcoverage.com/ You can obtain free information from an Information and Assistance Officer of the state Division of Workers' Compen- sation, or you can hear recorded information and a list of local offices by calling (800) 736-7401. A list of Information and Assistance offices can be found at the end of this pamphlet to help you locate the I&A office nearest you. You may also go to the DWC web site at: http:/twww.dir.ca.gov for further information. You can consult with an attorney. Most attorneys offer one free consultation. If you decide to hire an attorney, his or her fee may be taken out of some of your benefits. For names of workers' compensation attorneys, call the State Bar of California at (415) 538-2120 or go to their web site at: http://www.californiaspecialist.org. You may get a list of attorneys from your local information and assistance officer or look in your yellow pages. W04NE116 travelers.com Page 3of6 The Travelers Indemnity Company and its property casualty affiliates. One Tower Square, Hartford, CT 06183 2016 The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The T. -......I___ 1-1...v—:1.1 iL... II 0 ......J .. a L....-..... a. / 7 [7.... 4n On— PREDESIGNATION OF PERSONAL PHYSICIAN In the event you sustain an injury or illness related to your employment, you may be treated for such injury or illness by your personal medical doctor (M.D.) or doctor of osteopathic medicine (D.O.) or medical group if: on the date of your work injury, you have health care coverage for injuries or illnesses that are not work related; the doctor is your regular physician, who shall be either a physician who has limited his or her practice of med- icine to general practice or who is a board-certified or board -eligible internist, pediatrician, obstetrician - gynecologist, family practitioner, and has previously directed your medical treatment, and retains your medical records; your "personal physician" may be a medical group if it is a single corporation or partnership composed of li- censed doctors of medicine or osteopathy, which operates an integrated multispecialty medical group provid- ing comprehensive medical services predominantly for nonoccupational illnesses and injuries; prior to the injury your doctor agrees to treat you for work injuries or illnesses; prior to the injury you provided your employer the following in writing: (1) notice that you want your personal doctor to treat you for a work-related injury or illness, and (2) your personal doctor's name and business ad- dress. You may use this form to notify your employer if you wish to have your personal medical doctor or a doctor of osteo- pathic medicine treat you for a work- related injury or illness and the above requirements are met. NOTICE OF PREDESIGNATION OF PERSONAL PHYSICIAN Employee: Complete this section. of employer) If I have a work-related injury or illness, I choose to be treated by: Name of Doctor, M.D., D.O., or medical group) Street address, city, state, zip code) Telephone number) Employee Name (please print): Employee's Address: Name of Insurance Company, Plan, or Fund providing health coverage for nonoccupational injuries or illnesses: Employee's Signature Physician: I agree to this Predesignation. Date: Signature: Date: Physician or designated employee of the physician or medical group) The physician is not required to sign this form, however, if the physician or designated employee of the physician or medical group does not sign, other documentation of the physician's agreement to be predesignated will be required pursuant to Title 8, California Code of Regulations, section 9780.1(a)(3). Title 8, California Code of Regulations, section 9783 Optional DWC Form 9783 Effective date July 1, 2014) Predesignation of Personal Physician; Reporting Duties of the Primary Treating Physician Regulations 8 C.C.R. section 9780, et seq. (Approved 02/12/2014) W04NE116 travelers.com Page 4of6 The Travelers Indemnity Company and its property casualty affiliates. One Tower Square, Hartford, CT 06183 2016 The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The T. -......I___ 1-1...v—:1.1 iL... II 0 ......J .. a L....-..... a. / 7 [7.... 4n On— NOTICE OF PERSONAL CHIROPRACTOR OR PERSONAL ACUPUNCTURIST If your employer or your employer's insurer does not have a Medical Provider Network, you may be able to change your treating physician to your personal chiropractor or acupuncturist following a work-related injury or illness. In order to be eligible to make this change, you must give your employer the name and business address of a personal chiropractor or acupuncturist in writing prior to the injury or illness. Your claims administrator generally has the right to select your treating physician within the first 30 days after your employer knows of your injury or illness. After your claims adminis- trator has initiated your treatment with another doctor during this period, you may then, upon request, have your treatment transferred to your personal chiropractor or acupuncturist. NOTE: If your date of injury is January 1, 2004, or later, a chiropractor cannot be your treating physician after you have received 24 chiropractic visits unless your employer has authorized additional visits in writing. The term "chiropractic visit" means any chiropractic office visit, regardless of whether the services performed involve chiropractic manipula- tion or are limited to evaluation and management. Once you have received 24 chiropractic visits, if you still require medical treatment, you will have to select a new physician who is not a chiropractor. This prohibition shall not apply to visits for postsurgical physical medicine visits prescribed by the surgeon, or physician designated by the surgeon, under the postsurgical component of the Division of Workers' Compensation's Medical Treatment Utilization Schedule. You may use this form to notify your employer of your personal chiropractor or acupuncturist. Your Chiropractor or Acupuncturist's Information: name of chiropractor or acupuncturist) street address, city, state, zip code) Telephone number) Employee Name (please print): Employee's Address: Employee's Signature Date: Title 8, California Code of Regulations, section 9783.1 Optional DWC Form 9783.1 Effective date July 1, 2014) Predesignation of Personal Physician; Reporting Duties of the Primary Treating Physician Regulations 8 C.C.R. section 9780, et seq. (Approved 02/12/2014) W04NE116 travelers.com Page 5of6 The Travelers Indemnity Company and its property casualty affiliates. One Tower Square, Hartford, CT 06183 2016 The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The T. -......I___ 1-1...v—:1.1 iL... II 0 ......J .. a L....-..... a. / 7 [7.... 4n On— Contact the information & assistance unit By phone at 1-800-736-7401: For recorded information that helps injured workers, employers and others un- derstand California's workers' compensation system, and their rights and responsibilities under the law. By attending a workshop for injured workers By calling or going in person to a local Information & Assistance Unit office: Anaheim Oxnard San Francisco 1065 N. PacifiCenter Drive 1901 N. Rice Ave., Ste. 200 455 Golden Gate Avenue, 2nd floor Anaheim, CA 92806 Oxnard, CA 93030 San Francisco, CA 94102-7014 714) 414-1801 805) 485-3528 415) 703-5020 Bakersfield Pomona San Jose 1800 30th Street, Suite 100 732 Corporate Center Drive 100 Paseo de San Antonio Bakersfield, CA 93301-1929 Pomona, CA 91768-2653 Room 241 661) 395-2514 909) 623-8568 San Jose, CA 95113-1402 408) 277-1292 Eureka Redding San Luis Obispo 100 "H" Street, Room 202 2115 Civic Center Drive, Room 15 4740 Allene Way, Suite 100 Eureka, CA 95501-0481 Redding, CA 96001-2796 San Luis Obispo, CA 93401 707) 441-5723 530) 225-2047 805) 596-4159 Fresno Riverside Santa Ana 2550 Mariposa Mall, Room 2035 3737 Main Street, Room 300 605 W Santa Ana Blvd Fresno, CA 93721-2219 Riverside, CA 92501-3337 Bldg 28, Room 451 559) 445-5355 951) 782-4347 Santa Ana, CA 92701 714) 558-4597 Long Beach Sacramento Santa Barbara *Satellite office 300 Oceangate Street, Suite 200 160 Promenade Circle, Suite 300 130 East Ortega Street Long Beach, CA 90802-4304 Sacramento, CA 95834 Santa Barbara, CA 93101-1631 562) 590-5240 916) 928-3158 805) 884 1032 Los Angeles Salinas Santa Rosa 320 W. 4th Street, 9th floor 1880 North Main Street, Suite 100 50 "D" Street, Room 420 Los Angeles, CA 90013-2329 Salinas, CA 93906-2037 Santa Rosa, CA 95404-4771 213) 576-7389 831) 443-3058 707) 576-2452 Marina del Rev San Bernardino Stockton 4720 Lincoln Blvd, 2nd floor 464 W. Fourth Street, Suite 239 31 East Channel Street, Room 344 Marina del Rey, CA 90292-6902 San Bernardino, CA 9240 1-1 41 1 Stockton, CA 95202-2314 310) 482-3820 909) 383-4522 209) 948-7980 Oakland San Diego Van Nuys 1515 Clay Street, 6th floor 7575 Metropolitan Drive, Suite 202 6150 Van Nuys Blvd., Room 105 Oakland, CA 94612 San Diego, CA 92102-4424 Van Nuys, CA 91401-3370 510) 622-2861 619) 767-2082 818) 901-5367 W04NE116 travelers.com Page 6of6 The Travelers Indemnity Company and its property casualty affiliates. One Tower Square, Hartford, CT 06183 2016 The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The T. -......I___ 1-1...v—:1.1 iL... II 0 ......J .. a L....-..... a. / 7 [7.... 4n On— TRAVELERS!' Sus beneficios de compensaci6n laboral CALIFORNIA Este formulario debe entregarse a todos los emp/eados recien contratados en e/ estado de California. Su contenido se aplica a los accidentes de trabajo ocurridos a partir del 1 de enero de 2013. Cualquier persona que haga o propicie que se haga cualquier declaraci6n sustancial a sabiendas falsa o fraudulenta con el prop6sito de obtener o denegar beneficios o pagos de compensaci6n laboral es culpable de un delito. Usted puede terser derecho a beneficios de compensaci6n laboral si resulta lesionado o se enferma a causa de su trabajo, o si es victima de un delito en el lugar de trabajo. La compensaci6n laboral cubre la mayoria de las lesiones y enfermedades fisicas o mentales relacionadas con el trabajo. Una lesi6n o enfermedad puede ser causada por un acontecimiento (como lastimarse la espalda en una caida) o por exposiciones repetidas a una circunstancia perjudicial como lastimarse la muneca por hacer el mismo movimiento una y otra vez). Los beneficios de compensaci6n laboral incluyen: Atenci6n medica: consultas medicas, servicios hospitalarios, fisioterapia, analisis de laboratorio, radiografias y medicamentos que seas razonablemente necesarios para tratar su lesi6n. No debe recibir nunca una factura. Es posible que las visitas para fisioterapia, terapia ocupacional y al quiropractico tengan un limite de 24 visitas para cada tipo. Beneficios por incapacidad temporal: Pagos si usted deja de recibir su salario mientras se recupera. Para la mayoria de las lesiones ocurridas despues del 18 de abril de 2004, los beneficios por incapacidad temporal se limitan a 104 semanas dentro del lapso de 5 anos a partir de la fecha de la lesi6n. Presentar de forma oportuna una reclamaci6n en el Departamento de Desarrollo Laboral (Employment Development Department) puede conducir a la obtenci6n de beneficios estatales adicionales por incapacidad cuando se terminan los beneficios por incapacidad total temporal (TTD, por sus siglas en ingles), o cuando estos se demoran o los deniegan. Beneficios por incapacidad permanente: Pagos si su lesi6n causa una incapacidad permanente. Una vez que su lesi6n se estabilice, es posible que el medico que to trata determine que usted tiene una incapacidad permanente, dependiendo de su grado de recuperaci6n. La cantidad de incapacidad permanente que su medico determine sera clasificada por su administrador de reclamaciones segun su edad y ocupaci6n con el fin de determiner el porcentaje y la cantidad correspondiente en d6lares que se le debe a usted a causa de la incapacidad permanente. La ley estatal establece dichas cantidades. Usted tiene derecho a obtener una clasificaci6n estatal de incapacidad o a apelar la clasificaci6n. Vales suplementarios por destituci6n laboral: Si su lesi6n conlleva a que usted falte a su trabajo y le causa una incapacidad permanente, usted puede recibir un vale suplementario por destituci6n laboral si su empleador no le ofrece un empleo modificado, alternativo o regular dentro de 60 dias de haber recibido el informe medico que indique que usted logr6 una recuperaci6n medica ma)oma. EI vale es para reembolsar los costos educativos y tiene un limite de $6,000.00. Si usted recibe un vale como consecuencia de su lesi6n, tiene dos anos desde la fecha en que le proporcionen el vale o cisco anos desde la fecha de su lesi6n (lo que ocurra ultimo), para solicitar el reembolso de los gastos que califiquen. Beneficios por muerte: Se pagan a los dependientes de un trabajador que muere a causa de una lesi6n o enfermedad laboral. Tambien se cubren los gastos del entierro; la cantidad maboma permitida depende de la fecha de la lesi6n. Los beneficios por incapacidad temporal, incapacidad permanente y muerte se pagan a una tasa basada en 2/3 de su salario semanal promedio, y estan sujetos a las cantidades minimas y maximas vigentes en el estado en la fecha de su lesi6n. Estos beneficios se pagan cada dos semanas mientras usted sea elegible. Programa para reintegrarse al trabajo: Si usted sufre la perdida permanente de sus ingresos como resultado de su lesi6n y se determina que sus beneficios por incapacidad permanente son desproporcionadamente bajos, es posible que usted califique para recibir dinero adicional del Fondo para la reintegraci6n al trabajo del Departamento de W04NFI16 Pagina 1 of 6 travelers.com The Travelers Indemnity Company y sus filiales de seguros generales/patrimoniales. One Tower Square, Hartford, CT 06183 2016 The Travelers Indemnity Company. Todos los derechos reservados. Travelers y el logotipo con la sombrilla de Travelers son marcas registradas de The Travelers Indemnity Company en los EE. UU. y otros pa ses. CE -10277 Rev. 10-2015 Relaciones Laborales (Department of Industrial Relations). Comuniquese con el Departamento de Relaciones Laborales en: www.dir.ca.gov/ para conocer mas acerca de este beneficio adicional. Es posible que las actividades como voluntario, en sus horas fibres, recreacionales, sociales o atleticas no esten cubiertas bajo la compensaci6n laboral. Si se lastima: Obtenga atenci6n medica. Si necesita primeros auxilios, comuniquese con su empleador. Si necesita atenci6n urgente, pida ayuda de inmediato. Informe sobre su lesion. Informe de inmediato a su supervisor sobre su lesi6n. No demore en hacerlo; existen limites de tiempo. Si espera demasiado, puede perder los derechos que tiene a recibir beneficios. Su empleador tiene que proporcionarle un formulario de reclamaci6n a mas tardar un dia laborable despues de que este enterado de su lesi6n, y tambien debe autorizar el tratamiento a mas tardar un dia laborable despues de que usted le entregue una copia del formulario Ileno y firmado. EI plazo de prescripci6n para presenter una reclamaci6n de compensaci6n laboral es de un ano a partir de la fecha de la lesi6n o, si esta se debe a exposiciones repetidas, un ano a partir del momento en que usted se dio cuenta o debi6 darse cuenta de que su trabajo caus6 la lesi6n. Vea a su medico tratante. Su medico tratante primario es el medico con la responsabilidad global de tratar su lesi6n o enfermedad. EI o ella estan a cargo de mantener la continuidad de su atenci6n, asi como de remitirlo a los especialistas. Si su empleador tiene una Red de Proveedores Medicos (MPN, por sus siglas en ingles) aprobada, es posible que ellos puedan limitar sus opciones de medicos tratantes, que retengan el control medico, y que le e)ojan que se atienda con un medico de la MPN desde el principio. (Una MPN es una red escogida de proveedores de atenci6n medica que proveen tratamiento a los empleados que se lesionan en el trabajo. Consulte con su empleador para obtener mas informaci6n sobre su MPN). De to contrario, su empleador tiene el derecho de escoger el medico que to tratara a usted por los primeros 30 dias. Si su empleador no tiene una MPN aprobada y usted desea cambiar de medico en los primeros 30 dias despues de presenter su reclamaci6n, su administrador de reclamaciones debe escoger un medico nuevo en un lapso de cisco dias despues de que usted to solicite. Si usted le proporcion6 a su empleador el hombre de su medico personal antes de sufrir la lesi6n y tiene seguro medico de grupo al momento de la lesi6n, usted puede tratarse con su medico personal incluso si su empleador tiene una MPN aprobada. Su medico personal debe ser un medico general o un medico internista, pediatra, ginecobstetra o medico de familia con certificado de especialidad o que hays completado su especialidad, o un grupo medico con multiples especialidades con doctores o licenciados en medicina, y debe haberlo tratado y terser sus antecedentes medicos y su historia clinica antes de su lesi6n laboral y tambien debe estar de acuerdo en tratarlo por una lesi6n o enfermedad laboral. Si su empleador no tiene una MPN aprobada y usted le dio a su empleador por escrito el hombre de su quiropractico o acupunturista personal antes de sufrir la lesi6n, usted puede cambiarse al quiropractico o acupunturista cuando to solicite. Si todavia necesita recibir atenci6n medica luego de 30 dias, quizas pueda cambiarse a un medico de su propia elecci6n. Para mayor comodidad, se adjuntan a este documento formularios opcionales para predesignar a su medico personal o a un grupo medico con multiples especialidades con doctores o licenciados en medicina. Tambien se adjuntan formularios para predesignar a su acupunturista o quiropractico personal si su empleador no cuenta con una red de proveedores medicos. Por ley, no se permite que los quiropracticos seas el medico tratante luego de 24 visitas. Discriminaci6n: Es ilegal que su empleador to castigue o to despida por sufrir una lesi6n o enfermedad laboral, por presenter una reclamaci6n, o por testificar en el caso de compensaci6n laboral de otra persona. Si se determine que su empleador ha cometido discriminaci6n, usted puede terser derecho a que se le reincorpore a su puesto de trabajo con pagos retroactivos, una mayor compensaci6n, y costos y gastos. Es posible que usted tenga otros derechos bajo la Ley de Protecci6n para Personas Discapacitadas (ADA, por sus siglas en ingles) o la Ley de Igualdad en el Empleo y la Vivienda (FEHA, por sus siglas en ingles). Para obtener mas informaci6n, comuniquese con FEHA al (800) 884- 1684 o con la Comisi6n de Igualdad de Oportunidades Laborales (EEOC, por sus siglas en ingles) al (800) 669-3362. Puede obtener informaci6n gratuita de un funcionario de informaci6n y ayuda de la Divisi6n de Compensaci6n Laboral de su estado. Puede escuchar informaci6n grabada y una lista de las oficinas locales Ilamando sin costo al (800) 736- 7401 o averiguar mas en linea en: httn://www.dir.ca.gov. W04NFI16 Pagina 2 of 6 travelers.com The Travelers Indemnity Company y sus filiales de seguros generales/patrimoniales. One Tower Square, Hartford, CT 06183 2016 The Travelers Indemnity Company. Todos los derechos reservados. Travelers y el logotipo con la sombrilla de Travelers son marcas registradas de The Travelers Indemnity Company en los EE. UU. y otros pa ses. CE -10277 Rev. 10-2015 Si su empleador no le proporciona atenci6n medica, usted tiene varias opciones. Primero, comuniquese con su administrador de reclamaciones para averiguar el estado de su reclamaci6n. Si le entreg6 a su empleador un formulario de reclamaci6n Ileno y firmado pero su reclamaci6n este retrasada por la investigaci6n, su empleador tiene que autorizar el tratamiento, hasta un maximo de $10,000.00, durante el retraso. Si todavia no se ha aceptado la reclamaci6n y sus costos medicos sobrepasan el limite reglamentario de $10,000.00, usted puede acudir a su plan medico de grupo para recibir atenci6n, buscar un medico, una clinica o un hospital que le facture directamente al administrador de reclamaciones, o utilizar los servicios publicos de atenci6n medica. Usted tiene derecho a estar en desacuerdo con las decisiones que afectan su reclamaci6n. Si este en desacuerdo, comuniquese primero con su administrador de reclamaciones para ver si to pueden resolver. Su compania de seguros de compensaci6n laboral es Travelers Property Casualty Com ag_ny of America. Tambien puede buscar su compania de seguros en el directorio en linea de WCIRB: hftps://www.caworkcompcoverage.com/ Puede obtener informaci6n gratuita de un funcionario de Informaci6n y Ayuda de la Divisi6n de Compensaci6n Laboral de su estado, o puede escuchar informaci6n grabada y una lista de las oficinas locales Ilamando al (800) 736-7401. Al final de este folleto, encontrara una lista de las oficinas de Informaci6n y Ayuda. Esto to ayudara a localizar la oficina mas cerca de usted. Para mas informaci6n, tambien puede visitar el sitio web del DWC en: httn://www.dir.ca.gov. Puede consulter con un abogado. La mayoria de los abogados ofrecen una consults gratuita. Si decide contratar un abogado, es posible que los honorarios se saquen de algunos de sus beneficios. Para obtener los nombres de los abogados especializados en compensaci6n laboral, (lame al Colegio de Abogados del estado de California al (415) 538-2120 o visite su sitio web en: httn://www.californiasnecialist.orq. EI funcionario local de informaci6n y ayuda puede proporcionarle una lista de los abogados o usted puede buscarlos en las paginas amarillas. WO4NFI16 Pagina 3 of 6 travelers.com The Travelers Indemnity Company y sus filiales de seguros generales/patrimoniales. One Tower Square, Hartford, CT 06183 2016 The Travelers Indemnity Company. Todos los derechos reservados. Travelers y el logotipo con la sombrilla de Travelers son marcas registradas de The Travelers Indemnity Company en los EE. UU. y otros pa ses. CE -10277 Rev. 10-2015 Designacion Previa De Medico Particular En caso de que usted sufra una lesion o enfermedad relacionada con su empleo, usted puede recibir tratamiento medico por esa lesion o enfermedad de su medico particular (M.D.), medico oste6pata (D.O.) o grupo medico si: en la fecha de su lesi6n de trabajo, usted tiene cobertura de salud por lesiones o enfermedades que no estan relacionado con el trabajo el medico es su medico familiar o de cabecera, que sera un medico que ha limitado su practica medica a medicina general o que es un internista certificado o elegible para certificaci6n, pediatra, gineco-obstreta, o medico de medicina familiar y que previamente ha estado a cargo de su tratamiento medico y tiene su expediente medico su "medico particular" puede ser un grupo medico si es una corporaci6n o sociedad o asociaci6n compuesta de doctores certificados en medicina u osteopatia, que opera un integrado grupo medico multidisciplinario que predominantemente proporciona amplios servicios medicos para lesiones y enfermedades no relacionadas con el trabajo. antes de la lesi6n su medico esta de acuerdo a proporcionarle tratamiento medico para su lesi6n o enfermedad de trabajo • antes de la lesi6n usted le proporcion6 a su empleador por escrito to siguiente: (1) notificaci6n de que quiere que su medico particular le brinde tratamiento para una lesi6n o enfermedad de trabajo y (2) el hombre y direcci6n comercial de su medico particular. Puede utilizar este formulario para notificarle a su empleador que desea que su medico particular o medico oste6pata to atienda para una lesi6n o enfermedad de trabajo y que los requisitos mencionados arriba han sido cumplidos. NOTICIA DE DESIGNACION PREVIA DE MEDICO PARTICULAR Empleado: Llene esta seccion. A: hombre del empleador) Si tengo una lesi6n o enfermedad de trabajo, yo elijo ser atendido por: hombre del medico) (M.D., D.O., o grupo medico) direcci6n, ciudad, estado, c6digo postal) numero de telefono) Nombre del Empleado (en letras de molde, por favor): Domicilio del Empleado: Nombre de la Compania de Seguros, Plan o Fondo de proporcionar cobertura de salud para lesiones o enfermedades no ocu pacional es: Firma del Empleado: Fecha: Medico: Estoy de acuerdo con esta Designacion Previa: Firma: Fecha: Medico o Empleado designado por el Medico o Grupo Medico) EI medico no esta obligado a firmar este formulario, sin embargo, si el medico o empleado designado por el medico o grupo medico no firma, sera necesario presentar documentaci6n sobre el consentimiento del medico de ser designado previamente de acuerdo al C6digo de Reglamentos de California, Ti tulo 8, seccion 9780.1 (a) (3). Ti tulo 8, Codigo de Regulaciones de California, seccion 9783 Opcional Formulario DWC 9783, Fecha de vigencia 1 de Julio 2014 Designacion Previa del Medico Personal; Obligaciones de Informaci6n de la primaria EI tratamiento medico Reglamentos 8 CCR Secci n 9780, et seq. (Aprobado 12/02/2014) W04NFI16 Pagina 4 of 6 travelers.com The Travelers Indemnity Company y sus filiales de seguros generales/patrimoniales. One Tower Square, Hartford, CT 06183 2016 The Travelers Indemnity Company. Todos los derechos reservados. Travelers y el logotipo con la sombrilla de Travelers son marcas registradas de The Travelers Indemnity Company en los EE. UU. y otros pa ses. CE -10277 Rev. 10-2015 ISO DE QUIROPRACTICO PERSONAL O ACUPUNTURISTA PERSONAL Si su empleador o la compania de seguros de su empleador no tiene una Red de Proveedores Medicos establecida, posiblemente puede cambiar su medico que to esta atendiendo a su quiropractico o acupunturista personal despu6s de una lesi6n o enfermedad de trabajo. Para hacer este cambio, usted debe darle por escrito a su empleador el nombre y la direcci6n comercial de un quiropractico o acupunturista personal antes de la lesi6n o enfermedad. Generalmente, su administrador de reclamos tiene el derecho de elegir al medico que le proporcionara el tratamiento dentro de los primeros 30 dias despu6s de que su empleador sepa de su lesi6n o enfermedad. Despu6s de que su administrador de reclamos ha iniciado su tratamiento con otro medico durante este tiempo, puede entonces usted, bajo petici6n, transferir su tratamiento a su quiropractico o acupunturista personal. NOTA: Si la fecha de la lesi6n es el 1 de enero de 2004 o posterior, un quiropractico no puede ser su medico tratante despu6s de haber recibido 24 visitas al quiropractico a menos que su empleador ha autorizado visitas adicionales por escrito. EI t6rmino "visita quiropractica", cualquier visita a la oficina de la quiropractica, independientemente de si los servicios prestados implican la manipulaci6n quiropractica o se limitan a la evaluaci6n y gesti6n. Una vez que haya recibido 24 visitas al quiropractico, si aun necesita tratamiento medico, usted tendra que elegir un nuevo medico que no es un quiropractico. Esta prohibici6n no se aplicara a las visitas para las visitas de medicina fisica posquirurgicos prescritos por el cirujano o un medico designado por el cirujano, en el marco del componente posquirurgica de la Divisi6n de Tratamiento Medico programa de utilizaci6n de Compensaci6n para Trabajadores. Puede utilizar este formulario para notificarle a su empleador de su quiropractico o acupunturista personal Informaci6n sobre su Quiropractico o Acupunturista: nombre del quiropractico o acupunturista) direcci6n, ciudad, estado, c6digo postal) numero de telefono) Nombre del Empleado (en letras de molde, por favor): Domicilio del Empleado: Firma del Empleado: Fecha: Ti tulo 8, C6digo de Regulaciones de California, secci6n 9783.1 Opcional Formulario DWC 9783.1, Fecha de vigencia 1 de Julio 2014) Designaci6n Previa del Medico Personal; Obligaciones de Informacion del Medico Primario Regulaciones 8 C.C.R. Secci6n 9780, et seq. (Aprobado 12/02/2014) W04NFI16 Pagina 5 of 6 travelers.com The Travelers Indemnity Company y sus filiales de seguros generales/patrimoniales. One Tower Square, Hartford, CT 06183 2016 The Travelers Indemnity Company. Todos los derechos reservados. Travelers y el logotipo con la sombrilla de Travelers son marcas registradas de The Travelers Indemnity Company en los EE. UU. y otros pa ses. CE -10277 Rev. 10-2015 Comuniquese con la unidad de informaci6n y ayuda Por telefono al 1-800-736-7401: Para obtener informaci6n grabada que ayuda a los trabajadores lesionados, los empleadores y otras personas a entender el sistema de compensaci6n laboral de California, y sus derechos y responsabilidades conforme a la ley. Asistiendo a un taller para trabajadores lesionados Llamando o yendo en persona a una oficina local de la Unidad de informaci6n y ayuda: Anaheim Oxnard San Francisco 1065 N. PacifiCenter Drive 1901 N. Rice Ave., Ste. 200 455 Golden Gate Avenue, 2nd floor Anaheim, CA 92806 Oxnard, CA 93036 San Francisco, CA 94102-7014 714) 414-1801 805) 485-3528 415) 703-5020 Bakersfield Pomona San Jose 1800 30th Street, Suite 100 732 Corporate Center Drive 100 Paseo de San Antonio Bakersfield, CA 93301-1929 Pomona, CA 91768-2653 Room 241 661) 395-2514 909) 623-8568 San Jose, CA 95113-1402 408) 277-1292 Eureka Redding San Luis Obispo 100 "H" Street, Room 202 25o He rnsted-D rive, 2nd Floor, Ste. B 4740 Allene Way, Suite 100 Eureka, CA 95501-0481 Redding, CA 96002 San Luis Obispo, CA 93401 707) 441-5723 530) 225-2047 805) 596-4159 Fresno Riverside Santa Ana 2550 Mariposa Mall, Suite 4078 3737 Main Street, Room 300 605 W Santa Ana Blvd Bldg 28, Room Fresno, CA 93721-2219 Riverside, CA 92501-3337 451 559) 445-5355 951) 782-4347 Santa Ana, CA 92701 714) 558-4597 Long Beach Sacramento Santa Barbara Satellite Office 300 Oceangate Street, Suite 200 160 Promenade Circle, Suite 300 130 E. Ortega Street Long Beach, CA 90802-4304 Sacramento, CA 95834 Santa Barbara, CA 93101-1631 562) 590-5240 916) 928-3158 805) 884-1032 Los Angeles Salinas Santa Rosa 320 W. 4th Street, 9th floor 1880 North Main Street, Suite 100 50 "D" Street, Room 420 Los Angeles, CA 90013-2329 Salinas, CA 93906-2037 Santa Rosa, CA 95404-4771 213) 576-7389 831) 443-3058 707) 576-2452 Marina del Rev San Bernardino Stockton 4720 Lincoln Blvd, 2nd&3rdfloors 464 W. Fourth Street, Suite 239 31 East Channel Street, Room 344 Marina del Rey, CA 90292-6902 San Bernardino, CA 92401-1 41 1 Stockton, CA 95202-2314 310) 482-3858 909) 383-4522 209) 948-7980 Oakland San Diego Van Nuys 1515 Clay Street, 6th floor 7575 Metropolitan Drive, Suite 202 6150 Van Nuys Blvd., Room 105 Oakland, CA 94612 San Diego, CA 92108 Van Nuys, CA 91401-3370 510) 622-2861 619) 767-2082 818) 901-5367 W04NFI16 Pagina 6 of 6 travelers.com The Travelers Indemnity Company y sus filiales de seguros generales/patrimoniales. One Tower Square, Hartford, CT 06183 2016 The Travelers Indemnity Company. Todos los derechos reservados. Travelers y el logotipo con la sombrilla de Travelers son marcas registradas de The Travelers Indemnity Company en los EE. UU. y otros pa ses. CE -10277 Rev. 10-2015 STATE OF CALIFORNIA IMPORTANT LOSS CONTROL INFORMATION The Loss Control Services outlined in the enclosed Safety Services notice are available at no additional cost to you. Workers' Compensation insurance policyholders may register comments about the insurer's loss control consultation services by writing to: State of California, Department of Industrial Relations, Division of Occupational Safety and Health, P.O. Box 420603, San Francisco, CA 94142. W04N1C01 IMPORTANT NOTICE TO CALIFORNIA EMPLOYERS NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANY PROVISION OF YOUR POLICY. YOU SHOULD REVIEW YOUR ENTIRE POLICY CAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TO DETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. California Labor Code Section 3550 requires you to post and keep posted in each of your California workplaces, in a conspicuous location frequented by employees, a notice that states the name of your current workers compensation insurance carrier and who is responsible for claims adjustment. The notice must be posted in English and Spanish if you have Spanish-speaking employees. Failure to keep the notice posted as required constitutes a misdemeanor. For your convenience, we have enclosed copies of notice DWC 7, Notice to Employees — Injuries Caused by Work, for each of your California locations. W04N1J15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 IMPORTANT NOTICE - SOLE PROPRIETORS, PARTNERS, LIMITED LIABILITY COMPANY MEMBERS AND LIMITED LIABILITY PARTNERS - IOWA NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANY PROVISION OF YOUR POLICY. YOU SHOULD REVIEW YOUR ENTIRE POLICY CAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TO DETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. In the state of Iowa, sole proprietors, partners, limited liability company members and limited liability partners are not automatically covered by the workers compensation laws of the state unless they purchase valid coverage that specifically endorses that person on to the policy. If you are a sole proprietor or have partners, limited liability company members or limited liability partners who elect to remain excluded from workers compensation coverage, the state of Iowa mandates that the attached nonelection form (14-0175) be completed, signed and filed with the Iowa Division of Workers' Compensation. A copy of the completed and signed form 14-0175 should also be mailed to your Travelers Representative. W14N1115 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 WUN1115 © 2015 The Travelers Indemnity Company. All rights reserved. Page 2 Of 3 DIVISION OF WORKERS' COMPENSATION IOWA. 1000 EAST GRAND AVENUE DES MOINES, IOWA 50319 WORKFORCE DEVELOPMENT 14-0175 (5-15) PROPRIETOR, LIMITED LIABILITY COMPANY MEMBER, LIMITED LIABILITY PARTNER, OR PARTNER NAME: ADDRESS (Include Street, City, State and Zip Code) NONELECTION OF WORKERS' COMPENSATION OR EMPLOYERS' LIABILITY COVERAGE (Iowa Code section 87.22) A proprietor, limited liability company member, limited liability partner, or partner who does not elect to be covered by the workers compensation law of this state pursuant to section 85.1A by purchasing valid workers' compensation insurance specifically including that person, shall file a nonelection of workers' compensation coverage by signing, and attaching to the workers' compensation or employers' liability policy a written nonelection, or if such a policy is not issued, by signing a written nonelection which is witnessed by two disinterest- ed individuals who are not, formally or informally, affiliated with the employer and which is filed by the employer with the workers' compen- sation commissioner. The workers' compensation commissioner shall maintain a list of those employers that have filed a written nonelec- tion pursuant to this subsection or written termination of that nonelection pursuant to subsection 5, paragraph "b", and that list shall be a public record open to public inspection. The written nonelection of coverage made pursuant to subsection 2, shall be in substantially the following form: NONELECTION OF WORKERS' COMPENSATION OR EMPLOYERS' LIABILITY COVERAGE I acknowledge that I am a proprietor, limited liability company member, limited liability partner, or partner and that I am not required to be covered by the workers' compensation law of this state pursuant to section 85.1A. I understand that by signing this statement I am not electing the coverage of chapters 85, 85A, and 85B of the Code of Iowa relating to workers compensation. I understand that my nonelection of the coverage of chapters 85, 85A, and 85B is not a waiver of any rights or remedies available to me or to others on my behalf in a civil action related to personal injuries sustained by me arising out of and in the course of my employment with the employer. I also understand that by signing this statement and checking alternative (1) below I am not electing employers' liability coverage for bodily injuries or death sustained by me arising out of and in the course of my employment with the employer. Check either alternative (1) or (2): 1) 1 am not electing the employers' liability coverage. 2) 1 am electing the employers' liability coverage by purchasing valid workers' compensation insurance specifically including me NAME (TYPED AND SIGNED): EMPLOYER'S OFFICE DATE CITY, COUNTY, STATE OF RESIDENCE WITNESS WITNESS I also understand that the signing of this statement and checking of alternative (1) below by an authorized agent of the employer is a nonelection for the employer of the employers' liability coverage for bodily injuries or death sustained by me arising out of and in the course of my employment with the employer. Check either alternative (1) or (2): 1) The employer does not elect the employers' liability coverage. 2) The employer elects the employers' liability coverage by purchasing valid workers' compensation insurance specifically including me. NAME (TYPED AND SIGNED): RELATIONSHIP TO EMPLOYER DATE CITY, COUNTY, STATE OF RESIDENCE WITNESS WITNESS The rejection or nonelection of workers' compensation coverage is not enforceable if it is required as a condition of employment. A proprietor, limited liability partner, or partner who signs a written nonelection with the workers' compensation commissioner pursuant to subsection 2 may terminate the nonelection by signing a written notice of termination which is witnessed by two disinterested individuals, who are not, formally or informally, affiliated with the employer and which is filed by the corporation with the workers' compensation commissioner. Following the filing of a notice of termination pursuant to this paragraph, the status of the person signing the notice of termination shall be the same as if the nonelection of coverage had not been made and the person may elect to be covered by the workers' compensation law of this state by purchasing valid workers' compensation insurance specifically including that person as provided in section 85.1A, except that the election of coverage shall not be effective as to any injury sustained or disease incurred less than one week alter the notice is filed. ATTENTION The enclosed Posting Notices must be displayed in a prominent location in the workplace. It is your responsibil- ity to distribute the applicable Posting Notice(s) to each of your locations and to notify each location that it must post these notices, and keep them posted, in a conspicuous location frequented by your employees. Posting Notices for the states of Missouri, New Mexico and Texas (Spanish Version) are provided on two separate forms, which must be connected to create one large no- tice to be posted. Please contact us at wcppn@travelers.com for assistance in completing the healthcare provider information on Post- ing Notices for Georgia, Pennsylvania, Tennessee and Virginia. While carriers are required to provide Posting Notices in AZ, AR, CA, DC, FL, ID, KS, KY, MO, and NY, Travelers is providing Posting Notices to you for all states covered under your policy as a courtesy. All such Posting Notices remain subject to state regulation and are subject to change at any time. For states in which Travelers is providing you with Posting Notices as a courtesy, Travel- ers assumes no obligation to provide you with revised notice(s) if a state changes its Posting Notice during the current policy term. If you need additional copies of any Posting Notice, please contact your agent. WUNNNN15 Page 1 of 1 REPORT OF SIGNIFICANT WORK EXPOSURE TO BODILY FLUIDS OR OTHER INFECTIOUS MATERIAL This form is not a claim form, but a report of exposure. Forms to report a claim to the Industrial Commission are available at: www.azica.gov .) 1. Exposed Employee Last Name 2. Address 3 4 5 6 7 Employer's Full Name Employer's Address Date of Exposure Address or Location of Exposure Birth Date First M. 1. Time of Exposure Job Title Phone No Describe the circumstances surrounding the exposure, including (if applicable) personal protective equipment worn and the names of any witnesses to the exposure (be specific) SAMPLE FORM Employers should obtain a supply of "REPORTING FORMS" from the Industrial Commission of Arizona. See "Notice to Employees" for address and phone number. 8. What were you exposed to? (Directly or indirectly via bandages, personal items, etc.) Check all that apply. Blood Vaginal fluid Broken skin Urine Any other fluid(s) containing blood or infectious material (Describe) Semen Surgical fluid(s) Mucous membrane Feces Airborne/Respiratory/Oral Secretions Other (specify): Saliva Vomitus Skin infection (e.g. abscesses, boils, or pus-filled/red/swollen/painful skin lesions) 9. Source person(s) information Unknown Known Name DOB Phone No. Address City State Zip 10. What part(s) of your body was exposed to bodily fluids/infectious material? Did exposure take place through your skin or mucous membrane (be specific)? 11. Did you have any open cuts, sores, rashes, or other breaks/ruptures in your skin or mucous membrane that were exposed to bodily fluids/infectious material (please describe)? I HAVE GIVEN THIS FORM TO MY EMPLOYER AND HAVE RECEIVED A COPY OF THIS COMPLETE FORM. EMPLOYEE SIGNATURE DATE Other Reauired Stens to Establish Prima Facie Claim for HIV. AIDS or Hepatitis C (A.R.S. 66 23-1043.02. -03: A.A.C. R20-5-1641 1. You must file this report with your employer no later than ten (10) days after your exposure. 2. You must have blood drawn no later than ten (10) calendar days after exposure. 3. You must have blood tested for HIV or Hepatitis C by Antibody Testing no later than thirty (30) calendar days after exposure and test results must be negative. 4. You must be tested or diagnosed as HIV positive no later than eighteen (18) months after the exposure, or tested and diagnosed as positive for the presence of Hepatitis C within seven (7) months after the exposure. 5. You must file a workers' compensation claim with the Industrial Commission of Arizona no later than one (1) year from the date of diagnosis or positive blood test if you wish to receive benefits under the workers' compensation system. Other Required Steps to Establish Prima Facie Claim for MRSA (A.R.S. S 23-1043.04: A.A.C. R20-5-164) 1. You must file this report with your employer no later than thirty (30) days after your exposure. 2. For a claim involving MRSA, you must be diagnosed with MRSA within fifteen (15) days after you report in writing to your employer the details of the exposure. 3. You must file a workers' compensation claim with the Industrial Commission of Arizona no later than one (1) year from the date of diagnosis if you wish to receive benefits under the workers' compensation system. Other Required Steps to Establish Prima Facie Claim for Spinal Meningitis or TB (A.R.S. S 23-1043.04: A.A.C. R20-5-164) 1. You must file this report with your employer no later than ten (10) days after your exposure. 2. For a claim involving spinal meningitis, you must be diagnosed within two (2) to eighteen (18) days of the possible significant exposure and for a claim involving tuberculosis, you must be diagnosed within twelve (12) weeks of the possi- ble significant exposure. 3. You must file a workers' compensation claim with the Industrial Commission of Arizona no later than one (1) year from the date of diagnosis if you wish to receive benefits under the workers' compensation system. Employer: Keep Original (Notify Carrier) Employee: Keep Copy THIS FORM APPROVED BY THE INDUSTRIAL COMMISSION OF ARIZONA Claims ICA 0124 -Rev 07.01.11 W02M2A18 TO BE POSTED BY EMPLOYER POLICY NUMBER (IJUB-4J20158-9-18) ISSUED TO: INET INC IPARQ NOTICE TO EMPLOYEES RE: ARIZONA WORKERS' COMPENSATION LAW All employees are hereby notified that this employer has complied with the provisions of the Arizona Workers' Compensation Law (Title 23, Chapter 6, Arizona Revised Statutes) as amended, and all the rules and regulations of The Industrial Commission of Arizona made in pursuance thereof, and has secured the payment of compensation to employees by insuring the payment of such compensation wlth:THE TRAVELERS INSURANCE COMPANIES All employees are hereby further notified that in the event they do not specifically reject the provisions of the said compulsory law, they are deemed by the laws of Arizona to have accepted the provisions of said law and to have elected to accept compensation under the terms thereof; and that under the terms thereof employees have the right to reject the same by written notice thereof prior to any injury sustained, and that the blanks and forms for such notice are available to all employees at the office of this employer. PARA SER COLOCADO POR EL PATRON NUMERO DE POLIZA (IJUB-4J20158-9-18) ISO A LOS EMPLEADOS RE: LEY DE COMPENSACION PARA LOS TRABAJADORES DE ARIZONA A todos los empleados se les notifica por este medio que este patron ha cumplido con las provisiones de la Ley de Compensacion para los Trabajadores de Arizona (Titulo 23, Capitulo 6, Estatutos Enmendados de Arizona) tal como han sido enmendados, y con todas las reglas y ordenanzas de La Comision Industrial de Arizona hechas en cumplimiento de esta, y ha asegurado el pago de compensacion a los empleados garantizando el pago de dicha compensacion por medio de: THE TRAVELERS INSURANCE COMPANIES Ademas, a todos los empleados se les notifica por este medio que en caso de que especificamente ellos no rechazen las disposiciones de dicha ley obligatoria, se les considerara bajo las leyes de Arizona de haber aceptado las provisiones de dicha ley y de haber escogido aceptar la compensacion bajo estos terminos; tambien bajo estos terminos los empleados tienen el derecho de rechazar la misma por medio de una notificacion por escrito antes de que sufran alguna lesion, todos los formularios o formas en blanco para tal notificacion por escrito estaran disponibles para todos los empleados en la oficina de este patron. KEEP POSTED IN A CONSPICUOUS PLACE. COLOQUESE EN LUGAR VISIBLE. W02P1 A96 EMPLOYEE SAFETY AND HEALTH PROTECTION The Arizona Occupational Safety and Health Act of 1972 (Act), provides safety and health protection for employees in Arizona. The Act requires each employer to furnish his employees with a place of employment free from recognized hazards that might cause serious injury or death. The Act further requires that employers and employees comply with all workplace safety and health standards, rules and regulations promulgated by the Industrial Commission. The Arizona Division of Occupational Safety and Health (ADOSH), a division of the Industrial Commission of Arizona, administers and enforces the requirements of the Act. As an employee, you have the following rights: You have the right to notify your employer or ADOSH about workplace hazards. You may ask ADOSH to keep your name confidential. You have the right to request that ADOSH conduct an inspection if you believe there are unsafe and/or unhealthful conditions in your workplace. You or your representative may participate in the inspection. If you believe you have been discriminated against for making safety and health complaints, or for exercising your rights under the Act, you have a right to file a complaint with ADOSH within 30 days of the discriminatory action. You are also afforded protection from discrimination under the Federal Occupational Safety and Health Act and may file a complaint with the U.S. Secretary of Labor within 30 days of the discriminatory action. You have the right to see any citations that have been issued to your employer. Your employer must post the citations at or near the location of the alleged violation. You have the right to protest the time frame given for correction of any violation. You have the right to obtain copies of your medical records or records of your exposure to toxic and harmful substances or conditions. Your employer must post this notice in your workplace. The Industrial Commission and ADOSH do not cover employers of household domestic labor, those in maritime activities (covered by OSHA), those in atomic energy activities (covered by the Atomic Energy Commission) and those in mining activities (covered by the Arizona Mine Inspector's office). To file a complaint, report an emergency or seek advice and assistance from ADOSH, contact the nearest ADOSH office: Phoenix: Tucson: 800 West Washington 2675 East Broadway Phoenix AZ. 85007 Tucson, AZ. 85716 602-542-5795 W 520-628-5478 Industrial Commission web site: www.ica.state.az.us Note: Persons wishing to register a complaint alleging inadequacy in the administration of the Arizona Occupational safety and Health plan may do so at the following address: U.S. Department of Labor- OSHA 3221 N.16th St., Suite 100 Phoenix, AZ 85016 Revised 11/01 Telephone: 1-800-475-4020 W02P2103 4.- I AAA• EI Acta de Seguridad y Sanidad Ocupacional de 1972 (Acta) provee protecci6n de seguridad y sanidad para los empleados en Arizona. EI Acta requiere que cads patron les ofrezca a sus empleados un lugar de empleo libre de riesgos reconocidos que puedan causar dano o muerte. EI Acta tambien requiere que los patrones y empleados cumplan con las normas, y los reglamentos de seguridad y sanidad promulgados por la Comisi6n Industrial. La ejecuci6n de esta ley se Ileva a cabo por la Divisi6n de Seguridad y Sanidad Ocupacional, un brazo de la Comisi6n Industrial de Arizona. Como empleado, Ud. tiene los derechos siguientes: Tiene el derecho de notificar a su patron o a ADOSH sobre peligros en su lugar de trabajo. Puede pedir a ADOSH que mantenga su nombre confidencialmente. Tiene el derecho de solicitar una inspecci6n por parte de ADOSH si cree que existen condiciones peligrosas o poco saludables en su lugar de trabajo. Usted o su representante puede participar en la inspeccion. Si cree que su patron to ha discriminado por presentar reclamos de seguridad y sanidad o por ejercer sus derechos bajo el Acta, puede presentar una queja a ADOSH durante un plazo de 30 dias despues de la acci6n de discriminaci6n. Tambien tiene protecci6n de discriminacion bajo el arta federal de seguridad y sanidad ocupacional y puede archivar una queja con el Secretario de Labor de los Estados Unidos dentro de 30 dias despues de la discriminacion alegada. Tiene el derecho de ver las citaciones enviadas a su empleador. Su empleador debe colocar las citaciones en un lugar visible en el sitio de la supuesta infracci6n o cerca de el. Tiene el derecho de protestar el tiempo dado para correjir una violaci6n. Tiene el derecho de recibir copias de su historial medico o de los registros de su exposici6n a sustancias o condiciones t6xicas y peligrosas. Su empleador debe colocar este aviso en su lugar de trabajo. La ley de seguridad y sanidad en el trabajo no aplica a aquellos patrones que emplean a servicio domestico, a patrones de actividades maritimas (protejidos bajo OSHA), a patrones en actividades de energia at6mica protegidos bajo la Comisi6n de Energia At6mica), o a patrones en actividades mineras (protegidos por la Oficina del Inspector de Minas del Estado de Arizona). Para registrar una queja, reportar una emergencia o pedir asistencia de ADOSH, p6ngase en contacto con la oficina mas cercaria: Phoenix: Tucson: 800 West Washington 2675 East Broadway Phoenix AZ. 85007 Tucson, AZ. 85716 602-542-5795 W 520-628-5478 Industrial Commission web site: www.ica.state.az.us Nota: Personas que deseen registrar quejas alegando falta de adecuadez en la administracion del plan de seguridad y sanidad ocupacional de Arizona pueden dirigirtas a la siguiente direcci6n: U.S. Department of Labor- OSHA 3221 N.16th St., Suite 100 Phoenix, AZ 85016 Revised 11/01 Telefono: 1-800-475-4020 W02P3103 WORK EXPOSURE TO BODILY FLUIDS NOTICE TO EMPLOYEES Re: Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS) & Hepatitis C Employees are notified that a claim may be made for a condition, infection, disease, or disability involving or related to the Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS), or Hepatitis C within the provisions of the Arizona Workers' Compensation Law, and the rules of The Industrial Commission of Arizona. Such a claim shall include the occurrence of a significant exposure at work, which generally means contact of an employee's ruptured or broken skin or mucous membrane with a person's blood, semen, vaginal fluid, surgical fluid(s) or any other fluid(s) containing blood. AN EMPLOYEE MUST CONSULT A PHYSICIAN TO SUPPORT A CLAIM. Claims cannot arise from sexual activity or illegal drug use. Certain classes of employees may more easily establish a claim related to HIV, AIDS, or Hepatitis C if they meet the following requirements: 1. The employee's regular course of employment involves handling or exposure to blood, semen, vaginal fluid, surgical fluid(s) or any other fluid(s) containing blood. Included in this category are health care providers, forensic laboratory workers, fire fighters, law enforcement officers, emergency medical technicians, paramedics and correctional officers. 2. NO LATER THAN TEN (10) CALENDAR DAYS after a possible significant exposure which arises out of and in the course of employment, the employee reports in writing to the employer the details of the exposure as provided by Commission rules. Reporting forms are available at the office of this employer or from the Industrial Commission of Arizona, 800 W. Washington, Phoenix, Arizona 85007, (602) 542-4661 or 2675 E. Broadway, Tucson, Arizona 85716, (520) 628-5188. If an employee chooses not to complete the reporting form, that employee may be at risk of losing a prima facie claim. 3. NO LATER THAN TEN (10) CALENDAR DAYS after the possible significant exposure the employee has blood drawn, and NO LATER THAN THIRTY (30) CALENDAR DAYS the blood is tested for HIV OR HEPATITIS C by antibody testing and the test results are negative. 4. NO LATER THAN EIGHTEEN (18) MONTHS after the date of the possible significant exposure at work, the employee is retested and the results of the test are HIV positive or the employee has been diagnosed as positive for the presence of HIV, or NO LATER THAN EVEN (7) MONTHS after the date of the possible signifi- cant exposure at work, the employee is retested and the results of the test are positive for the presence of Hepatitis C or the employee has been diagnosed as positive for the presence of Hepatitis C. KEEP POSTED IN CONSPICUOUS PLACE NEXT TO WORKERS' COMPENSATION NOTICE TO EMPLOYEES THIS NOTICE APPROVED BY THE INDUSTRIAL COMMISSION OF ARIZONA FOR CARRIER USE ICA Form 04-615-01 W02P4008 EXPOSICION A FLUIDOS CORPORALES EN EL TRABAJO AVISO A LOS EMPLEADOS Re: EI Virus de la Inmunodeficiencia Humana (VIH), Sindrome de la Inmunodeficiencia Adquirida (SIDA) y Hepatitis C Se les notifica a los empleados que se puede hacer una reclamaci6n por una condici6n, infecci6n, enfermedad o incapacidad relacionada con o derivada del Virus de Inmunodeficiencia Humana (VIE), Sindrome de Inmunodeficiencia Adquirida (SIDA), o Hepatitis C bajo to provisto por la Ley de Compensaci6n para los Trabajadores de Arizona y las reglas de La Comisi6n Industrial de Arizona. Tal reclamaci6n debe incluir el suceso de una exposici6n importante en el trabajo, la que por to general significa contacto de alguna ruptura de la piel o mucosa del empleado con la sangre, semen, fluido vaginal, fluido(s) quirurgico(s) o cualquier otro fluido de una persona que contenga sangre. EL EMPLEADO DEBE CONSULTAR A UN MEDICO PARA CONFIRMAR SU RECLAMACION. Las reclamaciones no pueden resultar de actividad sexual o use ilicito de drogas. Ciertas clases de empleados pueden establecer mss facilmente una reclamaci6n relacionada con el VIH, SIDA o Hepatitis C si reUnen los requisitos siguientes: 1. EI curso regular del empleo del empleado requiere el manejo de o la exposici6n a sangre, semen, fluido vaginal, fluido(s) quirurgico(s) o cualquier otro fluido que contenga sangre. Incluidos en esta categoria son los proveedores de cuidados de la salud, trabajadores de laboratorios forenses, bomberos, agentes policiales, tecnicos medicos de emergencia, paramedicos y-agentes correccionales. 2. NO MAS DE DIEZ (10) DIAS DE CALENDARIO despues de una posible exposici6n importante que results de y en el curso de su trabajo, el empleado reporta a su patron por escrito los detalles de la exposici6n como to proveen las reglas de la Comisi6n. Las formas de reporte estan disponibles en la oficina de este patron o de la Comisi6n Industrial de Arizona, 800 W. Washington, Phoenix, Arizona 85007, (602) 542-4661 o 2675 E. Broadway, Tucson, Arizona 85716, (520) 628-5188. Si un empleado elige no Ilenar la forma de reporte, ese empleado corre el riesgo de perder una reclamaci6n de prima facie. 3. NO MAS DE DIEZ (10) DIAS DE CALENDARIO despues de una posible exposici6n importante el empleado va a que le saquen sangre, y NO MAS DE TREINTA (30) DIAS DE CALENDARIO la sangre es analizada para VIH O HEPATITIS C por medio de analisis de anticuerpos y el analisis resulta negativo. 4. NO MAS DE DIECIOCHO (18) MESES despues de la fecha de la posible exposici6n importante en el trabajo, el empleado es examinado nuevemente y los resultados del analisis son positivos por VIH o el empleado ha sido diagnosticado como positivo por la presencia de VI , o NO MAS DE SIETE (7) MESES despuesh de la fecha de la posible exposici6n importante en el trabajo, el empleado es examinado nuevamente y los resultados del analisis son positivos por la presencia de Hepatitis C o el empleado ha sido diagnosticado como positivo por la presencia de Hepatitis C. MANTENER FIJO EN UN LUGAR SOBRESALIENTE JUNTO AL AVISO A LOS EMPLADOS SOME COMPENSACION PARA TRABAJADORES ESTE AVISO HA SIDO APROBADO POR LA COMISION INDUSTRIAL DE ARIZONA PARA USO DE LAS ASEGURADORAS W02P5008 WORK EXPOSURE TO METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA), SPINAL MENINGITIS, OR TUBERCULOSIS (TB) Notice to Employees Employees are notified that a claim may be made for a condition, infection, disease or disability involving or related to MRSA, spinal meningitis, or TB within the provisions of the Arizona Workers' Compensation Law. A.R.S. § 23-1043.04) Such a claim shall include the occurrence of a significant exposure at work, which is defined to mean an exposure in the course of employment to aerosolized MRSA, spinal meningitis or TB bacteria. Significant exposure also includes exposure in the course of employment to MRSA through bodily fluids or skin. Certain classes of employees (as defined below) may more easily establish a claim related to MRSA, spinal meningitis or TB by meeting the following requirements: 1. The employee's regular course of employment involves handling or exposure to MRSA, spinal meningitis or TB. For purposes of establishing a claim under this section, "employee" is limited to firefighters, law enforcement officers, correction officers, probation officers, emergency medical technicians and para- medics who are not employed by a health care institution; 2. No later than thirty (30) calendar days after a possible significant exposure, the employee reports in writ- ing to the employer the details of the exposure; 3. A diagnosis is made within the following time -frames: a. For a claim involving MRSA, the employee must be diagnosed with MRSA within fifteen (15) days after the employee reports pursuant to Item No. 2 above; b. For a claim involving spinal meningitis, the employee must be diagnosed with spinal meningitis within two (2) to eighteen (18) days of the possible significant exposure; and c. For a claim involving TB, the employee is diagnosed with TB within twelve (12) weeks of the possi- ble significant exposure. Expenses for post -exposure evaluation and follow-up, including reasonably required prophylactic treatment for MRSA, spinal meningitis, and TB is considered a medical benefit under the Arizona Workers' Compensation Act for any significant exposure that arises out of and in the course of employment if the employee files a claim for the significant exposure or the employee reports in writing the details of the exposure. Providing post -exposure evaluation and follow-up, including prophylactic treatment, does not, however, constitute acceptance of a claim for a condition, infection, disease or disability involving or related to a significant exposure. Employers must post this notice in a conspicuous place next to the Workers' Compensation Notice to Employees. REV 7/11 W02P6T11 INET INC ISSUE TO: IPARQ STATE OF CALIFORNIA —DEPARTMENT OF INDUSTRIAL RELATIONS Division of Workers' Compensation ' Notice to Employees — Injuries Caused By Work F You may be entitled to workers' compensation benefits if you are injured or become ill because of your job. Workers' compensation covers most work-related physical or mental injuries and illnesses. An injury or illness can be caused by one event (such as hurting your back in a fall) or by repeated exposures (such as hurting your wrist from doing the same motion over and over). Benefits. Workers' compensation benefits include: Medical Care: Doctor visits, hospital services, physical therapy, lab tests, x-rays, medicines, medical equipment and travel costs that are reasonably necessary to treat your injury. You should never see a bill. There are limits on chiropractic, physical therapy and occupational therapy visits. Temporary Disability (TD) Benefits: Payments if you lose wages while recovering. For most injuries, TD benefits may not be paid for more than 104 weeks within five years from the date of injury. Permanent Disability (PD) Benefits: Payments if you do not recover completely and your injury causes a permanent loss of physical or mental function that a doctor can measure. Supplemental Job Displacement Benefit: A nontransferable voucher, if you are injured on or after 1/1/2004, your injury causes permanent disability, and your employer does not offer you regular, modified, or alternative work. Death Benefits: Paid to your dependents if you die from a work-related injury or illness. Naming Your Own Physician Before Injury or Illness (Predesignation). You may be able to choose the doctor who will treat you for a job injury or illness. If eligible, you must tell your employer, in writing, the name and address of your personal physician or medical group before you are injured. You must obtain their agreement to treat you for your work injury. For instructions, see the written information about workers' compensation that your employer is required to give to new employees. If You Get Hurt: 1. Get Medical Care. If you need emergency care, call 911 for help immediately from the hospital, ambulance, fire department or police department. If you need first aid, contact your employer. 2. Report Your Injury. Report the injury immediately to your supervisor or to an employer representative. Don't delay. There are time limits. If you wait too long, you may lose your right to benefits. Your employer is required to provide you with a claim form within one working day after learning about your injury. Within one working day after you file a claim form, your employer or claims administrator must authorize the provision of all treatment, up to ten thousand dollars, consistent with the applicable treatment guidelines, for your alleged injury until the claim is accepted or rejected. 3. See Your Primary Treating Physician (PTP). This is the doctor with overall responsibility for treating your injury or illness. If you predesignated your personal physician or a medical group, you may see your personal physician or the medical group after you are injured. If your employer is using a medical provider network (MPN) or a health care organization (HCO), in most cases you will be treated within the MPN or HCO unless you predesignated a personal physician or medical group. An MPN is a group of physicians and health care providers who provide treatment to workers injured on the job. You should receive information from your employer if you are covered by an HCO or a MPN. Contact your employer for more information. If your employer is not using an MPN or HCO, in most cases the claims administrator can choose the doctor who first treats you when you are injured, unless you predesignated a personal physician or medical group. 4. Medical Provider Networks. Your employer may be using an MPN, which is a group of health care providers designated to provide treatment to workers injured on the job. If you have predesignated a personal physician or medical group prior to your work injury, then you may go there to receive treatment from your predesignated doctor. If you are treating with a non-MPN doctor for an existing injury, you may be required to change to a doctor within the MPN. For more information, see the MPN contact information below: MPN website: WWW.MYWCINFO.COM MPN Effective Date: 05-28-2018 MPN Identification number 2493 If you need help locating an MPN physician, call your MPN access assistant at: (800) 287-9682 If you have questions about the MPN or want to file a complaint against the MPN, call the MPN Contact Person at (800) 287-9682 Discrimination. It is illegal for your employer to punish or fire you for having a work injury or illness, for filing a claim, or testifying in another person's workers' compensation case. If proven, you may receive lost wages, job reinstatement, increased benefits, and costs and expenses up to limits set by the state. Questions? Learn more about workers' compensation by reading the information that your employer is required to give you at time of hire. If you have questions, see your employer or the claims administrator (who handles workers' compensation claims for your employer): TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Claims Administrator Phone 1-800-238-6225 Workers' compensation insurer Enter "self-insured" if appropriate) You can also get free information from a State Division of Workers' Compensation Information (DWC) & Assistance Officer. The nearest Information & Assistance Officer can be found at location: by calling toll-free (800) 736-7401. Learn more information about workers' compensation online booklet "Workers' Compensation in California: A Guidebook for Injured Workers." or www.dwc.ca.gov and access a useful False claims and false denials. Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers' compensation benefits or payments is guilty of a felony and may be fined and imprisoned. Your employer may not be liable for the payment of workers' compensation benefits for any injury that arises from your voluntary participation in any off-duty, recreational, social, or athletic activity that is not part of your work-related duties. DWC 7 (1/1/2016) INET INC ISSUE TO: IPARQ ESTADO DE CALIFORNIA — DEPARTAMENTO DE RELACIONES INDUSTRIALES Division de Compensacion de Trabajadores Aviso a los Empleados — Lesiones Causadas por el Trabajo r Es posible que usted tenga derecho a beneficios de compensacion de trabajadores si usted se lesiona o se enferma a causa de su trabajo. La compensacion de trabajadores cubre la mayor a de las lesiones y enfermedades fisicas o mentales relacionadas con el trabajo. Una lesion o enfermedad puede ser causada por un evento (como por ejemplo lastimarse la espalda en una ca da) o por acciones repetidas (como por ejemplo lastimarse la muneca por hacer el mismo movimiento una y otra vez). Beneficios. Los beneficios de compensacion de trabajadores incluyen: Atencion Medica: Consultas medicas, servicios de hospital, terapia fisica, analisis de laboratorio, radiografias, medicinas, equipo medico y costos de viajar que son razonablemente necesarias para tratar su lesion. Usted nunca debera ver un cobro. Hay limites para visitas quiropracticas, de terapia fisica y de terapia ocupacional. Beneficios por Incapacidad Temporal (TD): Pagos si usted pierde sueldo mientras se recupera. Para la mayor de las lesiones, beneficios de TD no se pagaran por mas de 104 semanas dentro de cinco anos despues de la fecha de la lesion. Beneficios por Incapacidad Permanente (PD): Pagos si usted no se recupera completamente y si su lesion le causa una perdida permanente de su funcion fisica o mental que un medico puede medir. Beneficio Suplementario por Desplazamiento de Trabajo: Un vale no-transferible si su lesion surge en o despues del 1/1/04, y su lesion le ocasiona una incapacidad permanente, y su empleador no le ofrece a usted un trabajo regular, modificado, o alternativo. Beneficios por Muerte: Pagados a sus dependientes si usted muere a causa de una lesion o enfermedad relacionada con el trabajo. Designacion de su Propio Medico Antes de una Lesion o Enfermedad (Designacion previa). Es posible que usted pueda elegir al medico que le atendera en una lesion o enfermedad relacionada con el trabajo. Si elegible, usted debe informarle al empleador, por escrito, el nombre y la direccion de su medico personal o grupo medico, antes de que usted se lesione. Usted debe de ponerse de acuerdo con su medico para que atienda la lesion causada por el trabajo. Para instrucciones, vea la informacion escrita sobre la compensacion de trabajadores que se le exige a su empleador darle a los empleados nuevos. Si Usted se Lastima: 1. Obtenga Atencion Medica. Si usted necesita atencion de emergencia, Ilame al 911 para ayuda inmediata de un hospital, una ambulancia, el departamento de bomberos o departamento de policia. Si usted necesita primeros auxilios, comuniquese con su empleador. 2. Reporte su Lesion. Reporte la lesion inmediatamente a su supervisor(a) o a un representante del empleador. No se demore. Hay limites de tiempo. Si usted espera demasiado, es posible que usted pierda su derecho a beneficios. Su empleador este obligado a proporcionarle un formulario de reclamo dentro de un dia laboral despues de saber de su lesion. Dentro de un dia despues de que usted presente un formulario de reclamo, el empleador o administrador de reclamos debe autorizar todo tratamiento medico, hasta diez mil dolares, de acuerdo con las pautas de tratamiento aplicables a su presunta lesi n, hasta que el reclamo sea aceptado o rechazado. 3. Consulte al Medico que Ie este Atendiendo (PTP). Este es el medico con la responsabilidad total de tratar su lesion o enfermedad. Si usted designo previamente a su medico personal o grupo medico, usted puede consultar a su medico personal o grupo medico despues de lesionarse. Si su empleador este utilizando una Red de Proveedores Medicos (MPN) o una Organizacion de Cuidado Medico (HCO), en la mayoria de los casos usted sera tratado dentro de la MPN o la HCO a menos que usted designo previamente un medico personal o grupo medico. Una MPN es un grupo de medicos y proveedores de atencion medica que proporcionan tratamiento a trabajadores lesionados en el trabajo. Usted debe recibir informaci n de su empleador si est cubierto por una HCO o una MPN. Hable con su empleador para mas informacion. Si su empleador no este utilizando una MPN o HCO, en la mayoria de los casos el administrador de reclamos puede escoger el medico que to atiende primero, cuando usted se lesiona, a menos que usted designo previamente a un medico personal o grupo medico. 4. Red de Proveedores Medicos (MPN): Es posible que su empleador use una MPN, to cual es un grupo de proveedores de asistencia medica designados para dar tratamiento a los trabajadores lesionados en el trabajo. Si usted ha hecho una designacion previa de un medico personal antes de lesionarse en el trabajo, entonces usted puede recibir tratamiento de su medico previamente designado. Si usted este recibiendo tratamiento de parte de un medico que no pertenece a la MPN para una lesion existente, puede querirse que usted se cambie a un medico dentro de la MPN. Para mas informacion, vea la siguiente informacion de contacto de la MPN : Pagina web de la MPN: WWW.MYWCINFO.COM Fecha de vigencia de la MPN: 05-28-2018 Numero de identificacion de la MPN: 2493 Si usted necesita ayuda en localizar un medico de una MPN, Ilame a su asistente de acceso de la MPN al: (800) 287-9682 Si uste d tie ne pre gunta s sobre la MPN o quiere presentar una queja en contra de la MPN, Ilame a la Persona de Contacto de la MPN al 8001287-9682 Discriminacion. Es ilegal que su empleador le castigue o despida por sufrir una lesion o enfermedad en el trabajo, por presenter un reclamo o por testificar en el caso de compensacion de trabajadores de otra persona. De ser probado, usted puede recibir pagos por perdida de sueldos, reposicion del trabajo, aumento de beneficios y gastos hasta los limites establecidos por el estado. tPreguntas? Aprenda mas sobre la compensacion de trabajadores leyendo la informacion que se requiere que su empleador le de cuando es contratado. Si usted tiene preguntas, vea a su empleador o al administrador de reclamos (que se encarga de los reclamos de compensacion de trabajadores de su empleador): Administrador de TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Reclamos Telefono 1-800-238-6225 Asegurador del Seguro de Compensacion de trabajador Anote "autoasegurado" si es apropiado) Usted tambien puede obtener informacion gratuita de un Oficial de Informacion y Asistencia de la Division Estatal de Compensacion de Trabajadores. EI Oficial de Informacion y Asistencia mas cercano se localiza en: o Ilamando al nimero gratuito (800) 736-7401. Usted puede obtener mas informacion sobre la compensacion del trabajador en el Internet en: www.dwc.ca.gov y acceder a una guia util "Compensacion del Trabajador de California Una Guia para Trabajadores Lesionados." Los reclamos falsos y rechazos falsos del reclamo. Cualquier persona que haga o que ocasione que se haga una declaracion o una representaci n material intencionalmente falsa o fraudulenta, con el fin de obtener o negar beneficios o pagos de compensacion de trabajadores, es culpable de un delito grave y puede ser multado y encarcelado. Es posible que su empleador no sea responsable por el pago de beneficios de compensacion de trabajadores para ninguna lesion que proviene su participacion voluntaria en cualquire actividad fuera del trabajo, recreativa, social, o atletica que no sea parte de sus deberes laborales. renin -7 14 14 '1r%4 c\ TO THE EMPLOYER: THIS NOTICE MUST BE POSTED IN A CONSPICUOUS PLACE UPON YOUR PREMISES REGARDING WORKERS' COMPENSATION INSURANCE ALL WORKERS EMPLOYED BY THE UNDERSIGNED ARE HEREBY NOTIFIED THAT THE EMPLOYER HAS COMPLIED WITH THE LAW AS TO SECURING THE PAYMENT OF COM- PENSATION TO EMPLOYEES AND THEIR DEPENDENTS, IN ACCORDANCE WITH THE PROVISIONS OF THE WORKERS COMPENSATION LAW. INET INC Date 05-28-18 IPARQ Employer By Employer's Authorized Agent An employee receiving an injury by accident must immediately notify his/her supervisor, superintendent, or the undersigned, who will provide medical attendance. Claim for compensation must be made in writing and given to the employer. Forms for giving notice of injury and making claim for compensation will be furnished by the employer, by the surety, THE TRAVELERS INSURANCE COMPANIES or upon application, by the Industrial Accident Commission, in Boise, Idaho. ICREV 11/94.EMP W11P1J96 TRAVELERS!' ONE TOWER SQUARE HARTFORD, CT 06183 INSURED'S NAME: INET INC IPARQ POLICY EFFECTIVE: 05-28-18 NEW/RENEWAL: R RESPONSIBILITY: I PAYMODE/ DIRECT BILL CODE: P WATCH FILE: 0 PROGRAM CODE: U14 AMS BINDER #: PKG POL NBR: UNKNOWN WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY OVERPRINT PAGE POLICY NUMBER: (IJUB-4J20158-9-18) POLICY EXPIRY: 05-28-19 SOLICITOR: 8K MSI: I AUDIT FREQUENCY: A SURVEY CODE: 2 NBR OF POL IN SAI: PARENT FEIN: 371566208 STATE PREDOMINANT CLASS & SYMBOL (* indicates if selected as Policy predominant) SAI: 5328CA211 SIC CODE: 7371 REINSURANCE: NEG COMM: .1200 AGENCY BILL: Y NAICS: 541511 32) CIGA SURCHARGE -WORKERS COMPENSATION 59) CA WC FRAUD ASSESSMENT OFFICE: PAYROLL 70A PRODUCER: AP INTEGO INS GROUP LLC X9275 RATER: HJ ISSUE DATE: 04-13-18 CHANGE EFFECTIVE DATE: 05-28-18 WUNT6H96 ST POLICY ST ST POLICY ST ST SYMBOL PREDOM CLASS ST SYMBOL PREDOM CLASS AZ ICUB 8742 CA IJUB * 8859 IA IEUB 8742 ID IOUB 8810 COMMISSION/INSTALLMENT SUMMARY ACCT EFF GROSS COMM MO DATE AMT RATE 05-18 05/28/18 16.00 #(59) 0000 05-18 05/28/18 16.00 #(32) 0000 05-18 05/28/18 1200 TOTALS 32) CIGA SURCHARGE -WORKERS COMPENSATION 59) CA WC FRAUD ASSESSMENT OFFICE: PAYROLL 70A PRODUCER: AP INTEGO INS GROUP LLC X9275 RATER: HJ ISSUE DATE: 04-13-18 CHANGE EFFECTIVE DATE: 05-28-18 WUNT6H96 WORKERS COMPENSATION NET RATE SUPPLEMENT NAMED INSURED: INET INC IPARQ QUOTE NO: (IJUB-4J20158-9-18) POLICY PERIOD: 05-28-18 TO 05-28-19 DATE: 04-13-18 WUNM2D06 PAGE NO.: 1 EXPENSE CONSTANT - FLAT CHARGE: INCLUDED LOSS CONSTANT - FLAT CHARGE: INCLUDED TOTAL - FLAT CHARGES: INCLUDED CLASS STATE LOCATION CODE DESCRIPTION NET RATE AZ 001 8742 SALESPERSONS OR COLLECTORS - 3564 CA 001 8859 COMPUTER PROGRAMMING OR 1146 IA 001 8742 SALESPERSONS OR COLLECTORS - 6491 ID 001 8810 COMPUTER SYSTEM DESIGNERS OR 3564 WUNM2D06 PAGE NO.: 1 ACOKO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD YYW) L..i' 04/30/2019 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(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Robert Tartre Ives Insurance Services, Inc. PHONE FAX Ext): (619)2245337 Arc No: (619)223-47162850WombleRoad, Suite 103 JL MAN 6021537469 ADDRESS: robert@ivesins.com San Diego, CA 92106 EACH OCCURRENCE 2,000,000 License #: OG13604 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: CNA Insurance INSURED INSURER B: The Hartford Insurance Company DAMAGE TO RENTED PREMISES (Ea occurrence) INET, Inc. MED EXP (Any one person) DBA IPARQ INSURER C 1050 Rosecrans St Ste G INSURER D: San Diego, CA 92106 INSURER E : 2,000,000 INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 19 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 LTR TYPE OF INSURANCE ADDLSUBRPOLICY IVSD WVD POLICY NUMBER EFF MM DDYWY POLICYMMDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 6021537469 06/02/2018 06/02/2019 EACH OCCURRENCE 2,000,000 CLAIMS -MADE [XI OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) 300,000 MED EXP (Any one person) 10,000 PERSONAL &ADV INJURY 2,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 4,000,000GEN'L X POLICY a PRO- JECT L_ LOC PRODUCTS - COMP/OP AGG 4,000,000 OTHER: AUTOMOBILE LIABILITY 6021537469 06/02/2018 06/02/2019 BINEDAEOaacccident)S LE LIMIT 1,000,000 BODILY INJURY (Per person) ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE Per accidentXHIREDNON -OWNED AUTOS ONLY X AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATEEXCESSLIABHCLAIMS-MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEF7E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE- EA EMPLOYEMandatoryinNH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT A IT/Professional Liab 6021537469 06/02/2018 06/02/2019 Aggregate 1,000,000 B Crime Bond 72TP0294464-18 02/04/2018 02/04/2019 Employee Theft 1 mm DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate holder is additional insured per blanket Al endorsement Primary and Non -Contributory wording included Waiver of Subrogation Included CERTIFICATE HOLDER CANCELLATION 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by RJT on April 30, 2019 at 01:12PM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Bremerton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Risk Management ACCORDANCE WITH THE POLICY PROVISIONS. 345 6th Street, Suite 100 AUTHORIZED REPRESENTATIVE Bremerton, WA 98337 Rd l t T&C RJT) 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by RJT on April 30, 2019 at 01:12PM 7. Out of Scope Service Fees The table below details PCS Mobile's hourly billing rate for work which falls outside of, or in exception to the accepted SOW and Implementation plan. Some examples of work that may meet these conditions include: Vehicle(s) not being prepared for installation requiring PCS Field technicians to complete the task. Designated personnel not being available as agreed upon. Training classes scheduled but not attended or additional sessions to train staff that are unable or fail to make scheduled training. IT personnel not available to facilitate required network access. Vehicle(s) not being available. 8. Technician Level Staff Assigned to Level Hourly Billing Rate Field Service Representative I 65/hour Field Service Representative II 75/hour Field Service Representative IIII 90/hour Video/LPR Specialist 150/hour 9.Insurance As required