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PW18-289 - Amendment - #1 - R. F. Duncan & Associates, Inc. - S 224th St Project Phase II - Hytek - 12/31/2018
�NTRecords Management Document CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to the City Clerk's Office. All portions are to be completed. If you have questions, please contact the City Clerk's Office at 253-SS6-5725. Vendor Name: R. F. Duncan & Associates, Inc, Vendor Number (JDE): Contract Number (City Clerk): Category: _ Contract Agreement Sub-Category (if applicable): Amendment Project Name: S. 224th St. Project - Hytek 12/31/18 / �� Contract Execution Date: Termination Date Dee Martindale PW: Engineering Contract Manager: Department: g g Contract Amount: $0 Budgeted: W Grant? Part of NEW Budget: El Local: 1-1State: ❑ Federal: D Related to a New Position: 1-1 Basis for Selection of Contractor? Other Approval Authority: Director z Mayor ❑ City Council Other Details: Extend the time of completion to December 31 . 2019.due to the project has been postponed for property acquisition. N T AMENDMENT NO. 1 NAME OF CONSULTANT OR VENDOR: Ft F. Duncan & A_Uociates, Inc CONTRACT NAME & PROJECT NUMBER: S. 224t" St P'roigct - Hlytek ORIGINAL AGREEMENT DATE: duly 17, 2018 This Amendment is made between the City and the above-referenced Consultant or Vendor and amends the original Agreement and all prior Amendments. All other provisions of the original Agreement or prior Amendments not inconsistent with this Amendment shall remain in full force and effect. For valuable consideration and by mutual consent of the parties, Consultant or Vendor's work is modified as follows: 1. Section I of the Agreement, entitled "Description of Work," is hereby modified to add additional work or revise existing work as follows: In addition to work required under the original Agreement and any prior Amendments, the Consultant or Vendor shall: The scope of work remains the same, however an amendment is necessary to extend the time of completion to December 31, 2019 due to the project has been postponed for property acquisition. 2. The contract amount and time for performance provisions of Section II "Time of Completion," and Section III, "Compensation," are modified as follows: Original Contract Sum, $900,p0 including applicable WSST .---....... -........—............_ _. .......... ...... Net Change by Previous Amendments $0 including applicable WSST ----._ �..... .............._ ....................—........... ... _...... _ urrent Contract Amount $900.1N1 including all previous amendments Current Amendment Sum - -... .mm _... ..--.... ...... ...... —.............. Applicable WSST Tax on this $U Amendment Revised Contract Sum _ . - - — ........ —.... — ......� _ �._..._.—---- —.m......... $I00.00 AMENDMENT - 1 OF 2 h � Original Time for Completion 12/31/18 (insert date) - __ p _........._ ..__.-. Revised Time for Com letion under n/a prior Amendments (insert date) Add'I Days Required (t) for this 365 calendar days Amendment Revised Time for Completion 12/31/19 (insert date) The Consultant or Vendor accepts all requirements of this Amendment by signing below, by its signature waives any protest or claim it may have regarding this Amendment, and acknowledges and accepts that this Amendment constitutes full payment and final settlement of all claims of any kind or nature arising from or connected with any work either covered or affected by this Amendment, including, without limitation, claims related to contract time, contract acceleration, onsite or home office overhead, or lost profits. This Amendment, unless otherwise provided, does not relieve the Consultant or Vendor from strict compliance with the guarantee and warranty provisions of the original Agreement. All acts consistent with the authority of the Agreement, previous Amendments (if any), and this Amendment, prior to the effective date of this Amendment, are hereby ratified and affirmed, and the terms of the Agreement, previous Amendments (if any), and this Amendment shall be deemed to have applied. The parties whose names appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. IN WITNESS, the parties below have executed this Amendment, which will become effective on the last date written below. _.. ....._..... _......... CONSULTANT/VENDOR: CITY OF KENT: By , \ By:. 1 (signature) (signature) Print Name: Richard F Duncan Print Its owner DATEName: -tE4gfQLM nag Maloney, _. _.._ Its_ Deli n En ins er (title) � de) DATE: 12-28-18 _.._ —............_. ..___ —..,...._. ......_ ATTEST: APPROVED AS TO FORM: (applicable if Mayor's signature required) Kent City Clerk Kent Law Department ...-.... Rr Dun-n-22d"Hyrek 2 Hma 1/Roklk-Wllmy AMENDMENT - 2 OF 2 tc'�,JA CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO 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 INSURERISt,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTAPIT Ip lhq certilicale holder Is an ADDITIONAL INSURE D. the pollcylles}must have ADOY fhONAL 1N SURED tyrnwlslolrs or be endorsed. If SUBROGATION IS WAIVED,subI to the terms and conditions of the policy,certain policies play require an endorsement. A statement on this cortificate does not confer rkilAts to the certificate holder in lieu of such enoorsenearill;a). PRODUCER rr%MI Judy Land emir Duncan 8 Associates Insurance Brokers jn .qua rttl I vi4 360-352 7535 rL slap 38p-943.834II P.O. Box 1458 -2111 Harrison Ave NW ,I,p INW Wtl dUdy�JYElaulYCael s corn Olympia, WA 98502 , , .,,v, - __. INSWNENn Ohlo Security.insurance Compa Ay. . 531311 INSURED R. F. Duncan&Associates,Inc INsu RER e: Ohio Security insurance Company_. _ IDEA The Granger Company IN'el1RER C P 0 BOX 12300 INSURERD Olympia, WA 98508 'INSUNERE. --- COWERAGES _ CERTIFICATE NUMBER Op0000pp 11t0D7 _ REVISpON NIJMtr3FR�t2__ _� Ilil'6TTID I'I IIY TI IaAND[ l (ANY OUIRFIRFLY 1, I II II II Fi NDIII N IARIY ,fJIRACIO F IPf�LND(AC MENJVIIE T.,P[CC uOUCv PeRl6D IIIfJILATfn NCIVUTH rnINDI Vt,ANY RFOUIk['.MENI ILItM R'CGN.IIIION WANVf�N TRACT OR ORIEk UOCUMENI NIfH RF;PLC] 10 AMIIGH fHM1S UIIIFRf rl MFl liF_I lit fl OR MAYIf tTAIN TI'i (JAIJCIL,AIIIIIII1)HYIIIL t OtICIc5'DL (CPIECO[If REIN S SUBJFCT IO ALI THE R:EUW'3, F N,CI_UFIn NS AM1IC CGNOI rICN, OF 911t III In If,IE13111f1r 9WPd IFV IV bI L1EI lv +I IA ILID @Y PAIO CLAFN,S. Rer I ". YPOFIN E TneMY➢U/IlwlmYVu1(orAwk,l F^G1^OM NNAM,Orti rY1MlOr51YY_FaYt atnM1y FYffYV A 7 COMMERCIAL GENERAL LIABILITY N BLS 19 56 69 63 77 05108/2018 05708/2011T9l� LIMITB Inalrfl�,Ihnpa.l d"- 10(70,(D0t1� YOIYff ISD J I i I J trio n 4`{I,on o,,, unl ] 1,000,000 v1 ( d" r I a 15,000. rII rNnl e IIPUI IN uv I r 1 000 ( ,000 6 I1 RrI NI,MIL at IYIAH ti 2,000,000 ....e..�._ �„ .......-.._—. ..._..�4(NV I4(YIM I'.It IIMu iS_. 0( 7 67p}f1 Of10 g omoeLE LIABILITY N N BAS 19 56 69 63 77 05123I201e 05/23/2019 Y vv , I K X 1 I Pv 7 Io mp i II I UMBRELLA LIAB I I .. _ _>................ __— ..__....__......,_. 1- ,,,....._yam.. .._ .._ .._...., � ,..........» EXCE95LIAe 1 1 4r II F1 atlUVd'NGI g I � 1.4VAI e.f.4 pr t WH9RN[RSZOMPENBRYIOIY FB INXiNJ: J _ �� �WI IkPo AND EMPLOYERS'LIABILITY I 1 Y1Yi ' r(ry y a,luu` IIt 1kv�+n4 @I(41V1 }v{I/IYYN(1 rl Yitl n.E � - -- 141n.[X1elVnfdi6Y'I;./h14J I N(N 11 (vd kPl4 Yh,We, f e r f t I"OPAS, d l..pRld lUl ttr )F4i finll ! OI '. - I OESC RIPTIONOFOPEnATIONSILDCATION9(VEHIOLE9 ACORDI iU1 /iOU llorlahfloe ,YA, ..h,d,,i,rY RE: All protects under contract between insured and certificate holder. ""`�°"ctlI City of Kent Is named as an additioinal insured in regard to the General Liability coverages above per form CG 88 10 0413 CERTIFiCAT E HOLDER CANCELL.AINIDN SHOULOANY OF THE ABOVE.DESCRIBED POLICIES BE CANCELLED BEFORE City of Kent THE EXPIRATION DAce THEREOF,Nd}TICE WILL BE DEL3VBRELY IN 400 West Gowe AccDROANce wtrlq TpiE POLIc°r PROVISIONS. Kent, WA 98032 --_......._.._>....._._._....�.._>_. A e 1 tlgR(PYfl F FPa,S,jERIA(/TIrVE .......__._.>.,i. ......._._......_._,.......,-._._ 1988 ACORD 25(201 W03) The ACORD name and logo are registered marks of ACORD RD CORPORATION,—AII rights reserved. Ponied by JAL o0 May 08, )018 al 04a 6PM Liberty v Mutual, ris on micE Policyholder information Named Insured & Mailing Address Agent Mailing Address &Phone No. R F DUNCAN & ASSOCIATES, INC (160) 352-7588-- --�� DBA 'fltE GRANGER COMPANY DUNCAN & ASSOCWT'BS INC PO BOX 12300 PO BOX W8 OLYMPIA, WA 98508 OLYMPIA, WA 99507-I458 Dear Policyholder: We know you work hard C build your business. WVe work together Wi(h }roar Agent, DUNCAN roc ASSOCIATES INC (360) 352-7588 a to help protnet the (hings you care about. Thank you for selecting us. r, Enclosed are your insurance documents consisting of Business Auto 'Ib fYud ),oru specific coverages, limits of liability, and premium, please refer to your Declaratiian5 page(s). If you have uuV questions or changes that may affect your insurance needs, please. contact your Agent at (360) 352-7588 Detach the 1D lard tatted at the back of the policy « 5 erifv that all inf uloation is collect If you have am c1bant4cs, plcasc contact your Agent at (300) 352-7588 Reminders In case of a claim, call your Agent or 1-800-362-00oo You Need To Know • AUTO I.D. CARDS ARL INCLUDED AT THE BACK OF TJJE. POLICY and can be used as evidence of insurance and provide you with information on what to do in case 0fi an accident. • CONTINUED ON NEXT PAGE To report a claim, call your Agent or 1-800-362-0000 DS 70 20 01 08 You Need To Know - continued • IS('X"l b(,E(Syl0 PQ}Ltli„Y'I°MiC)V,filili(S9 'tire firlpcnaraV Nniicc(s,) Io I�<rBtcy ktrrlder(+,y provide a gentlel e,KpVanan)tt Of C hango% in covexnnc to your polkuy, I'lic [mpnrtant Notice(s) to Pohcylboldn(;s) is not a part of your insut,unce policy ,and it 4d,co not nitur policy irrervfi9ianS or condifl ins. Only Ch¢ pr(o is'iunts of your pofoey dctermrue lite. .scopr of`your insurance lyrrda°U0.icroor. It is imporian{ thi you read your policy carefully to determine your rights, duties and M)r o is and is not Covered. FORM NUMBER 'FI1'LE C'NA90 16 11 16 2016 Commercial Auto Miscellaneous Form Revisions Advisory TJotice to Policyholders b,P 74 44 09 06 U.S. Treasury Department's Office of Foreign Assers Control (OFAC) Advisory Notice to Policyholders NP 88 01 09 08 Important Information About Driving Outside of the United States and Proof of Auto Insurance NP 89 71 09 10 lmportaut Policyholder Irtfonnation Concerning Billing Practices Liberty Northwest SNA46 02 09 17 Important Notice To Policyholders Revisions To The Transfer Of Rights Of Recovery Against Others To Us Provision • 'Plus policy will be direct billed. You may choose to combine any number of policies on one bill with your billing account, Please contact your agent for more infomiatlon. tl 4 0 CNA 90 16 11 16 2016 COMMERCIAL AUTO MISCELLANEOUS FORM REVISIONS ADVISORY NOTICE TO POLICYHOLDERS 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 si'. 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 forms and endorsements which apply to your ® renewal policy being issued by us. The forms and endorsements may reduce or broaden coverage, ® Reductions Of Coverage CA 23 44 - Public Or Livery Passenger Conveyance Exclusion When this endorsement is attached to your policy, insurance provided under any applicable Covered Auto Liability, Physical Damage, Auto Medical Payments, Uninsured and/or Underinsured Motorists and Personal Injury Protection (or similar no-fault) Coverage is excluded while any covered auto is being used as a public or livery conveyance for passengers. This includes, but is not limited to, any period of time a covered auto is being used by an insured who is logged into a "transportation network platform" as a driver, whether or not a passenger is occupying the covered auto, CA 23 45 - Public Or Livery Passenger Conveyance And On-demand Delivery Services Exclusion When this endorsement is attached to your policy, insurance provided under any applicable Covered Auto Liability, Physical Damage, Auto Medical Payments, Uninsured and/or Underinsured Motorists and Personal Injury Protection (o( similar no-fault) Coverage is excluded while any covered auto is being used: s As a public or livery conveyance for passengers,. This includes, but is not limited to, any period of time a covered auto is being used by an insured who is logged into a ''transportation network platform" as a driver, whether or not a passenger Is occupying the covered auto; of m By an insured who is logged into a "transportation network platform" or "delivery network platform" as a driver to provide delivery services, which includes courier services, whether or not the goods, items or products to be dOivered are in the covered auto. CNA 90 16 11 16 © 2016Liberty Mutual Insurance Page 1 of 1 NP 74 44 09 06 U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY NOTICE TO POLICYHOLDERS 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 coverages you are provided.. This Notice provides information concerning possible impact on your insurance coverage due to directives issued by OFAC. Please read this Notice carefully. Please refer any questions you may have to your insurance agent. The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presiden- tial declarations of "national emergency". OFAC has identified and listed numerous: • Foreign agents; • Front organizations, • Terrorists; • Terrorist organizations, and • Narcotics traffickers, as "Specially Designated Nationals and Blocked Persons". This list can be located on the United States Treasury's web, site -http//VAvw.treas.govlofac. In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entity claiming the benefits of this insurance has violated U.S. sanctions law or is a Specially Designated National and Blocked Person, as identified by OFAC, this insurance will be considered a blocked or frozen contract and all provisions of this insurance are immediately subject to OFAC. When an insurance policy is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments also apply. 2)11 Liberty Mutual Insurance.All rights reserved. NP 74 44 09 06 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 1 of 1 NP 88 01 09 08 IMPORTANT INFORMATION ABOUT DRIVING OUTSIDE OF THE UNITED STATES AND PROOF OF AUTO INSURANCE THIS NOTICE DOES NOT PROVIDE ANY COVERAGE, NOR CAN IT BE CONSTRUED TO REPLACE ANY PROVISIONS OF YOUR POLICY, YOU SHOULD READ YOUR POLICY AND REVIEW YOUR POLICY DECLARATIONS FOR COMPLETE INFORMATION ABOUT THE " COVERAGE THAT APPLIES, IF THERE IS ANY CONFLICT BETWEEN THE POLICY AND THIS NOTICE, THE PROVISIONS OF THE POLICY PREVAIL. This notice provides you with information about territory provisions included in your policy. Your policy provides coverage for accidents or losses that occur within the policy period shown on the Declarations and within the policy territory. The policy territory is defined as the United States of America, its possessions (such as American Samoa, Guam and the U.S. Virgin Islands), Puerto Rico or Canada. While that is the case, in locations outside of the United States, authorities may not accept the Auto Identification Card we pro- vided to you with your policy as proof that you have Insurance- For example, Canada requires non-resident operators to carry a special identification Card. For this reason, before you drive outside of the United States, be sure that you: a Familiarize yourself with the motor vehicle laws in the countries or territories you plan to drive in, and 0 Obtain a "Canada Non-Resident Inter-Province Motor Vehicle Liability Insurance Card" from your independent insurance agent when driving in Canada. In addition, because your policy's territory definition does not include Mexico, if you plan to drive in Mexico, contact your independent insurance agent to purchase Mexican Auto InSlUrange. Under Mexican laws, auto accidents are not just civil offenses. They are considered criminal offenses and, therefore, the consequences of droving uninsured can be severe. If you have any questions about this notice or the territory provisions of your policy, please contact your independent insurance agent. Your agent can answer your questions and, to the extent possible, ensure your coverage meets your insurance needs. NP 88 01 o9 08 Page 1 of 1 NP 89 71 09 10 IMPORTANT POLICYHOLDER INFORMATION CONCERNING BILLING PRACTICES ®ear Valued Policyholder: This insert provides you with important information about our policy billing practices that may affect you. Please review it carefully and contact your agent if you have any questions. Premium Notice: We will mail you a policy Premium Notice separately. The Premium Notice will provide you with specifics regarding your agent, the account and policy billed, the billing company, payment plan, policy number, transaction dates, description of transactions, charges/credits, policy amount balance, mini- mum amount, and payment due date. This insert explains fees that may apply to and be shown on your Premium Notice, Available Premium Payment Plans: • Annual Payment Plan: When this plan applies, you have elected to pay the entire premium amount balance shown on your Premium Notice in full, No installment billing fee applies when the Annual Payment Plan applies. m Installment Payment Plan: When this plan applies, you have elected to pay your policy premium in installments (e,g.: quarterly or monthly installments - Installment Payment Plans vary by state). As noted below, an installment fee may apply when the Installment Payment Plan applies, The Premium Payment Plan that applies to your policy is shown on the lop of your Premium Notice. Please contact your agent if you want to change your Payment Plan election, Installment Payment Plan Fee: If you elected to pay your premiums in installments using the Installment Premium Payment Plan, an installment billing fee applies to each installment bill. The installment billing charge will not apply, however, if you pay the entire balance due when you receive the bill for the first installment, Because the amount of the installment charge varies from state to state, please consult your Premium Notice for the actual fee that applies. Dishonored Payment Fee: Your financial institution may refuse to honor the premium payment withdrawal request you submit to us due to insufficient funds in your account or for some other reason. If that is the case, and your premium payment withdrawal request is returned to us dishonored, a payment return fee will apply. Because the amount of the return fee varies from state to state, please consult your Premium Notice for the actual fee that applies. Late Payment Fee: If we do not receive the minimum amount due on or before the date or time the payment is due, as indicated on your Premium Notice, you will receive a policy cancellation notice effective at a future date that will also reflect a late payment fee charge. Issuance of the cancellation notice due to non-payment of a scheduled installment(s) may result in the billing and collection of all or part of any outstanding premiums due for the policy period. Late Payment Fees vary from state to state and are not applicable in some states. Special Note: Please note that some states do not permit the charging of certain fees. Therefore, if your state does not allow the charging of an Installment Payment Plan, Dishonored Payment or Late Payment Fee,the disallowed fee will not be charged and will not be included on your Premium Notice. EFT-Automatic Withdrawals Payment Option: When you select this option, you will not be sent Premium Notices and, in most cases, will not be charged installment fees. For more information on our EFT-Auto- matic Withdrawals payment option, refer to the attached policyholder plan notice and enrollment sheet, Once again, please contact your agent if you have any questions about the above billing practice informa- tion, Thank you for selecting us to service your insurance needs. NP 89 71 09 10 © 2010 Liberty Mutual Insurance Company All rights reserved Page 1 of 1 SNA 46 02 09 17 IMPORTANT NOTICE TO POLICYHOLDERS REVISIONS TO THE TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US PROVISION Dear Valued Policyholder, Thank you for selecting us as your carrier for your commercial insurance. This Notice contains a brief summary of a coverage change being made to your policy. This Notice does not form a part of your policy nor is any coverage provided by this Notice, It should not be construed as replacing any provision of your policy. You should read your policy and review your Declara- bons page for complete information on the coverages you are provided. If there is any conflict between the Policy and this Notice, THE PROVOSIONS OF THE POLICY SHALL PREVAIL, This Notice provides information concerning the following forms and endorsements which apply to your renewal policy being issued by us. The forms and endorsements may reduce or broaden coverage. Should you have questions after reviewing the changes outlined below, please contact your independent agent. Thank you for your business. CLARIFICATION OF COVERAGE Washington Changes Endorsement -AC 01 15 08 17 We have updated the Transfer Of Rights Of Recovery Against Others To Us condition found in E.2.b. to more closely follow the language found in Washington Administrative Code 284-30-393. SNA 46 02 09 17 © 2017 Liberty Mutual Insurance Page 1 of 1 Coverage Is Provided in: X.I�7CCt Policy Number Ohio Security Insurance Company BAS (19) 55 69 63 77 INSURANCE' Policy PeYit1(II From 0512312018 To 05/23/2019 Common Policy Declarations 12:01 am Standard Time at Insured Mailing Location Named Insured&Mailing Address Agent Mailing Address & Phone No. R F Df GNCAN & ASSOCIATES INC (300) 352-7588 DBA THF, GRANGER COMPANY DUNCAN &. ASSOCIATES INC PO BOX 12300 PO t30X 14.59 OL1'MPIA, WA 98508 OLYMPIA, WA 99507-1458 Named Insured Is:CORPORATION Named Insured Business Is: REAL ESTA"Ili APPRAILSALS In relarn for the payment of Me premium, and subject to all the leans of this policy, we agree with you to provide the insurance as slated in this poiicp. SUMMARY OF COVERAGE PARTS AND CHARGES This policy consists of this Common Poliry Declarations page, Comnion Policy Conditions, Coverage P8i1s (which consist of coverage loans and other applicable forms and endorsements, if any, issued to Ibnn a part of them) and any other forms and endorsements issued to be part of this policy. COVERAGE PART CHARGES Business Auto s1,693 . 00 Total Charges for all of the above coverage parts: $1,693.00 Coverage for Terrorism resulting front Nuclear, Biological or Chemical Acts is Excluded Note: This is not a bill IMPORTANT MESSAGES — ----------- Issue Date 031/1ri116 Authorized Representative To report a claim, calf your Agent or 1-800-362-0000 DS 70 21 11 16 03115711f 56696377 N0180462 235 1 INSUh6t1 CDPY 003229 PAGE ,i 17F 65 s Coverage Is Provided In Policy Number r1Ab1lt Ohio SecuriY Insurance Company s (19) 56 696377 t t71 nsunnicePolicyPeriod From 0 512 3/2 01 B To 05/23/2019 Common Policy Declarations 12:01 am Standard Time at Insured Mailing Location Named Insured Agent R F DUNCAN & ASSOCIATES, INC (360) 352-7588 DBA THE CRANCBR COMPANY DUNCAN & ASSOCIATES INC POLICY FORMS AND ENDORSEMENTS This section lists all the Forms and Endorsements for your policy. Refer to these documents as ❑eed,,l for detailed information concerning your coverage. FORM NUMBER TITLE STATI Applicable ,� ............ _ ._._.�_ — ........_..... _ _ .... AC 0O 31 Ol 14 Changes In Your Policy WA AC 01 15 08 17 Washington Changes WA AC 94 59 06 14 State Application Of Terrorism Exclusion Endorsements Involving Nuclear, WA RiologWe11 OrChemical Terrorism CA 00 OI 03 06 Business Auto Coverage Form WA CA 21 34 O7 08 Washington Undcrinsured Motorists Coverage WA CA 23 45 11 16 Public or Livery Passcngea Conveyance and On - Demand Delivery Services WA Excl us i o n CA 23 85 01 06 Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism WA CA 23 87 01 06 Exclusion of"I'en-orism Involving Nuclear, Biological or Chemical "ferrorisin Above WA Minimum ,Statutory Limits CA 23 89 01 06 Alaska Exclusion of Furrorism Involving Nuclear, Biological or Chemical WA Terrorism Above Minimum SLakdory Limits CA 23 93 Ol 06 Washington F_xelus-ion of Terrorism Involving Nuclear, Biological or Chemical WA Terrorism CA 85 47 12 93 Temporary Substitute Auto - Phvsical Damage Insurance WA CA 85 .53 12 93 Recreational Trailers and Boat Trailers CA 010 DI 10 Business Auto Coverage Enhancement Endorsement WA _ CA 99 03 03 06 Auto Medical Payments Coverage WA CA 99 89 05 01 Washington Loss Payable Roan Reg-335 WA IT Ol 23 If 13 Washington Changes - Defense Costs WA ]L 01 46 OS IO Washington Common Policy Conditions WA It Ol US 09 08 Nuclei Energy Liability Exclusion En m dorseent (Broad Form) WA WA In witness whereof, we have caused this policy 10 be ,signed by our authorized uffieers, Mark Touhey Paul Condrin Secretary President To report a claim, call your Agent or 1-800-362-0000 US 70 21 11 16 65/15/16 56696377 NolU0462 235 N CAFVPNm INSURED COPY 003229 PAGE 10 OF 66 r Coverage Is Provided In: ;a t; Ohio Security Insurance Company PolicyNumber Mk111�, BAS m) 6 696377 INSURANCE Policy Periods Business Automobile From 05123/2018To0 5123/2 01 9 12'01 am Standard Time Policy Declarations at Insured Mailing Location ITEM ONE: Named Insured Agent R F DUNCAN &. r\SSOCIA ILO, INC (366) 352-7588 DBA TFIF GRANGER CCOMPANY DUNCAN Bc ASSOCIA"CES INC 91 ITEM TWO: SCHEDULE OF COVERAGES AND COVERED AUTOS 'this policy provides only those coverages where a charge is shown in the premlum column below. Rauh of these coverages will apply only to those "autos" shown as covered "autos "Autos" arc shown as covered "autos" for a particular covemttc by the entry of ore or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form next to the name of the coverage-, "See Business Auto Coverage Form CA (i) (ll for Covered Auto Symbol Descriptions COVERAGES LIMIT PREMIUM Liability Insurance $I,000 M10 each accident $962.00 Covered Auto Symbal(s) 01* Medical Payments $1S,000 per person $79.00 Covered Auto Symbolk) 02" ........ .... ...._....- ,_....,,. ..... . ...._,-.,....__ . _.,..., . _., .... ,,,, _ ........ Ilrnderiusured Motorist Coverage Limit $164.00 Washington Undeiinsured Motorists Bodily Injury and Property Damap$l, 000, 000 each accident - Covcmd Auto Symbol(s) 02* Physical Damage Refer to Item Three Comprehensive $134.00 Covered Auto Symbol(s) 07" (Collision $3C4.00 i_'overed Auto Symbol(s) 0?* Miscellaneous Coverages Business Auto Enhancement Lndorsement $50.00 Total Provisional Charges: $1,693.00 Note: This is not a bill To report a claim, call your Agent or 1-800-362-0000 DS 70 43 01 08 03I1"flu 58696377 N9 aW2 235 NMFPPNO INSURED COPY 0U92M PAGE 11 OF 66 Coverage is Provided In: policy Number, Liberty Ohio Security Insurance Company BAS (19) 5669 63 77 INSURANCE Policy Period' Business Automobile From 05/23/2018 To 05123/2019 12.01 am Standard Time Policy Declarations at insured Mailing Location Named Insured Agent R. F DUNCAN & ASS0C1Af1:S, INC (360) 352-7588 DBA TIIF GRANGER COMPANY DUNCAN &. ASSOCIATES INC SUMMARY OF COVERED VEHICLES UNIT YEAR MAKE/MODEL VIN TERR ST CLASS ZIP SYM/COST 001 2011 DODGE 1500 D7RViGTOBS545210 035 46 01199 98502 $30,385 To report a claim, call your Agent or 1-800-362-0000 DS 70 43 01 08 fA7l15118 56696377 N0190462 236 NCAFpPNO INSURED COPY 003229 PAGE 12 OF 66 s Y7 Coverage Is Provided In i; .11Ycj,t Policy Number: ., y ranee Company GAS (19) 56 69 63 77 iM"�.tY i.'AY e1�.. Ohio Security.Insurance .....��._�..___�.___......... iNauIRAsEa Policy Period, Business Automobile From 0 512 312 01 8 To 05/23/2019 12;01 am Standard Time Policy Declarations at Insured Mailing Location Named Insured Agent R F DUNCAN & ASSOCIATES, INC (360) 352-7589 DBA THE GRANGER COMPANY DUNC:AN & ASSOCIATES INC ITEM THREE; COVERED VEHICLES AND PREMIUM DETAIL MONO UNIT 001 2011 DODGE 1500 VIN: 1D7RV1GTOBS545210 Rating CLASS SYMJCOST TERRITORY RISK STATE RATING ZIP TOWN CODE -- Factors o1199 $30,385 035 WA 98502 0217 Loss Payee Alaska USA Federal Credit Union PO Box 691608 SAN AN'I'ONIO, TX 7,9269 DESCRIPTION PREMIUM Liability Insurance $729.00 Medical Payments $79.00 Underinsured Motorist Bodily Injury and Property Damage $164.00 Physical Damage Comptchensrve Actual Cash Value Less $500 Deductible $134.00 Collision - Actual Cash Vttlue Less $500 Deductible $304.00 Total Premium $1,410.00 ITEM FOUR: HIRED AUTO COVERAGE Estimated Annual Rate Per Each Cost of Hire $100 Annual _,, ,,,,,,,,,,,,,,, ,_ .,,,,. ,,,.,,,.,, ,,,,,, ,,,,,,,,,,,,,.... ,,.. _ Cost of Hire Liability .$700-Oil 1.400 $78.00 Cost of Hire means the total amount you incur for the hire of"autos"you don't own (not Including "autos" you borrow or rent from your partners or employees or their family or their family members). Cost of hire does not include charges for services performed by motor carriers of properly or passengers. To report a claim, call your Agent or 1-800-362-0000 US 71) 43 Ill 08 _. 56696377 N0180402 235 NCAFPPNO INSURED COPY 003229 PAGE 11 I)F 66 Coverage is Provided In: Policy Number: 1.4bettY Ohio Security Insurance Company BAS (19) 56 69 63 77 miIt11AIl _ _ .... .... ...__..... ...,_. - INSURANCE Policy Period: From 05/23/201 B To 05/23/2019 Business Automobile 12.01 are Standard Turre Policy Declarations at Insured Mailing Location Named Insured Agent R F' DUNC.AN & ASSOCIATES, INC (360) 352.7588 �-- �- DBA TILE GRANGER COMPANY DUNCAN & ASSOCIATES fT,4C ITEM FIVE: NON-OWNERSHIP LIABILITY COVERAGE N'ruua:cUrucu:ul.s.-1:4usva,c s k-:ling.13"is Number 11n,mi n, Other than Garage Service Number of Employees 7 $155.00 Operations and Otlrer Than Social Service Agencies To report a claim, call your Agent or 1-800-362-0000 US 70 43 01 08 U:i/I5118 56696177 N0190402 295 NCAFpNNO INSURED COPY 003229 PAGE 11 OF 66 Policy Number Issued by THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHANGES IN YOUR POLICY This endorsement applies to. CA 00 01 12 93 - Business Auto Coverage Form ®_ CA 0001 07 97 -Business Auto Coverage Form CA 00 01 1 D 01 -Business Auto Coverage Form CA 00 01 03 06- Business Auto Coverage Form CA 00 05 12 93-Garage Coverage Form CA 00 05 07 97-Garage Coverage Form CA 00 05 10 01 -Garage Coverage Form CA 0005 03 06 -Garage Coverage Form CA 00 12 12 93 -Truckers Coverage Form _ CA 00 1207 97-Truckers Coverage Form CA 00 12 10 01 -Truckers Coverage Form CA 00 12 03 06-Truckers Coverage Form CA DO 20 12 93- Motor Carrier Coverage Form CA DO 20 07 97- Motor Carrier Coverage Form CA 00 20 10 01 -Motor Carrier Coverage Form CA 00 20 03 06-Motor Carrier Coverage Form This endorsement modifies the endorsements attached to the above coverage forms. 1 Any reference to Covered Autos Liability Coverage is changed to Liability Coverage, 2. Any reference in Physical Damage Coverage to 'loss" to any one covered "auto" is changed to "loss" in any one "accident." 3. Any reference to Auto Dealers Coverage Form is changed to Garage Coverage Form. 4. Any reference to Motor Carriers Coverage Form also applies to Truckers Coverage Form. AC 00 31 01 14 © 2013 Liberty Mutual Insurance. All rights reserved Page 1 of 1 COMMERCIAL AUTO AC 01 15 08 17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, WASHINGTON CHANGES For a covered "auto" licensed or principally garaged in, or for ''garage operations" conducted in, Washing- ton, this endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGEFORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. Changes In Liability Coverage The Employee Indemnification And Employer's Liability Exclusion applies only to "bodily injury" to any "employee" of the insured whose employment is not subject to the Industrial Insurance Act of Wash- ington (Washington Revised Code Title 51). With respect to "bodily injury" to "employees" of the insured whose employment is subject to the Industrial Insurance Act of Washington, the Employee Indemnification And Employer's Liability Exclu- sion Is replaced with the following: This insurance does not apply to "bodily injury" to: a. An "employee" of the insured arising out of and in the course of. (1) Employment by the "insured", or (2) Performing duties related to the conduct of the "insured's" business, or b. Any obligation to share damages with or repay someone else who must pay damages because of the injury. This exclusion does not apply to "bodily injury" to domestic "employees" not, entitled to workers' compensation benefits or to liability assumed by the insured under an "'insured contract". A domestic "employee" is a person engaged in household or domestic work performed principally in connection with a residence premises. B. Changes In Physical Damage Coverage 1. The lead-in to Paragraph 8.1, is replaced by the following: We will not pay for "loss" caused directly or indirectly by any of the following: 2. The Limit of Insurance Provision with respect to repair or replacement resulting in better than like kind or quality is replaced by the following, and supersedes any provision to the contrary:. We may deduct for betterment for parts normally subject to repair and replacement during the useful life of the "auto". In this event, deductions shall be limited to the lesser of: a. An amount equal to the proportion that the expired life of the part to be repaired or replaced bears to the normal useful life of that part; or b. The amount which the resale value of the "auto" is increased from the repair or replacement. 3. The following is added to Paragraph C. Limit Of Insurance: We will not pay for a loss which is paid under Underinsured Motorists Coverage. AC 01 15 08 17 © 2017 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 1 of 2 C. Changes In Garagekeepers Coverage If Garagekeepers Coverage in the Garage Coverage Form is selected or if the Garagekeepers Coverage endorsement or the Garagekeepers Coverage -Customers Sound Receiving Equipment enidorsement Is attached, Ellen Exclusion 3. is replaced by the following. We will not pay for "loss" arising directly or indirectly out of the following. a, War, including undeclared or civil war; b. Warlike action by a military farce, 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 c. Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. ® D. Changes In Conditions 1. The Appraisal For Physical Damage Loss Condition is replaced by the following: APPRAISAL FOR PHYSICAL DAMAGE LOSS If you and we disagree on the amount of "loss", either may demand an appraisal of the "loss". In this event, each party will select a competent appraiser. The two appraisers will select a competent and Impartial umpire, The appraisers will state separately the actual cash value 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. Neither we nor you shall be held to have waived any rights by any act relating to appraisal, 2. The Transfer Of Rights Of Recovery Against Others To Us Condition is replaced by the following. Transfer Of Rights Of Recovery Against Others To Us a. If any person or organization to or for whom we make payment under this Coverage Form has rights to recover damages from another, those rights are transferred to us for that payment. That person or organization must do everything necessary to secure our rights and must do nothing after "accident" or "loss" to Impair them. b. We will include your deductible, if any, in our subrogation demands, Any recoveries will be allocated first to you for any deductible(s) incurred in the loss, less applicable comparable fault, Deductions for expenses will not be made from the deductible recovery unless an outside attorney is retained to collect the recovery, The deduction will then be made only as a pro rate share of the allocated loss adjustment expense. 3. The following is added to the Legal Action Against Us Condition: If this action is brought pursuant to Sec. 3 of RCW 48.30 then 20 days prior to filing such an action, you are required to provide written notice of the basis for the cause of action to us and the Office of the Insurance Commissioner. Such notice may be sent by regular mail, registered mail, or certified mail with return receipt requested. Q 2017Liberty Mutual Insurance AC 01 15 08 17 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 2 of 2 Policy Number Issued by THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. State Application Of Terrorism Exclusion Endorsements Involving Nuclear, Biological Or Chemical Terrorism This endorsement modifies insurance provided under the fallowing, BUSINESS AUTO COVERAGEFORM MOTOR CARRIER COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM If part of your policy, the below described Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism Endorsements shall apply as follows, Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism -CA 23 85 01 06 This endorsement applies in all states except Alaska, Connecticut, Florida, Georgia, Hawaii, Kansas, Kentucky, Massachusetts, New Jersey, New York, Oklahoma, Oregon, Virginia and Washington. Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism Above Minimum Statutory Limits -CA 23 87 01 06 This endorsement applies only in Connecticut, Hawaii, Kansas, Kentucky, Massachusetts, New Jersey, Oklahoma and Oregon. Alaska Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism Above Minimum Statu- tory Limits -CA 23 89 01 06 This endorsement applies only in Alaska. Washington Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism -CA 23 93 01 06 This endorsement applies only in the state of Washington. AC 84 59 06 14 © 2014 Liberty Mutual Group of Companies.All rights reserved. Page 1 of 1 CA 00 01 03 06 BUSINESS AUTO COVERAGE FORM Various provisions in this policy restrict coverage. SECTION I - COVERED AUTOS Read the entire policy carefully to determine rights, duties and what is and is not covered ITEM TWO of the Declarations shows the "autos" pltrou hou[ this that are covered "autos" for each of your cov- 9 policy the words "you" and erages The following numerical symbols de- your" refer to the Named Insured shown in the scribe the "autos" that may be covered "autos".Declarations. The words "we", "us" and "our" refer to the Company providing this insurance. The symbols entered next to a coverage on the Declarations designate the only "'autos' that are Other words and phrases that appear In quotation covered "autos", marks have special meaning, Refer to Section V - A. Description Of Covered Auto Designation Defiinitons, Symbols Symbol Descr.... l>tra,r Of Covered Auto Desinahorti smbo{s 1 Ainy,_Auto" 2 Owned Only those "autos" you own (and for Liability Coverage any "trailers" _. "Autos" you don't own while attached to power units you awn,) This includes y-ouacaLi:re ownership of after glte ogllcy bec aas, 3� Owned Only the private passenger "autos" you awn. This includes those private Private passenger "autos" you aceuire ownership of after the policy begins, Passenger 4 Owned Only those "autos" you own that are not of the private passenger type "Autos" Other (and for Liability Coverage any "trailers" you don't own while attached Than Private to power units you own), This includes those "autos" not of the Passenger private passenger type you acquire ownership of after the policy begins. "Autos" Only 5 Owned Only those autos" you own that are required to have No-Fault benefits "Autos" in the state where they are licensed or principally garaged, This Subject includes those "autos" you acquire ownership of after the policy begins To No-Fault provided they are required to have No-Fault benefits in the state where they � ......._ are licgn5ed r3r_,prilgeally garaged,._, 6 Owned Only those "autos" you own that because of the law in the state where "Autos" they are licensed or principally garaged are required to have and Subject cannot reject Uninsured Motorists Coverage. This includes those To A "autos" you acquire ownership of after the policy begins provided Compulsory they are subject to the same stale uninsured motorists requirement, Uninsured Motorists Law 7 Specifically Only those "autos" described in Item Three of Declarations for which Described a premium charge is shown (and for Liability Coverage any "trailers" "Autos" You don't own while attached to any cower unit described in Item Three) 8 Hired Autos" Only those autos" you lease hire, rent or borrow. This does not include Only any "auto" you lease, hire, rent, or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households. CA 00 01 03 06 ©ISO Properties, Inc., 2005 Page 1 of 13 .. SvrnVig�,..._._ - f)oscrintiora Of Covgrod Auto CaesigfiA ogn_Syirrl7a}I�y. 9 Non-Owned Only those "autos" you do not own, lease, hire, rent or borrow that "Autos" are used in connection with your business. This includes "autos" owned Only by your "employees", partners (if you are a partnership), members (if you are a limited liability company), or members of their households but only wllViC USef{' i17_.Y2-ur bu Line&'.',_,—(1r 1LA__)P 7 sC)nal 2Lfai9'S. _ 19 Mobile Equip- Only those "autos" that are land vehicles and that would quality under the inert Subject definition of "mobile equipment" under this policy if they were not To COmpul- subject to a compulsory or financial responsibility law or other sory Or motor vehicle insurance law where they are licensed or principally garaged. Financial Responsibility Or Other Motor Vehicle Insurance _- Law Ohl:y_ B. Owned Autos You Acquire After The Policy d. Loss"', or Begins e. Destruction 1. If symbols 1, 2, 3, 4, 5, 6 or 19 are SECTION II - LIABILITY COVERAGE entered next to a coverage in ITEM TWO of the Declarations, then you have cov- A. Coverage erage for "autos" that you acquire of the We will pay all sums an "insured" legally type described for the remainder of the must pay as damages because of "bodily policy period. injury" or "property damage" to which this 2. But, if symbol 7 is entered next to a insurance applies, caused by an "accident" coverage in ITEM TWO of the Declara- and resulting from the ownership, mainten- tions, an "auto" you acquire will be a ante or use of a covered "auto." covered "auto" for that coverage only if We will also pay all sums an "insured" le- a. We already cover all "autos" that gally must pay as a "covered pollution cost you own for that coverage or it re- or expense" to which this insurance applies, places an "auto" you previously caused by an "accident" and resulting from owned that had that coverage; and the ownership, maintenance or use of cov- ered "autos," However, we will only pay for b. You tell us within 30 days after you the "covered pollution cost or expense" if acquire it that you want us to cover there is either "bodily injury"' or "property it for that coverage. damage" to which this insurance applies that C. Certain Trailers, Mobile Equipment And Tenn- is caused by the same "accident." porary Substitute Autos We have the right and duty to defend any If Liability Coverage is provided by this Cov- "insured" against a "sulf' asking for such erage Form, the following types of vehicles damages or a "covered pollution Cost or ex- are also covered "autos" for Liability Cov- pense",. However, we have tin only to defend erage', any 'insured" against a "suit" seeking dam- e. "Trailers" with a load capacity of 2,000 ages for "bodily injury" or "property dam- age or a 'Covered pollution cost or pounds or less designed primarily for travel on public roads. expense`" to which this insurance does not apply. We may investigate and settle any 2. "Mobile equipment" while being carried claim or Suit" as we consider appropriate.. or towed by a covered "auto." Our duty to defend Or settle ends when the 3. Any "auto"' you do riot own while used Lirabilay Coverage Limit Of Insurance has with the permission of its owner as a been exhausted by payment of judgments or temporary substitute fua a covered settlements, "auto" you own that. is out, of service 1. Who Is An Insured because of Its: a. Breakdown; The following are "insureds": b. Repair, a. You for any covered "auto," c. Servicing; b• Anyone else while using with your permission a covered "auto" you own, hire or borrow except, CA 00 01 03 06 ©ISO Properties, Inc., 2005 Page 2 of 13 (1) The owner or anyone else from (6) All interest on the full amount of whom you hire or borrow a cov- any judgment that accrues after ered "auto". This exception does entry of the judgment in any not apply if the covered "auto" "suit" against the "insured" we is a "trailer" connected to a cov- defend, but our duty to pay in- ered "auto" you own. terest ends when we have paid, (2) Your "employee" If the covered offered to pay or deposited in "auto' is owned by that "em- court the part of the judgment ployee'' or a member of his or that is within our Limit of Insur- her household. ance. (3) Someone using a covered These payments will not reduce the "auto" while he or she is work- Limit of Insurance. ing in a business of selling, ser- b. Out of State Coverage Extensions. vicing, repairing, parking or storing "autos" unless that busi- While a covered "auto" is away from ness is yours, the state where it is licensed we will, ' (4) Anyone other than your "em- (1) Increase the Limit of Insurance ployees", partners (If you are a for Liability Coverage to meet partnership), members (if you the limits specified by a compul- are a limited liability company), sory or financial responsibility or a lessee or borrower or any of law of the jurisdiction where the their "employees", while moving covered "auto" is being used, property to or from a covered This extension does not apply to "auto". the limit or limits specified by (5) A partner (if you are a partner- any law governing motor carriers ship), or a member (if you are a of passengers or property. limited liability company), for a (2) Provide the minimum amounts covered "auto" owned by him or and types of other coverages, her or a member of his or her such as no-fault, required of out- household. of-stale vehicles by the jurisdic- c. Anyone liable for the conduct of an tion where the covered "auto" is "insured" described above but only being used. to the extent of that liability, We will not pay anyone more than 2. Coverage Extensions once for the same elements of loss because of these extensions. a. Supplementary Payments. B. Exclusions We will pay for the "insured This insurance does not apply to any of the (1) All expenses we incur. following (2) Up to $2,000 for cost of bail 1. Expected Or Intended Injury bonds (including bonds for re- lated traffic law violations) re- "Bodily injury" or "property damage" ex- quired because of an "accident" pected or intended from the standpoint we cover. We do not have to of the "insured", furnish these bonds. 2. Contractual (3) The cost of bonds to release at- Liability assumed under any contract or tachments in any "suit" against agreement. the "insured" we defend, but only for bond amounts within But this exclusion does not apply to H- our Limit of Insurance, ability for damages: (4) All reasonable expenses incurred a. Assumed in a contract or agreement by the "insured" at our request, that is the n 'insured contract" pro- including actual loss of earnings "bodilyvide injury" or "prop- erty damage" occurs subsequent to - - - - time—off—from—work.. - the execution of the contract or agreement; or (5) All costs taxed against the "in- sured" In any "suit" against the "Insured" we defend. CA 00 01 03 06 ©ISO Properties, Inc., 2005 Page 3 of 13 b. That the "insured" would have in the 6. Care, Custody Or Control absence of the contract or agree- "property damage" to or "covered agree- ment, pollution cost or expense" involving 3. Workers' Compensation property owned or transported by the Any obligation for which the "insured" "insured" or in the "insured's" care, cus- or the "insured's" insurer may be held tody or control. But this exclusion does liable under any workers' compensation, not apply to liability assumed under a disability benefits or unemployment com- sidetrack agreement. pensation law or any similar law. 7. Handling Of Property 4. Employee Indemnification And Employ. "Bodily injury" or "property damage" re- er's Liability sulting from the handling of property. "Bodily injury" to: a. Before it is moved from the place a. An "employee" of the "insured" where it is accepted by the "insured" arising out of and in the course of: for movement into or onto the cov- (1) EmplOyement by the "Insured", ered "auto"; or or b. After it is moved from the covered "auto" to the place where it is finally (2) Performing the duties related to delivered by the "insured". the conduct of the "insured's" business. or 8. Movement Of Property By Mechanical Device b. The spouse, child, parent, brother or "Bodily injury" or "property damage" re- sister of that "employee" a con- sulting from the movement of property sequence of Paragraph a. above by a mechanical device (other than a This exclusion applies: hand truck) unless the device is attached (1) Whether the "insured" may be to the covered "auto". liable as an employer or in any 9. Operations other capacity', and "Bodilyinu j rY' or "property damage" (2) To any obligation to share dam- arising out of the operation of: ages with or repay someone else a. Any equipment listed in Paragraphs who must pay damages because 6.b. and li of the definition of "mo- of the injury, bile equipment", or But this exclusion does not apply to b. Machinery or equipment that is on, "bodily injury" to domestic "employees" attached to, or part of, a land vehicle not entitled to workers' compensation that would qualify under the defini. benefits or to liability assumed by the lion of "mobile equipment" if it were "insured" under an "insured contract", not subject to a compulsory or firi For the purposes of the Coverage Form, cial responsibility law or other motor a domestic "employee" is a person en. vehicle insurance law where it is li- gaged in household or domestic work tensed or principally garaged, performed principally in connection with a residence premises. 10. Completed Operations S. Fellow Employee "Bodily injury" or "property damage" arising out of your work after that work "Bodily injury" to any fellow "employee" has been completed or abandoned, of the "insured" arising out of and in the course of the fellow "employee's" em- In this exclusion, your work means: ployment or while performing duties re- a. Work or operations performed by lated to the conduct of your business, you or on your behalf; and b. Materials, parts Or equipment fur- nished in connection with such work or operations. CA 00 01 03 06 ©ISO Properties, Inc., 2005 Page 4 of 13 Your work includes warranties or repre- Paragraph a. above does not apply to sentations made at any time with respect fuels, lubricants, fluids, exhaust gas. to the fitness, quality, durability or per- es or other similar "pollutants" that formance of any of the items included in are needed for or result from the Paragraphs a. or b. above. normal electrical, hydraulic or me. Your work will be deemed completed at chanical functioning of the covered the earliest of the following times: "auto" or its parts, if: (1) When all of the work called for In (1) The "pollutants" escape, seep, your contract has been completed migrate, or are discharged, dis- (2) When all of the work to be done at persed or released directly from the site has been completed if your an "auto" part designed by its contract calls for work at more than manufacturer to hold, store, re- one site. ceive or dispose of such "pollu- tants'`, and (3) When that part of the work done at a (2) The "bodily injury", "property job site has been put to its intended damage" or "covered use by any person or organization g pollution other than another contractor or sub- cost or expense" does not arise contractor working on the same pro- out of the operation of any ject, equipment listed in Paragraphs 6.b. and 6.c. of the definition of Work that may need service, main- "mobile equipment tenance, correction, repair or Paragraphs b. and c. above of this exclu- ® replacement, but which is otherwise sion do not apply to "accidents" that complete, will be treated as complet- ed. occur away from premises awned by or rented to an "insured" with respect to 11, Pollution "pollutants" not in or upon a covered "Bodily injury" or "property damage" "auto" if: arising out of the actual, alleged or (1) The "pollutants" or any property threatened discharge, dispersal, seepage, in which the "pollutants" are migration, release or escape of "pollu- contained are upset, overturned tarts" or damaged as a result of the a. That are, or that are contained in any maintenance or use of a covered property that Is: "auto", and (1) Being transported or towed by, (2) The discharge, dispersal, seep- handled, or handled for move- age, migration, release or escape ment into, onto or from, the cov- of the "pollutants" is caused di- ered "auto", rectly by such upset, overturn or (2) Otherwise in the course of damage. transit by or on behalf of the 12. War "insured"', or "Bodily injury" or "property damage" (3) Being stored, disposed of, treat arising directly or indirectly out of: ed or processed in or upon the a. War, including undeclared or civil covered "auto", war; b,. Before the "pollutants" or any prop- b. Warlike action by a military farce, erty in which the "pollutants" are including action in hindering or de- contained are moved from the place fending against an actual or expect- where they are accepted by the "in_ ed attack, by any government, sured" for movement into or onto sovereign or other authority using the covered "auto", or military personnel or other agents, c. After the "pollutants" or any prop- or erty in which the "pollutants" are c. Insurrection, rebellion, revolution, contained are moved from the cov- usurped power, or action taken by Bred_"auto" to- the—place_where they governmental authority in hindering are finally delivered, disposed of or or defending against any of these. abandoned by the "insured CA 00 01 03 06 IDISO Properties, Inc., 2005 Page 5 of 13 13. Racing 2. Towing. Covered "autos" while used in any pro- We will pay up to the limit shown in the fessienal or organized racing or demoli- Declarations for towing and labor costs tion contest or stunting activity, or while incurred each time a covered "auto" of practicing for such contest or activity, the private passenger type is disabled, This insurance also toes not apply while However, the labor must be performed at that covered "auto" is being prepared for the place of disablement, such a contest or activity. 3. Glass Breakage - Hitting a Bird or Ani- C. Limit Of Insurance mal - Falling Objects or Missiles. Regardless of the number of covered If you carry Comprehensive Coverage for "autos", "Insureds", premiums paid, claims the damaged covered "auto", we will made or vehicles involved in the "accident", pay for the following under Comprehen- the most we will pay for the total of all sive Coverage: damages and "covered pollution cost or ex- a. Glass breakage, pense'' combined, resulting from any one "accident" is the Limit of Insurance for Liabil- b. "Loss" caused by hitting a bird or ity Coverage shown in the Declarations, animal; and All "bodilyinjury," p y damage" and c. "Loss" caused by falling objects or "property 'covered pollution cost or expense" resulting missiles. from continuous or repeated exposure to However, you have the option of having substantially the saine conditions will be con- glass breakage caused by a covered sidered as resulting from one "accident .1auto's" collision or overturn considered No one will be entitled to receive duplicate a "loss" under Collision Coverage, payments for the same elements of "loss" 4, Coverage Extensions under this Coverage Farm and any Medical Payments Coverage Endorsement, Uninsured a. Transporation Expenses Motorists Coverage Endorsement or Underin- We will pay up to $20 per day to a sured Motorists Coverage Endorsement at- maximum of $600 for temporary tached to this Coverage Part. transportation expense incurred by SECTION III - PHYSICAL DAMAGE COVERAGE you because of the total theft of a covered "auto" of the private pas- A. Coverage senger type. We will pay only for I. We will pay for "loss•" to a covered those covered "autos" for which you "auto" or its equipment under: carry either Comprehensive or Spad- a. Comprehensive Coverage. From any fled Causes of Loss Coverage, We Will pay for temporary transportation cause except: expenses incurred during the period (1) The covered "auto's" collision beginning 48 hours after the theft with another object; or and ending, regardless of the poll- (2) The covered "auto's" overturn. cys expiration, when the covered "auto' is returned to use or we pay It, Specified Causes of Loss Coverage. for its "loss". Caused by: It. Loss Of Use Expenses (1) Fire, lightning or explosion, For Hired Auto Physical Damage, we (2) Theft, will pay expenses for which an "in. sured" becomes legally responsible (3) Windstorm, hail or earthquake; to pay for loss of use of a vehicle (4) Flood; rented or hired without a driver, un- (5) Mischief or vandalism; or der a written rental contract or agreement. We will pay for loss of (6) The sinking, burning, collision or use expenses if caused by: derailment of any conveyance transporting the covered "auto", (1) Other than collision only if the Declarations indicate that Com- c. Collision Coverage. Caused by. prehensive Coverage is provided (1) The covered "autos" collision for any covered "auto', with another object, or (2) The covered "auto'e overturn. CA 00 01 03 06 ©ISO Properties, Inc., 2005 Page 6 of 13 (2) Specified Causes Of Loss only if 3. We will not pay for "loss" caused by or the Declarations indicate that resu9ting from any of the following un- Specified Causes Of Loss Cov- less caused by other "loss" that is cov- erage is provided for any cov- eyed by this insurance: ered "auto, or (3) Collision only if the Declarations a. Wear and tear, freezing, indicate that Collision Coverage mechanical or electrical break- is provided for any covered down. "auto b. Blowouts, punctures or other However, the most we will pay for road damage to tires, any expenses for loss of use is $20 4. We will not pay for "loss" to any of the ®_ per day, to a maximum of $boo. following. B. Exclusions a. Tapes, records, discs or other similar 1. We will not pay for "loss" caused by or audio, visual or data electronic de- resulting from any of the following. Such vices designed for use with audio, _ "loss" Is excluded regardless of any oth- visual or data electronic equipment. er cause or event that contributes con- It. Any device designed or used to de- currently or in any sequence to the lect speed measuring equipment "loss such as radar or laser detectors and a. Nuclear Hazard. any jamming apparatus intended to elude or disrupt speed measurement (1) The explosion of any weapon equipment. employing atomic fission or fu- sion; c. Any electronic equipment, without or regard to whether this equipment is (2) Nuclear reaction or radiation, or permanently Installed, that receives radioactive contamination, how- or transmits audio, visual or data ever caused signals and that Is not designed sole- b. War or Military Action, ly for the reproduction of sound. (1) War, including undeclared or civ- d. Any accessories used with the elec- il war, tronlc equipment described In (2) Warlike action by a military Paragraph c. above. force, Including action in hinder- Exclusions 4.c. and 4.d. do not apply to, ing or defending against an ac- a. Equipment designed solely for the tual or expected attack, by any reproduction of sound and accesso- government, sovereign or other ries used with such equipment, pro- authority using military person- vided such equipment is nel or other agents, or permanently installed in the covered (3) Insurrection, rebellion, revolu- "auto" at the time of the "loss" or tion, usurped power or action such equipment Is removable from a taken by governmental authority housing unit which is permanently in hindering or defending against installed in the covered "auto" at the any of these time of the "loss", and such equip- 2. We will not pay for "loss" to any cov- ment is designed to be solely op- ered "auto" while used in any profes- erated by use of the power from the sional or organized racing or demolition the covered ered "auto or electrical system, in or upon contest or stunting activity, or while the c practicing for such contest or activity. We It. Any other electronic equipment that will also not pay for "loss" to any cov- is: ered "auto" while that covered "auto" is (1) Necessary for the normal opera- being prepared for such a contest or ac- tion of the covered "auto" or the tivity. monitoring of the covered "auto's" operating system, or CA 00 01 03 06 ©ISO Properties, Inc., 2005 Page 7 of 13 (2) An integral part of the same unit a. Pay its chosen appraiser. and housing any sound reproducing equipment described in a above b. Bear the other expenses of the ap- . and permanently installed in the praisal and umpire equally. opening of the dash or console If we submit to an appraisal, we will still of the covered "auto" normally retain our right to deny the claim, used by the manufacturer for in- 2, Duties In The Event Of Accident, Claim, stallation of a radio, Suit Or Loss 5. We will not pay for "loss" to a covered NJe have no duty to provide coverage "auto" due to "diminution in value". under this policy unless there has been C. Limit Of Insurance full compliance with the following duties: 1. The most we will pay for "loss" in any a. In the event of "accident", claim, one "accident" is the lesser of: "suit" or "loss", you must give us or our authorized representative prompt a. The actual cash value of the damag- notice of the "accident" or "loss" ed or stolen property as of the time Include: of the "loss", or (1) How, when and where the "ac- b. The cost of repairing or replacing the cident" or "loss" occurred, damaged or stolen property with oth- er property of like kind and quality. (2) The "insured's" name and ad- 2. An adjustment for depreciation and phys- dress', and ical condition will be made in (3) To the extent possible, the determining actual cash value in the names and addresses of any in- event of a total "loss". jured persons and witnesses. 3. If a repair or replacement results in bet- b. Additionally, you and any other in- ter than like kind or quality, we will not volved "insured" must: pay for the amount of the betterment. (1) Assume no obligation, make no D. Deductible payment or incur no expense For each covered "auto', our obligation to without our consent, except at pay for, repair, return or replace damaged or the "Insureds" own cost. stolen property will be reduced by the ap (2) Immediately send us copies of pticable deductible shown in the Deo9ara- any request, demand, order, no- tions. Any Comprehensive Coverage lice, summons or legal paper re- deductible shown in the Declarations does ceived concerning the claim or not apply to "loss" caused by fire or light- "suit". ning. (3) Cooperate with us in the inves- SECTION IV - BUSINESS AUTO CONDITIONS tigation or settlement of the The following conditions apply in addition to the claim or defense against the Common Policy Conditions: "Suit A. Loss Conditions (4) Authorize us to obtain medical records or other pertinent infor- 1. Appraisal For Physical Damage Loss oration. If you and we disagree on the amount of (5) Submit to examination, at our "loss", either may demand an appraisal expense, by physicians of our of the "loss", In this event, each party choice, as often as we reason- will select a competent appraiser. The ably require. two appraisers will select a competent and impartial umpire. The appraisers will c. If there is "loss" to a covered "auto"state separately floe actual cast) value or its equipment you must also do and amount of "loss". If they fall to the following: agree, they will submit their differences (1) Promptly notify the police If the to the umpire. A decision agreed to by covered "auto" or any of its any two will be binding. Each party will equipment is stolen. CA 00 01 03 06 ©ISO Properties, Inc., 2005 Page 8 of 13 (2) Take all reasonable steps to pro- 5. Transfer Of Rights Of Recovery Against tect the covered "auto" from fur- Others To Us ther damage. Also keep a record of your expenses for consider- If any person or organization to or for ation in the settlement of the whom we make payment under this Cov- claim, erage Form has rights to recover dam- ages from another, those rights are (3) Permit us to inspect the covered transferred to us. That person or organi- "autc" and records proving the zation must do everything necessary to "loss" before its repair or dis- secure our rights and must do nothing position. after "accident" or "loss" to impair ®_ (4) Agree to examinations under them. oath at our request and give us a B. General Conditions signed statement of your an- 1. Bankruptcy —_ swers. 3. Legal Action Against Us Bankruptcy or insolvency of the "in- sured" or the "insured's" estate will not No one may bring a legal action against relieve us of any obligations under this ®_ us under this Coverage Form until: Coverage Form. a. There has been full compliance with 2. Concealment, Misrepresentation Or all the terms of this Coverage Form; Fraud and This Coverage Form Is void in any case I Under Liability Coverage, we agree of fraud by you at any time as it relates ® in writing that the "insured" has an to this Coverage Form. It is also void if obligation to pay or until the amount you or any other "insured", at any time, of that obligation has finally been intentionally conceal or misrepresent a determined by judgment after trial material fact concerning: No one has the right under this poli- cy to bring us into an action to deter- a. This Coverage Form, mine the "insured's" liability. b. The covered "auto"; 4. Loss Payment - Physical Damage c. Your interest in the covered "auto Coverages or At our option we may: d. A claim under this Coverage Form, a. Pay for, repair or replace damaged 3. Liberalization or stolen property; If we revise this Coverage Form to pro- b. Return the stolen property, at our ex- vide more coverage without additional pense. We will pay for any damage premium charge, your policy will auto- that results to the "auto" from the matically provide the additional coverage theft, or as of the day the revision is effective in c. Take all or any part of the damaged your state. or stolen property at an agreed or 4. No Benefit To Bailee - Physical Damage appraised value. Coverages If we pay for the "loss", our payment We will not recognize any assignment or will include the applicable sales tax for grant any coverage for the benefit of any the damaged or stolen property, person or organization holding, storing or transporting property for a fee regard- less of any other provision of this Cov- erage Form. CA 00 01 03 06 ©ISO Properties, Inc., 2005 Page 9 of 13 5. Other Insurance b. If this policy is issued for more than a. For any covered "auto" you own, one year, the premium for this Cov- this Coverage Form provides primary erage Form will be computed annu- insurance. For any covered "auto" ally based on our rates or premiums you don't own, the insurance pro- in effect at the beginning of each vided by this Coverage Form is ex- year of the policy, cess over any other collectible 7. Policy Period, Coverage Territory insurance. However, while a covered'auto" which is a "trailer" is con- Under this Coverage Form, we cover "ac- netted to another vehicle, the Liabil- cidents'' and "losses" occurring: ity Coverage this Coverage Form a. During the policy period shown in provides for the "trailer" is: the Declarations, and (1) Excess while it is connected to a b. Within the coverage territory, motor vehicle you do not own. The coverage territory is: (2) Primary while it is connected to a. The United States of America, a covered "auto" you own, b. The territories and possessions of I For Hired Auto Physical Damage the United States of America, Coverage, any covered "auto" you C. Puerto Rico; lease, hire, rent or borrow is deemed to be a covered "auto" you own. d. Canada; and However, any "auto" that is leased, e. Anywhere in the world if: hired, rented or borrowed with a driver is not a covered "auto (1) A covered "auto" of the private c. Regardless of the provisions of Para- passenger type is leased, hired, graph a. above, this Coverage Form's rented or borrowed without a Liability Coverage is primary for any driver for a period of 30 days or liability assumed under an "insured less, and contract". (2) The "insured's" responsibility to d. When this Coverage Form and any pay damages is determined in a Unit- other Coverage Form or policy cov- ers on the same basis, either excess ed States of America, the ter. possessions of the or primary, we will pay only our ritories and p share. Our share is the proportion United States of America, Puerto that the Limit of Insurance of our Rico, or Canada or in a settle- Coverage Form bears to the total of ment we agree to. the limits of all the Coverage Forms We also cover "loss" to, or "accidents" and policies covering on the same involving, a covered "auto" while being basis. transported between any of these places. G. Premium Audit 8. Two Or More Coverage Forms Or Poli- a. The estimated premium for this Cov- ties Issued By Us erage Form is based on the expo- If this Coverage Form and any other Cov- sures you told us you would have erage Form or policy issued to you by us when this policy began. We will or any company affiliated with us apply compute the final premium due to the same "accident"', the aggregate when we determine your actual ex- maximum Limit of Insurance under all. pOSnre S. The estimated total premi- the Coverage Forms or policies shall not. um will be credited against the final exceed the highest applicable Limit of Premium due and the first Named insurance under any one Coverage Form Insured will be billed for the balance, or potlicy,. This condition does not apply if any, If the estimated total premium to any Coverage Form or policy issued exceeds the final premium due, the by us or all affiliated company specs . first Named Insured will get a re- caalgy to apply as excess, Insurance over fund. this Coverage Form. CA 00 01 03 06 "'ISO Properties, Inc„ 2005 Page 10 of 13 SECTION V - DEFINITIONS b. Before the "pollutants" or any prop- A. "Accident" includes continuous or repeated erty in which the "pollutants" are exposure to the same conditions resulting in contained are moved from the place "bodily injury" or "property damage". where they are accepted by the "in- B. "Auto" means', sured" for movement into or onto 1. Aland motor vehicle, "trailer" or semi- the covered "auto", or trailer designed for travel on public c. After the "pollutants" or any prop- roads, or erty in which the "pollutants" are 2. Any other land vehicle that is subject to contained are moved from the cov- a compulsory or financial responsibilityered "auto" to the place where they law or other motor vehicle Insurance law are finally delivered, disposed of or abandoned by the "insured," where it is licensed or principally ga-raged. Paragraph a, above does not apply to However, "auto" does not include "mobile fuels, lubricants, fluids, exhaust gas- ® equipment". es or other similar "pollutants" that are needed for or result from the C. "Bodily injury" means bodily injury, sickness normal electrical, hydraulic or me- or disease sustained by a person including chanical functioning of the covered death resulting from any of these. "auto" or its parts, if: D. "Covered pollution cost or expense" means (1) The "pollutants" escape, seep, - any cost or expense arising cut of: migrate, or are discharged, dis- ®_ 1. Any request, demand, order or statutory persed or released directly from or regulatory requirement that any "in- an "auto" part designed by its sured" or others test for, monitor, clean manufacturer to hold, store, re- up, remove, contain, treat, detoxify or ceive or dispose of such "pollu- neutralize, or in any way respond to, or tants"', and assess the effects of "pollutants"; or (2) The "bodily injury," "property 2. Any claim or "suit" by or on behalf of a damage" or "covered pollution governmental authority for damages be- cost or expense" does not arise cause of testing for, monitoring, cleaning out of the operation of any up, removing, containing, treating, detox- equipment listed in Paragraphs ifying or neutralizing, or in any way re- i or 6.c. of the definition of sponding to or assessing the effects of "mobile equipment." "pollutants". Paragraphs b. and c. above do not "Covered pollution cost or expense" does not apply to "accidents" that occur away include any cost or expense arising out of from premises owned by or rented the actual, alleged or threatened discharge, to an "insured" with respect to "pol- dispersal, seepage, migration, release or es- lutants" not in or upon a covered cape of "pollutants": "auto" if: a. That are, or that are contained in any (1) The "pollutants" or any property property that is: in which the "pollutants" are contained are upset, overturned (1) Being transported or towed by, or damaged as a result of the handled, or handled for move- maintenance or use of a covered ment into, onto or from the cov- "auto", and ered "auto"; (2) The discharge, dispersal, seep- (2) Otherwise in the course of age, migration, release or escape transit by or on behalf of the of the "pollutants" Is caused di- "insured"', rectly by such upset, overturn or (3) Being stored, disposed of, treat- damage. ed or processed in or upon the covered "auto or CA 00 01 03 06 ©ISO Properties, Inc., 2005 Page 11 of 13 E. "Diminution in value" means the actual or a. That indemnifies a railroad for "bod- perceived loss in market value or resale val- ily injury" or "property damage" ue which results from a direct and accidental arising out of construction or demoli- "loss tion operations, within 50 feet of any F. "Employee" includes a "leased worker", railroad property and affecting any "Employee" does not include a "temporary railroad bridge or trestle, tracks, road worker,, beds, tunnel, underpass or crossing, G. "Insured" means any person or organization or qualifying as an insured in the Who Is An b. That pertains to the loan, lease or Insured provision of the applicable coverage, rental of an "auto" to you or any of Except with respect to the Limit of Insurance, your "employees", if the "auto" is the coverage afforded applies separately to loaned, leased or rented with a driv- each insured who is seeking coverage or er; or against whom a claim or "suit" Is brought. c. That holds a person or organization H. "Insured contract" means' engaged in the business of transport- ing property by "auto" for hire harm- less for your use of a covered "auto" 2. A sidetrack agreement; over a route or territory that person 3. Any easement or license agreement, ex- or organization is authorized to serve by public authority, cent in connection with construction or demolition operations on or within 50 1• "Leased worker" means a person leased to feet of a railroad, you by a labor leasing firm under an agree- ment between you and the labor leasing firm, 4. An obligation, as required by ordinance, to perform duties related to the conduct of to indemnify a municipality, except in your business. "Leased worker" does not in- connection with work for a municipality, elude a "temporary worker". 5. That part of any other contract or agree- J. "Loss" means direct and accidental loss or ment pertaining to your business (includ- damage, ing an indemnification of a municipality in connection with work performed for a K. "Mobile equipment" means any of the fol- munlcipality) under which you assume lowing types of land vehicles, Including any the tort IiabRity of another to pay for attached machinery or equipment: "bodily Injury" or "Property dainage" to 1. Bulldozers, farm machinery, forklifts and a third person or organization. 'fort liaWl- other vehicles designed for use princi- ity means a liability that would be im- pally off public roads, posed by law in the absence of any contract or agreement. 2• Vehicles maintained for use solely on or 6. That part of any contract or agreement next to premises you own or rent; entered into, as part o1 your business, 3. Vehicles that travel on crawler treads; pertaining to the rental of lease, by you 4. Vehicles, whether self-propelled or not, or any of your "employees"„ of any maintained primarily to provide mobility "auto." However, such contract or agree- to permanently mounted: rnent shall riot be considered an "insured contract" to the extent that it obligates a, Power cranes, shovels, loaders, dig- .., you or any of your "employees" to pay gers or drills; or for "property damage" to any "auto" re- b• Road construction or resurfacing nted or leased by you or any of your equipment such as graders, scrapers "employees". or rollers. An "insured contract" does not include that part of any contract or agreement. CA 00 01 03 06 ©ISO Properties, Inc., 2005 Page 12 of 13 5. Vehicles riot described in Paragraphs J., L. "PolMants" means any solid, liquid, gaseous 2., 3., or 4u above that are not self-pro- ar thermal irritant or contaminant, including pelled and are maintained primarily to smoke, vapor, soot, fumes, acids, aikaliis, provide mobility to permanently attached chemicals and waste Waste includes materi- equipment of the following types: als to be recycled, reconditioned or re- a. Air compressors, pumps and gener- claimed. ators, including spraying, welding, M, "Property damage" means damage to or loss building cleaning, geophysical explo- of use of tangible property. ration, lighting and well servicing N. "Suit" means a civil proceeding in which: equipment; or b. Cherry pickers and similar devices 1. Damages because of "bodily injury" or used to raise or lower workers. °property damage"; or 6. Vehicles not described in Paragraphs 1., 2. A "covered pollution cost or expense", 2., 3, or 4. above maintained primarily to which this insurance applies, are alleged. for purposes other than the transporta- "Suit" includes: tion of persons or cargo. However, self- = propelled vehicles with the following a. An arbitration proceeding in which types of permanently attached equipment such damages or "covered pollution costs or expenses" are claimed and are not "mobile equipment' but will be considered "autos": to which the "insured" must submit a. Equipment designed primarily for: or does submit with our consent; or b. Any other alternative dispute resolu- (1) Snow removal, tion proceeding in which such dam- (2) Road maintenance, but not con- ages or "covered pollution costs or struction or resurfacing, or expenses" are claimed and to which (3j Street cleaning; the insured submits with our con- sent. b. Cherry pickers and similar devices mounted on automobile or truck O• "Temporary worker" means a person who is chassis and used to raise or lower furnished to you to substitute for a perma- workers; and nent "employee" on leave or to meet sea- sonal or short-term workload conditions. c. Air compressors, pumps and gener£tors, including spraying, weld- P. "Trailer" includes semitrailer. ing, building cleaning, geophysical exploration, lighting or well servicing equipment. However, "mobile equipment" does not in- clude land vehicles that are subject to a com- pulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. Land vehicles subject to a compulsory or financial respon- sibility, law or other motor vehicle insurance law are considered "autos". CA 00 01 03 06 ©ISO Properties, Inc„ 2005 Page 13 of 13 POLICY NUMBER. COMMERICAL AUTO CA 21 34 01 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WASHINGTON UNDERINSURED MOTORISTS COVERAGE For a covered "auto" licensed or principally garaged in, or for "garage operations" conducted in, Washing- ton, this endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. Named Insured Endorsement Effective: SCHEDULE "Bodily Injury" And "Property Damage": $ Each "Accident" or "Bodily Injury" $ Each "Accident" This endorsement provides "bodily injury" and "property damage" "underinsured motorists coverage" unless an "X" is entered below. ❑ If an X" is entered in this box, this endorsement provides "bodily injury" "underinsured motorists " coverage" only for the following autos. Description Of "Autos (If no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement,) A. Coverage b. Anyone else "occupying" a covered 1. We will pay all sums the "insured" is le- "auto" or a temporary substitute for gaily entitled to recover as compensatory a covered "auto". The covered damages from the owner or driver of an "auto" must be out of service be- "underinsured motor vehicle". The dam- cause of its breakdown, repair, ser- ages must result from "bodily injury" or vicing, "loss" or destruction. "property damage" sustained by the "in- c. Anyone for damages he or she is en- sured" caused by an "accident The titled to recover because of "bodily owner's or driver's liability for these injury" sustained by another "in- damages must result from the owner- sured" ship, maintenance or use of the 2, A partnership, limited liability company, "Is An Insurensured motor vehicle", corporation or any other form of organi- zation, then the following are "insureds": If the Named Insured is designated in the a. Anyone "Occupying" Declarations as: Py 9' a covered "auto" or a temporary substitute for 1. An Individual, then the following are "in- a covered "auto". The covered sureds": "auto" must be out of service be. a. The Named Insured and any "family cause of its breakdown, repair, ser- members"'. vicing, "loss" or destruction_ CA 21 34 01 08 Copyrighted ISO Properties, Inc. DISO Properties, Inc., 2007 Page 1 of 5 It, Anyone for damages he or she is en- 6. Anyone using a vehicle without a reason- titled to recover because of "bodily able belief that the person is entitled to injury" sustained by another "in- do so. sured". 7, "Bodil injury"ju ry" or "property damage" to c. The Named Insured for "property an "'insured" while operating or "occupy- damage" only, ln,g" a motorcycle or motor driver) cycle C. Exclusions which is nnt a covered "auto" for Llabildky This insurance does not apply to Coverage under this Coverage Form. _ 1. The benefit of any insurer or self-insurer 8. Punitive or exemplary damages: under any workers' compensation law or 9• "Bodily injury" or "property damage" any similar disability benefits law, arising directly or indirectly out of. 2. The benefit of any insurer of property. a. War, including undeclared or civil 3. "Bodily injury" sustained by. war; a. An individual Named Insured while In. Warlike action by a military force, in- " chiding action In hindering or de- occupying" any vehicle owned by that Named Insured or made avail- tending against an actual or expect- able for that Named Insured's regu- ed attack, by any government, lar use that is not a covered "auto" sovereign or other authority using for Liability Coverage under this Cov- military personnel or other agents, _ erage Form; or In. Any "family member" while "occu- C. Insurrection, rebellion, revolution, pying" any vehicle owned by that usurped power, or action taken by "family member" or available for governmental authority in hindering that "family member's" regular use or defending against any of these. that is not a covered "auto" for Li- D. Limit Of Insurance ability Coverage under this Coverage 1. Regardless of the number of covered Form; or "autos", "insureds", premiums paid, c. Any "family member" whi'e "occu- caims made or vehicles involved in the pying" any vehicle owned by the "accident", the most we will pay for all Named Insured or made available for damages resulting from any one ''acci- the Named Insured's regular use that dent" is the limit shown in the Schedule is insured for Liability Coverage on a or in the Declarations. primary basis under any other Cov- 2. No one will be entitled to receive dupli- erage Form or policy. cate payments for the same elements of 4. Property contained in or struck by any ve- "loss" under this Coverage Form and any hicle owned by or available for the regu- Liability Coverage Form, Medical Pay- lar use of the Named Insured or any ments Coverage endorsement or Person- "family member", if the Named Insured al Injury Protection Coverage endorse- is an individual, which is not a covered ment attached to this Coverage Part. "auto" for Liability Coverage under this We will not make a duplicate payment Coverage Form. under this Coverage for any element of 5. The first $300 of the amount of "property "loss" for which payment has been made damage" to the property of each "in- by or for anyone who is legally responsi- sured" as the result of any one "acci_ ble. dent" caused by a hit- and-run vehicle as E- Changes In Conditions described in Paragraph 5.d of the defini- The conditions are changed for Washington tion of "underinsured motor vehicle In Undernsured Motorists Coverage as follows'. all other cases, this insurance does not 1. Other Insurance in the Business Auto and apply to the first $100 of the amount of Garage Coverage Forms and Other Insur- "property damage" to the property of ante - Primary And Excess Insurance each "insured" as the result of any one Provisions in the Truckers and Motor Car- "accident". rier Coverage Forms are replaced by the following. Copyrighted ISO Properties, Inc. CA 21 34 01 08 wISO Properties, Inc., 2007 Page 2 of 5 If there is other applicable insurance 3. Legal Action Against Us is replaced by available under one or more policies or the following: provisions of coverage: a. No one may bring a legal action a. The maximum recovery under all against us under this Coverage Form coverage forms or policies combined until there has been full compliance may equal but not exceed the high- with all the terms of this Coverage est applicable limit for any one ve- Form. hicle under any coverage form or b. Any legal action against us under policy providing coverage on either a this Coverage Form must be brought primary or excess basis. within 1 year after the date on which b. Any insurance we provide with re- the course of action accrues. spect to a vehicle the Named Insured If this action is brought pursuant to See. 3 does not own shall be excess over of RCW 48.30 then 20 days prior to filing any other collectible underinsured such an action, you are required to pro- motorists insurance providing cover- vide written notice of the basis for the age on a primary basisr cause of action to us and the Office of the c. If the coverage under this coverage Insurance Commissioner. Such notice form is provided may be sent by regular mail, registered (1) On a primary basis, we will pay mail or certified mail with return receipt only our share of the loss that requested. must be paid under insurance 4. Transfer Of Rights Of Recovery Against providing coverage on a primary Others To Us is changed by adding the basis, Our share is the propor- following: tion that our limit of liability If we make any payment and the "in- bears to the total of all applica- sured" recovers from another party, the ble limits of liability for coverage "insured" shall hold the proceeds in trust on a primary basis. for us and pay us back the amount we (2) On an excess basis, we will pay have paid. We shall be entitled to recov- only our share of the loss that ery only after the "insured" has been ful- must be paid under insurance ly compensated for damages, providing coverage on a excess Our rights to riot apply under this provi- basis. Our share is the propor- sion with respect to damages caused by lion that our limit of liability bears to the total of all applica- an "accident" ,,oath an "underinsured mo- ble limits of liability for coverage for vehicle" if we: on an excess basis. a. Have been given prompt notice of 2. Duties In The Event Of Accident, Claim, tentative settlement between an "in- Suit Or Loss is changed by adding the sured" and the insurer of an following: "underinsured motor vehicle', and a. A person seeking Underinsured Mo- b. Fail to advance payment to the "in- torists Coverage must also promptly sured" in an amount equal to the ten- notify us in wring a tentative set- ,. dement between thee tative settlement within 30 days after "insured" and receipt of notification, the insurer of an "underinsured mo- If we advance payment to the "insured" for vehicle'', and allow us 30 days to in an amount equal to the tentative settle- advance payment to that "insured" ment within 30 days after receipt of no- in an amount equal to the tentative tification. settlement to preserve our rights (1) That payment will be separate from against the insurer, owner or oper- any amount the "insured" is entitled ater of such "under6nsured motor ve• to recover under the provisions of hide". However, this provision does Underinsured Motorists Coverage, not apply if failure to notify us does and not prejudice our right to recover (2) We also have a right to recover the payneent from the person legally re- advanced payment. sponsible for the "accident" Copyrighted ISO Properties, Inc. CA 21 34 01 OS ©ISO Properties, Inc., 2007 Page 3 of 5 5. The following condition is added. "Suit" includes. ARBITRATION 0) An arbitration proceeding in a. If we and an "insured" disagree which such damages or ''cov- whether the "insured" is legally en- ered pollution costs or ex- titled to recover damages from the penses" are claimed, or owner or driver of an "underinsured (2) Any other alternative dispute motor vehicle" or do not agree as to resolution proceeding in which the amount of damages that are re- such damages or "covered pol- coverable by that "insured", then the lution costs or expenses" are matter may be arbitrated. However, claimed, disputes concerning coverage under 5. "Underinsured motor vehicle" means a this endorsement may not be arbi- land motor vehicle or "trailer": trated. Both parties must agree to ar- a bitration. If so agreed, each party will . For which no liability bond or policy select an arbitrator, The two arbitra- applies at the time of an "accident" tors will select a third. If they cannot or agree within 30 days, either may re- b- For which liability bonds or policies ® quest that selection be made by a apply at the time of an "accident", judge of a court having jurisdiction, but the amount paid under the all of _ We will pay all arbitration expenses, the bonds or policies to an insured is Arbitration expenses will not Include not enough to pay the full amount an ---- the "Insured's" attorney's fees or "insured" is legally entitled to recov- any expenses incurred in producing er as damages caused by the "acci- evidence or witnesses. dent" or b. Unless both parties agree otherwise, C. For which all insuring or bonding arbitration will take place in the companies deny coverage or are or county in which the "insured" lives, becomes insolvent: or Local rules of law as to arbitration d. That is a hit-and-run vehicle and nei- procedure and evidence will apply. A ther the driver nor owner can be decision agreed to by two of the ar- identified- The vehicle must either. bitrators will be binding. j1) Hit an "Insured", a covered F. Additional Definitions "auto" or a vehicle an "insured" As used in this endorsement is "occupying", or 1. "Property damage" means injury to or (2) Cause "bodily injury" or "prop- destruction of the property of an "in- erty damage" with no physical cured". contact with the "insured" or the 2. "Family member" means a person relat- vehicle the "insured" was "occu- ed to an individual Named Insured by pying" at the time of the ''acci- blood, marriage or adoption who is a dent" provided: resident of such Named Insured's house- (a) The facts of the "accident" hold, including a ward or foster child can be corroborated by com- 3. "Occupying" means in, upon, getting in, petent evidence other than on, out or off, the testimony of any person having an underinsured mo- o. "Suit" means a civil proceeding in torists coverage claim as a which, result of such "accident", a. Damages because of "bodily injury" and or "property damage or (b) Someone reports the "acci- b. A "covered pollution cost or ex- dent" to the police within 72 pense" to which this insurance ap- hours of the "accident". plies, are alleged. Copyrighted ISO Properties, Inc. CA 21 34 01 08 ©ISO Properties, Inc., 2007 Page 4 of 5 However, "underinsured motor vehicle" b. Owned by a governmental unit or does not include any vehicle; agency. This provision does not ap- a. For which the Liability Coverage of ply if the governmental unit or agen- this Coverage Form applies. For cy is unable to pay damages because which the Liability Coverage of this of financial Inability or insolvency. Coverage Form applies. However, if 6. Whenever the terms "uninsured motor- the Named Insured is an individual ists coverage" or "uninsured motor ve- and that Named Insured or any "fam- hicle" appear in the Coverage Form or ily member" sustain damages while any endorsements attached to the Cov- "occupying", or when struck by, an erage Form, they are replaced by the "auto" which is a covered "auto" for terms "underinsured motorists cover- Liability Coverage under this Cover- age" and "underinsured motor vehicle" age Form, this exception to this defi- for covered "autos" licensed in or ''ga- nition of an "underinsured motor ve- rage operations" conducted in Washing- hicle" does not apply to that Named ton. Insured or any such "family mem- ber". Copyrighted ISO Properties, Inc, CA 21 34 01 06 'ISO Properties, Inc., 2007 Page 5 of 5 COMMERCIAL AUTO CA 23 45 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PUBLIC OR LIVERY PASSENGER CONVEYANCE AND ON-DEMAND DELIVERY SERVICES EXCLUSION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply ® unless modified by the endorsement. A. Changes In Covered Autos Liability Cov- to provide "delivery services", whether erage or not the goods, items or products to The following exclusion is added: be delivered are in the covered "auto" ® Public Or Livery Passenger Conveyance C. Changes In Auto Medical Payments And On-demand Delivery Services If Auto Medical Payments Coverage is at- This insurance does not apply to any cov- tached, then the following exclusion is ered "auto" while being used, added: 1. As a public or livery conveyance for Public Or Livery Passenger Conveyance and passengers, This includes, but is not On-demand Delivery Services limited to, any period of time a covered This insurance does not apply to. "auto" is being used by an "insured" "Bodily jury" sustained by an "insured" o � in who is logged into a "transportation "occupying" a covered "auto" while it is network platform" as a driver, whether being used. or not a passenger is "occupying" the covered "auto", or 1. As a public or livery conveyance for passengers. This includes, but is not 2. By an "insured" who is logged into a limited to, any period of time a covered "transportation network platform" or "auto" is being used by an "insured" "delivery network platform" as a driver who is logged into a "transportation to provide "delivery services", whether network platform" as a driver, whether or not the goods, items or products to or not a passenger is "occupying" the be delivered are in the covered "auto covered "auto" or B. Changes In Physical Damage Coverage 2, By an "insured" who is logged into a The following exclusion is added. "transportation network platform" or We will not pay for "loss" to any covered "delivery network platform" as a driver "autos" while being used: to provide "delivery services", whether or not the goods, items or products to 1. As a public or livery conveyance for be delivered are in the covered "auto". passengers. This includes, but is not limited to, any period of time a covered D. Changes In Uninsured And/Or Underinsured "auto" is being used by an "insured" Motorists Coverage who is logged into a "transportation 1. If Uninsured and/or Underinsured Mo- network platform" as a driver, whether torists Coverage is attached, and. or not a passenger Is "occupying" the a. Contains, in whole or in part, a covered "auto"; or public or livery exclusion, then the 2. By an "insured" who is logged into a following exclusion in Paragraph 2. "transportation network platform" or does not apply, "delivery network platform" as a driver CA 23 45 11 16 0 Insurance Services Office, Inc., 2016 Page 1 of 2 b. Does not contain a public or livery not limited to, any period of time a exclusion, then the following exclu- covered "auto" is being used by an sion in Paragraph 2, is added. "insured" who is logged into a 2. Public Or Livery Passenger Conveyance "transportation network platform" And On- demand Delivery Services as a driver, whether or not a pas- This insurance does not apply to any senger is "occupying" the covered covered "auto" while being used: "auto"; or a. Asa public or livery conveyance for b. By an "insured" who is logged into "transportation network platform" passengers. This includes, but is or "delivery network platform" as a not limited to, any period of time a driver to provide "delivery ser- covered "auto" is being used by an vices", whether or not :he goods, "insured" who is logged into a itemss or products to be delivered "transportation network platform" are the covered "auto" as a driver, whether or not a pas- senger is "occupying" the covered F. Additional Definitions "auto", or As used in this endorsement: b. By an "insured" who is logged into 1. "Delivery network platform" means an a "transportation network platform" online- enabled application or digital or "delivery network platform" as a network, used to connect customers. driver to provide "delivery set- a. With drivers, or vices", whether or not the goods, items or products to be delivered b. With local vendors using drivers; are in the covered "auto". for the purpose of providing prear- E. Changes In Personal Injury Protection Cov- ranged "delivery services" for compen- erage sation. A "delivery network platform" 1. If Personal Injury Protection, no-fault or does not include a "transportation net- other similar coverage is attached, and. work platform". a. Contains, in whole or in part, a 2. "Delivery services" includes courier ser- public or livery exclusion, then the vices. following exclusion in Paragraph 2. 3. "Occupying" means in, upon, getting in, does not apply, on, out or off, I Does not contain a public or givery 4. "Transportation network platform" exclusion, then the following exclu- means an online- enabled application or sion in Paragraph 2. is added, digital network used to connect passen- 2. Public Or Livery Passenger Conveyance gers with drivers using vehicles for the And On- domand Delivery Services purpose of providing prearranged trans- This insurance does not apply to any portation services for compensation, covered "auto" while being used, a. As a public or livery conveyance for Passengers. This includes, but is Page 2 of 2 Insurance Services Office, Inc., 2016 CA 23 45 11 16 COMMERCIAL AUTO CA 23 85 01 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF TERRORISM INVOLVING NUCLEAR, BIOLOGICAL OR CHEMICAL TERRORISM This endorsement modifies insurance provided under the following. BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM ® SINGLE INTEREST AUTOMOBILE PHYSICAL DAMAGE INSURANCE POLICY TRUCKERS COVERAGE FORM With respect to coverage provided by this en- 2. "Any injury, damage, loss or expense" dorsement, the provisions of the Coverage Form means any injury, damage, loss or ex- pense covered under any Coverage Form ® apply unless modified by the endorsement. or Policy to which this endorsement is A. The fallowing definitions are added and apply applicable, and includes but is not limited under this endorsement wherever the term to "bodily injury", "property damage'' terrorism, or the phrase any injury, damage, "personal injury", "personal and adver- loss or expense, are enclosed in quotation tising injury", "loss", loss of use, rental marks. reimbursement after "loss" or "covered 1. "Terrorism" means activities against per- pollution cost or expense", as may be de- sons, organizations or property of any na- fined under this Coverage Form, Policy or ture: any applicable endorsement. a. That involve the following or prep- B. The following exclusion is added'. aration for the following. EXCLUSION OF TERRORISM (1) Use or threat of force or We will not pay for "any injury, damage, loss violence; or or expense" caused directly or indirectly by (2) Commission or threat of a dan- "terrorism", including action in hindering or gerous act, or defending against an actual or expected in- (3) Commission or threat of an act cident of "terrorism". "Any injury, damage, that interferes with or disrupts loss or expense" is excluded regardless of an electronic, communication, any other cause or event that contributes con- information, or mechanical sys- currently or In any sequence to such injury, tem, and damage, loss or expense. But this exclusion applies only when one or more of the follow- b. When one or both of the following ing are attributed to an incident of "terror- applies: ism" (1) The effect is to intimidate or cc- 1. The "terrorism" is carried out by means erce a government or the civilian of the dispersal or application of radioac- population or any segment tive material, or through the use of a nu- thereof, or to disrupt any seg- clear weapon or device that involves or ment of the economy, or produces a nuclear reaction, nuclear radi- (2) It appears that the intent is to in- ation or radioactive contamination; or timidate or coerce a govern- 2. Radioactive material is released, and it ment, or to further po- litical, appears that one purpose of the "terror- ideological, religious, social or ism" was to release such material; or economic objectives or to ex- press (or express opposition to) a philosophy or ideology. CA 23 85 01 06 ©ISO Properties, Inc., 2004 Page 1 of 2 3. The "terrorism" is carried out by means C. In the event of any incident of 'terrorism" of the dispersal or application of patho- that is not subject to this Exclusion, coverage genic or poisonous biological or chemi- does not apply to "any injury, damage, loss cal materials. or or expense" that is otherwise excluded under 4. Pathogenic or poisonous biological or this Coverage Form, Policy or any applicable chemical materials are released, and it endorsement. appears that one purpose of the "terror- ism" was to release such materials. s CA 23 85 01 06 OISO Properties, Inc., 2004 Page 2 of 2 COMMERCIAL AUTO CA 23 87 01 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF TERRORISM INVOLVING NUCLEAR, BIOLOGICAL OR CHEMICAL TERRORISM ABOVE MINIMUM STATUTORY LIMITS This endorsement modifies insurance provided under the following, BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM ®_ MOTOR CARRIER COVERAGE FORM ® SINGLE INTEREST AUTOMOBILE PHYSICAL DAMAGE INSURANCE POLICY TRUCKERS COVERAGE FORM With respect to coverage provided by this en- 2. "Any injury, damage, loss or expense" dorsement, the provisions of the Coverage Form means any injury, damage, loss or ex- apply unless modified by the endorsement. pense covered under any Coverage Form _ A. The following definitions are added and apply or Policy to which this endorsement is under this endorsement wherever the term applicable, and includes but is not limited terrorism, or the phrase any injury, damage, to "bodily injury", "property damage loss or expense, are enclosed In quotation "personal injury", "personal and adver- marks: tising injury", "loss", loss of use, rental reimbursement after "loss" or "covered o 1. "Terrorism' means activities against an per- pollution cost or expense", as may be de- lure.sons, organizations or property f any na- fined under this Coverage Form, Policy or any applicable endorsement. a. That involve the following or prep- B. The following exclusion is added: aration for the following: (1) Use or threat of force or EXCLUSION OF TERRORISM violence, or We will not pay for "any injury, damage, loss (2) Commission or threat of a dan- or expense" caused directly or indirectly by gerous act, or "terrorism", including action in hindering or defending against an actual or expected in- (3) Commission or threat of an act cident of "terrorism". "Any injury, damage, that interferes with or disrupts loss or expense" is excluded regardless of an electronic, communication, any other cause or event that contributes con- information, or mechanical sys- currently or in any sequence to such injury, tem, and damage, loss or expense. But this exclusion I When one or both of the following applies only when one or more of the follow- applies: ing are attributed to an incident of "terror- (1) The effect is to intimidate or co- ism": erce a government or the civilian 1. The "terrorism" is carried out by means population or any segment of the dispersal or application of radioac- thereof, or to disrupt any seg- tive material, or through the use of a nu- ment of the economy, or clear weapon or device that Involves or (2) It appears that the intent is to in- produces a nuclear reaction, nuclear radi- timidate or coerce a govern- ation or radioactive contamination; or ment, or to further political, 2. Radioactive material is released, and it ideological, religious, social or appears that one purpose of the "terror- economic objectives or to ex- ism" was to release such material, or press (or express opposition to) a philosophy or ideology. CA 23 87 01 06 © ISO Properties, Inc„ 2004 Page 1 of 2 3. The "terrorism" is carried out by means With respect to Uninsured and/or of the dispersal or application of patho- Underinsured Motorists Coverage, if applica- genic or poisonous biological or chemi- ble, this Exclusion applies only to the extent cal materials; or that the limit of such coverage exceeds the 4. Pathogenic or poisonous biological or minimum statutory permitted limits for Unin- chemical materials are released, and it sured and/or Underinsured Motorists Cover- appears that one purpose of the "terror- age. Those limits are equal to the minimum ism" was to release such materials. limit permitted for Liability Coverage. However, with respect to Liability and Per- C. In the event of any incident of "terrorism" sonal Injury Protection Coverage, if applica- that is not subject to this Exclusion, coverage ble, this Exclusion applies only to the extent does not apply to "any injury, damage, loss that the limit of such coverage exceeds the or expense" that is otherwise excluded under state compulsory or financial responsibility this Coverage Form, Policy or any applicable law minimum limits for each coverage. endorsement. CA 23 87 01 06 © ISO Properties, Inc., 2004 Page 2 of 2 COMMERCIAL AUTO CA 23 89 01 o6 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY„ ALASKA EXCLUSION OF TERRORISM INVOLVING NUCLEAR, BIOLOGICAL OR CHEMICAL TERRORISM ABOVE MINIMUM STATUTORY LIMITS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGEFORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM SINGLE INTEREST AUTOMOBILE PHYSICAL DAMAGE INSURANCE POLICY TRUCKERS COVERAGE FORM With respect to coverage provided by this en- 2. "Any injury, damage, loss or expense" dorsement, the provisions of the Coverage Form means any injury, damage, loss or ex- apply unless modified by the endorsement pence covered under any Coverage Form A. The following definitions are added and apply or Policy to which this endorsement is under this endorsement wherever the term applicable, and includes but is not limited terrorism, or the phrase any injury, damage, to "bodily Injury", "property damage loss or expense, are enclosed in quotafion "personal injury", "personal and adver- marks: tising injury", "loss", loss of use, rental .„ 1. "Terrorism" means activities against per- reimbursement after "loss" or "covered sons, organizations or property of any na- pollution cost or expense", as may be de- lure: fined under this Coverage Form, Policy or any applicable endorsement. a. That involve the following or prep- aration for the following: B. The following exclusion is added: (1) Use or threat of force or EXCLUSION OF TERRORISM violence, or We will not pay for "any injury, damage, loss (2) Commission or threat of a dan- or expense" caused by "terrorism", including gercus act; or action in hindering or defending against an actual or expected incident of "terrorism". (3) Commission or threat of an act But this exclusion applies only when one or that interferes with or disrupts more of the following are attributed to an an electronic, communication, incident of"terrorism": information, or mechanical sys- tem; and 1. The "terrorism" is carried out by means - of the dispersal or application of radioac- b. When one or both of the following tive material, or through the use of a nu- applies clear weapon or device that involves or (1) The effect is to intimidate or co- produces a nuclear reaction, nuclear radi- erce a government or the civilian ation or radioactive contamination; or population or any segment 2. Radioactive material is released, and it thereof, or to disrupt any seg- appears that one purpose of the "terror- ment of the economy; or ism" was to release such material, or (2) It appears that the intent is to In- 3. The "terrorism" Is carried out by means tiimidate or coerce a govern- of the dispersal or application of patho- ment, or to further political, genic or poisonous biological or chemi- ideological, religious, social or cal materials, or economic objectives or to ex- _ -press_(or_express_opposition to) a philosophy or ideology. CA 23 89 01 06 ©ISO Properties, Inc„ 2004 Page 1 of 2 4. Pathogenic or poisonous biological or C. In the event of any incident of "terrorism" chemical materials are released, and it that is rot subject to this Exclusion, coverage appears that one purpose of the "terror- does not apply to "any injury, damage, loss ism" was to release such materials. or expense" that is otherwise excluded under However, with respect to Liability Coverage, this Coverage Form, Policy or any applicable this Exclusion applies only to the extent that endorsement. the limit of such coverage exceeds the state compulsory or financial responsibility law minimum limits. With respect to Uninsured and Underinsured Motorists Coverage, this Exclusion applies only to the extent that the limit of such cov- erage exceeds the minimum statutory permit- ted limits for Uninsured and Underinsured Motorists Coverage. Those limits are equal to the minimum limit permitted for Liability Coverage. r CA 23 89 01 06 ©ISO Properties, Inc., 2004 Page 2 of 2 COMMERCIAL AUTO CA 23 93 01 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,. WASHINGTON EXCLUSION OF TERRORISM INVOLVING NUCLEAR, BIOLOGICAL OR CHEMICAL TERRORISM This endorsement modifies insurance provided under the following: ®_ BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM ® SINGLE INTEREST AUTOMOBILE PHYSICAL DAMAGE INSURANCE POLICY TRUCKERS COVERAGE FORM With respect to coverage provided by this en- 2. "Any injury, damage, loss or expense" dorsement, the provisions of the Coverage Form means any injury, damage, loss or ex- apply unless modified by the endorsement. pense covered under any Coverage Form A. The following definitions are added and apply or Policy to which this endorsement is under this endorsement wherever the term applicable, and includes but is not limited ® terrorism, or the phrase any injury, damage, to "bodily injury,, "property damage", loss or expense, are enclosed in quotation "personal injury", "personal and adver- marks: tising injury", "loss", loss of use, rental 1. "Terrorism" means activities against per- reimbursement after "loss" or "covered sons, organizations or property of any na- pollution cost or expense", as may be de- tu re: fined under this Coverage Form, Policy or any applicable endorsement. a. That involve the following or prep- aration for the following', B. The following exclusion is added: (1) Use or threat of force or EXCLUSION OF TERRORISM violence; or We will not pay for "any Injury, damage, loss (2) Commission or threat of a dan- or expense" caused directly or indirectly by gerous act, or "terrorism", including action in hindering or defending against an actual or expected in- (3) Commission or threat of an act cident of "terrorism". But this exclusion ap- that interferes with or disrupts plies only when one or more of the following an electronic, communication, are attributed to an incident of "terrorism": information, or mechanical sys- 1, The "terrorism" is carried out b means tem; and y of the dispersal or application of radioac- b. When one or both of the following tive material, or through the use of a nu- applies: clear weapon or device that involves or (1) The effect is to intimidate or co- produces a nuclear reaction, nuclear radi- erce a government or the civilian ation or radioactive contamination, or population or any segment 2. Radioactive material is released, and it thereof, or to disrupt any seg- appears that one purpose of the "terror- ment of the economy; or ism" was to release such material; or (2) It appears that the intent is to in- 3. The "terrorism" is carried out by means timidate or coerce a govern- of the dispersal or application of patho- ment, or to further political, genic or poisonous biological or chemi- Ideological, religious, social or cal materials; or economic objectives or to ex- press (or express opposition to) a philosophy or ideology. CA 23 93 01 06 © ISO Properties, Ina, 2004 Page 1 of 2 4. Pathogenic or poisonous biological or C. In the event of any incident of "terrorism" chemical materials are released, and it that is not subject to this Exclusion, coverage appears that one purpose of the "terror- does not apply to "any injury, damage, loss ism" was to release such materials. or expense" that is otherwise excluded under this Coverage Form, Policy or any applicable endorsement. CA 23 93 01 06 © ISO Properties, Inc., 2004 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. TEMPORARY SUBSTITUTE AUTO - PHYSICAL DAMAGE INSURANCE This endorsement modifies insurance provided under the following. BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. If Physical Damage Coverage is provided by this Coverage Form, the following types of vehicles are also covered "autos" for Physical Damage Coverage Any "auto" you do not own while used with the permission of its owner as a temporary substitute for a covered "auto" you own that is out of service because of its', a. Breakdown, b. Repair; c. Servicing, d. "Loss". or e. Destruction. CA 86 47 12 93 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, RECREATIONAL TRAILERS AND BOAT TRAILERS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. CERTAIN TRAILERS, MOBILE EQUIPMENT AND TEMPORARY SUBSTITUTE AUTOS of SECTION I - COVERED AUTOS is amended by the addition of the following: 4. Recreational trailers and boat trailers designed for use with an auto of the private passenger type provided the trailers are not used for business purposes. y CA 85 53 12 93 Page 1 of 1 COMMERCIAL AUTO CA 88 10 01 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM W ith respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. COVERAGEINDEX SUBJECT PROVISICL NUM_QER,� ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 3 ACCIDENTAL AIRBAG DEPLOYMENT 12 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 18 AMENDED FELLOW EMPLOYEE EXCLUSION 5 AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 13 BROAD FORM INSURED 1 BODILY INJURY REDEFINED 21 EMPLOYEES AS INSUREDS Jitcluding employee hired auto) 2 EXTENDED CANCELLATION CONDITION 22 EXTRA EXPENSE - BROADENED COVERAGE 10 GLASS REPAIR- WAIVER OF DEDUCTIBLE 15 HIRED AUTO PHYSICAL DAMAGE(including employee hired auto) 6 HIRED AUTO COVERAGE TERRITORY 20 LOAN / LEASE GAP 14 PARKED AUTO COLLISION COVERAGE(WAIVER OF DEDUCTIBLE) 16 PERSONAL EFFECTS COVERAGE 11 PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 8 RENTAL REIMBURSEMENT 9 SUPPLEMENTARY PAYMENTS 4 TOWING AND LABOR 7 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 17 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 19 SECTION II -LIABILITY COVERAGE is amended as follows' 1. BROAD FORM INSURED SECTION II - LIABILITY COVERAGE, paragraph AA, - WHO IS AN INSURED is amended to include the following as an insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured" does not include any organization that: (1) Is a partnership or joint venture or (2) Is an insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply' (1) If there is similar insurance or a self-insured retention plan available to that organization, ©2010Libeny Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 1 of 7 (2) If the Limits of Insurance of any other insurance policy have been exhausted; or (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: f. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their employment by you. Insurance provided by this endorse- ment is excess over any other insurance available to any "employee". g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties re- lated to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, paragraph AA. - WHO IS AN INSURED is amended to include the following as an insured: h. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured", However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto", (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you', and (3) Only for the duration of that contract, agreement or permit 4. SUPPLEMENTARY PAYMENTS SECTION II - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, para- graphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including actual loss of earn- ings up to $500 a day because of time off from work, S. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added: SECTION II - LIABILITY, exclusion B.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. SECTION III -PHYSICAL DAMAGE COVERAGE is amended as follows, 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended by adding the following. If hired "autos" are covered "autos" for L'iattVlity Coverage, and If Comprehensive, Specified Causes of Loss or Collision coverage are (provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Cartage coverages provided are extended to "autos": a. You hire, rent or borrow, or 1(1 rty al ed CA 66 10 01 10 Includes copyrighted yriight(den material of Insurance Se vices Ofi icAll eglnc with its Permission Page 2 of 7 b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only If the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible. A. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000 or (2) The actual cash value of the damaged or stolen property as of the time of the "loss", or (3) The cost of repairing or replacing the damaged or stolen property with other prcperty of ® like kind and quality, minus a deductible. B. The deductible will be equal to the largest deductible applicable to any awned "auto" for that ® coverage. C. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. D. Subject to a maximum of $750 per ''accident'', we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. ® E. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver, or (2) Any "auto" that is hired, rented or borrowed from your "employee". For the purposes of this provision, SECTION V-DEFINITIONS is amended by adding the following: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. ,. 7. TOWING AND LABOR SECTION III - PHYSICAL DAMAGE COVERAGE, paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is dis- abled' a. For private passenger type vehicles, we will pay up to $50 per disablement. b. For "light trucks'', we will pay up to $50 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVVV) of 10,000 pounds or less, c. For "medium trucks" we will pay up to $150 per disablement, "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 - 20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE- ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a., Coverage Extension of SECTION III - PHYSICAL DAMAGE COVERAGE, is amend- ed to provide a limit of $50 per day and a maximum limit of $1,500 ©20101_iberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 3 of 7 9. RENTAL REIMBURSEMENT SECTION III - PHYSICAL DAMAGE COVERAGE,A. COVERAGE, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those expenses Incurred after the first 24 hours, following the "accident' or "loss" to the covered "auto," b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". it. This coverage does not apply unless you have a business necessity that other "autos" avail- able for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. f. No deductible applies to this coverage. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11. 10. EXTRA EXPENSE - BROADENED COVERAGE Under SECTION III - PHYSICAL DAMAGE COVERAGE,A. COVERAGE,we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000, 11. PERSONAL EFFECTS COVERAGE A. SECTION If - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you awn and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto," The insurance provided under this provision is excess over any other collectible insurance, B. SECTION V-DEFINITIONS is amended by adding the following: Four the purposes of this provision, "personal effects" ,mean tangible property that is worn or carried by an Insured." "Personal effects" does not include tools, equipment, jewelry, money or securities. 1Z ACCIDENTAL AIRBAG DEPLOYMENT SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the follow- ing. If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other cov- erage or warranty, 13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclu. sions 4.c. and 4.d, is deleted and replaced with the following: 02010 Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 4 of 7 Exclusion 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, Visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto" at the time of the "loss'" and such equipment Is designed to be solely operated by use of the power from the "'auto's" electrical system, In Or upon the cowered "auto" and physical damage coverages are provided for the covered "auto or If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. 14. LOAN ! LEASE GAP COVERAGE A. Paragraph C., LIMIT OF INSURANCE of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of. a. Overdue payments and financial penalties associated with those payments as of the date of the "loss", b. Financial penalties imposed under a lease due to high mileage, excessive use or ab- normal wear and tear, c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, d. Transfer or rollover balances from previous loans or leases, e. Final payment due under a "Balloon Loan", f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto", g. Security deposits not refunded by a lessor, In. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto", i. Any amount representing taxes, j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. ADDITIONAL CONDITIONS This coverage applies only to the original loan for which the covered "auto" that incurred the loss serves as collateral, or lease written on the covered "auto" that incurred the loss. C. SECTION V-OEFINTIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value, A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. ©2010 Liberty Mutual Insurance Company.All rights reserved. CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 5 of 7 15. GLASS REPAIR-WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 16. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 Ibs, or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured", I Legally parked; and c. Unoccupied. The "loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations, This provision does not apply to any "loss" if the covered "auto" is in the charge of any person or organization engaged In the automobile business. SECTION IV - BUSINESS AUTO CONDITIONS is amended as follows: 17. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following, If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 18. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.2.a, is replaced in its entirety by the fallowing. a In the vent of "accident", claim, "suit" or "loss', you must promptly notify us when It Is known e 1. You, if you are an Individual, 2, A partner, if you are a partnership, 3. Member, if you are a limited liability company, 4. An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. To the extent possible, notice to us should include: a (1) How, when and where the "accident" or "loss" took place, (2) The "insureds" name and address; and (3) The names and addresses of any injured persons and witnesses. 19. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.S., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the fallowing, If the person or organization has waived those rights before an "accident"waived also. or "loss", our rights are CO2. CA 88 10 o1 10 Includes copyrighted e hted materialfy of ual (insurance Servnsurance paruy All rights wILM with iced. ices�Cfdice Inc., its Permission. Page 6 of 7 20. HIRED AUTO COVERAGE TERRITORY SECI`ION IV - BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is amended by the addition of the fallowing: f. Per "'autos" aired 30 days or less, the coverage territory Is anywhere In the world, provided that the insured's respor ii'uty to pay for damages is determined in a "suit', on the merits, In the, United States, the territories and possessions of the United States of America, Puerto Rica or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver SECTION V -DEFINITIONS is amended as follows: 0 21. BODILY INJURY REDEFINED Under SECTION V- DEFINTIONS, definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. COMMMON POLICY CONDITIONS =_ 22. EXTENDED CANCELLATION CONDITION S COMMON POLICY CONDITIONS, paragraph A. - CANCELLATION condition applies except as fol- lows, If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancella- tion. ©2010 Liberty Mutual Insurance Company.All rights reserved, CA 88 10 01 10 Includes copyrighted material of Insurance Services Office Inc,with its Permission. Page 7 of 7 COMMERCIAL AUTO CA 99 03 03 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, AUTO MEDICAL PAYMENTS COVERAGE This endorsement modifies insurance provided under the following. BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this en- 3. "Bodily injury" sustained by any "fam- dorsement, the provisions of the Coverage Form ily member" while "occupying" or apply unless modified by the endorsement struck by any vehicle (other than a cov- A. Coverage ered "auto") owned by or furnished or available for the regular use of any We will pay reasonable expenses incurred "family member". for necessary medical and funeral services q "Bodily injury" to your "employee" to or for an "insured" who sustains "bodily injury" caused by "accident". We will pay arising out of and in the course of ern- injury"those expenses incurred, for services ployment by you. However, we will cov- rendered within three years from the date of er "bodily injury" to your domestic the "accident". "employees" if not entitled to workers' compensation benefits. For the pur- B. Who Is An Insured poses of this endorsement, a domestic 1. You while "occupying" or, while a pe- "ermployee" is a person engaged in destrian, when struck by any "auto". household or domestic work performed' 2. If you are an individual, any "family principally in connection with a resi- dence premises, member" while "occupying"Y or, while a pedestrian, when struck b any "auto". 5. "Bodily injury" to an "insured" while 3. Anyone else "occupying" a covered working in a business of selling, servic- "auto" or a temporary substitute for a that repairing or parking "autos" unless that business is yours. covered "auto". The covered "auto" must be out of service because of its 6. "Bodily injury" arising directly or in- breakdown, repair, servicing, loss or de- directly out of: slruction. a. War, including undeclared or civil C. Exclusions war; This insurance does not apply to any of the b. Warlike action by a military force, following including action in hindering or de- l. "Bodily injury" sustained by an "In fending against an actual on expect- sured" while "occupying" a vehicle lo- ad attack„ by any government, sov- cated for use as a premises. ereign or other authority using rnilitary personnel or other agents. 2. "Bodily Injury," sustained by you or any or "family mehtber" while "°occupying" or c. Insurrection, rebellion, revolution, struck by any vehicle (other then a cov- usurped Power, or action "aken by ered "auto") awned by you or furnished governmental authority in hindering Or avertable for year regular use. or defending, against any of these, CA 99 03 03 06 ©ISO Properties, Inc., 2005 Page 1 of 2 7. "Bodily injury" to anyone using a ve- E. Changes In Conditions hicle without a reasonable belief that The Conditions are changed for Auto Medi- the person is entitled to do so, cal Payments Coverage as follows. 6. sure ty Injury" sustained by an "ed 1. The Transfer Of Rights Of Recovery sired" while "occupying'" any Covered g auto" while used in any professional Against Others To Us Condition does — raping or demolition contest or stunting not apply, activity, or whHe practicing for such 2. The reference in Other Insurance in the contest or activity. This insurance also Business Auto and Garage Coverage does not apply to any "bodily injury" Forms and Other insurance - Promary sustained by an "insured" while the And Excess Insurance Provision in the 'i5_55 "auto" is being prepared for such a Truckers and Motor Carrier Coverage contest or activity. Forms to "other collectible insurance" D. Limit Of Insurance applies only to other collectible auto medical payments insurance. Regardless of the number of covered F. Additional Definitions "autos'" "insureds", premiums paid, Claims made or vehicles involved in the "accdeni", As used in this endorsement' the most we will pay tar "bodily injury" for 1. "Family member" means a person re- each "insured" injured in any one "acc'o- fated to you by blood, marriage or dent" is the Limit Of Insurance for Auto adoption who is a resident of your ® Medical Payments Coverage shown in the household.., including a ward or foster Declarations. child. No one will be entitled to receive duplicate 2. "Occupying" means in, upon, getting in, payments for the same elements of "loss" on, out or off. under this coverage and any Liability Cov- erage Form, Uninsured Motorists Coverage endorsement or Underinsured Motorists Coverage endorsement attached to this Cov- erage Part. CA 99 03 03 06 ©ISO Properties, Inc., 2005 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, CA 99 89 D5 01 WASHINGTON LOSS PAYABLE FORM REG-335 This endorsement reflects the text of the form promulgated in Washington State Insurance Commissioner's Regulation No. 335, as reproduced in Section 284-21-990 of the Washington Administrative Code, SCHEDULE r:En7dorsement nce Cornp,�sruy � Number Effective Date ------.__�........ To ed Party ress Additional Secured Party Address By Agent - (If no entry appears above, information required to complete this endorsement will be shown in the Declara. tions as applicable to this endorsement.) A. Loss or damage, if any, under this policy shall D. The company reserves the right to cancel the be payable first to the loss payee or mort- policy at any time as provided by its terms, gagee (hereinafter called secured party), and, but in such case the company shall mail to second, to the insured, as their interests may the secured party a notice stating when such appear; provided, that, upon demand for sep. cancellation shall became effective as to the arate Settlement by the secured party, tine interest of said secured party. The amount arri of said loss shall be paid directly to and form of such notice shall not be less than the secured party to the extent of Its Interest that required to be given the named insured, B. This insurance as to the interest of the se- by law or by the policy provisions, whichever cured party shall not be invatidated by any act is more favorable to the secured party. or neglect of Pine 'insured named in said policy E. If the Insured fails to render proof of loss Of his agents employees or representatives, within the time granted in the policy condi- nor by any change in the title or ownership of bons, such secured party shall do so within the insured property; provided, however', sixty days after having knowledge of a loss, in that, the conversion, embezzlement or secre- farm and manner as provided by the policy, tion by the named insured or his agents, I and, further, shall be subject to the provisions PIDyees or representatives is not covered Lin- of the policy relating to appraisal and the time der said policy unless specifically insured of payment and bringing suit. against and premiums paid therefor, C. In applying the pro rats provisions of the poli- cy, the amount payable to the secured party shall be reduced only to the extent of pro rala payments receivable by the secured party on- der other policies, CA 99 89 05 01 © 180 Properties, Inc„ 2000 Page 1 of 2 CA 99 89 05 01 WASHINGTON LOSS PAYABLE FORM REG-335 F. Whenever the company shall pay the secured G. All terms and conditions of the policy remain party any sum for loss or damage under poli- unchanged except as herein specifically pro- cy and shall claim that, as to the insured, no vided. liability exists, the company shall, to the ex- H. All notices sent to the secured party shall be tent of such payment, be thereupon legally sent to its last reported address, which must subrogated to all the rights of the party to be stated in the policy or in this endorsement, whom such payment shall be made, under all collateral held to secure the debt, or may, at Its option, pay to the secured party the whole _ principal due or to grow due on the mortgage or other security agreement, with interest, and shall thereupon receive a full assignment and transfer of the mortgage or other security agreement and of all collateral held to secure it; but no subrogation shall impair the right of the secured party to recover the full amount due it. i� CA 99 89 05 01 © I50 Properties, Inc., 2000 Page 2 of 2 IL 01 23 11 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,. WASHINGTON CHANGES - DEFENSE COSTS This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGEPART COMMERCIAL GENERAL LIABI_ITY COVERAGEPART COMMERCIAL LIABILITY UMBRELLA COVERAGEPART COMMERCIAL PROPERTY COVERAGE PART- LEGAL LIABILITY COVERAGE FORM COMMERCIAL PROPERTY COVERAGE PART-MORTGAGEHOLDER'S ERRORSAND OMISSIONS COVERAGE FORM ELECTRONICDATA LIABILITY COVERAGEPART FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCT WITHDRAWAL COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK COVERAGE PART A. The provisions of Paragraph B. are added to 5. Coverage C - Mortgageholder's Liability all Insuring Agreements that set forth a duty under the Mortgageholder's Errors And to defend under: Omissions Coverage Form, 1. Section I of the Commercial General Li- Paragraph B. also applies to any other provi- ability, Commercial Liability Umbrella, sion in the policy that sets forth a duty to de- Electronic Data Liability, Farm, Liquor Li- fend. ability, Owners And Contractors Protec- B. If we initially defend an insured ("insured") or live Liability, Pollution Liability, Pro- pay for an insured's ("insured's") defense but ducts/Completed Operations Liability, later determine that none of the claims Product Withdrawal, Medical Profession- ("claims"), for which we provided a defense al Liability, Railroad Protective Liability or defense costs, are covered under this in- and Underground Storage Tank Cover- surance, we have the right to reimbursement age Parts, Auto Dealers Coverage Form for the defense costs we have incurred. and the Farm Umbrella Liability Policy, 2. Section II under the Auto Dealers, Busi- The right to reimbursementpplothe under this have i - sion will only apply to the costs we have in- ness Auto and Motor Carrier Coverage curred after we notify you in writing that Forms, there may not be coverage and that we are 3. Section III under the Auto Dealers and reserving our rights to terminate the defense Motor Carrier Coverage Forms; or the payment of defense costs and to seek 4. Section A. Coverage under the Legal Li- reimbursement for defense costs. ability Coverage Form: and IL 01 23 11 13 © Insurance Services Office, Inc., 2013 Page 1 of 1 IL 01 46 06 10 WASHINGTON COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. The conditions in this endorsement replace any 3. We may cancel the Commercial Property similar conditions in the policy that are less favor- Coverage Part and the Capital Assets Pro- able to the insured. gram (Output Policy) Coverage Part, if A. Cancellation made a part of this policy, by mailing or 1. The first Named Insured shown in the delivering to the first Named Insured and the first Named Insured's agent or broker Declarations may cancel this policy by notifying us or the insurance producer in written notice of cancellation at least five one of the following ways days before the effective date of cancella- tion for any structure where two or more a. Written notice by mail, fax or e-mail; of the following conditions exist. - b. Surrender of the policy or binder, or a. Without reasonable explanation, the c. Verbal notice. structure is unoccupied for more Upon receipt of such notice, we will can- than 60 consecutive days, or at least cel this policy or any binder issued as evi- 65% of the rental units are unoccu- dence of coverage, effective on the later pied for more than 120 consecutive of the following; days, unless the structure is main- a. The date on which notice is received tained for seasonal occupancy or is or the policy or binder is surren- under construction or repair; dered, or b. Without reasonable explanation, b. The date of cancellation requested progress toward completion of per- by the first Named Insured manent repairs to the structure has not occurred within 60 days after re- 2. We may cancel this policy by mailing or ceipt of funds following satisfactory delivering to the first Named Insured and adjustment or adjudication of loss re- the first Named Insured's agent or broker sulting from afire; written notice of cancellation, including the actual reason for the cancellation, to c. Because of its physical condition, the the last mailing address known to us, at structure is in danger of collapse, least d. Because of its physical condition, a a. 10 days before the effective date of vacation or demolition order has cancellation if we cancel for nonpay- been issued for the structure, or it ment of premium, or has been declared unsafe in accor- dance with applicable law, b. 45 days before the effective date of e, Fixed and salvageable items have cancellation if we cancel for any oth- - er reason; been removed from the structure, in- dicating an intent to vacate the slruc- except as provided in Paragraphs 3. and ture', 4. below. f. Without reasonable explanation, heat, water, sewer and electricity are not furnished for the structure for 60 consecutive days; or g. The structure Is not maintained in substantial compliance with fire, safety and building codes. IL 01 46 08 10 © Insurance Services Office, Inc„ 2010 Page 1 of 4 4. If: 7. If this policy is cancelled, we will send a. You are an individual; the first Named Insured any premium re- b. A covered auto you own is of the fund due, If we cancel, the refund will be "private passenger type and pro rata. If the first Named Insured can- cels, the refund will be at least 90% of the c. The policy does not cover garage, pro rata refund unless the following ap- automobile sales agency, repair plies: shop, service station or public park- ing place operations hazards, a. For Division Two - Equipment Break- down, if the first Named Insured can- we may cancel the Commercial Auto- cels, the refund will be at least 75% mobile Coverage Part by mailing or of the pro rata refund. delivering to the first Named Insured and b. If, the first Named Insured's agent or broker written notice of cancellation, including (1) You are an individual, the actual reason for cancellation, to the (2) A covered auto you own is of the last mailing address known to us: "private passenger type"; a. At least 10 days before the effective (3) The policy does not cover ga- date of cancellation if we cancel for rage, automobile sales agency, nonpayment of premium; or repair shop, service station or b. At least 10 days before the effective public parking place operations date of cancellation for any other rea- hazards; and son if the policy is in effect less than (4) The first Named Insured cancels 30 days, or the refund will be not less than 90% c. At least 20 days before the effective of any unearned portion not exceed- date of cancellation for other than ing $100, plus 95% of any unearned nonpayment if the policy is in effect portion over $100 but not exceeding 30 days or more; or $500, and not less than 97% of any d. At least 20 days before the effective unearned portion in excess of $500. date of cancellation if the policy is in The cancellation will be effective even if effect for 60 days or more or is a re- we have not made or offered a refund, newal or continuation policy, and the 8. If notice is mailed, proof of mailing will reason for cancellation is that your be sufficient proof of notice. driver's license or that of any driver who customarily uses a covered B. Changes "auto" has been suspended or The policy contains all the agreements be- revoked during policy period. tween you and us concerning the insurance S. We will also mail or deliver to any mort- afforded. The first Named Insured shown in gage holder, pledgee or other person the Declarations is authorized to make shown in this policy to have an interest in changes in the terms of this policy with our any loss which may occur under this poli- consent. This policy's terms can be amended cy, at their last mailing address known to or waived only by endorsement issued by us us, written notice of cancellation, prior to and made a part of this policy. the effective date of cancellation. If can- C. Examination Of Your Books And Records cellation is for reasons other than those We may examine and audit your books and contained in Paragraph A.3. above, this records as they relate to this policy at any notice will be the same as that mailed or tine during the policy period and up to three delivered to the first Named Insured. If years afterward, cancellation is for a reason contained in Paragraph A.3, above, we will mail or de- D. Inspection And Surveys liver this notice at least 20 days prior to I. We have the right to. the effective date of cancellation, a. Make inspections and surveys at any 6. Notice of cancellation will state the effec- time', tive date of cancellation. The policy pe- b. Give you reports on the conditions rod will end on that date. we find', and C. Recommend changes. Page 2 of 4 121 Insurance Services Office, Inc., 2010 IL 01 46 08 10 2. We are not obligated to make any nspec- G. Nonrenewal tions, surveys, reports or recommend,," 1. We may elect not to renew this policy by tions, and any such actions we do under- take relate only to insurability and the mailing or delivering written notice of prItMiums to be charged. We do not nonrenewal, stating the reasons far make safety inspections. We do not un- nonrenewal, [o the first Named Insured dertake to perform the duty of any person and the first Named mailinInsureg agent or or organization to broker, at their last mailing addresses 9 provide for the health known to us. We will also mail to any or safety of workers or the public. And we do not warrant that conditions: mortgage holder, pledgee or other per- ® son shown in this policy to have an inter- _ a. Are safe or healthful, or est in any loss which may occur under ® h. Comply with laws, regulations, this policy, at their last mailing address codes or standards. known to us, written notice of 3. Paragraphs, 1- and 2. of this condition ap- nonrenewal. We will mail or deliver these ply not only to us„ but also to any rating, notices at least 45 days before the: advisory, rate service or similar organize. a. Expiration of the policy; or tion which makes insurance inspections, b. Anniversary date of this policy if this surveys, reports or recommendations. policy has been written for a term of 4. Paragraph 2. of this condition does not more than one year. apply to any inspections, surveys, reports Otherwise, we will renew this policy un- or recommendations we may make rela- less: five to certification, under state or mu- a. The first Named Insured fails to pay nicipal statutes, ordinances or regula- the renewal premium after we have tions, of boilers, pressure vessels or expressed our willingness to renew, elevators. including a statement of the renewal E. Premiums premium, to the first Named Insured The first Named Insured shown in the Dec- and the first Named Insured's insur- larations: ante agent or broker, at least 20 days 1. Is responsible for the payment of all pre- before the expiration date; miums; and b. Other coverage acceptable to the in- 2. Will be the payee for any return premi- sured has been procured prior to the ums we pay. expiration date of the policy; or F. Transfer Of Your Rights And Duties Under c. The policy clearly states that it is not This Policy renewable and is for a specific line, subclassification, or type of coverage Your rights and duties under this policy may that is not offered on a renewable ba- not be transferred without our written con- sls. sent except in the case of death of an individ- ual Named Insured. 2. If. If you die, your rights and duties will be trans- a. You are an individual, " ferred to your legal representative but only It. A covered auto you own is of the while acting within the scope of duties as .private passenger type", and your legal representative. Until your legal re- c. The policy does not cover garage, presentative is appointed, anyone having automobile sales agency, repair proper temporary custody of your property shop, service station or public park- will have your rights and duties but only with ing place operations hazards, respect to that property. IL 01 46 08 10 © Insurance Services Office, Inc., 2010 Page 3 of 4 the following applies to nonrenewal of b. We will not refuse to renew Liability the Commercial Automobile Coverage Coverage or Collision Coverage sole- Part in place of GA.: ly because an "insured" has submit- a. We may elect not to renew or con- ted claims under Comprehensive tinue this policy by mailing or Coverage or Towing And Labor Cov- delivering to you and your agent or erage. broker written notice at least 20 days c. If we fail to mail or deliver proper no- before the end of the policy period, tice of nonrenewal and you obtain including the actual reason for other insurance, this policy will end nonrenewal. If the policy period is on the effective date of that insur- more than one year, we will have the ance. right not to renew or continue it only at an anniversary of its original effec- tive date. If we offer to renew or con- tinue and you do not accept, this policy will terminate at the end of the current policy period. Failure to pay the required renewal or continuation premium when due shall mean that you nave not accepted our offer. Page 4 of 4 p Insurance Services Office, Inc., 2010 IL 01 46 08 10 IL 01 98 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (Broad Form) This endorsement modifies insurance provided under the following. COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART FARM COVERAGE PART FARM UMBRELLA LIABILITY POLICY LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY 1. The insurance does not apply: B. Under any Medical Payments Coverage, A. Under any Liability Coverage, to "bodily to expenses incurred with respect to injury" or "property damage": "bodily injury" resulting from the "haz- ardous properties" of "nuclear matel (1) With respect to which an "insured" al" and arising cut of the operation of a under the policy is also an insured "nuclear facility" by any person or or- under a nuclear energy liability poll- ganization. cy issued by Nuclear Energy Liabil- ity Insurance Association, Mutual C. Under any Liability Coverage, to "bodily Atomic Energy Liability Underwrit- injury" or "property damage" resulting ers, Nuclear Insurance Association from "hazardous properties" of "nuclear of Canada or any of their succes- material", if sors, or would be an insured under (1) The "nuclear material" (a) is at any any such policy but for its termina- "nuclear facility" owned by, or op- tion upon exhaustion of its limit of erated by or on behalf of, an "in- liability or sured" or (b) has been discharged (2) Resulting from the "hazardous or dispersed therefrom, properties" of "nuclear material" (2) The "nuclear material" is contained and with respect to which (a) any In "spent fuel" or "waste" at any person or organization Is required time possessed, handled, used, pro- to maintain financial protection pur- cessed, stored, transported or suant to the Atomic Energy Act of disposed of, by or on behalf of an 1954, or any law amendatory there- "insured" or of, or (b) the "insured" is, or had this policy not been Issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agree- ment entered into by the United States of America, or any agency thereof, with any person or organi- zation. IL 01 98 09 08 (DISO Properties, Inc., 2007 Page 1 of 2 (3) The "bodily injury" or "property "Nuclear facility" means: damage" arises out of the furnish- ing by an "Insured" of services, materials, parts or equipment in (b) Any equipment or device designed connection with the planning, con- or used for (1) separating the iso- struction, maintenance, operation or topes of uranium or plutonium, (2) use of any "nuclear facility", but if processing or utilizing "spent fuel", such facility is located within the or (3) handling, processing or pack- United States of America, its ter- aging "waste", ritories or possessions or Canada, (c) Any equipment or device used for this Exclusion (3) applies only to the processing, fabricating or "property damage" to such "nucle- alloying of "special nuclear mate- ar facility" and any property rial" if at any time the total amount thereat. of such material in the custody of 2. As used in this endorsement. the "insured" at the premises "Hazardous properties" include radioactive, where such equipment or device is toxic or explosive properties; located consists of or contains more than 25 grams of plutonium "Nuclear material" means "source materi- or uranium 233 or any combination al", "Special nuclear material" or "by-prod- thereof, or more than 250 grams of uct material", uranium 235; "Source material", "special nuclear mate- (d) Any structure, basin, excavation, rial", and "by-product material" have the premises or place prepared or used meanings given them in the Atomic Energy for the storage or disposal of Act of 1954 or in any law amendatory there- "waste" of; a.nd includes the site on which any of the "Spent fuel" means any fuel element or fuel foregoing is located, all operations conduct- component, solid or liquid, which has been ed on such site and all premises used for used or exposed to radiation in a "nuclear such operations, reactor" "Nuclear reactor" means any apparatus de- "Waste" Mear's any waste maternal (a) contain- signed or used to sustain nuclear fission in ing ""by-product material" other than the tailings a self-supporting chain reaction or to con- or wastes produced by the extraction or con- tain a critical mass of fissionable material centration of uranium or thorium from any ore processed primarily for its "source material" "Property damage" includes all forms of ra- content, and (b) resulting from the operation by dioactive contamination of property. any person or organization of any "nuclear fa- cility" Included under the first two paragraphs of the definition of "nuclear faoilfty"', s: IL 01 98 09 09 ©ISO Properties, Inc., 2007 Page 2 of 2 t5N 1.117CI"d�r M I..I t t)a N.. INSURANCE Policy Number: BLS 56696377 Prior Policy; NOT AVAILABLE Cov ri;gt Is Provided In The Ohio SQcur py I❑swnnee Compilly Biili,np 1'y°Irtir. llnec[ Bill R i� Named Insured and Mailing Address: Agent: A F DUNCAN & ASSOCIATES, INC DUNCAN & ASSOCIATES INC PO BOX 12300 PO BOX 1458 OLYMPIA, WA 98.508 OLYMPIA, WA 98507-1458 Agent Code: 466104 Agent Phone: (360) 352-7588 Policy Declarations, Forms and Endorsements N N M W h [h N N d _o in 46 6104 BLS 56696377 05/08/2019 DUNCAN & ASSOCIATES INC 5(Odl PO BOX 1458 OLYMPIA, WA 98507-1458 II.I.I,1I11I1I1II1Fil",I.,1II1I1 oil III III III I We strive to produce a quality product for our agents to deliver to the policyholder, In doing so, we ask that you assist us by taking time to review the enclosed policy accuracy, If there are any modifications that need to be made, we request that you return this letter to the Business Center oudini r what is in error, Named Insured; R P DUNCAN & ASSOCIATES, INC Corrections needed to be made on this policy (This form is not for routine change requests); Thank you for your assistance. Please send to', Liberty Mutual Insurance ATTENTION: C.S.I. UNIT _..._ __,_...— __ . ....�.m..._ c u; NONE '� I�ilrc�Pl� IN3UR N Policyholder Information 0RANCE ANCE Named Insured&Malling Address Agent Mailing Address&Phone No. R F DUNCAN & ASSOCIATES, INC (360) 352-7588 DBA THE GRANGER COMPANY DUNCAN & ASSOCIATES INC PO BOX 12300 PO BOX 1458 OLYMPIA, WA 98508 OLYMPIA, WA 98507-1458 Dear Policyholder: We know you work hard to build your business, We work together with your agent, DUNCAN & ASSOCIATES INC (360) 352-7588 ' to help protect the things you care about. Thank you for selecting us. r, Enclosed are your Insurance documents consisting of • General Liability To find your specific coverages, limits of liability, and premium, please refer to your Declaral9ons page(s). If you have any questions or changes that may affect your insurance needs, please contact your Agent at (360) 352-7588 . Verify that all information is correct . If you have any changes, please contact your Agent at (360) 352-7588 Reminders . In case of a claim, call your Agent or 1-900-362-0000 You Need To Know . CONTINUED ON NEXT PAGE, ro repart a clalm, call your Agent at t-600-$62.0000 DS 70 20 01 08 You Need To Know - continued • NOTICE,(S) TO POlACYJJ()LDFRfS) 7110 Important Notoce(s) to provide a genDlitl uxplalarldon of changes In c(Werry'o to your Policy, The, bullOrtunt Nolicc,(s) to poIn;yhj:)IdQr(s) is not 11 pall of your assurance policy sird it does nor alter policy provisions or eondifioll& Only lhe provisions, of your policy doernine the scope of your insurance proicution. it lN hupornnd that you read your Policy carefully to denn:nurc Your lights, dm1cK and what Is anal is net covered, FORM NUMBER TITIE NP 10 58 04 17 Important Notice To Policyholders Potential Reductions And Chrriflication of Coverage - Limitation Of Coverage To Designated Premises Or Project Endorsement (CO 21 44 07 98) NP 72 42 01 15 Terrorism Insurance Premium Disclosure And Opportunity To Reject NP 74 44 09 06 U.S. Treasury Department's Office of Foreign Assets Control (OFAC) Advisory Notice to Policyholders NP 74 50 01 07 Iniporunt Audit Information NP 89 71 09 10 Important Policyholder Information Concerning Billing Practices Liberty Northwest NP 96 00 10 14 General Liability Access Or Disclosure Of Confidential Or Personal Information Exclusions Advisory Notice To Policyholders • This policy will be direct billed. You may choose to combine any number ol'policies on one bill with your billing account. Please contact your "gent for more unfoinantion. No10580417 IMPORTANT NOTICE TO POLICYHOLDERS POTENTIAL REDUCTIONS AND CLARIFICATION OF COVERAGE - LIMITATION OF COVERAGE TO DESIGNATED PREMISES OR PROJECT ENDORSEMENT (CG 21 44 07 98 or CG 21 44 01 85) Dear Valued Policyholder, Thank you for selecting us as your carrier for your commercial insurance. We are adopting ISO's clarifica- tion of the endorsement "Limitation of Coverage to Designated Premises or Project" and this notice con- tains a summary of the changes made to your policy. Please note that not all of the changes noted may apply to your specific policy. If your expiring policy did not contain endorsement CG 21 44 07 98 or CG 21 44 01 85, this change does not affect your policy In addition, this notice does not reference every editorial change made to the endorsement or coverage form; It only reflects significant coverage changes. Please read your policy and review your declarations page for complete coverage information. No coverage Is provided by this notice, nor can It be construed to replace any provisions of your policy, If there are discrepancies between your policy and this notice, the provisions of the policy shall prevail. These changes become effective as of the effective date of your replacement policy. Please note that this notice does not apply to you or your policy in the event you have received, or do receive, a notice of cancellation or nonrenewal. Should you have questions after reviewing the changes outlined below, please contact your independent agent. Thank you for your business Expiring Form Expiring Form Number New Form New Form Number Limitation of Coverage CG 21 44 07 98 Limitation of Coverage CG 21 44 04 17 to Designated Premises CG 21 44 01 85 to Designated Premises, or Project Project, or Operation. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE COMMERCIAL GENERAL LIABILITYCOVERAGE PART. XISCE!LANLEVUS GN,AVIIES • Similar to the expiring endorsement CG 21 44 07 98 or CG 21 44 01 85, the revised endorsement CG 21 44 04 17 modifies the Commercial General 1-lability Coverage fart. However, In doing so, the revised endorsement separately replaces select sections of the Coverage A • Bodily Injury And Property Darn- age Liability, Coverage B - Personal And Advertising Injury Liability, and Coverage C - Medical Pay. monts Insuring agreements, For greater delineation In this regard, the revised endorsement contains separate paragraphs addressing the Insuring agreements for Coverage A, B, and C. • The revised endorsement explicitly Incorporates the term "operation" into the endorsement's Schad- ule, separate from the Pretnlses field, The term "operation" has also been added to the revised endorse- ment's three Insuring agreement paragraphs, as wail as Its title. E01"NUAI."DUCTIUNS IN COVERAGE • Your CG 21 44 04 17 no longer contains wording referring to coverage granted for Injury or damage arising out the "ownership, maintenance or use of the premises shown In the schedule and operations necessary or Incidental to those premises", The expiring endorsement included this language, • Your CG 21 44 04 17 now contains an expanded clarlficadon of coverage for coverage part A, adding that this Insurance only applies If "bodily Injury" or property darrrago" are caused by an "occurrence" that takes place In the "coverage territory", aind only if the "bodily Injury" or "property damage" 1) occurs can the premises shown In the Schedule or the grounds and structures appurtenant to those premises; or 2)Arises out of the project or operation shown in the Schedule, The expiring endorsement did not contain these conditions, NP 10 58 04 17 © 2017 Liberty Mutual Insurance Page 1 of 2 0 Your GG 2 1 44 04 17 crow contains an exli aI@fllfClliull of coverage for coverage part B, ,lddloq that this ns"ref" 011iy applies to "personal anti advottismo injury" mausmd by nil offense committed in kh a c o ve r a g e territory" a+rid enIy If the 0(fe I l S e arisen U t of yo k a r 1)us i ne ss I) Par to r m e d on t I I e p re n I- ises shown In the schedule, or 2) in connection with the project or opLraflon shown in the Srlhe(juie; and during the policy period. 'I'llL new ii also requires that if the "Inersolial anti sciverusiij!) inin y,, cause by 1) False arrest, detention or imprisonment; or 2 is ) I lie wrongful eviction from, wrongftj@ entry into, or invasion of the right of private occupancy of a room, dvvcHh)g or preml,se,s trial ,, poison occoples, conirnitted by or on i of Its owner, landlord w lessor; then such offense must arise shown In the Schedule and the offense must have been of your business performed on the premises okil committed on the premises shown in the Schedule or the grounds and structures appurtenant to those premises.The expiring endorsements did not contain these conditions, Your CG 21 44 04 17 now contains an expanded clarification of coverage for Part C, adding that coverage for rneoical expenses appNes to "'bodily Injury" caused by an accident that takes place In the coverage territory" only if the "bodily Injury" 1) Occurs on the premises shown In the Schedule or the grounds and structures appurtenant to those premises; or 2) Arises out of the project or operation shown in the Schedule The accident must also take Place during the policy period, the expenses must be Incurred and reported within one year of the date of the accident, and the Injured person submits to examination, at our expense,by physicians of our choice as often as we reasonably require. NP 10 58 04 17 @ 2017 Liberty MUtUal InSUrancu Page 2 of 2 03/15/18 R F DUNCAN & ASSOCIATES, INC BLS (19) 56 69 63 77 DBA THE GRANGER COMPANY From 05/08/2018 To 05/08/2019 PO BOX 12300 OLYMPIA, WA 985o8 (360) 352-7588 DUNCAN G ASSOCIATES INC PO BOX 1458 OLYMPIA, WA 98507-1458 TFRRORI'SN9 I(U,. UfiA ,E f1 A4119M 015CI pSURE AND QPP RT(LN TY 7a-REJC7 This notice contains important information about the Terrorism Risk Insurance Act and its effect on your policy, Please read it carefully. THE TERRORISM R6SK INSURANCE AC,T The Terrorism Risk Insurance Act, including all amendments l"TRIA" or the "Act"), establishes a program to spread the risk of catastrophic losses from certain acts of terrorism between Insurers and the federal government. If an Individual insurer's losses from certified acts of terrorism exceed a specified deductible amotrnt, the government will relrnburse the Insurer for a percentage of losses (the "Federal Share") paid in excess of the deductible, but only If aggregate industry losses from such acts exceed the "Program Trig- ger'". An Insurer that has met Its Insurer deductible is not plable for any portion of losses In excess of$100 billion per year. Similarly, the federal government is not liable for any losses covered by the Act that exceed this amount. If aggregate insured losses exceed $100 billion, losses up to that amount may be pro-rated, as determined by the Secretary of the Treasury. The Federal Share and Program Trigger by calendar year are: Calendar Year Federal Share Program Trigger 2015 850/6 $100,000,000 2016 840/. $120,000,000 2017 83% $140,000,000 2018 82% $160,000,000 2019 81% $180,000,000 2020 _ 80% $200,000,,000 IMIUM ATQRY t�HFER OF CQVETBpGE FQR "CERTIFIED ACTS OF,=fERF10RpSM1" AN) fa1SCLp5URE Q7F PR[. TRIA requires Insurers to make coverage available for any loss that occurs within the United States (or outside of the U.S. In the case of U,S, missions and certain air carriers and vessels), results from a "certified act of terrorism" AND that Is otherwise covered under your policy. A "certified act of terrorism" means: Why 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 W to be an act of terrorism; NP 72 42 01 15 © 2016 LlbertY Mutual Insurance Page 1 of 2 (II) to be a violent act or an act that is dangerous tc - (1) human iii (II) property; or (III) Infrastructure; (III) to have resulted in damage within the United States, or outside of the United States In the case of- (I) an air carrier (as defined in section 40102 of title 49, United', States Code) or United States flag vessel (or a vessel based principally In the United States,on which United.States income tax Is paid and whose insurance coverage is subject to regulation in the United States); or (II) the premises of a United States mission; and (iv) to have 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. REJECTING TERftCSfRISIM INSi0EtlC[COVERA(zL 18ffl&LYOU MUST i We have included in your policy coverage for losses resulting from "certified acts of terrorism" as defined above, THE PREMIUM CHARGE FOR THIS COVERAGE APPEARS ON THE DECLARATIONS PAGE OF THE POLICY AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS COVERED BY THE FEDERAL GOV- ERNMENT UNDER THE ACT, If we are providing you with a quote, the premium charge will also appear on yourquote as a separate line item charge IF YOU CHOOSE TO REJECT THIS COVERAGE, PLEASE CHECK THE BOX BELOW, SIGN THE ACKNOWL- EDGMENT„ AND RETURN THIS FORM TO THE ADDRESS BELOW Please onsura env raieotion is eeoived w9hinthir 30) tames sai#Ity offaativr drtite of Y-owr mol9cy"„ Before making a decision to reject terrorism Insurance, refer to the Disclaimer for Standard Fire Policy States located at the end of this Notice. ❑ 1 hereby reject this offer of coverage, I understand that by rejecting this offer, I will have no coverage for losses arlsing from "certified acts of terrorism" and my policy will be endorsed accordingly. Policyholder/Applicant's Signature Print Name Date Signed Named Insured Policy Number R F DUNCAN c ASSOCIATES, INC BLS (19) 56 69 63 77 DBA THE GRANGER COMPANY Policy Effective/Explratlon Date From 05/08/2018 To 05/08/2019 IF YOU REJECTED THIS COVERAGE, PLEASE RETURN THIS FORM TO: Attn Commerclal Lines Division -Terrorism PO Box 66400 London, KY 40742-6400 Note: Certain states (currently CA, GA, IA, IL, ME, MO, NY, NC, NJ, OR, Fill, WA, WI and WV) mandate coverage for loss caused by fire following a "certified act of terrorism" In certain types of Insurance policies. If you reject TRIA coverage In these states on those policies, you will not be charged any additional premium for that state mandated coverage. The summary of the Act and the coverage under your policy contained in this notice is necessarily general in nature. Your policy contains specific terms, definitions, exclusions and conditions. In case of any conflict, your policy language will control the resolution of all coverage questions. Please read your policy carefully. If you have any questions regarding this notice, please contact your agent NP 72 42 01 15 © 2D15 Liberty Mutual Insurance Page 2 of 2 NP 74 44 00 06 U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY NOTICE TO POLICYHOLDERS 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 coverages you are provided. This Notice provides information concerning possible Impact on your Insurance coverage due to directives Issued by OFAC. Please read this Notice carefully. Please refer any questions you may have to your insurance agent. The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presiden- tial declarations of "national emergency OFAC has Identified and listed numerous: • Foreign agents; a Front organizations; • Terrorists; • Terrorist organizations; and • Narcotics traffickers; as "Specially Designated Nationals and Blocked Persons", This list can be located on the United States Treasury's web site- http//www.treas.gov/ofac. In accordance with OFAC regulations, if it is determined that you or any other Insured, or any person or entity claiming the benefits of this Insurance has violated U.S. sanctions law or is a Specially Designated National and Blocked Person, as Identified by OFAC, this insurance will be considered, a blocked or frozen contract and all provisions of this Insurance are immediately subject to OFAC, When an Insurance policy Is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments also apply, © 2011 Liberty Mutual Insurance.All rights reserved, NP 74 44 09 06 Includes copyrighted metednl of Insurance Services Office,Inc.,with Its permission, Page 1 Of 1 NP 74 50 01 07 Important Notice Notice to Policyholders This explanation Is not a part of your Insurance policy, and It does not alter any of its provisions or conditions. Please refer any questions you may have to your Insurance agent, We would like to thank you for being a policyholder, We appreciate your business, If your policy contains a condition stating it is subject to a premium audit We would like to take this opportunity to explain how the audit process works and answer the most common questions we receive from our policyholders, The information in this notice will make it easier for you to prepare for your audit. Insurance Premium Audit Facts Audits can benefit our policyholders by allowing us to collect the appropriate amount of premium for each policy. Most commercial policies are written based on estimated or fluctuating exposure bases. At the end of the policy term an audit will determine the actual exposure bases and the premium will be adjusted accord- ingly.Acompany representative will conduct the audit. The premium auditor will examine and audit records that relate to your policy. The records necessary to complete the audit will vary, based on the coverages you have. Types of records that may be requested for your audit Include, but are not limited to: • Payroll Records, Including 941 forms • Sales Journals or income statements • General Ledger • Cash Disbursements Journal Subcontractor Certificates Keeping accurate and complete records will allow the auditor to properly classify and allocate your expo- sures correctly. Often there are allowable credits available according to insurance manual classification and rating rules. The premium auditor will be able to give you the credits, to which you are entitled, If your records provide the necessary details Providing the records your auditor needs can save you time and money as well as expedite the audit process. How Audits are Conducted Audits are handled in different ways, depending on the types of coverages you may have. We conduct audits in the following ways: Physical Audit - An auditor will contact you and set up a convenient time to personally come to your business and review your records. Phone Audit -Forms will be mailed to you, explaining what Is necessary to complete a phone audit. The phone auditor will contact you or your bookkeeper for this information. Voluntary Audit - Forms will be mailed to you for completion, We will provide you with contact Information ify you_need assistance In completing the forms NP 74 50 01 07 Completing the audit Many states have enacted legislation that governs the time In which an audit must be completed, billed and paid. This applies to audits for cancelled policies as well as regular audits. In order to comply with state regulations, It is important to make your records available for audit when our representative contacts you. We will make every effort to complete the audit within a reasonable time after the close of the policy period stated In your policy Frequently Asked Ouestions 0:What if I use subcontractors? A: Subcontractors ere factored In to the audit process Subcontractors who do not have Insurance are treated as though they are your employees at the time of the audit. If your subcontractor furnishes you with a certificate of liability or workers' compensation Insurance, your Insurance cost for that subcontractor could be less See your policy for details on limits of insurance requlred for certificates. 0: 1 have no employees and work alone, Does the Insurance company still need to complete an audit? A: Yes. The auditor will need to verify you worked alone by examining business records that may Include taxfllings,disbursements, and check stubs. 0: Do I need an audit if I have cancelled my policy or am no longer insured with you? A: An audit may still be necessary even if you no longer have an active policy with us The audit would cover the time period for which you were insured by us. Other factors that may determine If an audit Is necessary include the time the policy was in effect and the amount of premium Involved, 0: If I use leased employees but the leasing company carries the liability, are the leased employees excluded from my General Liability policy? A: No, The manual rules stipulate that all leased employees are covered on the Insured's policy. 0:Is it necessary to keep records on any casual labor I use? A: Yes. Casual labor payroll Is examined during the audit 0: What happens if I do not comply with the audit and fail to provide all necessary records and verifica- tion? A, It's Important to provide the necessary information in order to complete the audit, If you fail to do so, your policy may be cancelled or nonrenewed. You may also receive an estimated audit statement based on Increased policy exposure estimates due to non-compliance of audit. If you would like additional information about the policy audit process, your independent agent can assist you. The Premium Audit Department is also available to answer any questions you may have regarding this process. Please contact us at 1-868-224-9246 or via E-mail at PremlumAuditServices@libertymutual com NP 74 50 01 07 NP89710910 IMPORTANT POLICYHOLDER INFORMATION CONCERNING BILLING PRACTICES Dear Valued Policyholder: This insert provides you with Important Information about our policy billing practices that may affect you. Please review it carefully and contact your agent If you have any questions. Premium Notice: We will mail you a policy Premium Notice separately, The Premium Notice will provide you with specifics regarding your agent, fhe account and policy billed, the billing company, payment plan, policy number, transaction dates, description of transactions,charges/credits, policy amountbaloijee, Inlo�l- murn amount, and payment due date This Insert expialns fees that may apply to and be shown on your Premium Notice. Available Premium Payment Plans: • Annual Payment Plan: When this plan applies, you have elected to pay the entire premium amount balance shown on your Premium Notice In full. No installment billing fee applies when the Annual Payment Plan applies. • Installment Payment Plan: When this plan applies, you have elected to pay your policy premium in installments (e.g,: quarterly or monthly installments - Installment Payment Plans vary by state), As noted below, an Installment fee may apply when the Installment Payment Plan applies. The Premium Payment Plan that applies to your policy is shown on the top of your Premium Notice. Please contact your agent if you want to change your Payment Plan election. Installment Payment Plan. Fee: If you elected to pay your premiums In installments using the Installment Premium Payment, Plan, an Installment hiding tee applies to each installment, bill. The installment tiling charge will not apply, however, if you pay the entire balance due when you receive the bill for the first installment. Because the amount of the installment charge varies from state to state, please consult your Premium Notice for the actual fee that applies. Dishonored Payment Fee: Your financial institution may refuse to honor the premium payment withdrawal request you submit to us due to insufficient funds in your account or for some other reason. If that is the case, and your premium payment withdrawal request Is returned to us dishonored, a payment return fee will apply. Because the amount of the return fee varies from state to state, please consult your Premium Notice for the actual fee that applies. Late Payment Fee: If we do not receive the minimum amount due on or before the date or time the payment Is due, as Indicated on your Premium Notice, you will receive a policy cancellation notice effective at a future date that will also reflect a late payment fee charge Issuance of the cancellation notice due to non-payment of a scheduled installment(s) may result in the billing and collection of all or part of any outstanding premiums due for the policy period, Late Payment Fees vary from state to state and are not applicable in some states. Special Note: Please note that some states do not permit the charging of certain fees. Therefore, if your state does not allow the charging of an Installment Payment Plan, Dishonored Payment or Late Payment Fee,the disallowed fee will not be charged and will not be included on your Premium Notice EFT-Automatic Withdrawals Payment Option: When you select this option, you will not be sent Premium Notices and, in most cases, will not be charged Installment fees. For more information on our EFT-Auto- matic Withdrawals payment option, refer to the attached policyholder plan notice and enrollment sheet Once again, please contact your agent if you have any questions about the above billing practice informa- tion, Thank you for selecting us to service your insurance needs. NP 89 71 09 10 0 2010 Liberty mutual insurance company,All rights reserved. Page 1 of 1 NP 96 00 10 14 GENERAL LIABILITY ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION EXCLUSIONS ADVISORY NOTICE TO POLICYHOLDERS Dear Valued Policyholder, Thank you for selecting us as your carrier for your commercial insurance. Your renewal policy contains an exclusion regarding access or disclosure of personal information. There Is more then one version of the exclusion and each Is described below, please note that not all of the forms or changes noted may apply to your specific policy. Any of the forms described in this notice may have comparable state specific forms in lieu of the forms mentioned below, In those situations, the title of the state forms on your policy will generally be very similar to one or more titles mentioned in this notice, The changes described below would also apply to those state specific forms, unless noted otherwise, In addition, this notice does not reference every change made to the endorsements or coverage forms, only material (or significant) changes. Please read your policy and review your declarations page for complete coverage information, No coverage Is provided by this notice, nor can it be construed to replace any provisions of your policy, If there are discrepancies between your policy and this notice, the provisions of the policy shall prevail. Should you have questions after reviewing the changes outlined below, please contact your broker or agent Thank you for your buslness. With respect to bodlly injury and property damage arising out of access or disclosure of confidential or personal Information, these changes are a reinforcement of coverage intent. Damages related to data breaches, and certain data-related liability, are not Intended to be covered by various liability coverage parts, These types of damages may be more appropriately covered under certain coverage endorsements providing data compromise, attack and extortion and network security liability, CG 21 06 05 14- Exclusion -Access Or Disclosure Of Confidential Or Personal Information And Data-related Liability - With Limited Bodily Injury Exception (For Use With The Commercial General Liability Coverage Part) When this endorsement Is attached to your policy: o Under Coverage A - Bodily Injury And Property Damage Liability, coverage is excluded for damages arising out of any access to or disclosure of confidential or personal information This Is a reinforce- ment of coverage. • Under Coverage B - Personal And Advertising Injury Liability,coverage Is excluded for personal and advertising injury arising out of any access to or dlscios,ure of confidential or personal Information. 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. CG 21 07 0514- Exclusion Access Or Disclosure Of Confidential Or Personal Information And Data-related Liability • Limited Bodily Injury Exception Not Included (For Use With The Commercial General Liability Coverage Part) When this endorsement Is attached to your policy: • Under Coverage A- Bodily injury And Property Damage Liability,coverage is excluded for damages arising out of any access to or disclosure of confidential or personal Information. This Is a reinforce- ment of coverage, Havvever when this endorsement is attached, it will result In a reduction of coverage due to the deletion of an exception with respect to damages because of bodily Injury arising out of loss of, loss of use of, damage to, corruption of, Inability to access, or Inability to manipulate electronic data. © 2014 Llberty Mutual Insurance NP 96 00 10 14 Includes copyrighted material of Insu,s,de services office, Inc.,with its permission, Page 1 of 2 • U rider Coverage B - Personal And Advert is I rig injury Liability,coverage Is O.xc I udad for personal and advertising Injury allSing Out Of any access to or disclosure of confidential or personal information To the extent that any access or disclosure of confidential or personal information results in on oral or written publication that violates a person's i of privacy, this may result In a reduction In coverage, CG 21 08 05 14 - Exclusion - Access Or Disclosure Of Confidential Or Personal Information (Coverage B Only) (For Use With The Commercial General Liability Coverage Part) When this endorsement is attached to Your Policy, coverage Is excluded for personal and advarnsulg Injury arising out of any access to or disclosure of confidential or personal' Information. To the extent that any access or disclosure of confidential or personal Information results In an oral or written poblica6con than. violates a person's right of privacy,this may result in a reduction in coverage. CG 04 37 05 14- Electronic Data Liability (For Use With The Commercial General Liability Coverage Part) With respect to damages arising out of access or disclosure of confidential or personal Information, when this endorsement is attached to your policy; • Under Coverage A - Bodily Injury And Property Damage Liability, coverage Is excluded for damages arising out of any access to or disclosure of confidential or personal information, This Is a reinforce- ment of coverage. • Under Coverage B- Personal And Advertising Injury Liability, coverage is excluded for personal and advertising Injury arising out of any access to or disclosure of confidential or personal informal 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. CG 33 53 05 14- Exclusion-Access Or Disclosure Of Confidential Or Personal Information And Data-related Liability - With Unri Bodily Injury Exception (For Use With The Owners And Contractors Protective Liability Coverage Part and Products/Completed Operations Coverage Part) When this endorsement Is attached to your policy, coverage Is excluded for damages arising out of any access to or disclosure of confidential or personal Information This is a reinforcement of coverage. CG 33 59 05 14- Exclusion -Access Or Disclosure Of Confidential Or Personal Information And Data-related Liability - Limited Bodily Injury Exception Not Included (For Use With The Owners And Contractors Protec- tive Liability and Prod ucts/Co an plated Operations Liability Coverage Parts) When this endorsement Is attached to your policy, coverage is excluded for damages arising out of any access to or disclosure of confidential or personal Information. This is a reinforcement of coverage. However, when this endorsement Is attached, It will result In a reduction of coverage due to the deletion of an exception with respect to damages because of bodily Injury arising out of loss of, loss of use of, damage to,corruption of, inability to access, or inability to manipulate electronic data. CG 33 63 05 14 - Exclusion - Access, Disclosure Or Unauthorized Use Of Electronic Data (For Use With The Electronic Data Liability Coverage Part) With respect to damages arising Out Of access Or disclosure of confidential or personal information, when this endorsement Is attached to your policy coverage Is excluded for damages arising out of any access to or disclosure of confidential or personal information. This Is a reinforcement of coverage. However, to the extent that damages arising out of theft or unauthorized viewing, copying, use, corruption, manipulation or deletion, of electronic data by any Named Insured, past or present employee, temporary worker or volunteer worker of the Named Insured may extend beyond loss of electronic data arising out of such theft or:he other listed items,this revision may be considered a reduction in coverage @ 2014 1.1borty Mutual Insurance NP 96 00 10,14 Includes copyrighted material of Insurance Sorvirlos Office, Inc,,with its ri Page 2 of 2 Caverage Is Provided In: Policy Numbor: Liberty Ohio Security Insurance Company Ot,S (19) 56 69 53 77 I� ttttsal. / ..__ I'pIV�F°odrltl. INaua"rAAce From 05/08/2018 To 05108/2090 Common Policy Declarations 1P:01 am Standard Time at li),;v'w d M'a/tlit0l.ocatl0rr Named Insured&_Mailing Address Agent Mailing Address&Phone No. R P DUNCAN & ASSOCIATES, INC (360) 3 52-75 88 DEA THE GRANGER COMPANY DUNCAN & ASSOCIATES INC PO BOX 12300 PO BOX 1458 OLYMPIA, WA 98508 OLYMPIA, WA 98507-1458 Named insured Is: CORPORATION Named Insured Business Is: REAL ESTATE APPRAISER In reruns for the payintad of the premiuny and subject to all the terms of this policy, we agree with you to provide the insurance as stated In this policy, SUMMARY OF COVERAGE PARTS AND CHARGES This policy consists of this Common Policy Declarations page, Common Policy Conditions, Coverage Parts (which consist of coverage forms and other applicable forms and endorsements, if any, issued to form a part of them) and any other forruS and endorsements issued to be part of [his policy. COVERAGE PART CHARGES Commercial General Liability $250.00 Totrrl Chat'gcs for all of the trbcwar eovertige.harts: $250.00 Certified Acts of Terrorism Ci)verage: $'I,00 (Itaeluded) Note. This is not a bill IMPORTANT MESSAGES . This policy Is auditable. Please refer to the conditions of the policy for details or contact your agent. Issue Date 03/15/18 Iluthorized Representative ro report a claim, call your Agent or 1-690.362-0000 DS 70 21 11 16 03/15/i8 66686377 N0180462 235 NCAFPPND AGENT COPY 000447 PAGE 17 OF 20 Coverage Is Provided In: Uberty OhloSacut6ylnsurancaC© Aa y _ Policy Number; Uttla BLS (19) 56896377 9MenRaHne POhcy Period: Common Polic Declarations 105/0012018To05108/2019 Y 12:01 am Standard Time Named Insured Agent at Insured Mailing Location R F DUNCAN & ASSOCIATES, INC (360) 352-7588 DBA THE GRANGER COMPANY DUNCAN & ASSOCIATES INC POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed Information concerning your coverage, FORM NUMBER TITLE CG 00 01 04 13 Commercial General Liubllity Coverage Form - Occurrence CG 01 81 05 08 Washington Changes CG 01 97 12 07 Washington Changes - Employment-Related Americas Exclusion CG 21 06 05 14 Exclusion - Access Or Disclosure Of Confidential Or Personal Information And Data-Related Liability - With Limltcd Bodily Injury Exception CO 21 70 01 15 Cap on Losses from Certified Acts of Terrorism CG 21 76 01 15 Exclusion of Punitive Damages Related to a Certified Act of Terrorism CO 22 24 04 13 Exclusion - Inspection, Appraisal and Survey Companies CG 24 26 04 13 Amendment of Insured Contract Definition CG 26 77 12 04 Washington - Fungi or Bacteria Exclusion CG 84 99 08 09 Non-Cumulation Liability Limits Same Occurrence CG 88 10 04 13 Commercial General Liability Extension CG 88 77 12 08 Medical Expense At Your Request Endorsement CO 89 27 10 09 Washington Exclusion- Asbestos IL Ol 23 11 13 Washington Changes - Defense Costs IL 01 46 08 10 Washington Common Policy Conditions IL 01 98 09 08 Nuclear Energy Liability Exclusion Endorsement (Broad Form) In witness whereof, we have caused this policy to he signed by onr authorized officers, Mark Touhey Paul Condrin Secretary President ro report a claim,call your Agent or 1-600-362.0000 DS 70 21 11 16 03/15118 55696377 N0180462 235 NCAFPPNO AGENT DOPY 000447 PAGE 18 OF 20 Coverage Is ProVlded In: Polley Number hiiavl'#y Ohio Security Insurance Compaoy BLS (19) 56 69 63 77 w1motllal. PoIICw 9'rOrIU(° iweoaawee Commercial General Liability From05/00/2018To05/08/2019 Declarations 12,'01 am standard Time at Insured Ma111ng Location Basis:Occurrence Named Insured Agent R P DUNCAN & ASSOCIATES, INC (360) 352-7588 DBA THE GRANGER COMPANY DUNCAN & ASSOCIATES INC SUMMARY OF LIMITS AND CHARGES Commercial DESCRIPTION LIMIT General Et Occurrence Llmit 1,000, 0 Liability _ .... _._ _.....m...... _..� ..._. Limits of Damage To Remises Rented To You Limit (Any One Premises) 1 000 000 Insurance Medical Expense Limit (Any One Person) 15,000 Personal and Advertising Ir�ury Limit 1,000,000 General Aggregate Limit (Other than Products Completed Operations) 2,000,000 Products - Completed Operations Aggregate Limit 2,000,000 Explanation of DESCRIPTION PREMIUM Charges .. . . D General Liabdily Schedule locals 166.0. - 0 Policy Writing Minimum Premium Adjustment 83.00 Certified Acts of Terrorism Cover age 1,00 __..._..... _ ............ ...___. ,-_. .,... _.. - ... __. Total Advance Charger $250.00 NMe: This is not a hill To report a claim, call yoarAgent or 1.880-382-8880 DS 70 22 01 08 03/15/1a 56696377 N0180462 235 NCAFPPNO AGENT COPY 000447 PAGE 19 OF 20 Coverage Is Provided In: 1.&19C1"(�" ONG Security Insurance Company Policy Number: — BLS (19) 56 69 63 77 14i4ia sei Policy Period'. Commercial General Liability From 05/08/2018 To 05/08/2019 Declarations Schedule 12:01 am standard Time at Insured Mailing Location Named Insured Agent R F DUNCAN & ASSOCIATES, INC (360) 352-7588 DBA THE GRANGER COMPANY DUNCAN & ASSOCIATES INC SUMMARY OF CLASSIFICATIONS - BY LOCATION 0001 909 West Bay Dr NW, OL YMPIA, WA 96502 Insured: R P DUNCAN & ASSOCIATES, INC CLASSIFICATION- 96317 Inspection And Appraisal Companies - Inspecting For Insurance Or Valuation Purposes Products-Completed Operations Are Subject To The. General Aggregate Limit. RATED/PER COVERAGE DESCRIPTION PREMIUM BASED ON- Executive Officers 1,000 PREMIUM Premise/Operations 17,800 Dollars Of Payroll 8.005 $142.00 Minimum Premium Adjustment $24.00 Tolni. Included CLASSIFICATION 96317 Inspection And Appraisal Companies - Inspecting For Insurance Or Valuation Purposes Products-Completed Operations Are Subject To The General Aggregate Limit, RATED/PER COVERAGE DESCRIPTION PREMIUM BASED ON- Employees Payroll 1,000 PREMIUM PremiselOperationg Dollars Of Payroll if any 8.CO5 Tnlnl.• ' Commercial General Liability Schedule Total $166.00 To report a claim, call your Agent or 1.800-362.000D DS 70 23 10 16 03/15118 56606377 N0180462 236 NCAFPPNC AGENT COPY 000447 PAGE 20 01 20 tl CERTIFICATE OF INSURANCE Pmduccr Issue Doe'.07/30/2018 Ibis Cerh FL,a e is innurel as a muter of information only end LIA ADMINISTRATORS & INSURANCE SFILV ICES roofers no rights upon the Certifcare Holder.ThLs Certificate P.O.Box 1319 docv not a amid,ex lend or alter the coverage affnrdcd by die Santa Barbara, CA 93 1 02-1 1 1 9 policy belo., Insured, 148215 COMPANY AFFORDING COVERAGE DUNCAN,RI, AND ASSOCIATF,S INC. 'I he Ganger Company Aspen American Insurance Company Richard F.Dmican P.O. Box 12300 Olympia,WA 98508 Fax Number: 360-867-1059 Aullionzed Representative 'I Isis is to certify that the policy of insurance listed below has been 'issued to like hisured named ahove fur the policy period indicated. Notwithstanding any requircmcm, term of condition of any contract or other domarnenl will,respuet to which this Certificate tnay be issued or may pertain, the insurance afforded by the policy described herein is subject to all the Loons, exclusions and conditions of such policy.Limits shown may have been reduced by paid claims. DISCLAIMER:This certiticatc of iustri does not affirmatively or negatively amend,extend, or after the coverage afforded by the insurance,policy_ TVPG OF INSURANCE POLiCV NUMBER 1 I FFC7IVF DATE GXPIRATIUN DATF IJMI75 Frafessiooal Liahility AA100"412 01 07/2U2018 07/21/2019 Each Claim $ 1,000,000 General Aggregate $ 2,000,000 Description of Upera[ions/LooaLious/Special Items: REAL ESTATE APPRAISERS PROFESSIONAL LIABILITY INSURANCE Certilicale Holder Cancellation: City of Kcnt, WA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 220 Fourth Avenue South BE CANCELLED BEFORE THE EXPIRATION DATE Kent, WA 98032 THEHk:OF, NOTICE WILL BE DELIVERED IN ACCORDANCE WFPH THE POLICY PROVISIONS. LIA0001 (11/97)