The URL can be used to link to this page

Home My WebLink AboutBEAN SPROUTS, LLC (2)URANCE NOT ON FILE A-2018-113-01 FEB 0 4 2021 '1ORK MAY NQT PPROCEED CLERK OF COUNCIL DATE; FIRST AMENDMENT TO Q {21ZCSA(1)(SIIviCtCclvaC)FA- FOOD SERVICE CONCESSION AGREEMENT WITH BEAN SPROUTS LLC THIS FIRST AMENDMENT to the Food Concession Agreement for the Santa Ana Zoo with Bean Sprouts LLC is entered into this --LONay of December, 2020, by and between the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California ("City"), and Bean Sprouts, LLC, a Wisconsin limited liability company ("Bean Sprouts"). RECITALS A. On May 1, 2018, the City entered into the Food Service Concession Agreement for Santa Ana Zoo #A-2018-113 with Bean Sprouts to provide food and beverages at the Santa Ana Zoo. B. From March 16, 2020 to October 16, 2020, Bean Sprouts food service at the Santa Ana Zoo was closed due to COVID-19 related closures of the Santa Ana Zoo. C. The parties desire to amend said Agreement to provide concessions to Bean Sprouts to reflect the impact of COVID-19 closures and the continuing effect of COVID-19 resulting in a decrease of food and beverage sales at the Santa Ana Zoo. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions of said Agreement, except as herein modified, the parties agree as follows: The parties agree that the provisions of Section 3 requiring lease payments and quarterly lease guarantee were waived between March 16, 2020 and October 16, 2020 due to the closure of the Santa Ana Zoo; 2. Section 3b, Lease Payments and Quarterly Lease Guarantee, shall be amended to read as follows: b. Bean Sprouts agrees to a minimum quarterly lease guarantee of $8400 a quarter in the event that Bean Sprouts gross revenues from concessions do not exceed $8400 a quarter. The lease guarantee will start on the first day of the month after the Go Live Date and will continue thereafter until this Agreement expires or is terminated. Effective October 17, 2020, the minimum quarterly guarantee will restart when Bean Sprouts has gross monthly sales of $45,000. 3. Section 3, Lease Payments and Quarterly Lease Guarantee, shall be amended to add subsection d: d. Effective October 17, 2020, Bean Sprouts agrees to pay 2% of monthly gross sales until they reach gross sales of $15,000 a month. Bean Sprouts agrees to pay 4% for gross monthly sales between $15,000 and $30,000. Bean Sprouts agrees to pay 6% of monthly gross sales for gross monthly sales above $30,000 a month. Bean Sprouts will need to hit the target in one month in order to trigger the new tier. For example, $30,000 of gross sales in December 2020 will trigger the 6 % payment moving forward. 4. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment to said Agreement the date and year first above written. ATTEST: DAISY Clerk of the Council APPROVED AS TO FORM: Sonia R. Carvalho City Attorney c�aun4. A . R Laura A. Rossini Acting Chief Assistant City Attorney RECOMMENDED FOR APPROVAL: /.% CITY OF SANTA ANA KRISTINE RIDGT City Manager BEAN SPROUTS, LLC. Executive Director Parks, Recreation, and Community Services Agency ,,-+LQ! llv arthen (Name) Co-founder and Co -CEO (Title) Digitally signed by Francine R. Francine R. Villareal Villareal Date: 2021.02.01 16:01:31-08'00' AC„C) " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1/28/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: FirstMark Insurance Group, Inc. FirstMark Insurance Grou , Inc p PHONE 425 582-9037 A/C, No, Ext : (A/C, No): ADDRESS: commercial@firstmarkinsurance.com 210 S Main St, Suite 203 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : SENTINEL INS CO LTD 11000 Edmonds WA 98020 INSURED INSURER B : INSURER C : Bay Sprouts LLC INSURER D : 11800 Foothill Blvd INSURER E : INSURER F : Sylmar CA 91342 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL a ADV INJURY $ 1,000,000 A Y 59SBARV9040 11/13/2020 11/13/2021 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ JJECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 HRDBB $ 1,000,000 OTHER: AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 59SBARV9040 11/13/2020 11/13/2021 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY /� AUTOS ONLY ��// /C (Per accident) $ x UMBRELLA LAB x OCCUR EACH OCCURRENCE $ 6,000,000 E IEXCESS LAB CLAIMS -MADE 59SBARV9040 11/13/2020 11/13/2021 AGGREGATE $ 6,000,000 DED I X RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 59WECAC9055 07/3/2020 07/3/2021 X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Bean Sprouts dba Bay Sprouts LLC. City of Santa Ana, Risk Management, its officers, employees, agents, representatives, and volunteers are included as Additional Insured with respect to General Liability where required by written contract. This insurance is Primary and Non -Contributory over any other insurance. 30-day written cancellation applies; 10-days in the event of non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division 20 Civic Center Plaza, 4th floor Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE * p�q �, - _ _— NS3R M&T7Agt'.Mh2dUltViBfOR RA REVIEWED & APPRovED BY.- .. ° ' Vd Wsk MPanngement Analyst © 1988-2015 ACORD ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Bean Sprouts 655 S. Main St. #200 Orange, CA 92868 kelly@beansprouts.com 714.883.2697 12/ 10/2020 City of Santa Ana Risk Management Division 20 Civic Center Plaza, Santa Ana, CA 92702 Re: Professional Liability Insurance Requirement. Dear City of Santa Ana Risk Management Division: I, Kelly Parthen, co-founder of Bean Sprouts, am not a licensed professional and will not employ a licensed professional during the course of my contract with the City of Santa Ana, CA. Sincerely, Kelly Parthen Co-founder Bean Sprouts ew cF RAMwagementDMsian �40 1°x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst Bean Sprouts 655 S. Main St. #200 Orange, CA 92868 kelly@beansprouts.com 714.883.2697 12/ 10/2020 City of Santa Ana Risk Management Division, 4' floor 20 Civic Center Plaza, Santa Ana, CA 92702 Re: Auto Insurance Requirement and Release of Liability. Dear City of Santa Ana Risk Management Division: I, Kelly Parthen, co-founder of Bean Sprouts, hereby release the City of Automobile Liability. I do not use/drive any vehicle during the course and scope of my agreement with the City of Santa Ana, CA Sincerely, Kelly IYrthen Co-founder Bean Sprouts ew cF RAMwagementDMsian �40 1°x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THE HARTFORD BUSINESS SERVICE CENTER THE 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 FIRSTMARK INSURANCE GROUP INC / 59305815 210 5TH AVENUE SOUTH STE 203 EDMONDS WA 98020 Policy Information: Policy Holder Details: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Policy Number: 59 WEC AC9055 May 25, 2020 Enclosed please find information pertaining to your policy. Please contact us if you have any questions or concerns. Thank you for selecting The Hartford for your business insurance needs. Sincerely, Your Hartford Service Team WLTRO04 cF RA ManWmed DMsian REVIEWED & APPROVED SY.- V"° --� Risk janagement Analyst ew cF RAManagementDMsian Jy/\'x REVIEWED & APPROVED BY: v --� Risk Pjanagement Analyst Policy Number 59 WEC AC9055 BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Dear Hartford Insured, Policy Effective Date 07/03/20 Re: An Important Message to Workers Compensation Policyholders The control of workplace accidents and injuries should be among the highest priorities of your firm. Each accident wastes precious human and financial resources, and introduces inefficiencies into your operations. From a practical standpoint, the control of accidents, and their inevitable costs, simply makes good business sense. An effective risk engineering program can save you money and aggravation, can positively impact your loss experience (and thus your premium), and most importantly, can help you maintain solid control of your operations. As a service to you, our valued customer, the Risk Engineering Department of The Hartford in cooperation with your independent agent, can assist you in establishing risk engineering strategies. If you would like assistance, please complete and return to us the reply portion of this brochure, or contact your independent agent. Services Available The following is a description of some of the services that we provide. The types of services that may be appropriate for your business depend upon the nature and size of your operations and the specific risk engineering services you have requested. The cost of risk engineering services may or may not be a part of your insurance premium. This depends on the extent of the requested services, agreements stated in your insurance policy and program, and statutory regulations that may require us to provide risk engineering services. 1) Reference Materials — Information about risk engineering topics that can be provided or made available to you to help you to enhance your risk engineering program. 2) Telephone Consultation — We can hold a teleconference with you to help you to evaluate your risk engineering program, identify areas for improvement, and recommend ways to implement such improvements. 3) Onsite Consultation — This consists of visiting your premises and helping you to assess and remedy your risk engineering needs onsite. This level of service is usually only appropriate for larger, higher hazard operations. The following are examples of some of the services that could be provided onsite: o A review of your safety program to determine its adequacy and recommend modifications to that plan where needed. REVIEWED & APPROVED BY.- v Policy Expiration R.Wjanagementftalpt Form 97485 16th Rev. Printed in U.S.A. Process Date: 05/25/20 o Specific hazard evaluations, including ergonomics, industrial hygiene or material handling. o An initial survey and evaluation to address potential safety and health hazards. o Consultation to help management establish a comprehensive loss prevention Program. o Periodic summaries of accidents and analysis of causes. o Follow-up visits to check on progress and to provide continuing assistance when required. A Word About OSHA The Occupational Safety and Health Act of 1970 and similarly approved State Plans require employers to provide their employees with safe and healthful places to work. The Occupational Safety and Health Administration (OSHA) of the U.S. Department of Labor and similar State agencies enforce the regulations and apply penalties (civil and criminal) for non-compliance. New standards have been developed, and through application and interpretation, standards change. You should make yourself aware of the standards that are applicable to your operations, and assure yourself that reasonable efforts are made to be in compliance. Copies of the standards are available through most libraries, or can be obtained through OSHA or the U.S. Government Printing Office. You should know that neither The Hartford, nor any other party, can fulfill your obligations under the Law. Questions related to your legal obligations should be referred to your legal counsel. Some Safety Reminders from The Hartford: Have you considered: o The need to formalize your safety efforts to assure compliance and document your efforts? o The need to acquire Material Safety Data Sheets on all hazardous materials and the need for training on appropriate safety measures for your employees? o Requirements for record keeping of injuries, illnesses, and exposure to hazardous substances? o Assessing each job task to determine hazards and needed controls? o Measuring each exposure to hazardous substances to determine the need for control or personal protective equipment? o What mechanisms are in place to periodically verify that exposure controls (guards, ventilation systems, etc.) are still in place and working? o What specific training your employees and your supervisors need to avoid hazards in the workplace? o What specific OSHA standards apply to your business? Form 97485 16th Rev. Printed in U.S.A. �40 1°x REVIEWED & APPROVED BY.- V"° W-- PIR Rt fjanagement Analyst o What mechanism exists to promptly investigate all accidents and 'near -misses' to limit the chance of another occurrence? o The financial impact an injury or illness has on your business? o What resources are available to you to help prevent accidents and illnesses? Thank you for your business. Sincerely, The Hartford's Risk Engineering Department Form 97485 16th Rev. Printed in U.S.A. �40 1°x REVIEWED & APPROVED BY.- V"° W-- MIR Rt fjanagement Analyst THIS BROCHURE IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY. IT IS NOT INTENDED TO BE A SUBSTITUTE FOR A COMPLETE ON -SITE SAFETY INSPECTION CONDUCTED BY A QUALIFIED RISK ENGINEERING SPECIALIST. READERS ARE ENCOURAGED TO HAVE SUCH AN INSPECTION CONDUCTED BOTH TO PROMOTE WORKPLACE SAFETY AND TO COMPLY WITH APPLICABLE LAW. FOR ADDITIONAL INFORMATION OR ASSISTANCE, EITHER TELEPHONE OR MAIL THIS FORM TO YOUR HARTFORD AGENT OR NEAREST OFFICE OF THE HARTFORD NOTICE TO ARKANSAS POLICYHOLDERS The Hartford is required by law to provide its policyholders with certain accident prevention services at no additional cost as required by ARK. Code Ann. §11-9-409(D) and Rule 32. If you would like more information, call The Hartford's Risk Engineering Department, One Hartford Plaza, T-7, Hartford, CT 06155 at 1-866-586-0467. If you have any questions about this requirement, call the Health and Safety Division, Arkansas Workers' Compensation Commission at 1-800-622-4472. NOTICE TO CALIFORNIA POLICYHOLDERS The Hartford is required by law to provide its policyholders with certain occupational safety and health risk engineering consultation services as required by the California Labor Code, §6354.5, at no additional charge. If you would like more information call The Hartford's Risk Engineering Department at 1-866-586- 0467 for occupational safety and health risk engineering consultation services. California Workers Compensation insurance policyholders may register comments about the insurer's risk engineering consultation service by writing to: State of California Department of Industrial Relations Division of Occupational Safety and Health P.O. Box 420603 San Francisco, California 94142 NOTICE TO PENNSYLVANIA POLICYHOLDERS The Hartford maintains and provides accident and illness prevention services as required by the nature of the policyholder's business or its operation, in accordance with the Pennsylvania Workers' Compensation Act. For more information about these services contact your Hartford Agent or nearest office of The Hartford. Form 97485 16th Rev. Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst NOTICE TO TEXAS POLICYHOLDERS Pursuant to Texas Labor Code §411.066, The Hartford is required to notify its policyholders that accident prevention services are available from The Hartford at no additional charge. These services may include surveys, recommendations, training programs, consultations, analyses of accident causes, industrial hygiene and industrial health services. The Hartford is also required to provide return -to -work coordination services as required by Texas Labor Code §413.021 and to notify you of the availability of the return -to -work reimbursement program for employers under Texas Labor Code §413.022. If you would like more information, contact The Hartford at 1-866-586-0467 and email contactriskengineering@thehartford.com for accident prevention services or 1-877-952-9222 and email CentralClaimCenter.WCEDM@thehartford.com for return -to -work coordination services. For information about these requirements call the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) at 1-800-687-7080 or for information about the return -to -work reimbursement program for employers call the TDI-DWC at 1-512-804-5000. If The Hartford fails to respond to your request for accident prevention services or return -to -work coordination services, you may file a complaint with the TDI-DWC in writing at http://www.tdi.texas.-gov or by mail to Texas Department of Insurance, Division of Workers' Compensation, MS-8, at 7551 Metro Center Drive, Austin, Texas 78744-1645. Form 97485 16th Rev. Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst To The Hartford's Risk Engineering Department: Yes — I am interested in obtaining information concerning: General Topics Business Continuity Accident Analysis Business Travel Safety Accident Investigations Establishing a Risk Engineering Program Hazard Recognition Safety Committees Ergonomics Back Injury Prevention Computer Workstation Cumulative Trauma Disorders Ergo Train -the -Trainer Telecommuting Transportation 3-D Driver Training Driving Defensively Fleet Newsletter Guide to Successful Driver Mgmt School Bus Driving Tips Name Company Address City & State Email Address: Contingency Planning Overview Emergency/Disaster Response Emergency Evacuation Drills Construction Construction Site Consultation Construction Equipment Hazards Hazard Communication Ladders & Scaffolds Emergency Preparedness Planning Trenching & Evacuation Industrial Hygiene Hazard Communication Industrial Hygiene (general) Indoor Air Quality Noise Exposures Respiratory Protection Workers' Compensation Bloodborne Pathogens Drug Screening Machine Safeguarding Return to Work Programs Slip and Falls Policy # Zip Code Telephone Fall Protection Property Automatic Sprinkler System Flammable Liquids Fire Prevention and Protection Fire Drill and Evacuation Hot Work Permit Program Other Topics Business Risk Management General Liability Investigations Product Liability Programs Safety Training Security/Terrorism For more information on the above, you can visit our website at https://www.thehartford.com/riskenclineerincl Or you may forward your request to: Fax line: 1-860-723-4459 Or mail to: The Hartford Financial Services Group Risk Engineering Department Form 97485 16th Rev. Printed in U.S.A. One Hartford Plaza, T-7 Hartford, CT 06155 wo„. RAMwwAmedDMsiun F Jy/ \'x REVIEWED & APPROVED BY: .. V --� Risk Pjanagement Analpt MAINTAINING YOUR RECORDS FOR AUDIT PURPOSES WHAT IS A PREMIUM ADJUSTMENT? When your Workers' Compensation policy was issued you paid a deposit premium based on the nature of your business and estimates of your payroll. At the end of the policy period, we conduct an audit to compare the estimates against the actual figures and operations. Based on this comparison an adjustment is made. If the actual premium is less than what you already have paid, a refund will be made. If it's more, you will be billed for the difference. These adjustments are subject to any minimum premiums that apply. HOW WILL THE PREMIUM ADJUSTMENT BE MADE? On smaller, less complex operations we may e-mail you, call you, or mail you a request to ask you to provide the information via our online web -based portal, mail or telephone. If we require this information, we will provide an electronic link to, or a paper copy of, the necessary forms for you to complete. On larger, more complex operations one of our Premium Auditors will contact you for an appointment. You will be contacted either by e-mail, telephone or mail. If directed, the auditor will contact your accountant to obtain as much information as possible and contact you at a later time for additional information that may be needed. BASIS OF PREMIUM Remuneration (Payroll) in most states, includes: Payment of: Wages, bonuses, commissions, overtime,* sick pay, vacation pay,* tool allowances, contributions to individual retirement accounts, employee contributions to employee benefit plans. Payments on basis of: Piece work, incentive plans, profit sharing. The value of: Housing furnished to employees,* meals furnished to employees,* store certificates, merchandise and other dollar substitutes. Form 98456 5th Rev. 12-13 Printed in U.S.A. Remuneration does not include: a. Employer contributions to a group insurance or pension plan other than statutory plans of insurance. b. Special awards for individual inventions or discoveries. c. Overtime.* Subcontractors. In the absence of other insurance, most state laws hold a contractor responsible for injuries to employees of subcontractors. At the time of audit Certificates of Insurance must be available for subcontractors with employees, in order to avoid payment of premium. Independent Contractors, without employees, whose duties closely resemble those of an employee, will be considered your employee with the appropriate premium charged. The actual working relationship between you and the Independent Contractor is examined. Items such as, but not limited to: whether the work performed is an integral part of your operations, whether you have the right to control the details of the work, the method of payment, who supplied the materials used, does the person regularly work for others, whose regulatory authority did person operate under, whether the person is involved in a separate and distinct business offering the same services to the public. RECORDS As part of the policy conditions, we are allowed to examine your financial books and records to determine actual exposures and operations. We would appreciate your cooperation in making the needed records available for the auditor's inspection. What Records Will Be Needed? The records needed will vary. In most cases, the Premium Auditor will be able to obtain the necessary audit data from two or more of the following records: Journals, Ledgers, State and Federal Tax Reports, Individual Earning Cards, Checkbooks and Contracts. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst How You Should Keep Your Records By maintaining your payroll records in accordance with the following guidelines, you might reduce your insurance costs. Overtime. In most states, the amount paid in excess of straight time pay can be deducted if it can be verified in your records. You must maintain your records to show pay separately by employee and in summary by classification of work. *Division of an employee's payroll to more than one classification is not allowed in most states. Exception: For construction, erection or stevedoring operations the payroll of an employee may be allocated to each type of work performed if proper records are kept. Your records must show the number of hours and amount of payroll for each type of work. If you do not keep such a breakdown, the full salary must be charged to the highest rated classification to which the employee is exposed. Executive Officers in most states are considered employees of their corporation and included in the Form 98456 5th Rev. 12-13 Printed in U.S.A. computation of premium. Their remuneration is assigned without division to the actual operation in which they are engaged. If their duties are the same as those of a worker, foreman or superintendent, their payroll is assigned to the classification that develops the highest payroll. Minimum and maximum payrolls apply to executive officers. Automated Records. If your records are automated or you plan to automate in the near future you can obtain maximum benefits by setting up your records to include insurance requirements. Our Premium Auditor will be pleased to assist you in setting up your records. Contact your Hartford Representative if you would like this assistance. NOTE: The contents of this publication are not intended to supersede any definitions or conditions of your policy, the Workers' Compensation Law or any legal rulings. *Your state may have specific rules or exceptions. Please contact your Hartford Representative for details that may apply and answer questions you may have. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst POLICY HOLDER NOTICE - PAYROLL BILLING Thank you for choosing The Hartford. Your policy is on our payroll billing method. The payroll billing method uses actual payrolls received throughout the policy period and a blended rate(s) to determine premiums due during the policy period. To learn more about how your premium is calculated on the payroll billing method please visit: httos://www.thehartford.com/blended Below are the blended rate(s) being used for each state and classification code on your policy: State Class Code Blended Rate Effective 8: WI 8006 7.900000 07/03/2020 12: 201 E HARGETT ST, 8006 3.780000 07/03/2020 RALEIGH, NC 10: 1801 E CHESTNUT 8078 5.240000 07/03/2020 AVE, SANTA ANA, CA 11: 480 N ARROYO BLVD, 8078 5.240000 07/03/2020 PASADENA,CA 4: 557 MCREYNOLD'S RD, 8078 5.240000 07/03/2020 SAUSALITO, CA 3: 2500 N. MAIN ST, SANTA 8078 5.240000 07/03/2020 ANA, CA 9: 200 W ISLAND AVE, SAN 8078 5.240000 07/03/2020 DIEGO, CA 2: 11800 FOOTHILLS BLVD, 8078 5.240000 07/03/2020 SYLMAR,CA 1: 600 E WASHINGTON ST, 8006 1.920000 07/03/2020 PHOENIX, AZ 1: 600 E WASHINGTON ST, 8810 0.170000 07/03/2020 PHOENIX, AZ 7: 301 N WASHINGTON 8006 2.440000 07/03/2020 ST., NAPERVILLE, IL 5: CO 8006 1.820000 07/03/2020 6: 1805 N 30TH ST, 8006 1.820000 07/03/2020 COLORADO SPRINGS, CO ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- Form G-4119-0 Printed in U.S.A. ��` "° ©2017, The Hartford - -- Wsk Pjanagement Analpt IMPORTANT NOTICE TO POLICYHOLDERS DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT A. Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act, as amended (TRIA), we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for "certified acts of terrorism" under TRIA. The charge for terrorism is shown in Item 4 of the Information Page or on the Schedule. The rate for terrorism will apply as of the effective date of your policy. The terrorism rates are subject to change at any time based on state regulatory action. B. The following definition is added with respect to the provisions of this endorsement: 1. A "certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of TRIA, to be an act of terrorism under TRIA. The criteria contained in TRIA for a "certified act of terrorism" include the following: a. The act results in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to TRIA; and b. The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of an United States mission; and c. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. Form WC 66 03 37 H Printed in U.S.A. C. Disclosure Of Federal Share Of Terrorism Losses Under TRIA The United States Department of the Treasury will reimburse insurers for a portion of such insured losses as indicated in the table below that exceeds the applicable insurer deductible: Calendar Year Federal Share of Terrorism Losses 2015 85% 2016 84% 2017 83% 2018 82% 2019 81 % 2020 or later 80% However, if aggregate insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. The United States Government has not charged any premium for their participation in covering terrorism losses. D. Cap On Insurer Liability for Terrorism Losses Under TRIA If aggregate insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year and we have met, or will meet, our insurer deductible under TRIA we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst and our estimate that we will exceed our insurer deductible. In accordance with Treasury procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. E. All other terms and conditions remain the same. Form WC 66 03 37 H Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst Customer Privacy Notice The Hartford Financial Services Group, Inc. and Affiliates* (herein called "we, our, and us") This Privacy Policy applies to our United States Operations We value your trust. We are committed to the responsible: a) management; b) use; and c) protection; of Personal Information. This notice describes how we collect, disclose, and protect Personal Information. We collect Personal Information to: a) service your Transactions with us; and b) support our business functions. We may obtain Personal Information from: a) You; b) your Transactions with us; and c) third parties such as a consumer -reporting agency. Based on the type of product or service You apply for or get from us, Personal Information such as: a) your name; b) your address; c) your income; d) your payment; or e) your credit history; may be gathered from sources such as applications, Transactions, and consumer reports. To serve You and service our business, we may share certain Personal Information. We will share Personal Information, only as allowed by law, with affiliates such as: a) our insurance companies; b) our employee agents; c) our brokerage firms; and d) our administrators. As allowed by law, we may share Personal Financial Information with our affiliates to: a) market our products; or b) market our services; to You without providing You with an option to prevent these disclosures. We may also share Personal Information, only as allowed by law, with unaffiliated third parties including: a) independent agents; b) brokerage firms; Form WC 66 03 30 L Printed in U.S.A. c) insurance companies; d) administrators; and e) service providers; who help us serve You and service our business. When allowed by law, we may share certain Personal Financial Information with other unaffiliated third parties who assist us by performing services or functions such as: a) taking surveys; b) marketing our products or services; or c) offering financial products or services under a joint agreement between us and one or more financial institutions. We, and third parties we partner with, may track some of the pages You visit through the use of: a) cookies; b) pixel tagging; or c) other technologies; and currently do not process or comply with any web browser's "do not track" signal or other similar mechanism that indicates a request to disable online tracking of individual users who visit our websites or use our services. For more information, our Online Privacy Policy, which governs information we collect on our website and our affiliate websites, is available at https://www.thehartford.com/online-privacy-policy. We will not sell or share your Personal Financial Information with anyone for purposes unrelated to our business functions without offering You the opportunity to: a) "opt -out;" or b) "opt -in;" as required by law. We only disclose Personal Health Information with: a) your authorization; or b) as otherwise allowed or required by law. Our employees have access to Personal Information in the course of doing their jobs, such as: a) underwriting policies; b) paying claims; c) developing new product d) advising customers of ou Risk MmRganadDMsian Jy/ \'x REVIEWED & APPROVED BY. - I .° --� Rusk Pjanagement Analpt We use manual and electronic security procedures to maintain: a) the confidentiality; and b) the integrity of; Personal Information that we have. We use these procedures to guard against unauthorized access. Some techniques we use to protect Personal Information include: a) secured files; b) user authentication; c) encryption; d) firewall technology; and e) the use of detection software. We are responsible for and must: a) identify information to be protected; b) provide an adequate level of protection for that data; and c) grant access to protected data only to those people who must use it in the performance of their job - related duties. Employees who violate our privacy policies and procedures may be subject to discipline, which may include termination of their employment with us. We will continue to follow our Privacy Policy regarding Personal Information even when a business relationship no longer exists between us. As used in this Privacy Notice: Application means your request for our product or service. Personal Financial Information means financial information such as: a) credit history; b) income; c) financial benefits; or d) policy or claim information. Personal Financial Information may include Social Security Numbers, Driver's license numbers, or other government -issued identification numbers, or credit, debit card, or bank account numbers. Personal Health Information means health information such as: a) your medical records; or b) information about your illness, disability or injury. Personal Information means information that identifies You personally and is not otherwise available to the public. It includes: a) Personal Financial Information; and b) Personal Health Information. Transaction means your business dealings with us, such as: a) your Application; b) your request for us to pay a claim; and c) your request for us to take an action on your account. You means an individual who has given us Personal Information in conjunction with: a) asking about; b) applying for; or c) obtaining; a financial product or service from us if the product or service is used mainly for personal, family, or household purposes. If you have any questions or comments about this privacy notice, please feel free to contact us at The Hartford - Law Department, Privacy Law, One Hartford Plaza, Hartford, CT 06155, or at Corporate PrivacyOffice@thehartford.com. This Customer Privacy Notice is being provided on behalf of The Hartford Financial Services Group, Inc. and its affiliates (including the following as of March 2019), to the extent required by the Gramm -Leach -Bliley Act and implementing regulations. 1stAGChoice, Inc.; Access CoverageCorp, Inc.; Access CoverageCorp Technologies, Inc.; Business Management Group, Inc.; Cervus Claim Solutions, LLC; First State Insurance Company; FTC Resolution Company LLC; Hart Re Group L.L.C.; Hartford Accident and Indemnity Company; Hartford Administrative Services Company; Hartford Casualty General Agency, Inc.; Hartford Casualty Insurance Company; Hartford Fire General Agency, Inc.; Hartford Fire Insurance Company; Hartford Funds Distributors, LLC; Hartford Funds Management Company, LLC; Hartford Funds Management Group, Inc.; Hartford Group Benefits Holding Company; Hartford Holdings, Inc.; Hartford Insurance Company of Illinois; Hartford Insurance Company of the Midwest; Hartford Insurance Company of the Southeast; Hartford Insurance, Ltd.; Hartford Integrated Technologies, Inc.; Hartford Investment Management Company; Hartford Life and Accident Insurance Company; Hartford Life, Ltd.; Hartford Lloyd's Corporation; Hartford Lloyd's Insurance Company; Hartford Management, Ltd.; Hartford of Texas General Agency, Inc.; Hartford Residual Market, L.C.C.; Hartford Specialty Insurance Services of Texas, LLC; Hartford STAG Ventures LLC; Hartford Strategic Investments, LLC; Hartford Underwriters General Agency, Inc.; Hartford Underwriters Insurance Company; Heritage Holdings, Inc.; Heritage Reinsurance Company, Ltd.; HIMCO Distribution Services Company; HLA LLC; HL Investment Advisors, LLC; Horizon Management Group, LLC; HRA Brokerage Services, Inc.; Lattice Strategies LLC; Maxum Casualty Insurance Company; Maxum Indemnity Company; Maxum Specialty Services Corporation; MPC Resolution Company LLC; New England Insurance Company; New England Reinsurance Corporation; New Ocean Insurance Co., Ltd.; Nutmeg Insurance Agency, Inc.; Nutmeg Insurance Company; Pacific Insurance Company, Limited; Property and Casualty Insurance Company of Hartford; Renato Acquisition Co.; Sentinel Insurance Company, Ltd.; Trumbull Flood Management, L.L.C.; Trumbull Insurance Company; Twin City Fire Insurance Company; Y-Risk, LLC. Form WC 66 03 30 L Printed in U.S.A. cF IZAManagk:medDMsian REVIEWED & APPROVED BY.- v --� Risk Pjanagement Analyst POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE Coverage for acts of terrorism is included in your policy. You are hereby notified that under the Terrorism Risk Insurance Act, as amended in 2015, the definition of act of terrorism has changed. As defined in Section 102(1) of the Act: The term "act of terrorism" means any act or acts that are certified by the Secretary of the Treasury -in consultation with the Secretary of Homeland Security, and the Attorney General of the United States -to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and 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. Under your coverage, any losses resulting from certified acts of terrorism may be partially reimbursed by the United States Government under a formula established by the Terrorism Risk Insurance Act, as amended. However, your policy may contain other exclusions which might affect your coverage, such as an exclusion for nuclear events. Under the formula, the United States Government generally reimburses 85% through 2015; 84% beginning on January 1, 2016; 83% beginning on January 1, 2017; 82% beginning on January 1, 2018; 81 % beginning on January 1, 2019 and 80% beginning on January 1, 2020, of covered terrorism losses exceeding the statutorily established deductible paid by the insurance company providing the coverage. The Terrorism Risk Insurance Act, as amended, contains a $100 billion cap that limits U.S. Government reimbursement as well as insurers' liability for losses resulting from certified acts of terrorism when the amount of such losses excceds $100 billion in any one calendar year. If the aggregate insured losses for all insurers exceed $100 billion, your coverage may be reduced. The portion of your annual premium that is attributable to coverage for acts of terrorism is $ 24 not include any charges for the portion of losses covered by the United States government under the Act. Name of Insurer: Hartford Underwriters Insurance Company Policy Number: 59 WEC AC9055 Form WC 66 04 24 Printed in U.S.A. , and does ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst PA. IMPORTANT NOTICE COLORADO WORKERS' COMPENSATION INSURANCE MEDICAL AND INDEMNITY DEDUCTIBLE ELECTION FORM Colorado Workers' Compensation Law permits an employer to purchase workers' compensation insurance with a deductible. The deductible is for medical and indemnity benefits only. There are nine "Per Claim" deductible options available. They are: NONE $ 500 1,000 1,500 2,000 2,500 5,000 10,000 13,500 15,500 16,000 16,500 17,000 17,500 All medical and indemnity claims shall be paid by the company. In such case, the law requires that you reimburse the company for any deductible amounts so paid. If you have any questions, or desire one of these deductible amounts to apply to your coverage, please call your Agent for a quote. This offer is valid for thirty days after the effective date of the policy with which this notice is enclosed. Policy Number 59 WEC AC9055 Employer Name BAY SPROUTS LLC Agent Name FIRSTMARK INSURANCE GROUP INC Return to Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER Address: 3600 WISEMAN BLVD SAN ANTONIO TX 78251 Form WC 66 01 49 H Printed in U.S.A. Process Date: 05/25/20 Date I Signature and Title Date I Signature ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- V"° Policy E _� RFskPjanagementAnalpt WORKERS' COMPENSATION SELECTION OF DESIGNATED MEDICAL PROVIDER DISCLOSURE STATEMENT If you select two Designated Medical Providers meeting the following qualifications, a premium credit will be applied to your policy. For policies eligible for this credit as well as schedule rating, the combination of the 2.5% credit and the schedule modification cannot exceed +/-25%. A qualified Designated Medical Provider is a medical provider, who: 1) Has a knowledge of work injuries; 2) Is knowledgeable of fee schedules; 3) Is decisive on medical -maximum -improvement determinations; 4) Communicates with you, the employer on such issues as case management and wellness programs; 5) Is knowledgeable of the employers operations. The names of the providers must be posted and well publicized by you, the employer. ** SIGN AND RETURN ** I am aware of the availability of a premium credit of 2.5%, if I select two qualified Designated Medical Providers. For policies eligible for this credit as well as schedule rating, the combination of the 2.5% credit and the schedule modification cannot exceed +/-25%. Insured Signature Policy Number 59 WEC AC9055 Issuing Office THE HARTFORD BUSINESS SERVICE CENTER Issuing Office 3600 WISEMAN BLVD Address SAN ANTONIO TX 78251 Form WC 66 02 81 C Printed in U.S.A. Process Date: 05/25/20 J�N RAMmWmentDMsian REVIEWED&APPROVEDSY:Policy ;Vl --� Risk Pjanagement Analyst WORKERS' COMPENSATION COST CONTAINMENT CERTIFICATION DISCLOSURE STATEMENT Cost Containment Certification is available from the Colorado Workers' Compensation Cost Containment Board. If you obtain certification, your policy will be subject to a premium credit which will be shown separately on your policy. PLEASE CHECK ONE (1) OF THE FOLLOWING BOXES BASED UPON YOUR BUSINESS ENTITY QUALIFICATION: ❑ I am aware if my business does qualify for experience and/or schedule rating under my workers' compensation insurance policy and my business has implemented a certified workers' compensation risk management program, my policy is subject to a 5% premium credit if the loss experience has improved since the last renewal date of workers' compensation insurance. This 5% premium credit is in addition to any schedule rating for which i may qualify. or, ❑ I am aware if my business does not qualify for experience and/or schedule rating under my workers' compensation insurance policy and my business entity has implemented a certified workers' compensation risk management program, my policy is subject to the following premium credit: Premium Dividend Dividend Criteria 10% If my business has been loss free for at least the last year immediately preceding the effective date of the premium credit. 8% If my business had one medical loss exceeding $250 in the last year immediately preceding the effective date of the premium credit. 6% If my business had two medical losses, each exceeding $250, in the last year immediately preceding the effective date of the premium credit. 4% If my business had three medical losses, each exceeding $250, in the last year immediately preceding the effective date of the premium credit. 2% If my business had three medical losses, each exceeding $250, and one claim for loss of time in the last year immediately preceding the effective date of the premium credit. 0% If my business had more than three medical losses and one claim for loss of time in the last year immediately preceding the effective date of the premium credit. Insured Signature Policy Number Issuing Office Issuing Office Address ***PLEASE SIGN AND RETURN*** 59 WEC AC9055 THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 Form WC 66 03 06 Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v POlicl R.Wjanagementftalpt THE HARTFORD INSTRUCTIONS EMPLOYEE'S CLAIM FOR WORKERS' COMPENSATION BENEFITS As of January 1, 1990, California employers are required by law to furnish a claim form to an injured worker within one working day of knowledge of a work -related injury or illness (other than First Aid). While it is mandatory for the employer to furnish the claim form to the employee, it is not mandatory for the employee to complete it. The employer should complete sections 9-17, with the exception of section 13 (which reads, "Date employer received claim form"). This is to be completed after the claimant has completed his or her portion of the claim form and returned it to you, at which time section 13 should be immediately filled out or date stamped. Penalties can be invoked if employers fail to provide an injured employee an EMPLOYEE'S CLAIM FOR COMPENSATION BENEFITS form or if employers fail to report the claim to the workers' compensation insurance carrier. DO NOT DELAY REPORTING A CLAIM TO THE HARTFORD: Whether or not the employee completes the EMPLOYEE'S CLAIM FOR WORKER'S COMPENSATION BENEFITS, please contact The Hartford's LossConnect (1-800-327-3636) to report every occupational injury or illness which results in lost time beyond the date of the incident or requires medical treatment beyond First Aid. Form WC 55 00 11 D Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst Workers' Compensation and Employers' Liability Business Insurance Policy UIN Form WC 99 00 02 (03/14) Risk MmRganentDMsian REVIEWED & APPROVED BY: --� Risk Pjanagement Analyst ew cF RAManagementDMsian Jy/\'x REVIEWED & APPROVED BY: v --� Risk Pjanagement Analyst (Policy Provisions: WCOOOOOOC) INFORMATION PAGE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: SEE ATTACHED ENDORSEMENT NCCI Company Number: 14397 Company Code: 9 POLICY NUMBER: 59 WEC AC9055 Previous Policy Number: 59 WEC AC9055 1. Named Insured and Mailing Address: BAY SPROUTS LLC (No., Street, Town, State, Zip Code) 655 S MAIN ST STE 200-317 ORANGE CA 92868 FEIN Number: 46-2577161 Suffix LARS RENEWAL 2 State Identification Number(s): Refer to the EXTENSION OF THE INFORMATION PAGE — WC990365. The Named Insured is: LLC Business of Named Insured: Full -Service Restaurants Other workplaces not shown above: See Endorsement - WC990366 2. Policy Period: From 07/03/20 To 07/03/21 ANNUAL 12:01 a.m., Standard time at the insured's mailing address. Producer's Name: FIRSTMARK INSURANCE GROUP INC 210 5TH AVENUE SOUTH STE 203 EDMONDS WA 98020 Producer's Code: 59305815 Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 (877) 287-1316 Total Estimated Annual Premium: $71,141 Deposit Premium: Policy Minimum Premium: $1,150 NC (Includes Increased Limit Min. Prem.) Audit Period: ANNUAL Installment Term: The policy is not binding unless countersigned by our authorized representative. Countersigned by �G`® �> 05/25/20 Authorized Representative Date J�N IZAMmWmentDMsion REVIEWED & APPROVED BY. - Form WC 00 00 01 A (1) Printed in U.S.A. Page VI Process Date: 05/25/20 Policy --_ Wsk Pjanagement Analpt INFORMATION PAGE (Continued) Policy Number: 59 WEC AC9055 3. A. Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states listed here: WI SEE ENDORSEMENT - WC 99 03 67 B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily injury by Accident $1,000,000 each accident Bodily injury by Disease $1,000,000 policy limit Bodily injury by Disease $1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any , listed here: ALL STATES EXCEPT NORTH DAKOTA, OHIO, WASHINGTON, WYOMING, U.S.TERRITORIES AND STATES DESIGNATED IN ITEM 3.A. OF THE INFORMATION PAGE. D. This policy includes these endorsements and schedule: SEE ENDORSEMENT -WC 99 03 68 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium Total Standard Premium Premium Discount Extended Broad Form Coverage Expense Constant Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement Catastrophe (Other Than Certified Acts Of Terrorism) Estimated Annual Premium (before Surcharges) Total Estimated Surcharges *See the attached Schedule(s) of Operations for Location and State Level Premium Information Total Estimated Annual Premium: $71,141 Deposit Premium: Policy Minimum Premium: $1,150 NC (Includes Increased Limit Min. Prem.) Interstate/Intrastate Identification Number: Refer to Schedule of Operations NAICS: 722110 Labor Contractors Policy Number: SIC: 5812 Form WC 00 00 01 A (1) Printed in U.S.A. Process Date: 05/25/20 $70,102 -$2,394 $1,179 $250 $308 $156 $69,601 $1,540 ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY. - Page 2 ,,; V Policy EXpirati —��— Wsk Pjanagement Analpt EXTENSION OF THE INFORMATION PAGE - ITEM 1 - NAMED INSURED Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Item 1 of the Information Page is completed to include as named insured: Named Insured: BAY SPROUTS LLC State ID : Not Applicable FEIN : 46-2577161 DBA Name BEAN SPROUTS CAFE BEAN SPROUTS CAFE & COOKING & BEAN SPROUTS SANTA ANA BEAN SPROUTS CAFE & COOKING SCHOOL BEAN SPROUTS LOS ANGELES & BEAN SPROUTS CAFE BEAN SPROUTS SANTA ANA Form WC 99 03 65 Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� RFskPjanagementAnalpt EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER WORKPLACES Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Item 1 of the Information Page is completed to include other workplaces of the named insured: 600 E WASHINGTON ST, PHOENIX, AZ 85004-2303 11800 FOOTHILLS BLVD, SYLMAR, CA 91342 2500 N. MAIN ST, SANTA ANA, CA 92705 557 MCREYNOLD'S RD, SAUSALITO, CA 94965 NO SPECIFIC LOCATION IN STATE OF CO 00000 1805 N 30TH ST, COLORADO SPRINGS, CO 80904 301 N WASHINGTON ST., NAPERVILLE, IL 60540 NO SPECIFIC LOCATION IN STATE OF WI 00000 200 W ISLAND AVE, SAN DIEGO, CA 92101-6850 1801 E CHESTNUT AVE, SANTA ANA, CA 92701-5001 480 N ARROYO BLVD, PASADENA, CA 91103-3269 201 E HARGETT ST, RALEIGH, NC 27601-1437 Form WC 99 03 66 Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� RFskPjanagementAnalpt EXTENSION OF THE INFORMATION PAGE - ITEM 3.A - STATES COVERED Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Item 3.A. of the Information Page is completed to include the following states: Wisconsin WI North Carolina NC California CA Arizona AZ Illinois IL Colorado CO Form WC 99 03 67 Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� RFskPjanagementAnalpt EXTENSION OF THE INFORMATION PAGE - ITEM 3.13 - ENDORSEMENTS Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Item 3.D. of the Information Page is completed to include the following endorsements: G-4119-0 POLICYHOLDER NOTICE -PAYROLL BILLING WC000000C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC000001A.1 INFORMATION PAGE WC000001A.2 INFORMATION PAGE WC000115 NOTIFICATION ENDORSEMENT OF PENDING LAW CHANGE TO TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015 WC000308 PARTNERS, OFFICERS AND OTHERS EXCLUSION ENDORSEMENT WC000313 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT WC000403 EXPERIENCE RATING MODIFICATION FACTOR ENDORSEMENT WC000406 Premium Discount Endorsement WC000406A PREMIUM DISCOUNT ENDORSEMENT WC000414A 90-DAY REPORTING REQUIREMENT- NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT WC000419 PREMIUM DUE DATE ENDORSEMENT WC000421 D CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT WC000422B TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT WC000424 AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT WCO20401 C ARIZONA ALCOHOL AND DRUG -FREE WORKPLACE PREMIUM CREDIT ENDORSEMENT WCO20601A ARIZONA CANCELLATION ENDORSEMENT Form WC 99 03 68 Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v POIIC WskPjanagementAnalyst EXTENSION OF THE INFORMATION PAGE - ITEM 3.13 - ENDORSEMENTS Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Item 3.D. of the Information Page is completed to include the following endorsements: WC040301 BB POLICY AMENDATORY ENDORSEMENT - CALIFORNIA WC040306 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA WC040360B EMPLOYERS LIABILITY COVERAGE AMENDATORY ENDORSEMENT - CALIFORNIA WC040421 OPTIONAL PREMIUM INCREASE ENDORSEMENT - CALIFORNIA WC040422 CALIFORNIA SHORT -RATE CANCELLATION ENDORSEMENT WC040601A CALIFORNIA CANCELLATION ENDORSEMENT WC050402 COLORADO CLASSIFICATION ENDORSEMENT WC050403 COLORADO PREMIUM CREDIT FOR CERTIFIED RISK MANAGEMENT PROGRAMS ENDORSEMENT WC120306A ILLINOIS WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY EXCLUSION ENDORSEMENT WC120601 F ILLINOIS AMENDATORY ENDORSEMENT WC120603 ILLINOIS RENEWAL ENDORSEMENT WC320301 D NORTH CAROLINA AMENDED COVERAGE ENDORSEMENT WC480601 C WISCONSIN LAW ENDORSEMENT WC480603B FOREIGN COVERAGE ENDORSEMENT WC480606B WISCONSIN CANCELLATION AND NONRENEWAL ENDORSEMENT WC550011 D Employees Claim for Workers compensation Benefits WC8804001 Notice to Employees - Injuries Caused By Work (TITLE IN SPANISH) Form WC 99 03 68 Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v POIIC R.WjanagementAnalyst EXTENSION OF THE INFORMATION PAGE - ITEM 3.13 - ENDORSEMENTS Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Item 3.D. of the Information Page is completed to include the following endorsements: WC8804011 Notice to Employees - Injuries Caused By Work WC9900011 Signature/ Copyright WC990002 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY BUSINESS INSURANCE POLICY WC990005 SCHEDULE OF OPERATIONS WC990069 AMENDATORY ENDORSEMENT - COLORADO WC990301 B WORKERS COMPENSATION BROAD FORM ENDORSEMENT EXTENDED OPTIONS WC990302B WORKERS COMPENSATION BROAD FORM ENDORSEMENT WC990303B WORKERS COMPENSATION BROAD FORM ENDORSEMENT EXTENDED OPTIONS WC990356A AMENDMENT TO WORKERS COMPENSATION BROAD FORM ENDORSEMENT EXTENDED OPTIONS - EMPLOYERS LIABILITY STOP GAP COVERAGE WC990357A AMENDMENT TO WORKERS COMPENSATION BROAD FORM ENDORSEMENT EXTENDED OPTIONS - EMPLOYERS LIABILITY STOP GAP COVERAGE WC990365 EXTENSION OF THE INFORMATION PAGE - ITEM 1 - NAMED INSURED WC990366 EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER WORKPLACES WC990367 EXTENSION OF THE INFORMATION PAGE - ITEM 3.A - STATES COVERED WC990368 EXTENSION OF THE INFORMATION PAGE - ITEM 3.D. - ENDORSEMENTS WC990371A ARIZONA COUNTERSIGNATURE EXCLUSION ENDORSEMENT WC990375 CALIFORNIA INSTALLMENT FEE DISCLOSURE ENDORSEMENT WC990380 WORKERS COMPENSATION BROAD FORM ENDORSEMENT Form WC 99 03 68 Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v POIIC R.WjanagementAnalyst POLICY INSURER LIST BY JURISDICTION INSURER NAIC JURISDICTION Sentinel Insurance Company Ltd. 11000 CA ONE HARTFORD PLAZA HARTFORD CT 06155 Trumbull Insurance Company 27120 IL CO ONE HARTFORD PLAZA HARTFORD CT 06155 Hartford Casualty Insurance Company 29424 AZ WI ONE HARTFORD PLAZA HARTFORD CT 06155 Hartford Underwriters Insurance Company 30104 NC ONE HARTFORD PLAZA HARTFORD CT 06155 THE COVERAGE PROVIDED IN EACH JURISDICTION IS WITH RESPECT TO THE LOCATIONS OF THE NAMED INSURED IN THAT JURISDICTION IN ACCORDANCE WITH THE WORKERS' COMPENSATION LAW OF THAT JURISDICTION. AS USED IN THIS POLICY, "COMPANY", "WE", "US" AND "OURS" MEAN THE MEMBER INSURANCE COMPANIES OF THE HARTFORD INSURANCE GROUP COLLECTIVELY PROVIDING THIS INSURANCE. Nothing herein, contained shall be held to vary, waive, alter or extend any of the terms, conditions, agreements or information of the policy, other than as herein stated. Form WC 66 04 40 Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� RFskPjanagementAnalpt SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: HARTFORD CASUALTY INSURANCE COMPANY Company Code: 3 Policy Number: 59 WEC AC9055 Schedule Number: 01-02-01 Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: BAY SPROUTS LLC 600 E WASHINGTON ST PHOENIX AZ 85004 FEIN: 46-2577161 NAICS: 722110 SIC: 5812 NO. OF EMPL: 1 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8006 339,200.00 1.860000 6,309 STORE: FRUIT OR VEGETABLE - RETAIL 8810 175,400.00 0.150000 263 CLERICAL OFFICE EMPLOYEES NOC Total State Summary Total Class Premium 6,572 Waiver of Subrogation 0.020000 250 Emp liab increased limits 0.003000 20 Total Estimated Annual Standard Premium 6,842 Premium discount 0.044000 -301 Extended Broad Form Coverage 2.500000 171 Terrorism Risk Insurance Program Reauthorization Act 514,600.00 0.010000 51 Disclosure Endorsement Catastrophe (other than certified acts of terrorism) 514,600.00 0.010000 51 Total Estimated Annual Premium 6,814 Countersigned by Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 05/25/20 ^ RAMmWmentDMsian Aw F REVIEWED & APPROVED BY.- i v Policy E Wsk Pjanagement Analpt SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: SENTINEL INSURANCE COMPANY LTD. Company Code: A Policy Number: 59 WEC AC9055 Schedule Number: 01-04-02 Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: BAY SPROUTS LLC 11800 FOOTHILLS BLVD SYLMAR CA 91342 FEIN: 46-2577161 NAICS: 722110 SIC: 5812 NO. OF EMPL: 0 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8078 SANDWICH SHOPS - NOT RESTAURANTS - N.O.0 Countersigned by Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 05/25/20 177,800.00 3.830000 6,810 ^ RAMmWmentDMsian Aw F REVIEWED & APPROVED BY.- i vmwd Policy E Wsk Pjanagement Analpt SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: SENTINEL INSURANCE COMPANY LTD. Company Code: A Policy Number: 59 WEC AC9055 Schedule Number: 01-04-03 Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: BAY SPROUTS LLC 2500 N. MAIN ST SANTA ANA CA 92705 FEIN: 46-2577161 NAICS: 722110 SIC: 5812 NO. OF EMPL: 17 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8078 SANDWICH SHOPS - NOT RESTAURANTS - N.O.0 Countersigned by Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 05/25/20 362,600.00 3.830000 13,888 ^ RAMmVmentDMsian Aw F REVIEWED & APPROVED BY.- i vmwd Policy E Wsk Pjanagement Analpt SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: SENTINEL INSURANCE COMPANY LTD. Company Code: A Policy Number: 59 WEC AC9055 Schedule Number: 01-04-04 Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: BAY SPROUTS LLC 557 MCREYNOLD'S RD SAUSALITO CA 94965 FEIN: 46-2577161 NAICS: 722110 SIC: 5812 NO. OF EMPL: 15 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8078 SANDWICH SHOPS - NOT RESTAURANTS - N.O.0 Countersigned by Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 05/25/20 333,400.00 3.830000 12,769 ^ RAMmVmentDMsian Aw F REVIEWED & APPROVED BY.- i vmwd Policy E Wsk Pjanagement Analpt SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: SENTINEL INSURANCE COMPANY LTD. Company Code: A Policy Number: 59 WEC AC9055 Schedule Number: 01-04-09 Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: BAY SPROUTS LLC 200 W ISLAND AVE SAN DIEGO CA 92101 FEIN: 46-2577161 NAICS: 722110 SIC: 5812 NO. OF EMPL: 14 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8078 SANDWICH SHOPS - NOT RESTAURANTS - N.O.0 Countersigned by Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 05/25/20 3.830000 I$] ^ RAMmWmentDMsian Aw F REVIEWED & APPROVED BY.- i vmwd Policy E Wsk Pjanagement Analpt SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: SENTINEL INSURANCE COMPANY LTD. Company Code: A Policy Number: 59 WEC AC9055 Schedule Number: 01-04-10 Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: BAY SPROUTS LLC 1801 E CHESTNUT AVE SANTA ANA CA 92701 FEIN: 46-2577161 NAICS: 722110 SIC: 5812 NO. OF EMPL: 12 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8078 SANDWICH SHOPS - NOT RESTAURANTS - N.O.0 Countersigned by Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 05/25/20 3.830000 I$] ^ RAMmVmentDMsian Aw F REVIEWED & APPROVED BY.- i vmwd Policy E Wsk Pjanagement Analpt SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: SENTINEL INSURANCE COMPANY LTD. Company Code: A Policy Number: 59 WEC AC9055 Schedule Number: 01-04-11 Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: BAY SPROUTS LLC 480 N ARROYO BLVD PASADENA CA 91103 FEIN: 46-2577161 NAICS: 722110 SIC: 5812 NO. OF EMPL: 15 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8078 BEVERAGE PREPARATION SHOPS - NOT BARS OR TAVERNS Total State Summary Total Class Premium CA Territorial Differential Waiver of Subrogation Experience modifier Schedule Rating Factor Total Estimated Annual Standard Premium Premium discount Extended Broad Form Coverage Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement CA User Fund CA Fraud CA Uninsured Employers Benefit Trust Fund CA Subsequent Injuries Benefit Trust Fund Assessments CA Occupational Safety & Health Fund CA Labor Enforcement & Compliance Fund Total Estimated Annual Premium Countersigned by Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 05/25/20 873,800.00 3.830000 0 33,467 1.361200 12,090 0.020000 669 1.140000 6,472 0.850000 -7,905 44,793 0.033000 -1,478 1.500000 790 0.020000 175 1.704000 755 0.334900 148 0.127400 56 0.482900 214 0.391800 173 0.381300 169 45,795 ^ RAMmWmentDMsian Aw F REVIEWED & APPROVED BY.- i vmwd Policy E Wsk Pjanagement Analpt SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: TRUMBULL INSURANCE COMPANY Company Code: H Policy Number: 59 WEC AC9055 Schedule Number: 01-05-05 Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: BAY SPROUTS LLC NO SPECIFIC LOCATION IN STATE OF CO 00000 FEIN: 46-2577161 NAICS: 722110 SIC: 5812 NO. OF EMPL: 0 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8006 STORE - DELICATESSEN - RETAIL Countersigned by Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 05/25/20 100.00 1.930000 2 ^ RAMmWmentDMsian Aw F REVIEWED & APPROVED BY.- i vmwd Policy E Wsk Pjanagement Analpt SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: TRUMBULL INSURANCE COMPANY Company Code: H Policy Number: 59 WEC AC9055 Schedule Number: 01-05-06 Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: BAY SPROUTS LLC 1805 N 30TH ST COLORADO SPRING CO 80904 FEIN: 46-2577161 NAICS: 722110 SIC: 5812 NO. OF EMPL: 0 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8006 362,500.00 1.930000 6,996 STORE: COFFEE, TEA OR SPICE - RETAIL Total State Summary Total Class Premium 6,998 Waiver of Subrogation 0.020000 250 Emp liab increased limits 0.003000 21 Schedule Rating Factor 0.900000 -727 Total Estimated Annual Standard Premium 6,542 Premium discount 0.033000 -216 Extended Broad Form Coverage 3 218 Terrorism Risk Insurance Program Reauthorization Act 362,600.00 0.006000 22 Disclosure Endorsement Catastrophe (other than certified acts of terrorism) 362,600.00 0.010000 36 Total Estimated Annual Premium 6,602 Countersigned by Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 05/25/20 ^ RAMmVmentDMsian Aw F REVIEWED & APPROVED BY.- i v Policy E Wsk Pjanagement Analpt SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: TRUMBULL INSURANCE COMPANY Company Code: H Policy Number: 59 WEC AC9055 Schedule Number: 01-12-07 Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: BAY SPROUTS LLC 301 N WASHINGTON ST. NAPERVILLE IL 60540 FEIN: 46-2577161 NAICS: 722110 SIC: 5812 NO. OF EMPL: 0 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8006 103,600.00 2.680000 2,776 STORE - DELICATESSEN - RETAIL Total State Summary Total Class Premium 2,776 Emp liab increased limits 0.014000 39 Schedule Rating Factor 0.900000 -282 Total Estimated Annual Standard Premium 2,533 Premium discount 0.033000 -84 Terrorism Risk Insurance Program Reauthorization Act 103,600.00 0.035000 36 Disclosure Endorsement Catastrophe (other than certified acts of terrorism) 103,600.00 0.020000 21 IL Industrial Commission Operations Fund Surcharge 1.010000 25 Total Estimated Annual Premium 2,531 Countersigned by Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 05/25/20 ^ RAMmWmentDMsian Aw F REVIEWED & APPROVED BY.- i v Policy E Wsk Pjanagement Analpt SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY Company Code: 6 Policy Number: 59 WEC AC9055 Schedule Number: 01-32-12 Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: BAY SPROUTS LLC 201 E HARGETT ST RALEIGH NC 27601 FEIN: 46-2577161 NAICS: 722110 SIC: 5812 NO. OF EMPL: 1 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8006 239,300.00 3.840000 9,189 COFFEE, TEA OR GROCERY DEALER - RETAIL Total State Summary Total Class Premium 9,189 Emp liab increased limits 0.011000 101 Total Estimated Annual Standard Premium 9,290 Premium discount 0.033000 -307 Expense constant 250 Terrorism Risk Insurance Program Reauthorization Act 239,300.00 0.010000 24 Disclosure Endorsement Catastrophe (other than certified acts of terrorism) 239,300.00 0.020000 48 Total Estimated Annual Premium 9,305 Countersigned by Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 05/25/20 ^ RAMmVmentDMsian Aw F REVIEWED & APPROVED BY.- i v Policy E Wsk Pjanagement Analpt SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER: HARTFORD CASUALTY INSURANCE COMPANY Company Code: 3 Policy Number: 59 WEC AC9055 Schedule Number: 01-48-08 Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: BAY SPROUTS LLC NO SPECIFIC LOCATION IN STATE OF WI 00000 FEIN: 46-2577161 NAICS: 722110 SIC: 5812 NO. OF EMPL: 0 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8006 1,200.00 4.270000 51 STORE - DELICATESSEN - RETAIL Total State Summary Total Class Premium 51 Emp liab increased limits 0.011000 1 Waiver of Subrogation 0.020000 50 Total Estimated Annual Standard Premium 102 Premium discount 0.078000 -8 Terrorism Risk Insurance Program Reauthorization Act 1,200.00 0.020000 0 Disclosure Endorsement Catastrophe (other than certified acts of terrorism) 1,200.00 0.010000 0 Total Estimated Annual Premium 94 Countersigned by Form WC 99 00 05 (1) Printed in U.S.A. Process Date: 05/25/20 ^ RAMmVmentDMsian Aw F REVIEWED & APPROVED BY.- i v Policy E Wsk Pjanagement Analpt WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY QUICK REFERENCE Beginning on Page INFORMATION PAGE General Section ............................ A. The Policy ............................. B. Who Is Insured ..................... C. Workers Compensation Law D. State ..................................... E. Locations .............................. PART ONE- WORKERS COMPENSATION INSURANCE. A. How This Insurance Applies ................................. B. We Will Pay........................................................... C. We Will Defend ..................................................... D. We Will Also Pay ................................................... E. Other Insurance .................................................... F. Payments You Must Make .................................... G. Recovery From Others .......................................... H. Statutory Provisions .............................................. 1 1 1 1 1 2 2 2 2 PART TWO - EMPLOYERS LIABILITY INSURANCE...... 2 Beginning on Page PART TWO - Continued G. Limits of Liability ......... H. Recovery From Others I. Actions Against Us...... PART THREE - OTHER STATES INSURANCE A. How This Insurance Applies .................... B. Notice ...................................................... PART FOUR -YOUR DUTIES IF INJURY OCCURS PART FIVE - PREMIUM...... A. Our Manuals........... B. Classifications......... C. Remuneration......... D. Premium Payments E. Final Premium........ F. Records .................. G. Audit ....................... 4 4 4 4 4 5 5 5 5 5 5 5 5 6 6 A. How This Insurance Applies ................................... 2 PART SIX - CONDITIONS ....................................... 6 B. We will Pay............................................................. 3 A. Inspection......................................................... 6 C. Exclusions.............................................................. 3 B. Long Term Policy ............................................. 6 D. We Will Defend ....................................................... 3 C. Transfer of Your Rights and Duties.................. 6 E. We Will Also Pay .................................................... 4 D. Cancellation..................................................... 6 F. Other Insurance...................................................... 4 E. Sole Representative......................................... 6 IMPORTANT: This Quick Reference is not part of the Workers Compensation and Employers Liability Policy and does not provide coverage. Refer to the Workers Compensation and Employers Liability Policy itself for actual contractual provisions. PLEASE READ THE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY CAREFULLY. Form WC 66 01 56 B Printed in U.S.A. Process Date: 05/25/20 cF RAMmWmentDMsian REVIEWED & APPROVED BY.- --� Risk janagement Analyst WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows: GENERAL SECTION A. The Policy This policy includes at its effective date the Information Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Information Page) and us (the insurer named on the Information Page). The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B. Who Is Insured You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured, but only in your capacity as an employer of the partnership's employees. C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen's compensation law, any federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits. D. State State means any state of the United States of America, and the District of Columbia. E. Locations This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it covers all other workplaces in Item 3.A. states unless you have other insurance or are self -insured for such workplaces. PART ONE -WORKERS COMPENSATION INSURANCE A. How This Insurance Applies This workers compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the policy period. 2. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. B. We Will Pay We will pay promptly when due the benefits required of you by the workers compensation law. Form WC 00 00 00 C Printed in U.S.A. Process Date: 05/25/20 C. We Will Defend We have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to investigate and settle these claims, proceedings or suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. D. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: 1. reasonable expenses incurred at our request, but not loss of earnings; ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- ,v POlicl R.Wjanagementftalpt 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this insurance; and 5. expenses we incur. E. Other Insurance We will not pay more than our share of benefits and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid. F. Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required because: 1. of your serious and willful misconduct; 2. you knowingly employ an employee in violation of law; 3. you fail to comply with a health or safety law or regulation; or 4. you discharge, coerce or otherwise discriminate against any employee in violation of the workers compensation law. If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. G. Recovery From Others We have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. H. Statutory Provisions These statements apply where they are required by law. 1. As between an injured worker and us, we have notice of the injury when you have notice. 2. Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our duties under this insurance after an injury occurs. 3. We are directly and primarily liable to any person entitled to the benefits payable by this insurance. Those persons may enforce our duties; so may an agency authorized by law. Enforcement may be against you and us. 4. Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law. 5. This insurance conforms to the parts of the workers compensation law that apply to: a. benefits payable by this insurance; b. special taxes, payments into security or other special funds, and assessments payable by us under that law. 6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your duties under this policy. PART TWO - EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies This employers liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must arise out of and in the course of the injured employee's employment by you. Form WC 00 00 00 C Printed in U.S.A. 2. The employment must be necessary or incidental to your work in a state or territory listed in Item 3.A. of the Information Page. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5. If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. B. We Will Pay We will pay all sums that you legally must pay as damages because of bodily injury to your employees, provided the bodily injury is covered by this Employers Liability Insurance. The damages we will pay, where recovery is permitted by law, include damages: 1. For which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages claimed against such third party as a result of injury to your employee; 2. For care and loss of services; and 3. For consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and 4. Because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer. C. Exclusions This insurance does not cover: 1. Liability assumed under a contract. This exclusion does not apply to a warranty that your work will be done in a workmanlike manner; 2. Punitive or exemplary damages because of bodily injury to an employee employed in violation of law; 3. Bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive officers; 4. Any obligation imposed by a workers com- pensation, occupational disease, unemployment compensation, or disability benefits law, or any similar law; 5. Bodily injury intentionally caused or aggravated by you; 6. Bodily injury occurring outside the United States of America, its territories or possessions, and Canada. Form WC 00 00 00 C Printed in U.S.A. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries; 7. Damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, dis- crimination against or termination of any employee, or any personnel practices, policies, acts or omissions; 8. Bodily injury to any person in work subject to the Longshore and Harbor Workers' Compensation Act (33 U.S.C. Sections 901 et seq.), the Noappropriated Fund Instrumentalities Act (5 U.S.C. Sections 8171 et seq.), the Outer Continental Shelf Lands Act (43 U.S.C. Sections 1331 et seq.), the Defense Base Act (42 U.S.C. Sections 1651-1654), the Federal Mine Safety and Health Act (30 U.S.C. Sections 801 et seq. and 901-944) any other federal workers or workmen's compensation law or other federal occupational disease law, or any amendments to these laws; 9. Bodily injury to any person in work subject to the Federal Employers' Liability Act (45 U.S.C. Sections 51 et seq.), any other federal laws obligating an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amendments to those laws; 10. Bodily injury to a master or member of the crew of any vessel, and does not cover punitive damages related to your duty or obligation to provide transportation, wages, maintenance, and cure under any applicable maritime law; 11. Fines or penalties imposed for violation of federal or state law; and 12. Damages payable under the Migrant and Seasonal Agricultural Worker Protection Act (29 U.S.C. Sections 1801 et seq.) and under any other federal law awarding damages for violation of those laws or regulations issued thereunder, and any amendments to those laws. D. We Will Defend We have the right and duty to defend, at our expense, any claim, proceeding or suit against you for damages payable by this insurance. We have the right to investigate and settle these claims, proceedings and suits. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. E. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: 1. Reasonable expenses incurred at our request, but not loss of earnings; 2. Premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. Litigation costs taxed against you; 4. Interest on a judgment as required by law until we offer the amount due under this insurance; and 5. Expenses we incur. F. Other Insurance We will not pay more than our share of damages and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance and self-insurance will be equal until the loss is paid. G. Limits of Liability A disease is not bodily injury by accident unless it results directly from bodily injury by accident. 2. Bodily Injury by Disease. The limit shown for "bodily injury by disease policy limit" is the most we will pay for all damages covered by this insurance and arising out of bodily injury by disease, regardless of the number of employees who sustain bodily injury by disease. The limit shown for "bodily injury by disease each employee" is the most we will pay for all damages because of bodily injury by disease to any one employee. Bodily injury by disease does not include disease that results directly from a bodily injury by accident. 3. We will not pay any claims for damages after we have paid the applicable limit of our liability under this insurance. H. Recovery From Others We have your rights to recover our payment from anyone liable for an injury covered by this insurance. You will do everything necessary to protect those rights for us and to help us enforce them. I. Actions Against Us There will be no right of action against us under this insurance unless: 1. You have complied with all the terms of this policy; and Our liability to pay for damages is limited. Our limits of 2. The amount you owe has been determined with liability are shown in Item 3.B. of the Information Page. our consent or by actual trial and final judgment. They apply as explained below. This insurance does not give anyone the right to add 1. Bodily Injury by Accident. The limit shown for us as a defendant in an action against you to "bodily injury by accident each accident" is the determine your liability. The bankruptcy or most we will pay for all damages covered by this insolvency of you or your estate will not relieve us of insurance because of bodily injury to one or more our obligations under this Part. employees in any one accident. PART THREE - OTHER STATES INSURANCE A. How This Insurance Applies This other states insurance applies only if one or more states are shown in Item 3.C. of the Information Page. 2. If you begin work in any one of those states after the effective date of this policy and are not insured or are not self -insured for such work, all provisions of the policy will apply as though that state were Form WC 00 00 00 C Printed in U.S.A. listed in Item 3.A. of the Information Page. 3. We will reimburse you for the benefits required by the workers compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them. 4. If you have work on the effective date of this policy in any state not listed in Item 3.A. of the ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst Information Page, coverage will not be afforded for B. Notice that state unless we are notified within thirty days. Tell us at once if you begin work in any state listed in Item 3.C. of the Information Page. PART FOUR - YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here. 1. Provide for immediate medical and other services required by the workers compensation law. 2. Give us or our agent the names and addresses of the injured persons and of witnesses, and other information we may need. 3. Promptly give us all papers related to the suit. A. Our Manuals notices, demands and legal injury, claim, proceeding or 4. Cooperate with us and assist us, as we may request, in the investigation, settlement or defense of any claim, proceeding or suit. 5. Do nothing after an injury occurs that would interfere with our right to recover from others. 6. Do not voluntarily make payments, assume obligations or incur expenses, except at your own cost. PART FIVE - PREMIUM All premium for this policy will be determined by our manuals of rules, rates, rating plans and classifications. We may change our manuals and apply the changes to this policy if authorized by law or a governmental agency regulating this insurance. B. Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classifications. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classifications, rates and premium basis by endorsement to this policy. C. Remuneration Premium for each work classification is determined by multiplying a rate times a premium basis. Remuneration is the most common premium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy period for the services of: 1. All your officers and employees engaged in work covered by this policy; and Form WC 00 00 00 C Printed in U.S.A. 2. all other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obligations. D. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. E. Final Premium The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. ew cF RAMwagementDMsian k4e \'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst If this policy is cancelled, final premium will be determined in the following way unless our manuals provide otherwise: 1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. 2. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short rate cancellation table and procedure. Final premium will not be less than the minimum premium. F. Records You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them. A. Inspection G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provision. PART SIX - CONDITIONS We have the right, but are not obligated to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or standards. Insurance rate service organizations have the same rights we have under this provision. B. Long Term Policy If the policy period is longer than one year and sixteen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force. C. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within thirty days after your death, we will cover your legal representative as insured. Form WC 00 00 00 C Printed in U.S.A. D. Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy. We must mail or deliver to you not less than ten days advance written notice stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancellation notice. 4. Any of these provisions that conflict with a law that controls the cancellation of the insurance in this policy is changed by this statement to comply with that law. E. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancellation. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PREMIUM DUE DATE ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Section D of Part Five of the policy is replaced by this provision: PART FIVE PREMIUM D. Premium is amended to read: law is not valid. The due date for audit and You will pay all premium when due. You will pay the retrospective premiums is the date of the billing. premium even if part or all of a workers compensation Countersigned by Form WC 00 04 19 Printed in U.S.A. Process Date: 05/25/20 Policy cF RAMmWmentDMsian REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Part Five - Premium, Section G. (Audit) of the Workers Compensation and Employers Liability Insurance Policy is revised by adding the following: If you do not allow us to examine and audit all of your records that relate to this policy, and/or do not provide audit information as requested, we may apply an Audit Noncompliance Charge. The method for determining the Audit Noncompliance Charge by state, where applicable, is shown in the Schedule below. If you allow us to examine and audit all of your records after we have applied an Audit Noncompliance Charge, we will revise your premium in accordance with our manuals and Part 5 - Premium, E. (Final Premium) of this policy. Failure to cooperate with this policy provision may result in the cancellation of your insurance coverage, as specified under the policy. Schedule State(s) Basis of Audit Noncompliance Maximum Audit Noncompliance Charge Charge Multiplier AL, AR, CO, CT, DC, DE, GA, IA, ID, Estimated Annual Premium Up to two times IL, KY, MD, ME, MI, MN, MS, NE, NH, NJ, NM, OR, RI, SC, SD, TN, UT, VA, VT, WV AZ, HI, KS, OK Estimated Annual Premium Two times NC Estimated Annual Premium Up to three times NV Estimated Annual Premium Up to one times WI Estimated Annual Premium One time Form WC 00 04 24 Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- ,v POlic) R.Wjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARIZONA CANCELLATION AND NONRENEWAL ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies because Arizona is shown in Item 3.A. of the Information Page. Part Six - Conditions, Section D. (Cancellation), of the policy is replaced by the following: D. Cancellation and Nonrenewal 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. If you cancel or fail to renew this policy, we must promptly notify the Industrial Commission of Arizona. 3. We may cancel this policy if you fail to pay premium when due, or when one or both of the parties to a professional employer agreement terminate the agreement. 4. If we cancel or nonrenewal this policy, we must mail or deliver to you and the Industrial Commission of Arizona at least 30 days' notice of the cancellation or nonrenewal. Mailing that notice to you at your mailing address shown in Item 1. of the Information Page will be sufficient to prove notice. If we nonrenew this policy and fail to give you notice of nonrenewal, coverage will not extend beyond the policy period. 5. The policy period will end on the day and hour stated in the cancellation or nonrenewal notice. Form WC 02 06 01 A Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- ,v POlic R.Wjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY AMENDATORY ENDORSEMENT - CALIFORNIA Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Information Page is subject to the following provisions: 1. Minors Illegally Employed - Not Insured. This policy does not cover liability for additional compensation imposed on you under Section 4557, Division IV, Labor Code of the State of California, by reason of injury to an employee under sixteen years of age and illegally employed at the time of injury. 2. Punitive or Exemplary Damages - Uninsurable. This policy does not cover punitive or exemplary damages where insurance of liability therefor is prohibited by law or contrary to public policy. 3. Increase in Indemnity Payment - Reimbursement. You are obligated to reimburse us for the amount of increase in indemnity payments made pursuant to Subdivision (d) of Section 4650 of the California Labor Code, if the late indemnity payment which gives rise to the increase in the amount of payment is due less than seven (7) days after we receive the completed claim form from you. You are obligated to reimburse us for any increase in indemnity payments not covered under this policy Form WC 04 03 01 BB Printed in U.S.A. Process Date: 05/25/20 and will reimburse us for any increase in indemnity payment not covered under the policy when the aggregate total amount of the reimbursement payments paid in a policy year exceeds one hundred dollars ($100). If we notify you in writing, within 30 days of the payment, that you are obligated to reimburse us, we will bill you for the amount of increase in indemnity payment and collect it no later than the final audit. You will have 60 days, following notice of the obligation to reimburse, to appeal the decision of the insurer to the Department of Insurance. 4. Application of Policy. Part One, "Workers Compensation Insurance", A, "How This Insurance Applies", is amended to read as follows: This workers compensation insurance applies to bodily injury by accident or disease, including death resulting therefrom. Bodily injury by accident must occur during the policy period. Bodily injury by disease must be caused or aggravated by the conditions of your employment. Your employee's exposure to those conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5. Rate Changes. The premium and rates with respect to the insurance provided by this policy by reason of the designation of California in ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� R.Wjanagementftalpt Item 3 of the Information Page are subject to change if ordered by the Insurance Commissioner of the State of California pursuant to Section 11737 of the California Insurance Code. Long Term Policy. If this policy is written for a period longer than one year, all the provisions of this policy shall apply separately to each consecutive twelve-month period or, if the first or last consecutive period is less than twelve months, to such period of less than twelve months, in the same manner as if a separate policy had been written for each consecutive period. Statutory Provision. Your employee has a first lien upon any amount which becomes owing to you by us on account of this policy, and in the case of your legal incapacity or inability to receive the money and pay it to the claimant, we will pay it directly to the claimant. Part Five, "Premium", E, "Final Premium", is amended to read as follows: The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work Form WC 04 03 01 BB Printed in U.S.A. covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise: a. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. b. If you cancel, final premium may be more than pro rata; it will be based on the time this policy was in force, and may be increased by our short -rate cancelation table and procedure. Final premium will not be less than the pro rata share of the minimum premium. It is further agreed that this policy, including all endorsements forming a part thereof, constitutes the entire contract of insurance. No condition, provision, agreement, or understanding not set forth in this policy or such endorsements shall affect such contract or any rights, duties, or privileges arising therefrom. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENDORSEMENT - CALIFORNIA Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 The insurance afforded by Part Two (Employers' Liability C. The "Exclusions" section is modified as follows (all Insurance) by reason of designation of California in Item 3 other exclusions in the "Exclusions" section remain of the Information Page is subject to the following as is): provisions: 1. Exclusion 1 is amended to read as follows: A. "How This Insurance Applies," is amended to read 1. liability assumed under a contract. as follows: 2. Exclusion 2 is deleted. A. How This Insurance Applies 3. Exclusion 7 is amended to read as follows: This employers' liability insurance applies to bodily 7. damages arising out of coercion, criticism, injury by accident or bodily injury by disease. demotion, evaluation, reassignment, Bodily injury means a physical injury, including discipline, defamation, harassment, resulting death. humiliation, discrimination against or 1. The bodily injury must arise out of and in the termination of any employee, termination of course of the injured employee's employment employment, or any personnel practices, by you. policies, acts or omissions. 2. The employment must be necessary or 4. The following exclusions are added: incidental to your work in California. 1. bodily injury to any member of the flying crew 3. Bodily injury by accident must occur during of any aircraft. the policy period. 2. bodily injury to an employee when you are 4. Bodily injury by disease must be caused or deprived of statutory or common law aggravated by the conditions of your defenses or are subject to penalty because employment. The employee's last day of last of your failure to secure your obligations exposure to the conditions causing or under the workers' compensation law(s) aggravating such bodily injury by disease applicable to you or otherwise fail to comply must occur during the policy period. with that law. 5. If you are sued, the original suit and any 3. liability arising from California Labor Code related legal actions for damages for bodily Section 2810.3 which relates to labor injury by accident or by disease must be contracting. brought in the United States of America, its territories or possessions, or Canada. Countersigned by cF RAMmWmentDMsian REVIEWED & APPROVED BY. - Form WC 04 03 60 B Printed in U.S.A. -' W Process Date: 05/25/20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OPTIONAL PREMIUM INCREASE ENDORSEMENT - CALIFORNIA Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 You must provide us, or our authorized representative, access to records necessary to perform a payroll verification audit. If you fail to provide access within 90 days after expiration of the policy, you are liable to pay a total premium equal to 3 times our current estimate of the annual premium for your policy. In addition, if you fail to provide access after our third request within a 90 day or longer period, you are also liable for our costs in attempting to perform the audit unless you provide a compelling business reason for your failure. We will contact you to schedule appointments during normal business hours. Form WC 04 04 21 Printed in U.S.A. Process Date: 05/25/20 We will notify you of your failure to provide access by mailing a certified, return -receipt document stating the increased premium and the total amount of our costs incurred in our attempt(s) to perform an audit. In addition to any other obligations under this contract, 30 days after you receive the notification, you will be obligated to pay the total premium and costs referenced above. If, thereafter, you provide access to your records within three years after the policy expires, or within another mutually agreed upon time, and we succeed in performing the audit to our satisfaction, we will revise your total premium and the costs due to reflect the results of the audit. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� R.Wjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA SHORT -RATE CANCELATION ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Information Page is subject to the following provisions: If you cancel the policy and a disclosure was provided in accordance with Section 481(c) of the California Insurance Code, final premium will be based on the time this policy was in force and increased by the short -rate cancelation table below: Extended Number of Days Percent of Full Policy Premium Extended Number of Days 1 .......... 5% 95-98 2 .......... 6% 99-102 3-4 .......... 7% 103-105 5-6 .......... 8% 106-109 7-8 .......... 9% 110-113 9-10 .......... 10% 114-116 11-12 .......... 11% 117-120 13-14 .......... 12% 121-124 15-16 .......... 13% 125-127 17-18 .......... 14% 128-131 19-20 .......... 15% 132-135 21-22 .......... 16% 136-138 23-25 .......... 17% 139-142 26-29 .......... 18% 143-146 30-32 (1 mo.) 19% 147-149 33-36 .......... 20% 150-153 37-40 .......... 21 % 154-156 41-43 .......... 22% 157-160 44-47 .......... 23% 161-164 48-51 .......... 24% 165-167 52-54 .......... 25% 168-171 55-58 .......... 26% 172-175 59-62 (2 mos.) 27% 176-178 63-65 .......... 28% 179-182 66-69 .......... 29% 183-187 70-73 .......... 30% 188-191 74-76 .......... 31 % 192-196 77-80 .......... 32% 197-200 81-83 .......... 33% 201-205 84-87 .......... 34% 206-209 88-91 (3 mos.) 35% 210-214 92-94 .......... 36% 215-218 Form WC 04 04 22 Printed in U.S.A. Process Date: 05/25/20 (4 mos.) (5 mos.) (6 mos.) (7 mos.) Percent of Full Policy Premium 37% 38% 39% 40% 41% 42% 43% 44% 45% 46% 47% 48% 49% 50% 51% 52% 53% 54% 55% 56% 57% 58% 59% 60% 61% 62% 63% 64% 65% 66% 67% 68% Extended Number of 219-223 224-228 229-232 233-237 238-241 242-246 247-250 251-255 256-260 261-264 265-269 270-273 274-278 279-282 283-287 288-291 292-296 297-301 302-305 306-310 311-314 315-319 320-323 324-328 329-332 333-337 338-342 343-346 347-351 352-355 356-360 361-365 (8 mos.) (9 mos.) (10 mos.) (11 mos.) Percent of Full Policy Premium 69% 70% 71% 72% 73% 74% 75% 76% 77% 78% 79% 80% 81% 82% 83% 84% 85% 86% 87% 88% 89% 90% 91% 92% 93% 94% 95% 96% 97% 98% 99% cF RAMmWmentDMsian REVIEWED & APPROVED BY.- V"° Policy E _� R.Wjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CANCELLATION ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. The cancellation condition in Part Six (Conditions) of the policy is replaced by these conditions: Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy for one or more of the following reasons: a. Non-payment of premium; b. Failure to report payroll; c. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us; e. Material misrepresentation made by you or your agent; f. Failure to cooperate with us in the investigation of a claim; g. Failure to comply with Federal or State safety orders; h. Failure to comply with written recommendations of our designated loss control representatives; i. The occurrence of a material change in the ownership of your business; j. The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss; k. The occurrence of any change in your business or operation that requires additional or different classification for premium calculation; I. The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties. 3. If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Item (g) through (1), we will give you 30 days advance written notice; however, we agree that in the event of cancellation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. 4. The policy period will end on the day and hour stated in the cancellation notice. Countersigned by: Form WC 04 06 01 A Printed in U.S.A. Process Date: 05/25/20 Policy cF Risk ManagementDMsian REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies only to the insurance provided by Part One (Workers Compensation Insurance) because Colorado is shown in Item 3.A. of the Information Page. Section B. Classifications of Part Five (Premium) is amended by adding the following: The assignment of a proper classification resulting in higher premium is allowed only if the misclassification was caused by your failure to provide accurate or complete data. If your operation changes during the policy term, you must notify us within ninety days of the change. Failure to notify us will be considered a failure to provide accurate or complete data. Section E. Final Premium of Part Five is amended by adding this sentence at the end of the first paragraph: Payments to us or to you based on improper classification may be collected or refunded during the term of the policy and for twelve months after the term. Countersigned by Form WC 05 04 02 Printed in U.S.A. Process Date: 05/25/20 cF RAMmVmentDMsian REVIEWED & APPROVED BY.- V"° Policy E _� R.Wjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ILLINOIS WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY EXCLUSION ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 C. Change Part Two — C. Exclusions 1. as follows: This insurance does not cover 1. liability assumed under a contract, and/or any agreement to waive your right to limit your liability for contribution to the amount of Form WC 12 03 06 A Printed in U.S.A. Process Date: 05/25/20 benefits payable under the Workers Compensation Act and the Workers Occupational Disease Act. This exclusion does not apply to a warranty that your work will be done in a workmanlike manner; ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� RFskPjanagementAnalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ILLINOIS AMENDATORY ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies because Illinois is shown in Item 3.A. of the Information Page. Part Two - Employers Liability Insurance, Section B. (We Will Pay), Item 3. of the policy is replaced by the following: For consequential bodily injury to a party to a civil union, spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and Part Five - Premium, Section G. (Audit) of the policy is replaced by the following: G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy ends. Information developed by audit will be used to determine final premium. The National Council on Compensation Insurance has the same rights we have under this provision. Part Six - Conditions, Section A. (Inspection) of the policy is replaced by the following: Form WC 12 06 01 F Printed in U.S.A. Process Date: 05/25/20 A. Inspection We have the right, but are not obliged, to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes, or standards. The National Council on Compensation Insurance has the same rights we have under this provision. Part Six - Conditions, Section D. (Cancellation) of the policy is replaced by the following: D. Cancellation 1. You may cancel this policy. You will mail or deliver advance written notice to us, stating when the cancellation is to take effect. 2. We may cancel this policy. We will mail to each named insured at the last known mailing address advance written notice stating when the cancellation is to take effect. We will maintain proof of mailing of the notice of cancellation. A copy of all such notices shall be sent to the broker or agent of record, if known, at the last known mailing address. The broker or agent of record may opt to accept notification electronically. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- ,v Policy E) R.Wjanagementftalpt 3. If we cancel because you do not pay all premium when due, we will mail the notice of cancellation at least ten days before the cancellation is to take effect. If we cancel for any other reason, we will mail the notice: a. At least 30 days before the cancellation is to take effect if the policy has been in force for 60 days or less; b. At least 60 days before the cancellation is to take effect if the policy has been in force for 61 days or more. 4. If this policy has been in effect for 60 days or more, we may cancel only for one of the following reasons: a. Nonpayment of premium; b. The policy was issued because of a material misrepresentation; c. You violated any of the terms and conditions of the policy; d. The risk originally accepted has measurably increased; e. The Director has determined that we no longer have adequate reinsurance to meet our needs; or f. The Director has determined that continuation of coverage could place us in violation of the laws of Illinois. 5. Our notice of cancellation will state our reasons for cancelling. 6. The policy period will end on the day and hour stated in the cancellation notice. Part Six - Conditions, Section E. (Sole Representative) of the policy is replaced by the following: E. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, or give us notice of cancellation. Form WC 12 06 01 F Printed in U.S.A. Part Six - Conditions of the policy is changed by adding the following: F. Nonrenewal 1. We may elect not to renew the policy. We will mail to each named insured the nonrenewal notice at the last known mailing address at least 60 days prior to the expiration of the current policy. We will maintain proof of mailing of the nonrenewal notice. An exact and unaltered copy of such notice will also be sent to the named insured's producer, if known, or the producer of record at the last known mailing address. The named insured's producer, if known, or the producer of record may opt to accept notification electronically. 2. If we fail to give at least 60 days' notice prior to the expiration date of the current policy, the policy will automatically be extended for one year under the same terms and conditions. We may increase the renewal premium, but such increase must be less than 30% of this policy's premium and notice of such increase must be delivered to the named insured on or before the date of expiration of this policy. Additionally, in accordance with 215 ILCS 5/462a, we may be required to provide the named insured with 30 days' written notice prior to the expiration of this policy if the renewal premium is in excess of 5% above the rate recommendation filed with and approved by the Illinois Department of Insurance. 3. Our notice of nonrenewal will provide a specific explanation on the reasons for not renewing. 4. If we fail to provide the notice of nonrenewal as required, the policy will still terminate on its expiration date if: a. You notify us or the producer who procured this policy that you do not want the policy renewed; or b. You fail to pay all premiums when due; or c. You obtain other insurance as a replacement of the policy. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ILLINOIS RENEWAL ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies because Illinois is shown in Item 3.A. of the Information Page. Part Six - Conditions of the policy is revised by adding the following: G. Renewal We may elect to renew the policy in accordance with 215 ILCS 5/143.17a. a. We will provide the named insured with written notice of our intent to renew if, compared to this current policy, the: o Renewal policy premium increases by 30% or more, or Changes in deductibles or coverage materially alter the renewal policy. b. We will mail or deliver the written renewal notice: To the named insured at the last known mailing address At least 60 days prior to the renewal or anniversary date of this current policy. c. If we fail to provide notice 60 days prior to the renewal or anniversary date, but we do mail or deliver the written renewal notice to the named insured not less than 31 days prior to the renewal or anniversary date of this current policy, then we may extend this policy at the current terms and conditions for the period of time needed to equal the 60 day time period required to provide notice of intention to renew. d. All renewal notices will also be sent to the producer, if known, or the producer of record, and to the mortgagee or lien holder listed on the policy. The producer, if known, or the producer of record and the mortgagee or lien holder may opt to accept notification electronically. e. If we fail to provide renewal notice as required above, the policy will automatically be extended for one year under the same terms and conditions. We may increase the renewal premium, but such increase must be less than 30% of this policy's premium and notice of such increase must be delivered to the named insured on or before the date of expiration of this current policy. The increase in premium is based on the known exposure as of the date of the quotation compared to the premium as of the last day of coverage for the current year's policy, annualized. The renewal premium may be subsequently amended to reflect any change in exposure or reinsurance costs not considered in the quotation. f. If we fail to provide the notice of renewal as required, the policy will still terminate on its expiration date if: (1) You notify us or the producer who procured this policy that you do not want the policy renewed; or (2) You fail to pay all premiums when due; or (3) You obtain other insurance as a replacement of the policy. g. Proof of mailing or proof of receipt of the notice of intent to renew to the named insured may be proven by a sworn affidavit by the company as to the usual and customary business practices of mailing notice pursuant to 215 ILCS 5/143.17a or may be proven consistent with Illinois Supreme Court Rule 236. ew cF RAMwagementDMsian °RE�AED&APPROVED SY: Form WC 12 06 03 Printed in U.S.A. x .v Process Date: 05/25/20 Policy _� RFARIana ementftal rst � 2. We may elect to conditionally renew the policy in accordance with 215 ILCS 5/462a. a. For policies issued, delivered, amended, or renewed on or after January 1, 2019 ("this policy") we will provide the employer with written notice of our intent to conditionally renew if, compared to this policy, the renewal premium is in excess of 5% above the rate recommendation filed with and approved by the Illinois Department of Insurance. b. To determine whether the renewal premium is in excess of 5% above the rate recommendation, we will not consider any premium increases generated from the following items: o Increased loss costs o Increased exposure units o The application of an experience rating modification o The application of a contracting classification premium adjustment program o The application of a large deductible program o The application of a retrospective rating plan o An audit of auditable coverages c. Mailing or delivering such written notice to the employer at least 30 days in advance of the expiration date of this policy, at the address shown in Item 1. of the Information Page, and to the authorized agent or broker will be deemed sufficient notice under this section. d. This conditional renewal notice will include a statement that clearly identifies: (1) The amount of the premium increase or, if the amount cannot reasonably be determined as of the time the notice is provided, a reasonable estimate of the premium increase based on information available to us at that time (2) The reason for the increased premium in excess of the rate recommendation filed with the Illinois Department of Insurance Form WC 12 06 03 Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NORTH CAROLINA AMENDED COVERAGE ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies only to the insurance provided by the policy because North Carolina is shown in Item 3.A. of the Information Page. The Cancellation Condition of the policy is replaced by this Condition: D. Cancellation and Nonrenewal 1. You may cancel this policy. If you cancel this policy, you must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy. (a) If this policy has been in effect for fewer than 60 days and is not a renewal policy, we may cancel this policy for any reason by giving you at least 30 days prior written notice of cancellation and the reasons for cancellation by registered or certified mail, return receipt requested. (b) If this policy has been in effect for at least 60 days or is a renewal policy, we may not cancel this policy without your prior written consent, except for any one of the following reasons: (1) Nonpayment of premium in accordance with the policy terms. (2) An act or omission by you or your representative that constitutes material misrepresentation or nondisclosure of a material fact in Form WC 32 03 01 D Printed in U.S.A. Process Date: 05/25/20 obtaining the policy, continuing the policy, or presenting a claim under the policy. (3) Increased hazard or material change in the risk assumed that could not have been reasonably contemplated by you and us at the time of assumption of the risk. (4) Substantial breach of contractual duties, conditions, or warranties that materially affects the insurability of the risk. (5) A fraudulent act against us by you or your representative that materially affects the insurability of the risk. (6) Willful failure by you or your representative to institute reasonable loss control measures that materially affect the insurability of the risk after written notice by us. (7) Loss of faculative reinsurance or loss of or substantial changes in applicable reinsurance as provided in G.S. 58-41-30. (8) Your conviction of a crime arising out of acts that materially affect the insurability of the risk (9) A determination by the Commissioner that the continuation of this policy would place us in violation of the laws of North Carolina. (10)You fail to meet the requirements contained in our corporate charter, articles of incorporation, or bylaws, when we are a company organized for the sole purpose of providing members of an organization with insurance coverage in North Carolina. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� R.Wjanagementftalpt (c) If we cancel for any of the reasons listed in with notice of nonrenewal at least 45 days paragraph (b), we must provide you with at prior to the anniversary date of the policy. least 15 days prior written notice of (c) The notice of nonrenewal must state the cancellation stating the precise reason for precise reason for nonrenewal. Failure to cancellation. We may provide this notice by send this notice, as provided in paragraphs registered or certified mail, return receipt 3 and 5, to any other person designated in requested, to you and any other person the policy to receive this notice invalidates designated in the policy to receive notice of the nonrenewal only as to that other cancellation at the addresses shown in the person's interest. policy or, if not indicated in the policy, at the last known addresses. Whenever notice of (d) Any nonrenewal attempted or made that is cancellation is given by registered or not in compliance with paragraphs (a), (b) certified mail, cancellation will not be and (c) is not effective. Paragraphs (a), (b) effective unless and until that method is and (c) do not apply if you have obtained employed and completed. Notice of intent to insurance elsewhere, have accepted cancel given by registered or certified mail replacement coverage, or have requested shall be conclusively presumed completed or agreed to nonrenewal. three days after the notice is sent if, on the 4. Whenever we lower coverage limits, raise same day that notice is sent by registered or deductibles, or raise premium rates for reasons certified mail, the insurer also provides within our exclusive control and other than at notice by first-class mail and by electronic your request, we will mail you written notice of means if available as defined in G.S. 58-2- the change at least 30 days in advance of the 255(a) to the insured and any other person effective date of the change. As used in this designated in the policy to receive notice. paragraph, the phrase, "reasons within our Any such supplemental notice given by exclusive control" does not mean experience electronic means shall be effective for the modification changes, exposure changes, or limited purpose of establishing this loss cost rate changes. conclusive presumption. Notice of 5. We must provide the notice required by cancellation may also be given by paragraphs 3 and 4 by mail to you and any anymethod permitted for service of process other person designated in the policy to receive pursuant to Rule 4 of the North Carolina this notice at the addresses shown in the policy Rules of Civil Procedure. Failure to send or, if not indicated in the policy, at the last notice as provided in this paragraph to any known addresses. Mailing copies of the notice other person designated in the policy to by regular first-class mail satisfies the notice receive notice of cancellation invalidates the requirements of paragraphs 3, 4 and 5. cancellation only as to that other person's interest. 6. We will also send copies of the notice required by this endorsement to the agent or broker of (d) Cancellation for nonpayment of premium is record, though failure to send copies of the not effective if the amount due is paid before notice to the agent or broker of record will not the effective date stated in the notice of invalidate a cancellation or nonrenewal. Mailing cancellation. copies of the notice by regular first-class mail to 3. We may refuse to renew this policy. the agent or broker of record satisfies the (a) If this policy is for a term of one year or less, requirements of this paragraph. Notice of we must provide you with notice of nonrenewal may also be given by any method nonrenewal at least 45 days prior to the permitted for service of process pursuant to expiration date of the policy. Rule 4 of the North Carolina Rules of Civil Procedure. (b) If this policy is for a term of more than one year or for an indefinite term, then to nonrenew the policy at the policy anniversary date we must provide you Form WC 32 03 01 D Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WISCONSIN LAW ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies only to the insurance provided by the policy because Wisconsin is shown in Item 3.A. of the Information Page. This policy is amended to reflect the following changes and/or additions to clarify or comply with Wisconsin Law: If our agent has knowledge of a change in or a violation of a policy condition, this will be considered our knowledge and will not void the policy or defeat a recovery for a claim. "Workers Compensation Law" means Chapter 102, Wisconsin Statutes. It does not include and Countersigned by this policy does not apply to any obligation under Chapter 40, Wisconsin Statutes, or Section 66.191, Wisconsin Statutes, or any amendment to these laws. III. Any language involving "Actions Against Us" is replaced and amended to provide that no legal action may be brought against us until there has been full compliance with all terms of this policy. IV. If an injury occurs that may be covered by this insurance, the policy is amended to provide that you must notify us of that injury as soon as reasonably possible. Form WC 48 06 01 C Printed in U.S.A. Process Date: 05/25/20 Policy cF Risk Managanad Msian Jy/ 1'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WISCONSIN CANCELLATION AND NONRENEWAL ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies only to the insurance provided by the policy because Wisconsin is shown in Item 3.A. of the Information Page. The Cancellation Section (D) of the Part Six - Conditions is deleted and replaced by the following: A. Cancellation You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. If you purchase replacement insurance, the cancellation becomes effective on the date the new coverage becomes effective. If no replacement coverage is purchased, the cancellation will be effective thirty (30) days after receipt of written notice by the Wisconsin Compensation Rating Bureau. 2. We may cancel the policy for any reason if the policy has been in effect for less than sixty (60) days. If the policy is issued for a term longer than one year or for an indefinite term, we may cancel the policy for any reason on an annual anniversary of the policy effective date. We may cancel the policy at any other time for the following reasons: a. you fail to pay all premiums when due, however, we must deliver or mail, first Form WC 48 06 06 B Printed in U.S.A. Process Date: 05/25/20 class, not less than thirty (30) days advance written notice stating when the cancellation is to take effect; b. a material misrepresentation; c. a substantial breach of the obligations, conditions or warranties under the policy; or d. a substantial change in the risk we assumed under the policy unless it was reasonable for us to foresee the change or expect the risk when we issued the policy. 3. If we cancel for any permissible reason other than nonpayment of premium when due, we must deliver or mail, first class, not less than* thirty (30) days notice stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 4. The policy period will end on the day and hour stated in a notice of cancellation. B. Nonrenewal You have the right to have the insurance renewed unless we deliver or mail to you not less than* sixty (60) days advance written notice stating our intention not to renew this policy. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° Policy E _� R.Wjanagementftalpt 2. We do not have to renew the insurance if you do not pay the renewal premium billing by the due date or if you accept replacement insurance, are insured elsewhere, requested or agree to nonrenewal, or if the policy is expressly designated as being nonrenewable. 3. If we renew the insurance, we may use the policy forms, rates and rating plans we are then using for similar risks. We may limit the policy to a term equivalent to the term of the expiring policy or one year, whichever is less. 4. If we offer to renew the insurance on less favorable terms, we will mail or deliver written notice of the new terms by first class mail to you, the policy holder, at least sixty (60) days prior to the renewal date. The definition of "terms" does not include manual rates, experience modification factors, or classification of risks. If we provide such notice within sixty (60) days prior to the renewal date, the new terms will not take effect until sixty (60) days after the notice is mailed or delivered, in which case, you, the policy holder, may elect to cancel the renewal policy at any time during the sixty (60) day period. The notice will include a statement of your right to cancel. If you elect to cancel the renewal policy during the sixty (60) day period, the return premium or additional premium charges shall be calculated proportionally on the basis of the old premiums. We need not mail or deliver this notice if the only change adverse to you is a premium increase that; (a) is less than 25%; or, (b) results from a change based on your action that alters the nature and extent of the risk insured against, including, but not limited to, a change in the classifications for the business. Any written agreement attached to and made a part of the policy, between the insurance carrier and policyholder which extends the cancellation or nonrenewal notification timeframe, will supercede the aforementioned notification requirements found in items A.3., and B.1., respectively. Countersigned by Form WC 48 06 06 B Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDATORY ENDORSEMENT COLORADO Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 It is agreed that this policy covers all employees of the insured, including statutory employees, and covers all business operations of the insured in any lawful endeavors, whether naturally connected or not, with respect to compensation and other benefits required of the insured by the Workers Compensation Law. Countersigned by Form WC 99 00 69 Printed in U.S.A. Process Date: 05/25/20 cF RAMmVmentDMsian REVIEWED & APPROVED BY.- v Policy E Wsk Pjanagement Analpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA INSTALLMENT FEE DISCLOSURE ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies only to the insurance provided because California is shown in Item 3.A. of the Information Page. A service fee of $7.00 is charged for each installment Form WC 99 03 75 Printed in U.S.A. Process Date: 05/25/20 when your premium is paid in installments. The service fee is $5.00 per withdrawal when you select an electronic fund transfer payment plan. The service fee will be added to the premium amount shown on your premium billing statement. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� RFskPjanagementAnalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CERTIFIED RISK MANAGEMENT PROGRAMS ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies to Part One (Workers Compensation Insurance) because Colorado is listed in Item 3.A of the Information Page. The Colorado Workers Compensation Cost Containment Board has determined that a premium differential shall be provided on all policies when you have selected a designed medical provider. If you qualify for experience and/or schedule rating and you have implemented a certified workers compensation risk management program or service, we must allow a 5% premium credit if your loss experience has improved since your last renewal date. The Schedule below will indicate if you qualify for this credit. If you do not qualify for experience and/or schedule rating on your workers compensation insurance and you have implemented a certified workers compensation risk management program or service, we must offer premium credits as follows: Premium Credit Credit Criteria 10% If you have been loss free for at least the last year immediately preceding the effective date of the premium credit. 8% If you have had one medical loss exceeding $250 in the last year immediately preceding the effective date of the premium credit. 6% If you have had two medical losses, each exceeding $250 within the last year immediately preceding the effective date of the premium credit. 4% If you have had three medical losses, each exceeding $250 within the last year immediately preceding the effective date of the premium credit. 2% If you have had three medical losses, each exceeding $250, and one claim for loss of time in the last year immediately preceding the effective date of the premium credit. 0% If you have had more than three medical losses and one claim for loss time in the last year immediately preceding the effective date of the premium credit. Countersigned by ew cF RAMwagementDMsian °RE�AED&APPROVED SY: Form WC 05 04 03 Printed in U.S.A. x .v Process Date: 05/25/20 Policy E �__ _� R.Wjanagementftalpt If you have selected a designated medical provider, we must allow a credit Of 2.5%. If you are eligible for schedule rating, the 2.5% credit must be included in the total schedule credit or debit, subject to the 25% maximum limitation. If you are not eligible for experience or schedule rating, the 2.5% credit will be applied, in addition to the premium credit applicable. The combined premium credit and the 2.5% credit for selection of a designated medical provider shall not exceed 12.5% Schedule % Premium Credit Certified Risk Management Program/Designated Medical Provider Form WC 05 04 03 Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARIZONA ALCOHOL- AND DRUG -FREE WORKPLACE PREMIUM CREDIT ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies only to the insurance provided by the policy because Arizona is shown in Item 3.A. of the Policy Information Page. This endorsement provides notice that premium for your policy may be affected by the Arizona Alcohol -and Drug - Free Workplace Premium Credit Program. You may qualify for a 5% premium credit if you have established and maintain a qualifying alcohol- and drug - free workplace program in accordance with Title 23, Chapter 2, Article 14 of Arizona Statutes. We will determine your eligibility for this premium credit after total premium has been paid for the policy period and may be revised at the time your final premium audit is processed. The determination that you have a qualifying program must be made each year that you receive the premium credit. To implement a premium credit program, the following guidelines must be established: 1. Insurers offering the premium credit program may apply a 5% premium credit to qualifying employers. 2. To receive the premium credit, you must: a. Provide a written statement to the insurer prior to or within 30 days after the beginning of the policy effective date each year, certifying that the business has implemented a program meeting the requirements of Title 23, Chapter 2, Article 14. b. At any time during the term of the policy, provide additional information to the insurer, as required, to confirm that a qualifying program has been established and is being maintained. Form WC 02 04 01 C Printed in U.S.A Process Date: 05/25/20 c. Comply with the alcohol and drug testing policy requirements in accordance with Title 23, Chapter 2, Article 14. d. Conduct alcohol and drug testing of prospective employees. e. Conduct alcohol and drug testing of an employee after the employee has been injured. f. Allow us to have access to the alcohol and drug testing results under d. and e. above. 3. The determination that you have established and maintain a qualifying program must be made during each policy term that you receive the premium credit. 4. Your certification and any other information relied upon by the insurer in granting the premium credit must be kept in the insurer's underwriting files and made available to the Department of Insurance upon request. 5. The premium credit may be applied after total premium has been paid for the policy period and may be revised at final audit to the employer's policy. The credit is applicable as a supplement to deviated rates and is applied in a multiplicative manner, after the application of the experience modification, and before the application of the premium discount and expense constant. 6. You must reimburse the premium credit if it is determined that you were not in compliance with the provisions of the program. 7. Minimum premium policies are eligible for this premium credit. 8. Residual market employers are eligible to apply for this premium credit. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� R.Wjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXPERIENCE RATING MODIFICATION FACTOR ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 The premium for the policy will be adjusted by an experience rating modification factor. The factor was not available when the policy was issued. The factor, if any, shown on the Information Page is an estimate. We will issue an endorsement to show the proper factor, if different from the factor shown, when it is calculated. Countersigned by Form WC 00 04 03 Printed in U.S.A. Process Date: 05/25/20 Policy cF RAMmVmentDMsian REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PREMIUM DISCOUNT ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Item 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. SCHEDULE 1. Table of States Alabama X Illinois Montana South Carolina Arkansas Kansas Nebraska South Dakota X California Kentucky New Hampshire Tennessee X Colorado Louisiana New Mexico Texas Connecticut Maine New York Utah Delaware Maryland X North Carolina Vermont District of Columbia Michigan Oklahoma Virginia Georgia Mississippi Oregon West Virginia Hawaii Missouri Pennsylvania Wyoming or any other State that has approved the premium discount plan applicable to the total policy premium on an interstate basis at the effective date of the policy. 2. Average percentage discount: 3.30 % 3. Other policies: 4. If there are no entries in Items 1, 2 and 3 of the Schedule, see the Premium Discount Endorsement attached to your policy number: Countersigned by Form WC 00 04 06 Printed in U.S.A. Process Date: 05/25/20 J�N RAMmWmentDMsian REVIEWED & APPROVEDSY: --� Risk Pjanagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PREMIUM DISCOUNT ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Item 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. SCHEDULE 1. State Estimated Eligible Premium First Next Next $5,000 $95,000 $400,000 Balance North Carolina 3.5% 5.0% 7.0% or any other State that has approved the premium discount plan applicable to the total policy premium on an interstate basis at the effective date of the policy. 2. Average percentage discount: 3.30 % 3. Other policies: 4. If there are no entries in Items 1, 2 and 3 of the Schedule, see the Premium Discount Endorsement attached to your policy number: Countersigned by Form WC 00 04 06 A Printed in U.S.A. Process Date: 05/25/20 J�N RAMmWmentDMsian REVIEWED & APPROVEDSY: --� Risk Pjanagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PREMIUM DISCOUNT ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Item 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. SCHEDULE 1. Table of States Alaska Idaho Massachusetts Rhode Island Arizona Indiana Minnesota Wisconsin Florida Iowa Nevada or any other State that has approved the premium discount plan applicable to the total policy premium on an interstate basis at the effective date of the policy. 2. Average percentage discount: 3.30 % 3. Other policies: 4. If there are no entries in Items 1, 2 and 3 of the Schedule, see the Premium Discount Endorsement attached to your policy number: Countersigned by Form WC 00 04 06 A Printed in U.S.A. Process Date: 05/25/20 J�N RAMmVmentDMsian REVIEWED & APPROVEDSY: --� Risk Pjanagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PREMIUM DISCOUNT ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Item 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. SCHEDULE 1. Table of States Alaska Idaho Massachusetts Rhode Island Arizona Indiana Minnesota X Wisconsin Florida Iowa Nevada or any other State that has approved the premium discount plan applicable to the total policy premium on an interstate basis at the effective date of the policy. 2. Average percentage discount: 7.80 % 3. Other policies: 4. If there are no entries in Items 1, 2 and 3 of the Schedule, see the Premium Discount Endorsement attached to your policy number: Countersigned by Form WC 00 04 06 A Printed in U.S.A. Process Date: 05/25/20 J�N RAMmVmentDMsian REVIEWED & APPROVEDSY: --� Risk Pjanagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PREMIUM DISCOUNT ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Item 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. SCHEDULE 1. Table of States Alaska Idaho Massachusetts Rhode Island X Arizona Indiana Minnesota Wisconsin Florida Iowa Nevada or any other State that has approved the premium discount plan applicable to the total policy premium on an interstate basis at the effective date of the policy. 2. Average percentage discount: 4.40 % 3. Other policies: 4. If there are no entries in Items 1, 2 and 3 of the Schedule, see the Premium Discount Endorsement attached to your policy number: Countersigned by Form WC 00 04 06 A Printed in U.S.A. Process Date: 05/25/20 J�N RAMmVmentDMsian REVIEWED & APPROVEDSY: --� Risk Pjanagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 1'�•��•��i�i � • - � •gam Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Section I of this endorsement expands coverage provided under WC 00 00 00. Section II of this endorsement provides additional coverage usually only provided by endorsement. Section III of this endorsement is a Schedule of Covered States. You may use the index to locate these coverage features quickly: INDEX SUBJECT SECTION I PARTS ONE and TWO 01 We Will Also Pay PART -THREE 02 How This Insurance Works PART - SIX 03 Transfer of Your Rights and Duties 04 Liberalization SECTION II VOLUNTARY COMPENSATION INSURANCE 05 Voluntary Compensation Insurance A. How This Insurance Applies B. We will Pay C. Exclusions D. Before We Pay E. Recovery From Others F. Employers' Liability Insurance EMPLOYERS' LIABILITY STOP GAP COVERAGE 06 Employers' Liability Stop Gap Coverage A. Stop Gap Coverage Limited Montana, North Dakota, Ohio, Washington, West Virginia and Wyoming B. Part One does not Apply C. Application of Coverage D. Additional Exclusions E. West Virginia SECTION III 07 Schedule of Covered States PAGE Msian Form WC 99 03 02 B Printed in U.S.A. (Ed. 8/00) �/ 1°?w GF REVIEW�� x ED & APPROVm BY. - Process Date: 05/25/20 Policy E I , V4 © 2000, The Hartford -�_— Wsk Pjanagement Analpt PARTS ONE and TWO 1. WE WILL ALSO PAY D. We Will Also Pay of Part One (WORKERS' COMPENSATION INSURANCE); and E. We Will Also Pay of Part Two (EMPLOYERS' LIABILITY INSURANCE) is replaced by the following: We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend: 1. reasonable expenses incurred at our request, INCLUDING loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this law; and 5. expenses we incur. VOLUNTARY COMPENSATION AND EMPLOYERS' LIABILITY COVERAGE 5. Voluntary Compensation Insurance A. How This Insurance Applies This insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must be sustained by any officer or employee not subject to the workers' compensation law of any state shown in Item 3.A. of the Information Page. 2. The bodily injury must arise out of and in the course of employment or incidental Form WC 99 03 02 B Printed in U.S.A. (Ed. 8/00) SECTION I PART THREE 2. How This Insurance Applies Paragraph 4. of A. How This Insurance Applies of Part 3 (Other States Insurance) is replaced by the following: 4. If you have work on the effective date of this policy in any state not listed in Item 3.A. of the Information Page, coverage will not be afforded for that state unless we are notified within sixty days. PART SIX 3. Transfer Of Your Rights and Duties C. Transfer Of Your Rights and Duties of Part 6 (Conditions) is replaced by the following: Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within sixty days after your death, we will cover your legal representative as insured. 4. Liberalization SECTION II If we adopt a change in this form that would broaden the coverage of this form without extra charge, the broader coverage will apply to this policy. It will apply when the change becomes effective in your state. to work in a state shown in Item 3.A. of the Information Page. 3. The bodily injury must occur in the United States of America, its territories or possessions, or Canada, and may occur elsewhere if the employee is a United States or Canadian citizen, or otherwise legal resident, and legally employed, in the United States or Canada and temporarily away from those places. 4. Bodily injury by accident must occur during the policy period. 5. Bodily injury by disease must be caused or aggravated by the conditions of the officer's or employee's employment. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- ,v --� Risk janagement Analyst The officer's or employee's last day of If the persons entitled to the benefits of this last exposure to the conditions causing insurance make a recovery from others, they or aggravating such bodily injury by must reimburse us for the benefits we paid them. disease must occur during the policy F. Employers' Liability Insurance period. Part Two (Employers' Liability Insurance) applies B. We Will Pay to bodily injury covered by this endorsement as We will pay an amount equal to the benefits though the State of Employment was shown in that would be required of you as if you and Item 3.A. of the Information Page. your employees were subject to the workers' This provision 5. does not apply in New Jersey or compensation law of any state shown in Item Wisconsin. 3.A. of the Information Page. We will pay those amounts to the persons who would be EMPLOYERS' LIABILITY STOP GAP COVERAGE entitled to them under the law. 6. Employers' Liability Stop Gap Coverage C. Exclusion A. This coverage only applies in Montana, North This insurance does not cover: Dakota, Ohio, Washington, West Virginia and Wyoming. 1. any obligation imposed by workers' compensation or occupational disease B. Part One (Workers' Compensation Insurance) law or any similar law. does not apply to work in states shown in Paragraph A above. 2. bodily injury intentionally caused or aggravated by you. C. Part Two (Employers' Liability Insurance) applies in the states, shown in Paragraph A., as though 3. officers or employees who have elected they were shown in Item 3.A. of the Information not to be subject to the state workers' Page. compensation law. D. Part Two, Section C. Exclusions is changed by 4. partners or sole proprietors not covered adding these exclusions. under the Standard Sole Proprietors, Partners, Officers and Others Coverage This insurance does not cover; Endorsement. 5. bodily injury intentionally caused or D. Before We Pay aggravated by you or in Ohio bodily injury resulting from an act which is determined by Before we pay benefits to the persons an Ohio court of law to have been committed entitled to them, they must: by you with the belief than an injury is 1. Release you and us, in writing, of all substantially certain to occur. However, the responsibility for the injury or death. cost of defending such claims or suits in Ohio 2. Transfer to us their right to recover from is covered. others who may be responsible for the 13. bodily injury sustained by any member of the injury or death. flying crew of any aircraft. 3. Cooperate with us and do everything 14. any claim for bodily injury with respect to necessary to enable us to enforce the which you are deprived of any defense or right to recover from others. defenses or are otherwise subject to penalty If the persons entitled to the benefits of this because of default in premium under the insurance fail to do those things, our duty to provisions of the workers' compensation law pay ends at once. If they claim damages or laws of a state shown in Paragraph A. from you or from us for the injury or death, E. This insurance applies to damages for which you our duty to pay ends at once. are liable under West Virginia Code Annot. S 23- E. Recovery From Others 4-2. If we make a recovery from others, we will keep an amount equal to our expenses of recovery and the benefits we paid. We will pay the balance to the persons entitled to it. Form WC 99 03 02 B Printed in U.S.A. (Ed. 8/00) ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- ,v --� Risk janagement Analyst SECTION III 7. SCHEDULE OF COVERED STATES A. This endorsement only applies in the states listed in this Schedule of Covered States. C. Schedule of Covered States: NC Countersigned by Form WC 99 03 02 B Printed in U.S.A. (Ed. 8/00) B. If a state, shown in Item 3.A. of the Information Page, approves this endorsement after the effective date of this policy, this endorsement will apply to this policy. The coverage will apply in the new state on the effective date of the state approval. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- ,v --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WORKERS' COMPENSATION BROAD FORM ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Section I of this endorsement expands coverage provided under WC 00 00 00. Section II of this endorsement provides additional coverage usually only provided by endorsement. Section III of this endorsement is a Schedule of Covered States. You may use the index to locate these coverage features quickly: INDEX SUBJECT SECTION I PARTS ONE and TWO 01 We Will Also Pay PART -THREE 02 How This Insurance Works PART - SIX 03 Transfer of Your Rights and Duties 04 Liberalization SECTION II VOLUNTARY COMPENSATION INSURANCE 05 Voluntary Compensation Insurance A. How This Insurance Applies B. We will Pay C. Exclusions D. Before We Pay E. Recovery From Others F. Employers' Liability Insurance EMPLOYERS' LIABILITY STOP GAP COVERAGE 06 Employers' Liability Stop Gap Coverage A. Stop Gap Coverage Limited North Dakota, Ohio, Washington, and Wyoming B. Part One does not Apply C. Application of Coverage D. Additional Exclusions SECTION III 07 Schedule of Covered States Form WC 99 03 80 Printed in U.S.A. Process Date: 05/25/20 © 2000, The Hartford PAGE 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 4 4 ew cF RAMwagementl?i skm Jy/ \'x REVIEWED & APPROVED BY.- Policy E , v --� W. janagement Analyst SECTION I PARTS ONE and TWO 1. WE WILL ALSO PAY D. We Will Also Pay of Part One (WORKERS' COMPENSATION INSURANCE); and E. We Will Also Pay of Part Two (EMPLOYERS' LIABILITY INSURANCE) is replaced by the following: We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend: 1. reasonable expenses incurred at our request, INCLUDING loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this law; and 5. expenses we incur. VOLUNTARY COMPENSATION AND EMPLOYERS' LIABILITY COVERAGE 5. Voluntary Compensation Insurance A. How This Insurance Applies PART THREE 2. How This Insurance Applies Paragraph 4. of A. How This Insurance Applies of Part 3 (Other States Insurance) is replaced by the following: 4. If you have work on the effective date of this policy in any state not listed in Item 3.A. of the Information Page, coverage will not be afforded for that state unless we are notified within sixty days. PART SIX 3. Transfer Of Your Rights and Duties C. Transfer Of Your Rights and Duties of Part 6 (Conditions) is replaced by the following: Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within sixty days after your death, we will cover your legal representative as insured. 4. Liberalization SECTION II This insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must be sustained by any officer or employee not subject to the workers' compensation law of any state shown in Item 3.A. of the Information Page. 2. The bodily injury must arise out of and in the course of employment or incidental to work Form WC 99 03 80 Printed in U.S.A. If we adopt a change in this form that would broaden the coverage of this form without extra charge, the broader coverage will apply to this policy. It will apply when the change becomes effective in your state. in a state shown in Item 3.A. of the Information Page. 3. The bodily injury must occur in the United States of America, its territories or possessions, or Canada, and may occur elsewhere if the employee is a United States or Canadian citizen, or otherwise legal resident, and legally employed, in the United States or Canada and temporarily away from those places. 4. Bodily injury by accident must occur during the policy period. 5. Bodily injury by disease must be caused or aggravated by the conditions of the officer's or employee's employment. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst The officer's or employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. B. We Will Pay We will pay an amount equal to the benefits that would be required of you as if you and your employees were subject to the workers' compensation law of any state shown in Item 3.A. of the Information Page. We will pay those amounts to the persons who would be entitled to them under the law. C. Exclusion This insurance does not cover: 1. any obligation imposed by workers' compensation or occupational disease law or any similar law. 2. bodily injury intentionally caused or aggravated by you. 3. officers or employees who have elected not to be subject to the state workers' compensation law. 4. partners or sole proprietors not covered under the Standard Sole Proprietors, Partners, Officers and Others Coverage Endorsement. D. Before We Pay Before we pay benefits to the persons entitled to them, they must: 1. Release you and us, in writing, of all responsibility for the injury or death. 2. Transfer to us their right to recover from others who may be responsible for the injury or death. 3. Cooperate with us and do everything necessary to enable us to enforce the right to recover from others. If the persons entitled to the benefits of this insurance fail to do those things, our duty to pay ends at once. If they claim damages from you or from us for the injury or death, our duty to pay ends at once. E. Recovery From Others If we make a recovery from others, we will keep an amount equal to our expenses of recovery Form WC 99 03 80 Printed in U.S.A. and the benefits we paid. We will pay the balance to the persons entitled to it. If the persons entitled to the benefits of this insurance make a recovery from others, they must reimburse us for the benefits we paid them. F. Employers' Liability Insurance Part Two (Employers' Liability Insurance) applies to bodily injury covered by this endorsement as though the State of Employment was shown in Item 3.A. of the Information Page. This provision 5. does not apply in New Jersey or Wisconsin. EMPLOYERS' LIABILITY STOP GAP COVERAGE 6. Employers' Liability Stop Gap Coverage A. This coverage only applies in North Dakota, Ohio, Washington and Wyoming. B. Part One (Workers' Compensation Insurance) does not apply to work in states shown in Paragraph A above. C. Part Two (Employers' Liability Insurance) applies in the states, shown in Paragraph A., as though they were shown in Item 3.A. of the Information Page. D. Part Two, Section C. Exclusions is changed by adding these exclusions. This insurance does not cover; 5. bodily injury intentionally caused or aggravated by you or in Ohio bodily injury resulting from an act which is determined by an Ohio court of law to have been committed by you with the belief that an injury is substantially certain to occur. However, the cost of defending such claims or suits in Ohio is covered. 13. bodily injury sustained by any member of the flying crew of any aircraft. 14. any claim for bodily injury with respect to which you are deprived of any defense or defenses or are otherwise subject to penalty because of default in premium under the provisions of the workers' compensation law or laws of a state shown in Paragraph A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst SECTION III 7. SCHEDULE OF COVERED STATES A. This endorsement only applies in the states listed in this Schedule of Covered States. C. Schedule of Covered States: IL Form WC 99 03 80 Printed in U.S.A. B. If a state, shown in Item 3.A. of the Information Page, approves this endorsement after the effective date of this policy, this endorsement will apply to this policy. The coverage will apply in the new state on the effective date of the state approval. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 1'�•��•��i�i � • - � •gam EXTENDED OPTIONS Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Section I of this endorsement expands coverage provided under WC 00 00 00. Section II of this endorsement provides additional coverage usually only provided by endorsement. Section III of this endorsement is a Schedule of Covered States. You may use the index to locate these coverage features quickly: SUBJECT SECTION I PARTS ONE and TWO 01 We Will Also Pay PART -THREE 02 How This Insurance Works PART - SIX 03 Transfer of Your Rights and Duties 04 Cancellation 05 Liberalization SECTION II VOLUNTARY COMPENSATION INSURANCE 06 Voluntary Compensation Insurance A. How This Insurance Applies B. We Will Pay C. Exclusions D. Before We Pay E. Recovery From Others F. Employers' Liability Insurance EMPLOYERS' LIABILITY STOP GAP ENDORSEMENT 07 Employers' Liability Stop Gap Coverage A. Stop Gap Coverage Limited to Montana, North Dakota, Ohio, Washington, West Virginia and Wyoming Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) Process Date: 05/25/20 INDEX PAGE 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 SUBJECT B. Part One Does Not Apply C. Application of Coverage D. Additional Exclusions E. West Virginia EXTENDED OPTIONS 01 Employers' Liability Insurance 02 Unintentional Failure to Disclose Hazards 03 Waiver of Our Right to Recover from Others 04 Foreign Voluntary Compensation A. How This Reimbursement Applies B. We Will Reimburse C. Exclusions D. Before We Pay E. Recovery From Others F. Reimbursement For Actual Loss Sustained G. Repatriation H. Endemic Disease 05 Longshore and Harbor Workers' Compensation Act Coverage Endorsement SECTION III 01 Schedule of Covered States © 2000, The Hartford PAGE 3 3 3 3 4 4 4 e sF RAMmWmentl?i skm �40 & REVIEWED & APPROVEDSY: Policy E , V4 --� Wsk Pjanagement Analyst SECTION I PARTS ONE and TWO 1. WE WILL ALSO PAY D. We Will Also Pay of Part One (WORKERS' COMPENSATION INSURANCE); and E. We Will Also Pay of Part Two (EMPLOYERS' LIABILITY INSURANCE) is replaced by the following: We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend: 1. reasonable expenses incurred at our request, INCLUDING loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this law; and 5. expenses we incur. PART THREE 2. How This Insurance Applies Paragraph 4. of A. How This Insurance Applies of Part 3 (Other States Insurance) is replaced by the following: 4. If you have work on the effective date of this policy in any state not listed in Item 3.A. of the Information Page, coverage will not be afforded for that state unless we are notified within sixty days. PART SIX 3. Transfer Of Your Rights and Duties C. Transfer Of Your Rights and Duties of Part 6 (Conditions) is replaced by the following: Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within sixty days after your death, we will cover your legal representative as insured. 4. Cancellation Paragraph 2. of D. Cancellation of Part 6 (Conditions) is replaced by the following: 2. We may cancel this policy. We must mail or deliver to you not less than 15 days advance written notice stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 5. Liberalization SECTION II VOLUNTARY COMPENSATION AND EMPLOYERS' LIABILITY COVERAGE 6. Voluntary Compensation Insurance A. How This Insurance Applies This insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must be sustained by any officer or employee not subject to the workers' compensation law of any state shown in Item 3.A. of the Information Page. Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) If we adopt a change in this form that would broaden the coverage of this form without extra charge, the broader coverage will apply to this policy. It will apply when the change becomes effective in your state. 2. The bodily injury must arise out of and in the course of employment or incidental to work in a state shown in Item 3.A. of the Information Page. 3. The bodily injury must occur in the United States of America, its territories or possessions, or Canada, and may occur elsewhere if the employee is a United States or Canadian citizen, or otherwise legal resident, and legally employed, in the United States or Canada and temporarily away from those places. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst 4. Bodily injury by accident must occur during the policy period. 5. Bodily injury by disease must be caused or aggravated by the conditions of the officer's or employee's employment. The officer's or employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. B. We Will Pay We will pay an amount equal to the benefits that would be required of you as if you and your employees were subject to the workers' compensation law of any state shown in Item 3.A. of the Information Page. We will pay those amounts to the persons who would be entitled to them under the law. C. Exclusion This insurance does not cover: 1. any obligation imposed by workers' compensation or occupational disease law or any similar law. 2. bodily injury intentionally caused or aggravated by you. 3. officers or employees who have elected not to be subject to the state workers' compensation law. 4. partners or sole proprietors not covered under the Standard Sole Proprietors, Partners, Officers and Others Coverage Endorsement. D. Before We Pay Before we pay benefits to the persons entitled to them, they must: 1. Release you and us, in writing, of all responsibility for the injury or death. 2. Transfer to us their right to recover from others who may be responsible for the injury or death. 3. Cooperate with us and do everything necessary to enable us to enforce the right to recover from others. If the persons entitled to the benefits of this insurance fail to do those things, our duty to pay ends at once. If they claim damages from you or from us for the injury or death, our duty to pay ends at once. E. Recovery From Others If we make a recovery from others, we will Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) keep an amount equal to our expenses of recovery and the benefits we paid. We will pay the balance to the persons entitled to it. If the persons entitled to the benefits of this insurance make a recovery from others, they must reimburse us for the benefits we paid them. F. Employers' Liability Insurance Part Two (Employers' Liability Insurance) applies to bodily injury covered by this endorsement as though the State of Employment was shown in Item 3.A. of the Information Page. This provision 6. does not apply in New Jersey or Wisconsin. EMPLOYERS' LIABILITY STOP GAP COVERAGE 7. Employers' Liability Stop Gap Coverage A. This coverage only applies in Montana, North Dakota, Ohio, Washington, West Virginia and Wyoming. B. Part One (Workers' Compensation Insurance) does not apply to work in states shown in Paragraph A above. C. Part Two (Employers' Liability Insurance) applies in the states, shown in Paragraph A., as though they were shown in Item 3.A. of the Information Page. D. Part Two, Section C. Exclusions is changed by adding these exclusions. This insurance does not cover; 5. bodily injury intentionally caused or aggravated by you or in Ohio bodily injury resulting from an act which is determined by an Ohio court of law to have been committed by you with the belief than an injury is substantially certain to occur. However, the cost of defending such claims or suits in Ohio is covered. 13. bodily injury sustained by any member of the flying crew of any aircraft. 14. any claim for bodily injury with respect to which you are deprived of any defense or defenses or are otherwise subject to penalty because of default in premium under the provisions of the workers' compensation law or laws of a state shown in Paragraph A. E. This insurance applies to damages for which you are liable under West Virginia Code Annot. S 23-4-2. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst EXTENDED OPTIONS 1. Employers' Liability Insurance Item 3.13. of the Information Page is replaced by the following: B. Employers' Liability Insurance: 1. Part Two of the policy applies to work in each state listed in Item 3.A. The Limits of Liability under Part Two are the higher of: Bodily Injury by Accident $500,000 Each Accident Bodily Injury by Disease $500,000 Policy Limit Bodily Injury by Disease $500,000 Each Employee OR 2. The amount shown in the Information Page. This provision 1 of EXTENDED OPTIONS does not apply in New York because the Limits Of Our Liability are unlimited. In this provision the limits are changed from $500,000 to $1,000,000 in California. 2. Unintentional Failure to Disclose Hazards If you unintentionally should fail to disclose all existing hazards at the inception date of your policy, we shall not deny coverage under this policy because of such failure. 3. Waiver of Our Right To Recover From Others A. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization for whom you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the agreement. B. This provision 3. does not apply in the states of Pennsylvania and Utah. Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) 4. Foreign Voluntary Compensation and Employers' Liability Reimbursement A. How This Reimbursement Applies This reimbursement provision applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must be sustained by an officer or employee. 2. The bodily injury must occur in the course of employment necessary or incidental to work in a country not listed in Exclusion C.1. of this provision. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The officer or employee's last exposure to those conditions of your employment must occur during the policy period. B. We Will Reimburse We will reimburse you for all amounts paid by you whether such amounts are: 1. voluntary payments for the benefits that would be required of you if you and your officers or employees were subject to any workers' compensation law of the state of hire of the individual employee. 2. sums to which Part Two (Employers' Liability Insurance) would apply if the Country of Employment were shown in Item 3.A. of the Information Page. C. Exclusions This insurance does not cover: 1. any occurrences in the United States, Canada, and any country or jurisdiction which is the subject of trade or economic sanctions imposed by the laws or regulations of the United States of America in effect as of the inception date of this policy. 2. any obligation imposed by a workers' compensation or occupational disease law, or similar law. 3. bodily injury intentionally caused or aggravated by you. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst 4. liability for any consequence, whether direct or indirect, of war, invasion, act of Foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military or usurped power. No endorsement now or subsequently attached to this policy shall be construed as overriding or waiving this limitation unless specific reference is made thereto. D. Before We Pay Before we reimburse you for the benefits to the persons entitled to them, you must have them: 1. release you and us, in writing, of all responsibility for the injury or death, 2. transfer to us their right to recover from others who may be responsible for their injury or death, 3. cooperate with us and do everything necessary to enable us to enforce the right to recover from others. If the persons entitled to the benefits paid fail to do these things, our duty to reimburse ends at 5. once. If they claim damages from us for the injury or death, our duty to reimburse ends at once. E. Recovery From Others If we make a recovery from others, we will keep an amount equal to our expenses of recovery and the benefits we reimbursed. We will pay the balance to the persons entitled to it. If persons entitled to the benefits make a recovery from others, they must repay us for the amounts that we have reimbursed you. F. Reimbursement for Actual Loss Sustained This endorsement provides only for reimbursement for the loss you actually sustain. In order for you to recover loss or expenses under this reimbursement you must: 1. actually sustain and pay the loss or expense in money after trial, or 2. secure our consent for the payment of the loss or expense. G. Repatriation Our reimbursement includes the additional expenses of repatriation to the United States Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) of America necessarily incurred as a direct result of bodily injury. Our reimbursement shall be limited as follows: 1. to the amount by which such expenses exceed the normal cost of returning the officer or employee if in good health, or 2. in the event of death, to the amount by which such expenses exceed the normal cost of returning the officer or employee if alive and in good health. In no event shall our reimbursement exceed the bodily injury by accident limit shown in Item 3.B. of the Information Page as respects any one such officer or employee whether dead or alive. H. Endemic Disease The word "disease" includes any endemic diseases. The coverage applies as if endemic diseases were included in the provisions of the workers' compensation law. Longshore and Harbor Workers' Compensation Act Coverage General Section C. Workers' Compensation Law is replaced by the following: C. Workers' Compensation Law Workers' Compensation Law means the workers or workers' compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page and the Longshore and Harbor Workers' Compensation Act (33 USC Sections 901-950). It includes any amendments to those laws that are in effect during the policy period. It does not include any other federal workers or workers' compensation law, other federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits. Part Two (Employers' Liability Insurance), C. Exclusions, exclusion 8, does not apply to work subject to the Longshore and Harbor Workers' Compensation Act. This coverage does not apply to work subject to the Defense Base Act, the Outer Continental Shelf Lands Act, or the Nonappropriated Fund Instrumentalities Act. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst SECTION III 1. SCHEDULE OF COVERED STATES A. This endorsement only applies in the states listed in this Schedule of Covered States. C. Schedule of Covered States: AZ Countersigned by Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) B. If a state, shown in Item 3.A. of the Information Page, approves this endorsement after the effective date of this policy, this endorsement will apply to this policy. The coverage will apply in the new state on the effective date of the state approval. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 1'�•��•��i�i � • - � •gam EXTENDED OPTIONS Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 Section I of this endorsement expands coverage provided under WC 00 00 00. Section II of this endorsement provides additional coverage usually only provided by endorsement. Section III of this endorsement is a Schedule of Covered States. You may use the index to locate these coverage features quickly: SUBJECT SECTION I PARTS ONE and TWO 01 We Will Also Pay PART -THREE 02 How This Insurance Works PART - SIX 03 Transfer of Your Rights and Duties 04 Liberalization SECTION II VOLUNTARY COMPENSATION INSURANCE 05 Voluntary Compensation Insurance A. How This Insurance Applies B. We Will Pay C. Exclusions D. Before We Pay E. Recovery From Others F. Employers' Liability Insurance EMPLOYERS' LIABILITY STOP GAP ENDORSEMENT 06 Employers' Liability Stop Gap Coverage A. Stop Gap Coverage Limited to Montana, North Dakota, Ohio, Washington, West Virginia and Wyoming Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Process Date: 05/25/20 INDEX PAGE 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 SUBJECT B. Part One Does Not Apply C. Application of Coverage D. Additional Exclusions E. West Virginia EXTENDED OPTIONS 01 Employers' Liability Insurance 02 Unintentional Failure to Disclose Hazards 03 Waiver of Our Right to Recover from Others 04 Foreign Voluntary Compensation A. How This Reimbursement Applies B. We Will Reimburse C. Exclusions D. Before We Pay E. Recovery From Others F. Reimbursement For Actual Loss Sustained G. Repatriation H. Endemic Disease 05 Longshore and Harbor Workers' Compensation Act Coverage Endorsement SECTION III 01 Schedule of Covered States PAGE 3 3 3 3 4 4 4 e sF RAMmWmentl?i skm �40 & REVIEWED & APPROVEDSY: Policy E , V4 © 2000, The Hartford —�_— WsknranagementAnalpt PARTS ONE and TWO 1. WE WILL ALSO PAY D. We Will Also Pay of Part One (WORKERS' COMPENSATION INSURANCE); and E. We Will Also Pay of Part Two (EMPLOYERS' LIABILITY INSURANCE) is replaced by the following: We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend: 1. reasonable expenses incurred at our request, INCLUDING loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this law; and 5. expenses we incur. VOLUNTARY COMPENSATION ANDEMPLOYERS' LIABILITY COVERAGE 5. Voluntary Compensation Insurance A. How This Insurance Applies This insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must be sustained by any officer or employee not subject to the workers' compensation law of any state shown in Item 3.A. of the Information Page. 2. The bodily injury must arise out of and in the course of employment or incidental to work in a state shown in Item 3.A. of the Information Page. Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) SECTION I PART THREE 2. How This Insurance Applies Paragraph 4. of A. How This Insurance Applies of Part 3 (Other States Insurance) is replaced by the following: 4. If you have work on the effective date of this policy in any state not listed in Item 3.A. of the Information Page, coverage will not be afforded for that state unless we are notified within sixty days. PART SIX 3. Transfer Of Your Rights and Duties C. Transfer Of Your Rights and Duties of Part 6 (Conditions) is replaced by the following: Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within sixty days after your death, we will cover your legal representative as insured. 4. Liberalization SECTION II If we adopt a change in this form that would broaden the coverage of this form without extra charge, the broader coverage will apply to this policy. It will apply when the change becomes effective in your state. 3. The bodily injury must occur in the United States of America, its territories or possessions, or Canada, and may occur elsewhere if the employee is a United States or Canadian citizen, or otherwise legal resident, and legally employed, in the United States or Canada and temporarily away from those places. 4. Bodily injury by accident must occur during the policy period. 5. Bodily injury by disease must be caused or aggravated by the conditions of the ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst officer's or employee's employment. The If the persons entitled to the benefits of this officer's or employee's last day of last insurance make a recovery from others, they exposure to the conditions causing or must reimburse us for the benefits we paid them. aggravating such bodily injury by disease F. Employers' Liability Insurance must occur during the policy period. Part Two (Employers' Liability Insurance) applies B. We Will Pay to bodily injury covered by this endorsement as We will pay an amount equal to the benefits though the State of Employment was shown in that would be required of you as if you and Item 3.A. of the Information Page. your employees were subject to the workers' This provision 5. does not apply in New Jersey or compensation law of any state shown in Item Wisconsin. 3.A. of the Information Page. We will pay those amounts to the persons who would be EMPLOYERS' LIABILITY STOP GAP COVERAGE entitled to them under the law. 6. Employers' Liability Stop Gap Coverage C. Exclusion A. This coverage only applies in Montana, North This insurance does not cover: Dakota, Ohio, Washington, West Virginia and Wyoming. 1. any obligation imposed by workers' compensation or occupational disease B. Part One (Workers' Compensation Insurance) law or any similar law. does not apply to work in states shown in Paragraph A above. 2. bodily injury intentionally caused or aggravated by you. C. Part Two (Employers' Liability Insurance) applies in the states, shown in Paragraph A., as though 3. officers or employees who have elected they were shown in Item 3.A. of the Information not to be subject to the state workers' Page. compensation law. D. Part Two, Section C. Exclusions is changed by 4. partners or sole proprietors not covered adding these exclusions. under the Standard Sole Proprietors, Partners, Officers and Others Coverage This insurance does not cover; Endorsement. 5. bodily injury intentionally caused or D. Before We Pay aggravated by you or in Ohio bodily injury resulting from an act which is determined by Before we pay benefits to the persons an Ohio court of law to have been committed entitled to them, they must: by you with the belief than an injury is 1. Release you and us, in writing, of all substantially certain to occur. However, the responsibility for the injury or death. cost of defending such claims or suits in Ohio 2. Transfer to us their right to recover from is covered. others who may be responsible for the 13. bodily injury sustained by any member of the injury or death. flying crew of any aircraft. 3. Cooperate with us and do everything 14. any claim for bodily injury with respect to necessary to enable us to enforce the which you are deprived of any defense or right to recover from others. defenses or are otherwise subject to penalty If the persons entitled to the benefits of this because of default in premium under the insurance fail to do those things, our duty to provisions of the workers' compensation law pay ends at once. If they claim damages or laws of a state shown in Paragraph A. from you or from us for the injury or death, E. This insurance applies to damages for which you our duty to pay ends at once. are liable under West Virginia Code Annot. S 23- E. Recovery From Others 4-2. If we make a recovery from others, we will keep an amount equal to our expenses of recovery and the benefits we paid. We will pay the balance to the persons entitled to it. Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst EXTENDED OPTIONS 1. Employers' Liability Insurance 4. Foreign Voluntary Compensation and Employers' Item 3.B. of the Information Page is replaced by Liability Reimbursement the following: A. How This Reimbursement Applies B. Employers' Liability Insurance: 1. Part Two of the policy applies to work in each state listed in Item 3.A. The Limits of Liability under Part Two are the higher of: Bodily Injury by Accident $500,000 Each Accident Bodily Injury by Disease $500,000 Policy Limit Bodily Injury by Disease $500,000 Each Employee OR 2. The amount shown in the Information Page. This provision 1 of EXTENDED OPTIONS does not apply in New York because the Limits Of Our Liability are unlimited. In this provision the limits are changed from $500,000 to $1,000,000 in California. 2. Unintentional Failure to Disclose Hazards If you unintentionally should fail to disclose all existing hazards at the inception date of your policy, we shall not deny coverage under this policy because of such failure. 3. Waiver of Our Right To Recover From Others A. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization for whom you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the agreement. B. This provision 3. does not apply in the states of Pennsylvania and Utah. Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) This reimbursement provision applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must be sustained by an officer or employee. 2. The bodily injury must occur in the course of employment necessary or incidental to work in a country not listed in Exclusion C.1. of this provision. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The officer or employee's last exposure to those conditions of your employment must occur during the policy period. B. We Will Reimburse We will reimburse you for all amounts paid by you whether such amounts are: 1. voluntary payments for the benefits that would be required of you if you and your officers or employees were subject to any workers' compensation law of the state of hire of the individual employee. 2. sums to which Part Two (Employers' Liability Insurance) would apply if the Country of Employment were shown in Item 3.A. of the Information Page. C. Exclusions This insurance does not cover: 1. any occurrences in the United States, Canada, and any country or jurisdiction which is the subject of trade or economic sanctions imposed by the laws or regulations of the United States of America in effect as of the inception date of this policy. 2. any obligation imposed by a workers' compensation or occupational disease law, or similar law. 3. bodily injury intentionally caused or aggravated by you. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst 4. liability for any consequence, whether of America necessarily incurred as a direct result direct or indirect, of war, invasion, act of of bodily injury. Foreign enemy, hostilities (whether war Our reimbursement shall be limited as follows: be declared or not), civil war, rebellion, revolution, insurrection or military or 1. to the amount by which such expenses usurped power. No endorsement now or exceed the normal cost of returning the subsequently attached to this policy shall officer or employee if in good health, or be construed as overriding or waiving 2. in the event of death, to the amount by which this limitation unless specific reference is such expenses exceed the normal cost of made thereto. returning the officer or employee if alive and D. Before We Pay in good health. Before we reimburse you for the benefits to In no event shall our reimbursement exceed the the persons entitled to them, you must have bodily injury by accident limit shown in Item 3.B. them: of the Information Page as respects any one such officer or employee whether dead or alive. 1. release you and us, in writing, of all responsibility for the injury or death, H. Endemic Disease 2. transfer to us their right to recover from The word "disease" includes any endemic others who may be responsible for their diseases. injury or death, The coverage applies as if endemic diseases 3. cooperate with us and do everything were included in the provisions of the workers' necessary to enable us to enforce the compensation law. right to recover from others. 5. Longshore and Harbor Workers' Compensation If the persons entitled to the benefits paid fail Act Coverage to do these things, our duty to reimburse General Section C. Workers' Compensation Law ends at once. If they claim damages from us is replaced by the following: for the injury or death, our duty to reimburse C. Workers' Compensation Law ends at once. Workers' Compensation Law means the workers E. Recovery From Others or workers' compensation law and occupational If we make a recovery from others, we will disease law of each state or territory named in keep an amount equal to our expenses of Item 3.A. of the Information Page and the recovery and the benefits we reimbursed. Longshore and Harbor Workers' Compensation We will pay the balance to the persons Act (33 USC Sections 901-950). It includes any entitled to it. If persons entitled to the amendments to those laws that are in effect benefits make a recovery from others, they during the policy period. It does not include any must repay us for the amounts that we have other federal workers or workers' compensation reimbursed you. law, other federal occupational disease law or the F. Reimbursement for Actual Loss provisions of any law that provide Sustained nonoccupational disability benefits. This endorsement provides only for Part Two (Employers' Liability Insurance), C. reimbursement for the loss you actually Exclusions, exclusion 8, does not apply to work sustain. In order for you to recover loss or subject to the Longshore and Harbor Workers' expenses under this reimbursement you Compensation Act. must: This coverage does not apply to work subject to 1. actually sustain and pay the loss or the Defense Base Act, the Outer Continental expense in money after trial, or Shelf Lands Act, or the Nonappropriated Fund Instrumentalities Act. 2. secure our consent for the payment of the loss or expense. G. Repatriation Our reimbursement includes the additional expenses of repatriation to the United States Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst SECTION III 1. SCHEDULE OF COVERED STATES A. This endorsement only applies in the states listed in this Schedule of Covered States. C. Schedule of Covered States: CA, CO Countersigned by Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) B. If a state, shown in Item 3.A. of the Information Page, approves this endorsement after the effective date of this policy, this endorsement will apply to this policy. The coverage will apply in the new state on the effective date of the state approval kuthorized Representative ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENDORSEMENT EXTENDED OPTIONS - EMPLOYERS' LIABILITY STOP GAP COVERAGE Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement changes the Workers' Compensation Broad Form Endorsement Extended Options — Employers' Liability Stop Gap Coverage 6. Employers' Liability Stop Gap Coverage Form WC 99 03 56 A Printed in U.S.A. (Ed.7/08) Process Date: 05/25/20 A. This coverage only applies in North Dakota, Ohio, Washington, and Wyoming. E. This paragraph is removed. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� RFskPjanagementAnalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENDORSEMENT EXTENDED OPTIONS - EMPLOYERS' LIABILITY STOP GAP COVERAGE Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement changes the Workers' Compensation Broad Form Endorsement Extended Options — Employers' Liability Stop Gap Coverage 7. Employers' Liability Stop Gap Coverage Form WC 99 03 57 A Printed in U.S.A. Process Date: 05/25/20 A. This coverage only applies in North Dakota, Ohio, Washington, and Wyoming. E. This paragraph is removed. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� RFskPjanagementAnalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FOREIGN COVERAGE ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement supersedes any other Foreign Coverage Endorsement attached to this policy as respects Wisconsin employees. Foreign Coverage for Wisconsin employees is provided under Part One of the policy, at no additional charge. Countersigned by Form WC 48 06 03 B Printed in U.S.A. Process Date: 05/25/20 Authorized Representative ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° Policy E _� RFskPjanagementAnalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2015. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2015. Form WC 00 04 22 B Printed in U.S.A. Process Date: 05/25/20 "Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. "Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. "Insurer Deductible" means, for the period beginning on January 1, 2015, and ending on December 31, 2020, an amount equal to 20% of our direct earned premiums, during the immediately preceding calendar year. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� R.Wjanagementftalpt Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses exceed: a. $100,000,000, with respect to such Insured Losses occurring in calendar year 2015, the United States Government would pay 85% of our Insured Losses that exceed our Insurer Deductible. b. $120,000,000, with respect to such Insured Losses occurring in calendar year 2016, the United States Government would pay 84% of our Insured Losses that exceed our Insurer Deductible. c. $140,000,000, with respect to such Insured Losses occurring in calendar year 2017, the United States Government would pay 83% of our Insured Losses that exceed our Insurer Deductible. State See Attached Schedule Form WC 00 04 22 B Printed in U.S.A. d. $160,000,000, with respect to such Insured Losses occurring in calendar year 2018, the United States Government would pay 82% of our Insured Losses that exceed our Insurer Deductible. e. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019, the United States Government would pay 81 % of our Insured Losses that exceed our Insurer Deductible. f. $200,000,000, with respect to such Insured Losses occurring in calendar year 2020, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. Schedule Rate The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. Premium ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in the event of a Catastrophe (other than Certified Acts of Terrorism) as that term is defined below. Your policy provides coverage for workers compensation losses caused by a Catastrophe (other than Certified Acts of Terrorism). This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 B), attached to this policy. For purposes of this endorsement, the following definitions apply: o Catastrophe (other than Certified Acts of Terrorism): Any single event, resulting from an Earthquake, Noncertified Act of Terrorism, or Catastrophic Industrial Accident, which results in aggregate workers compensation losses in excess of $50 million. o Earthquake: The shaking and vibration at the surface of the earth resulting from underground movement along a fault plane or from volcanic activity. o Noncertified Act of Terrorism: An event that is not certified as an Act of Terrorism by the Secretary State WI NC AZ of Treasury pursuant to the Terrorism Risk Insurance Act of 2002 (as amended) but that meets all of the following criteria: a. It is an act that is violent or dangerous to human life, property, or infrastructure; b. The act results in damage within the United States, or outside of the United States in the case of the premises of United States missions or air carriers or vessels as those terms are defined in the Terrorism Risk Insurance Act of 2002 (as amended); and c. It is an act that has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. o Catastrophic Industrial Accident: A chemical release, large explosion, or small blast that is localized in nature and affects workers in a small perimeter the size of a building. The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe (other than Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. Schedule Rate 0.010000 0.020000 0.010000 Form WC 00 04 21 D Printed in U.S.A. Process Date: 05/25/20 Policy Premium $0 $48 cF RAMmWmentDMsian REVIEWED & APPROVED BY.- v mwd --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in the event of a Catastrophe (other than Certified Acts of Terrorism) as that term is defined below. Your policy provides coverage for workers compensation losses caused by a Catastrophe (other than Certified Acts of Terrorism). This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 B), attached to this policy. For purposes of this endorsement, the following definitions apply: o Catastrophe (other than Certified Acts of Terrorism): Any single event, resulting from an Earthquake, Noncertified Act of Terrorism, or Catastrophic Industrial Accident, which results in aggregate workers compensation losses in excess of $50 million. o Earthquake: The shaking and vibration at the surface of the earth resulting from underground movement along a fault plane or from volcanic activity. o Noncertified Act of Terrorism: An event that is not certified as an Act of Terrorism by the Secretary of Treasury pursuant to the Terrorism Risk Insurance Act of 2002 (as amended) but that meets all of the following criteria: a. It is an act that is violent or dangerous to human life, property, or infrastructure; b. The act results in damage within the United States, or outside of the United States in the case of the premises of United States missions or air carriers or vessels as those terms are defined in the Terrorism Risk Insurance Act of 2002 (as amended); and c. It is an act that has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. o Catastrophic Industrial Accident: A chemical release, large explosion, or small blast that is localized in nature and affects workers in a small perimeter the size of a building. The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe (other than Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium IL 0.020000 $21 CO 0.010000 $36 ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- Form WC 00 04 21 D Printed in U.S.A. I" "& Process Date: 05/25/20 Policy E) R.Wjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 90-DAY REPORTING REQUIREMENT - NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 You must report any change in ownership to us in writing within 90 days of the date of the change. Change in ownership includes sales, purchases, other transfers, mergers, consolidations, dissolutions, formations of a new entity and other changes provided for in the applicable experience rating plan. Experience rating is mandatory for all eligible insureds. The experience rating modification factor, if any, applicable to this policy, may change if there is a change in your ownership or in that of one or more of the entities eligible to be combined with you for experience rating purposes. Failure to report any change in ownership, regardless of whether the change is reported within 90 days of such change, may result in revision of the experience rating modification factor used to determine your premium. This reporting requirement applies regardless of whether an experience rating modification is currently applicable to this policy. Form WC 00 04 14 A Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- ,v Polic) WskPjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE Any person or organization from whom you are required by contract or agreement to obtain this waiver from us. Endorsement is not applicable in KY, NH, NJ or for any MO construction risk Countersigned by ew cF RAMwagementDMsian °RE�AED&APPROVED SY: Form WC 00 03 13 Printed in U.S.A. x .v Process Date: 05/25/20 Policy E �__ _� R.Wjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 05/25/20 cF RAMmWmentDMsian REVIEWED & APPROVED BY.- V"° Policy E _� R.Wjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARIZONA COUNTERSIGNATURE EXCLUSION ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement applies only to the insurance provided by the policy because Arizona is shown in Item 3.A. of the Information Page. The following wording, as may be contained in this policy, does not apply in Arizona: "This policy is not binding unless countersigned by our authorized representative." Form WC 99 03 71 A Printed in U.S.A. Process Date: 05/25/20 "This endorsement shall not be binding unless countersigned by a duly authorized agent of the company, provided that if this endorsement takes effect as of the effective date of the policy and, at issue of said policy, forms a part thereof, countersigned on the Information Page of said policy by a duly authorized Agent of the company shall constitute valid countersignature of this endorsement." ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� R.Wjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PARTNERS, OFFICERS, AND OTHERS EXCLUSION ENDORSEMENT Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 The policy does not cover bodily injury to any person described in the Schedule. The premium basis for the policy does not include the remuneration of such persons. You will reimburse us for any payment we must make because of bodily injury to such persons. Partners Officers SCHEDULE Others SEIP SHANNON KELLY PARTHEN Sole Proprietors Countersigned by ew cF RAMwagementDMsian °RE�AED&APPROVED SY: Form WC 00 03 08 Printed in U.S.A. x .V Process Date: 05/25/20 Policy E �__ _ � RA Pjanagement Analpt POLICY ADJUSTMENT NOTICE The premium we charged for your enclosed Hartford policy was based, in part, on estimates and assumptions related to items such as payroll, sales revenue, and the nature of business operations for the policy period shown. When your coverage period expires, a premium audit will be conducted to ensure the premium you paid for your insurance was accurate. In order to complete the premium audit, when your policy coverage period expires you may receive, via e-mail or US Postal mail, a request to complete an "Insured's Report of Exposure" Form. Alternatively, you may receive notice that a Premium Audit representative will be contacting you to review your records and discuss your business operations over the phone or in person. The purpose of the statement, phone call or visit is for the Premium Audit Department to collect the information required to ensure that the premium you paid for your coverage was accurate. Once the audit is complete, you will receive a Statement of Premium Adjustment which will reflect the amount of your policy auditable premium, and will indicate whether you are owed a refund or if additional premium is due for the policy period shown. If we owe you a return premium, The Hartford will apply the refund amount to any current account balance. If your account is paid in full, or if your refund amount is greater than the current account balance, we will issue you a refund check. You can expect to receive this check within the next 30 days. If you owe us an additional premium, the entire amount will appear as due and payable on your next bill. This amount will appear as "Premium Audit" on your bill. If you have any questions regarding the Premium Audit process, please call your insurance agent. Thank you for doing business with The Hartford. Form G-3058-1 Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst WISCONSIN NOTICE OF RIGHT TO FILE A COMPLAINT KEEP THIS WITH YOUR INSURANCE PAPERS PROBLEMS WITH YOUR INSURANCE? - If you are having problems with your insurance company or agent, do not hesitate to contact the insurance company or agent to resolve your problem. THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 (877) 287-1316 You can also contact the OFFICE OF THE COMMISSIONER OF INSURANCE, a state agency which enforces Wisconsin's insurance laws, and file a complaint. You can contact the OFFICE OF THE COMMISSIONER OF INSURANCE by writing to: Office of the Commissioner of Insurance Complaints Department P. O. Box 7873 Madison, WI 53707-7873 or you can call 1-800-236-8517 outside of Madison or 266-0103 in Madison, and request a complaint form. Form G-3143-0 Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- V"° E) Risk Pjanagement Analyst IMPORTANT INFORMATION FOR ILLINOIS POLICYHOLDERS IN THE EVENT YOU NEED TO CONTACT SOMEONE ABOUT THIS POLICY, PLEASE CONTACT YOUR HARTFORD AGENT. If you have a complaint, you may contact The Hartford at the address stated below. The Hartford Customer Relations Department Hartford Plaza Hartford, CT 06115 Telephone: 1-800-727-0721 If you have been unable to contact or obtain satisfaction from your agent or from The Hartford's Customer Relations Department, you may contact the Illinois Department of Insurance at the address below. ILLINOIS DEPARTMENT OF INSURANCE Consumer Services Section Springfield, IL 62767 Written correspondence is preferable so that a record of your inquiry is maintained. PLEASE MAKE SURE TO INCLUDE YOUR POLICY NUMBER IN ANY CORRESPONDENCE. Form G-3177-1 Printed in U.S.A. Process Date:05/25/20 Jy/\'x REVIEWED & APPROVED BY.- v Polk WskPjanagementftalpt PRODUCER COMPENSATION NOTICE You can review and obtain information on The Hartford's producer compensation practices at www.TheHartford.com or at 1-800-592-5717. Form G-3418-0 �40 1°x REVIEWED & APPROVED BY.- V"° --� RFsk janagement Analyst POLICYHOLDER NOTICE YOUR RIGHT TO RATING AND DIVIDEND INFORMATION Information Available to You A. Information Available from Us - Sentinel Insurance Company Ltd. (1) General questions regarding your policy should be directed to your Hartford Agent or Sentinel Insurance Company Ltd. 3600 WISEMAN BLVD SAN ANTONIO TX 78251 Telephone: (877) 287-1316 www.thehartford.com (2) Dividend Calculation. If this is a participating policy (a policy on which a dividend may be paid), upon payment or non-payment of a dividend, we shall provide a written explanation to you that sets forth the basis of the dividend calculation. The explanation will be in clear, understandable language and will express the dividend as a dollar amount and as a percentage of the earned premium for the policy year on which the dividend is calculated. (3) Claims Information. Pursuant to Sections 3761 and 3762 of the California Labor Code, you are entitled to receive information in our claim files that affects your premium. Copies of documents will be supplied at your expense during reasonable business hours. For claims covered under this policy, we will estimate the ultimate cost of unsettled claims for statistical purposes eighteen months after the policy becomes effective and will report those estimates to the Workers' Compensation Insurance Rating Bureau of California (WCIRB) no later than twenty months after the policy becomes effective. The cost of any settled claims will also be reported at that time. At twelve- month intervals thereafter, we will update and report to the WCIRB the estimated cost of any unsettled claims and the actual final cost of any claims settled in the interim. The amounts we report will be used by the WCIRB to compute your experience modification if you are eligible for experience rating. B. Information Available from the Workers' Compensation Insurance Rating Bureau of California (1) The WCIRB is a licensed rating organization and the California Insurance Commissioner's designated statistical agent. As such, the WCIRB is responsible for administering the California Workers' Compensation Uniform Statistical Reporting Plan-1995 (USRP) and the California Workers' Compensation Experience Rating Plan-1995 (ERP). WCIRB contact information is: WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attn: Customer Service; 888.229.2472 (phone); 415.778.7272 (fax); and customerservicea-wcirb.com (email). The regulations contained in the USRP and ERP are available for public viewing through the WCIRB's website at wcirb.com. (2) Policyholder Information. Pursuant to California Insurance Code (CIC) Section 11752.6, upon written request, you are entitled to information relating to loss experience, claims, classification assignments, and policy contracts as well as rating plans, rating systems, manual rules, or other information impacting your premium that is maintained in the records of the WCIRB. Complaints and Requests for Action requesting policyholder information should be forwarded to: WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attn: Custodian of Records. The Custodian of Records can be reached at 415.777.0777 (phone) and 415.778.7272 (fax). Form PN 04 99 01 G (03/19) Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Policy E _� R.Wjanagementftalpt (3) Experience Rating Form. Each experience rated risk may receive a single copy of its current Experience Rating Form/Worksheet free of charge by completing a Policyholder Experience Rating Worksheet Request Form on the WCIRB's website at wcirb.com/ratesheet. The Experience Rating Form/Worksheet will include a Loss -Free Rating, which is the experience modification that would have been calculated if $0 (zero) actual losses were incurred during the experience period. This hypothetical rating calculation is provided for informational purposes only. II. Dispute Process You may dispute our actions or the actions of the WCIRB pursuant to CIC Sections 11737 and 11753.1. A. Our Dispute Resolution Process. You may send us a written Complaint and Request for Action requesting that we reconsider a change in a classification assignment that results in an increased premium and/or requesting that we review the manner in which our rating system has been applied in connection with the insurance afforded or offered you. Written Complaints and Requests for Action should be forwarded to: Sentinel Insurance Company Ltd. One Hartford Plaza, T.4.175, Hartford, CT 06155; Telephone (800) 451-6944; Fax (860) 723-4289. After you send your Complaint and Request for Action, we have 30 days to send you a written notice indicating whether or not your written request will be reviewed. If we agree to review your request, we must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If we decline to review your request, if you are dissatisfied with the decision upon review, or if we fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in paragraph II.C., below. B. Disputing the Actions of the WCIRB. If you have been aggrieved by any decision, action, or omission to act of the WCIRB, you may request, in writing, that the WCIRB reconsider its decision, action, or omission to act. You may also request, in writing, that the WCIRB review the manner in which its rating system has been applied in connection with the insurance afforded or offered you. For requests related to classification disputes, the reporting of experience, or coverage issues, your initial request for review must be received by the WCIRB within 12 months after the expiration date of the policy to which the request for review pertains, except if the request involves the application of the Revision of Losses rule. For requests related to your experience modification, your initial request for review must be received by the WCIRB within 6 months after the issuance, or 12 months after the expiration date, of the experience modification to which the request for review pertains, whichever is later, except if the request for review involves the application of the Revision of Losses rule. If the request involves the Revision of Losses rule, the time to state your appeal may be longer. (See Section VI, Rule 7 of the ERP). You may commence the review process by sending the WCIRB a written Inquiry. Written Inquiries should be sent to: WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attn: Customer Service. Customer Service can be reached at 888.229.2472 (phone), 415.778.7272 (fax) and customerservicea-wcirb.com (email). If you are dissatisfied with the WCIRB's decision upon an Inquiry, or if the WCIRB fails to respond within 90 days after receipt of the Inquiry, you may pursue the subject of the Inquiry by sending the WCIRB a written Complaint and Request for Action. After you send your Complaint and Request for Action, the WCIRB has 30 days to send you written notice indicating whether or not your written request will be reviewed. If the WCIRB agrees to review your request, it must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If the WCIRB declines to review your request, if you are dissatisfied with the decision upon review, or if the WCIRB fails to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in paragraph II.C., below. Written Complaints and Requests for Action should be forwarded to: WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attn: Complaints and Reconsideration. The WCIRB's contact information is 888.229.2472 (phone), 415.371.5204 (fax) and customerservicea-wcirb.com (email). Form PN 04 99 01 G (03/19) Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst C. California Department of Insurance — Appeals to the Insurance Commissioner. After you follow the appropriate dispute resolution process described above, if (1) we or the WCIRB decline to review your request, (2) you are dissatisfied with the decision upon review, or (3) we or the WCIRB fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner pursuant to CIC Sections 11737, 11752.6, 11753.1 and Title 10, California Code of Regulations, Section 2509.40 et seq. You must file your appeal within 30 days after we or the WCIRB send you the notice rejecting review of your Complaint and Request for Action or the decision upon your Complaint and Request for Action. If no written decision regarding your Complaint and Request for Action is sent, your appeal must be filed within 120 days after you sent your Complaint and Request for Action to us or to the WCIRB. The filing address for all appeals to the Insurance Commissioner is: Administrative Hearing Bureau California Department of Insurance 45 Fremont Street, 22nd Floor San Francisco, CA 94105 415.538.4102 You have the right to a hearing before the Insurance Commissioner, and our action, or the action of the WCIRB, may be affirmed, modified or reversed. III. Resources Available to You in Obtaining Information and Pursuing Disputes A. Policyholder Ombudsman. Pursuant to California Insurance Code Section 11752.6, a policyholder ombudsman is available at the WCIRB to assist you in obtaining and evaluating the rating, policy, and claims information referenced in I.A. and I.B., above. The ombudsman may advise you on any dispute with us, the WCIRB, or on an appeal to the Insurance Commissioner pursuant to Section 11737 of the Insurance Code. The address of the policyholder ombudsman is WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attn: Policyholder Ombudsman. The policyholder ombudsman can be reached at 415.778.7159 (phone), 415.371.5288 (fax) and ombudsmana-wcirb.com (email). B. California Department of Insurance - Information and Assistance. Information and assistance on policy questions can be obtained from the Department of Insurance Consumer HOTLINE, 800.927.HELP (4357) or insurance.ca.gov. For questions and correspondence regarding appeals to the Administrative Hearing Bureau, see the contact information in paragraph II.C. This notice does not change the policy to which it is attached. Form PN 04 99 01 G (03/19) Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst CALIFORNIA WORKERS' COMPENSATION INSURANCE RATING LAWS Pursuant to Section 11752.8 of the California Insurance Code, we are providing you with an explanation of the California workers' compensation rating laws. 2 El We establish our own rates for workers' compensation. Our rates, rating plans, and related information are filed with the insurance commissioner and are open for public inspection. The insurance commissioner can disapprove our rates, rating plans, or classifications only if he or she has determined after public hearing that our rates might jeopardize our ability to pay claims or create a monopoly in the market. A monopoly is defined by law as a market where one insurer writes 20% or more of that part of the California workers' compensation insurance that is not written by the State Compensation Insurance Fund. If the insurance commissioner disapproves our rates, rating plans, or classifications, he or she may order an increase in the rates applicable to outstanding policies. Rating organizations may develop pure premium rates that are subject to the insurance commissioner's approval. A pure premium rate reflects the anticipated cost and expenses of claims per $100 of payroll for a given classification. Pure premium rates are advisory only, as we are not required to use the pure premium rates developed by any rating organization in establishing our own rates. We must adhere to a single, uniform experience rating plan. If you are eligible for experience rating under the plan, we will be required to adjust your Form PN 04 99 02 B (Ed. 5-02) Printed in U.S.A. premium to reflect your claim history. A better claim history generally results in a lower experience rating modification; more claims, or more expensive claims, generally result in a higher experience rating modification. The uniform experience rating plan, which is developed by the insurance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. A standard classification system, developed by the insurance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. The standard classification system is a method of recognizing and separating policyholders into industry or occupational groups according to their similarities and/or differences. We can adopt and apply the standard classification system or develop and apply our own classification system, provided we can report the payroll, expenses, and other costs of claims in a way that is consistent with the uniform statistical plan or the standard classification system. Our rates and classifications may not violate the Unruh Civil Rights Act or be unfairly discriminatory. 7. We will provide an appeal process for you to appeal the way we rate your insurance policy. The process requires us to respond to your written appeal within 30 days. If you are not satisfied with the result of your appeal, you may appeal our decision to the insurance commissioner. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst CALIFORNIA WORKERS' COMPENSATION INSURANCE NOTICE OF NONRENEWAL Section 11664 of the California Insurance Code requires us, in most instances, to provide you with a notice of nonrenewal. Except as specified in paragraphs 1 through 6 below, if we elect to nonrenew your policy, we are required to deliver or mail to you a written notice stating the reason or reasons for the nonrenewal of the policy. The notice is required to be sent to you no earlier than 120 days before the end of the policy period and no later than 30 days before the end of the policy period. If we fail to provide you the required notice, we are required to continue the coverage under the policy with no change in the premium rate until 60 days after we provide you with the required notice. We are not required to provide you with a notice of nonrenewal in any of the following situations: Your policy was transferred or renewed without a change in its terms or conditions or the rate on which the premium is based to another insurer or other insurers who are members of the same insurance group as us. 2. The policy was extended for 90 days or less and the required notice was given prior to the extension. You obtained replacement coverage or agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. Form PN 04 99 02 B (Ed. 5-02) Printed in U.S.A. 4. The policy is for a period of no more than 60 days and you were notified at the time of issuance that it may not be renewed. 5. You requested a change in the terms or conditions or risks covered by the policy within 60 days prior to the end of the policy period. 6. We made a written offer to you to renew the policy at a premium rate increase of less than 25 percent. (A) If the premium rate in your governing classification is to be increased 25 percent or greater and we intend to renew the policy, we shall provide a written notice of a renewal offer not less than 30 days prior to the policy renewal date. The governing classification shall be determined by the rules and regulations established in accordance with California Insurance Code 11750.3(c). (B) For purposes of this means the cost of exposure prior to the risk variations based considerations such a experience rating. Notice, "premium rate" insurance per unit of application of individual on loss or expense 3 scheduled rating and This notice does not change the policy to which it is attached. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V'° --� Risk janagement Analyst POLICYHOLDER NOTICE PAYROLL RECORD AND AUDIT REQUIREMENTS FOR DUAL WAGE CONSTRUCTION OR ERECTION CLASSIFICATIONS Your policy includes one or more construction or erection classifications. Dual wage classifications are pairs of classifications that describe the same construction or erection operation yet are assigned based upon whether the employee's hourly wage is above or below a specified threshold. Each pair of dual wage classifications contains one "high wage" classification that is assignable to payrolls earned by employees whose regular hourly wage equals or exceeds a specified wage threshold and one "low wage" classification that is assignable to payrolls earned by employees whose regular hourly wage is less than the specified threshold. Payroll Record Requirements The assignment of a high wage classification is contingent on verifying that the employee's hourly wage equals or exceeds the specified wage threshold. The determination of the regular hourly wage for any non -salaried employee must be supported by one of the following sources: o Original time cards or time book entries for each employee. Original records must include the operations performed, the total hours worked each day and the times the employee started and ended each work period throughout the workday. At job locations where all of the employer's operations cease for a uniform unpaid meal period, recording the start and stop times of the uniform break period is not required. A valid collective bargaining agreement that shows the regular hourly wage rate by job classification of a worker. If using a collective bargaining agreement, the records must include an employee roster by job classification that permits the reconciliation of individual employees to the job classifications set forth in the collective bargaining agreement. The non -salaried employee's regular hourly wage shall be determined by dividing that employee's total remuneration by the hours worked during the pay period, irrespective of whether the employee is paid on an hourly, piecework, production or commission basis. The payroll earned by any non -salaried employees for whom the records specified above are not maintained and/or made available will be assigned to the low wage classification that describes the operations performed. The regular hourly wage of salaried employees is determined by dividing the total annual remuneration by 2000 hours. If an employee is salaried for less than 12 months, the regular hourly wage for the salaried period is calculated on a prorated basis. Audit Requirements If your policy has an effective date on or after January 1, 2020 and produces a final premium of $10,500 or more, a physical audit is required at least once a year; if it produces a final premium of less than $10,500 and develops payroll in a high wage classification, a physical audit of the policy is required unless the policy is a renewal and a physical audit was completed for one of the two immediately preceding policy periods. A "physical audit" is defined as an audit of payroll, whether conducted at the policyholder's location or at a remote site, that is based upon an auditor's examination of the policyholder's books of accounts and original payroll records (in either electronic or hard copy form) as necessary to determine and verify the exposure amounts by classification. If you hold a C-39 Roofing Contractor license from the California Contractors State License Board, a physical audit is required on the complete policy period of each policy regardless of the amount of final premium. See California Insurance Code Section 11665(a) for additional requirements regarding the audit of C-39 license holders Form PN 04 99 06 D Printed in U.S.A. cF RAMmWmentDMsian Jy/ 1'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTIFICATION ENDORSEMENT OF PENDING LAW CHANGE TO TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015 Policy Number: 59 WEC AC9055 Endorsement Number: Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: BAY SPROUTS LLC 655 S MAIN ST STE 200-317 ORANGE CA 92868 This endorsement is being attached to your workers compensation and employers liability insurance policy. This endorsement does not replace the separate Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC00 04 22 B) that is attached to your current policy and which remains in effect as applicable. The Terrorism Risk Insurance Act of 2002 (TRIA), as previously amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2015 (TRIPRA 2015), provides for a program under which the federal government will share in the payment of insured losses caused by certain acts of terrorism. In the absence of affirmative US Congressional action to extend, update, or otherwise reauthorize TRIPRA2015, in whole or in part, TRIPRA 2015 is scheduled to expire on December 31, 2020. Since the timetable for any further Congressional action regarding TRIPRA 2015 is presently unknown, and exposure to acts of terrorism remains, we are providing policyholders with relevant information concerning their workers compensation policies in the event of the TRIPRA 2015's expiration. Your policy provides coverage for workers compensation losses caused by acts of terrorism, including workers compensation benefit obligations dictated by state law, except in Pennsylvania, where injuries or deaths resulting from certain war -related activities are excluded from workers compensation coverage. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy. The premium charge for the coverage that your policy provides for terrorism losses is shown in Item 4 of the policy Information Page or the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 B) Schedule that is attached to your policy. This amount may continue or change for new, renewal, and in -force policies in effect on or after December 31, 2020, in the event of TRIPRA 2015's expiration, subject to regulatory review in accordance with applicable state law. You need not do anything further at this time. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. © Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved. Form WC 00 01 15 (01/20) Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Polic _� R.Wjanagementftalpt CALIFORNIA NOTICE CALIFORNIA LABOR CODE 3551 PROVIDES THAT EVERY EMPLOYER SUBJECT TO THE COMPENSATION PROVISIONS OF THIS CODE, EXCEPT EMPLOYERS OF EMPLOYEES DEFINED IN SUBDIVISION (d) OF SECTION 3351, SHALL GIVE EVERY NEW EMPLOYEE, EITHER AT THE TIME OF HIRE, OR BY THE END OF THE FIRST PAY PERIOD, WRITTEN NOTICE OF THE INFORMATION CONTAINED IN SECTION 3550. CALIFORNIA LABOR CODE 3550 PROVIDES THAT EVERY EMPLOYER SUBJECT TO THE COMPENSATION PROVISIONS OF THIS DIVISION SHALL POST AND KEEP POSTED IN A CONSPICUOUS LOCATION FREQUENTED BY EMPLOYEES, AND WHERE THE NOTICE MAY BE EASILY READ BY EMPLOYEES DURING THE HOURS OF THE WORKDAY, A NOTICE WHICH SHALL STATE THE NAME OF THE CURRENT COMPENSATION INSURANCE CARRIER OF THE EMPLOYER, OR WHEN SUCH IS THE FACT, THAT THE EMPLOYER IS SELF -INSURED, AND WHO IS RESPONSIBLE FOR CLAIMS ADJUSTMENT. Form WC 66 00 15 A Printed in U.S.A. ew cF RAMwagementDMsian �40 1°x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst WORKERS' COMPENSATION DISCLOSURE FORM IMPORTANT NOTICE TO POLICYHOLDERS 1. NOTICE OF CHANGE IN RATE BY CLASSIFICATION If you desire information whenever there is a change in your workers' compensation insurance rate by classification, you must request such information from your insurer. This request for information must be in writing. 2. NOTICE OF POLICYHOLDER'S RIGHT TO APPEAL CLASSIFICATION Your insurer can charge and collect any additional amount of money not included in the initial premium charged as a result of job misclassification. If you have any questions regarding the employee classification assigned to calculate your workers' compensation insurance premium, you need to direct your questions to your insurer or the insurer's authorized representative within either thirty (30) days after the anniversary date of the policy or the date of receipt by you of notice of a change in job classification. Within thirty (30) days after receipt of your request for information, your insurer or the insurer's authorized representative must explain to you why a particular employee classification was used. If you disagree with your insurer or the insurer's authorized representative on the employee classification assignment, you may appeal to the Workers' Compensation Classification Appeal Board by filing written notice with said board within thirty (30) days after you have exhausted all appeal review procedures provided by the insurer. Your request should be sent to the Secretary of the Colorado Workers' Compensation Classification Appeals Board, Michael Craddock, c/o National Council on Compensation Insurance, 901 Peninsula Corporate Circle, Boca Raton, FL 33487. Written instructions for your appearance before the Colorado Workers' Compensation Classification Appeals Board will be furnished by the Secretary of the board. The board will render a decision as to whether a misclassification has occurred. A decision by the board is final and not subject to appeal unless you, the insurer or Pinnacol Assurance provides written notice of appeal within thirty (30) days after the board's decision to the office of the Commissioner of Insurance, 1560 Broadway, Suite 850, Denver, CO 80202. The Commissioner shall review any decision of the board properly appealed. 3. NOTICE OF AVAILABILITY OF MEDICAL CASE MANAGEMENT SERVICES On appropriate cases, staff Health Service Representatives (R.N.'s) or outside vendors are assigned for medical case management to insure quality medical care and rehabilitation at a reasonable cost. The use includes, but is not limited to, coordinating with qualified medical providers, monitoring the rehabilitation process and working with employers to return the injured party to their regular or a modified position. Form WC 66 00 89 B Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst TO OUR POLICYHOLDERS: Colorado House Bill 1212 requires that companies providing Workers' Compensation Coverage in Colorado make available their risk management services in order that all insureds may establish a formal risk management program. If your company is interested in establishing such a program, please contact your independent agent and they will see to it that this material is provided to you. Form WC 66 01 20 Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v --� Risk Pjanagement Analyst PA. IMPORTANT NOTICE COLORADO WORKERS' COMPENSATION INSURANCE MEDICAL AND INDEMNITY DEDUCTIBLE ELECTION FORM Colorado Workers' Compensation Law permits an employer to purchase workers' compensation insurance with a deductible. The deductible is for medical and indemnity benefits only. There are nine "Per Claim" deductible options available. They are: NONE $ 500 1,000 1,500 2,000 2,500 5,000 10,000 13,500 15,500 16,000 16,500 17,000 17,500 All medical and indemnity claims shall be paid by the company. In such case, the law requires that you reimburse the company for any deductible amounts so paid. If you have any questions, or desire one of these deductible amounts to apply to your coverage, please call your Agent for a quote. This offer is valid for thirty days after the effective date of the policy with which this notice is enclosed. Policy Number 59 WEC AC9055 Employer Name BAY SPROUTS LLC Agent Name FIRSTMARK INSURANCE GROUP INC Return to Issuing Office: THE HARTFORD BUSINESS SERVICE CENTER Address: 3600 WISEMAN BLVD SAN ANTONIO TX 78251 Form WC 66 01 49 H Printed in U.S.A. Process Date: 05/25/20 Date I Signature and Title Date I Signature ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- V"° Policy E _� RFskPjanagementAnalpt CALIFORNIA WORKERS' COMPENSATION INSURANCE RATING LAWS Pursuant to Section 11752.8 of the California Insurance Code, we are providing you with an explanation of the California workers' compensation rating laws applicable to new and renewal policies with policy effective dates on and after January 1, 1995. 1. The laws requiring all insurers to charge the same minimum rate uniformly to all employers within a given classification has been repealed. Beginning January 1, 1995, we will establish our own rates for workers' compensation. Our rates will not be applicable prior to the first normal policy effective date of a policy incepting on or after January 1, 1995. Our rates, rating plans and related information are filed with the Insurance Commissioner and are open for public inspection. 2. The Insurance Commissioner can disapprove our rates, rating plans or classifications only if he has determined after public hearing that our rates might jeopardize our ability to pay claims or create a monopoly in the market. A monopoly is defined by law as a market where one insurer writes 20% or more of that part of the California workers' compensation insurance that is not written by the State Compensation Insurance Fund. If the insurance Commissioner disapproves our rates, rating plans or classification, he may order an increase in the rates applicable to outstanding policies. 3. Rating organizations may develop pure premium rates which are subject to the Insurance Commissioner's approval. A pure premium rate reflects the anticipated cost and expenses of claims per $100 of payroll for a given classification. Pure premium rates are advisory only, as we are not required to sue the pure premium rates developed by any rating organization in establishing our own rates. 4. We must adhere to a single, uniform experience rating plan. If you are eligible for experience rating under the plan, we will be required to adjust your premium to reflect your claim history. A better claim history generally results in a lower experience rating modification; more claims, or more expensive claims, generally result in a higher experience rating modification. The uniform experience rating plan developed by the insurance rating organization designated by the Insurance commissioner is subject to the approval of the Insurance Commissioner. 5. A standard classification system developed by the insurance rating organization designated by the Insurance Commissioner is subject to approval of the Insurance Commissioner. The standard classification system is a method of recognizing and separating policyholders into industry or occupational groups according to their similarities and/or differences. We can adopt and apply the standard classification system or develop and apply our own classification system, provided that we can report the payroll, expenses and other costs of claims in a way which is consistent with the standard classification system. Our rates and classifications may not violate the Unruh Civil Rights Act or be unfairly discriminatory. We will provide an appeal process for you to appeal the way we rate your insurance policy. The process will require us to respond to your written appeal within 30 days. If you are not satisfied with the result of your appeal, you may appeal our decision to the Insurance Commissioner. Form WC 66 02 05 A Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst ARIZONA NOTICE INDEPENDENT CONTRACTORS Section 23-902 of the Arizona statutes states that a contractor is deemed an employee of the "employer" for which they are working if: o The employer retains supervision or control over the contractor and o The work is ongoing, regular, ordinary, or routine in your operation and is routinely done by your own employees If the above conditions are met, we will treat the contractor as an employee and make the appropriate premium charge. Section 23-964, Section L of the Arizona statutes allows a contractor who is a sole proprietor to waive rights to Workers Compensation coverage. No additional premium charge will be made, if the sole proprietor completes form WC 66 02 35 "Arizona Sole Proprietor Waiver". For further information, please contact your agent or broker. Form WC 66 02 48 Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst We're protected by WORKERS' COMPENSATION Follow safety rules and you'll be protected from injury. But if you are injured at work, you're protected by benefits. PREVENT THE ABUSE OF WORKERS' COMPENSATION CLAIMS We Help Employers Fight Fraud If you suspect a claim is fraudulent, or that it abuses the system, work with your insurance carrier to prepare evidence of the alleged fraud. Then Report the case to: Workers' Compensation Fraud Unit 201 E. Washington Avenue P.O. Box 7901 Madison, WI 53707-7901 For quick help, call the Fraud Hotline: (608) 261-8486 What We Can Do to Help The Workers' Compensation Division is authorized by Wisconsin Statute 102.125 to work with employers and insurers to report, investigate, and prosecute allegations of Workers' Compensation fraud. Here's what we do: o Work with you and your insurance carrier to determine if there is enough evidence to take the case to court. o Refer the case to the local District Attorney's Office for prosecution if there is sufficient evidence of fraud. Cooperation from the Justice Department and District Attorneys has been excellent. They will prosecute! PROVE IT! Conviction of a fraudulent claim requires proof beyond a reasonable doubt of an intentional misrepresentation to secure benefits. Only the best - documented cases succeed. Prevention Is the Best Defense A well -designed loss control program and the serious threat of legal action are very effective deterrents to abusive claims. Fraud Prevention Tips 1. Develop a first-class safety program. Claims are less likely to mushroom if injuries are prevented and employees feel that management is genuinely concerned about their safety. You can do that by establishing and practicing clear and comprehensive safety policies. 2. Establish strong accident investigation procedures. Injured employees and witnesses should be interviewed in person about the accident as soon as possible. Document all statements. Get a signed statement from the claimant. 3. Send the Supervisor with the injured worker to the medical provider. Show concern for getting first-class medical evaluations and treatments. 4. Establish procedures for a clear understanding of essential information. Make sure the treating physician understands the nature of the job. Make sure the supervisor understands return -to - work limitations. 5. Make sure employees understand that false claims can be punished by termination and criminal prosecution. o You don't need a lawyer to get benefits o You won't get in trouble for reporting an injury or making a truthful claim. Report injuries to your supervisor immediately. o Your supervisor will help you start your claim. o Don't make a Workers' Compensation claim unless it's legitimate. You risk jail, a fine or job loss. Call the Fraud Hotline if you know about a false claim, (608) 261-8486. Or you can reach the Fraud Unit on the World Wide Web at http://www.dwd.state.wi.us/wc. Save everyone the added insurance costs and a possible reduction in wage increases. Fraud hurts us all. The Department of Workforce Development does not discriminate on the basis of disability in the provision of services or in employment. If you need this printed material interpreted or in a different form, or if you need assistance in using this servic Deaf and hearing or speech impaired callers may reach the Fraud Unit through the Wisconsin TRS. WKC-10 µop Risk Mwag merdDMsian REVIEWED & APPROVED BY. - Form WC 66 02 72 Printed in U.S.A. Z v --� Risk Pjanagement Analyst WORKERS' COMPENSATION SELECTION OF DESIGNATED MEDICAL PROVIDER DISCLOSURE STATEMENT If you select two Designated Medical Providers meeting the following qualifications, a premium credit will be applied to your policy. For policies eligible for this credit as well as schedule rating, the combination of the 2.5% credit and the schedule modification cannot exceed +/-25%. A qualified Designated Medical Provider is a medical provider, who: 1) Has a knowledge of work injuries; 2) Is knowledgeable of fee schedules; 3) Is decisive on medical -maximum -improvement determinations; 4) Communicates with you, the employer on such issues as case management and wellness programs; 5) Is knowledgeable of the employers operations. The names of the providers must be posted and well publicized by you, the employer. ** SIGN AND RETURN ** I am aware of the availability of a premium credit of 2.5%, if I select two qualified Designated Medical Providers. For policies eligible for this credit as well as schedule rating, the combination of the 2.5% credit and the schedule modification cannot exceed +/-25%. Insured Signature Policy Number 59 WEC AC9055 Issuing Office THE HARTFORD BUSINESS SERVICE CENTER Issuing Office 3600 WISEMAN BLVD Address SAN ANTONIO TX 78251 Form WC 66 02 81 C Printed in U.S.A. Process Date: 05/25/20 J�N RAMmWmentDMsian REVIEWED&APPROVEDSY:Policy ;Vl --� Risk Pjanagement Analyst WORKERS' COMPENSATION COST CONTAINMENT CERTIFICATION DISCLOSURE STATEMENT Cost Containment Certification is available from the Colorado Workers' Compensation Cost Containment Board. If you obtain certification, your policy will be subject to a premium credit which will be shown separately on your policy. PLEASE CHECK ONE (1) OF THE FOLLOWING BOXES BASED UPON YOUR BUSINESS ENTITY QUALIFICATION: ❑ I am aware if my business does qualify for experience and/or schedule rating under my workers' compensation insurance policy and my business has implemented a certified workers' compensation risk management program, my policy is subject to a 5% premium credit if the loss experience has improved since the last renewal date of workers' compensation insurance. This 5% premium credit is in addition to any schedule rating for which i may qualify. or, ❑ I am aware if my business does not qualify for experience and/or schedule rating under my workers' compensation insurance policy and my business entity has implemented a certified workers' compensation risk management program, my policy is subject to the following premium credit: Premium Dividend Dividend Criteria 10% If my business has been loss free for at least the last year immediately preceding the effective date of the premium credit. 8% If my business had one medical loss exceeding $250 in the last year immediately preceding the effective date of the premium credit. 6% If my business had two medical losses, each exceeding $250, in the last year immediately preceding the effective date of the premium credit. 4% If my business had three medical losses, each exceeding $250, in the last year immediately preceding the effective date of the premium credit. 2% If my business had three medical losses, each exceeding $250, and one claim for loss of time in the last year immediately preceding the effective date of the premium credit. 0% If my business had more than three medical losses and one claim for loss of time in the last year immediately preceding the effective date of the premium credit. Insured Signature Policy Number Issuing Office Issuing Office Address ***PLEASE SIGN AND RETURN*** 59 WEC AC9055 THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 Form WC 66 03 06 Printed in U.S.A. Process Date: 05/25/20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v POlicl R.Wjanagementftalpt Reporting a Work -Related Injury is Time Sensitive! Call The Hartford's LossConnect immediately to report a claim. 1-800-327-3636 Available 24 hours a day, 365 days a year. The Benefits of Timely Loss Reporting: Research has shown that faster loss reporting significantly affects loss costs. The sooner we are notified, the sooner we can investigate the accident and coordinate with you, the injured employee, and the medical team to ensure the fastest possible return to health and work. The Effect of Timely Reporting on Controlling the Cost of Your Loss: Average Loss for Closed Claims (Accident Years 2002-2005) Report Lag in Days Percent Change in Loss Costs Compared to First Week Report Incident Day -6% Week 1 0% Week 2 13% Week 3 or 4 16% 1 Month or Later 24% Statutory requirements also necessitate the prompt initial reporting of the accident causing injury or death. Failure to comply may result in a fineable offense by the State. Information You'll Need Company Information o Account Number o Location Code (if applicable) o Parent Company (or program name) o Policy Number Worker Information o Name, DOB, Address, Phone o Social Security Number o Age, Gender o Marital Status, Number of Dependants o Hire Date, Years in Current Position o Wage Information Incident Information o Type of injury (burn, cut, etc.)? o Exact body part injured? o What caused the accident? o Any reason to question the injury? o Any witnesses? o Address where injury occurred? o Where was the injured employee treated? (Provide name, address, phone of medical provider.) o When was the accident reported to you and by whom (date, time)? Network Providers A listing of more than 400,000 network providers qualified to treat work -related injuries is available online at www.talispoint.com/hartext or by calling our Network Referral Unit at 1-800-327-3636 (select 4 at the prompt). Since network referrals are often impacted by state specific rules, please call to learn how to maxim on behalf of your employees. Form WC 66 03 84 Printed in U.S.A. cF RAMmVmentDMsian Jy/ 1'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst MANAGING WORKERS' COMPENSATION COSTS IN ILLINOIS Workers' compensation claim management directly impacts the treatment of your injured workers and may impact your company's insurance costs as well. Illinois provides employers and their insurance companies with an important tool to help manage an injured worker's recovery and related costs. "Right to direct" rules allow an employer to direct an injured employee to a preferred provider organization for medical care. This helps ensure that injured workers can access network care for treatment whenever possible. Network doctors are experienced in treating workplace injuries and working with our claims handlers. They have also agreed to negotiated rates. This means that The Hartford can better coordinate appropriate, cost effective care for workplace injuries. Set up a Preferred Provider Program Ensuring the right to direct treatment By following the steps below, an employer can designate use of the Illinois Preferred Provider Program (PPP) and require that injured workers seek treatment through PPP network providers. While employees can opt out of the program, participation in the PPP can be a great benefit to the outcome of the claim in terms of the employee's recovery, return to work and related costs. 1. Employer delivers the Advisory Preferred Provider Program Notice to all employees. This step is optional but recommended by The Hartford to help ensure program acceptance. 2. Employer provides Mandatory Preferred Provider Program Notice and Acknowledgement to injured worker immediately after an injury occurs. 3. We recommend that the employer create a provider list from the Online Provider Search Tool at http://www.talispoint.com/htfd/external/ or by calling The Hartford's Network Referral Unit at 1-800-327-3636 and selecting 4 at the prompt. The forms noted above and additional information on The Hartford's Illinois Preferred Provider Program can be found at www.thehartford.com/il-workers-compensation. Focus on return to work Another advantage of using network doctors is their experience with return to work. Return -to -work programs are designed to help get injured workers back on the job, even if they haven't fully recovered from an injury. This approach often involves finding transitional duties that suit an injured worker's limited physical capabilities. An effective return -to - work program can improve employee satisfaction and retention and potentially impact your cost of doing business. Employers play a vital role in facilitating return to work. If you don't already have a return -to -work program, consider starting one at your company. Form WC 66 04 16 Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst Policyholder Notice: Illinois Based on what we know at this time — including underwriting information we have on file, state requirements, current rate plans and more — you can expect the following: Your expiring premium is $67,080. The estimated premium for your renewal policy will be $71,141. We are required to advise you that had we followed the industry recommended rate change in Illinois, your premium would have been $70,907 or $234 lower. The reason for the increase is based on our general loss experience in the state and your risk characteristics. The renewal terms described here may change as we get closer to your renewal date. If there are any additional changes we'll notify you under separate cover. If you have questions about this notice or your policy, please contact your insurance agent or broker, or contact us directly. Thank you for choosing The Hartford to be your insurance provider. We look forward to continuing to provide coverage that meets your insurance needs. Form WC 66 04 43 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v --� Risk janagement Analyst POLICY NUMBER: 59 WEC AC9055 Our President and Secretary have signed this policy countersigned by our duly authorized representative. ;95n�. Lisa Levin, Secretary Where required by law, the Information Page has been C/�°'jaoulwt Douglas Elliot, President Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. © 2000 National Council on Compensation Insurance. DELAWARE: Delaware forms have been copyrighted by the Delaware Compensation Rating Bureau or the Pennsylvania Compensation Rating Bureau. NEW JERSEY: New Jersey forms have been copyrighted by the Compensation Rating and Inspection Bureau. NEW YORK: New York forms have been copyrighted by the New York Compensation Insurance Rating Board. PENNSYLVANIA: Pennsylvania forms have been copyrighted by the Pennsylvania Compensation Rating Bureau or the Delaware Compensation Rating Bureau. Form WC 99 00 01 1 (Signature/Copyright) cF IZAManagmedDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THANK YOU FOR RENEWING YOUR POLICY WITH US If you're receiving this renewal through the mail directly from The Hartford, please note that we've only attached new, changed or updated documents. These include your new declarations page, which outlines your coverage, as well as any notices and brochures with updated information. We leave out unchanged documents to help cut down on paperwork and mailing costs. You can keep the attached documents filed alongside those from your previous policy if you wish. If you're receiving this renewal electronically, or it's been mailed by your agent, it may include all of your documents - even ones that haven't changed. In either case, keep in mind that you can view, download or print any of these documents online. Just register or log into your account https:Hbusiness.thehartford.com and click on "Documents". For added convenience, you can also pay your bill, request a Certificate of Insurance, check claims status, update preferences and more. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Form G-4159-0 © 2019, The Hartford ----- Wsk Pjanagement Analpt Insurance Policy Billing Information Thank you for selecting The Hartford for your business insurance needs. Shortly, you will receive your first bill from us. You are receiving this Notice so you know what to expect as a valued customer of The Hartford. Should you have any questions after reviewing this information, please contact us at 866-467-8730, and we will be happy to assist you. o Your total policy premium will appear on your policy's Declarations Page. You will be billed based on the payment plan you selected. o You may pay the "minimum due" as it appears on your insurance bill or pay the policy balance in full. o An installment service fee is added to each installment. A late fee will also be applied if the "minimum due" is not received by the due date shown on your bill. Service and late payment fees do not apply in all states. o If you selected installment billing, any credit or additional premium due as the result of a change made to your policy, will be spread over the remaining billing installments. Additional premium due as a result of an audit will be billed in full on your next bill date following the completion of the audit. o If you elected Electronic Funds Transfer (EFT), policy changes may result in changes to the amount automatically withdrawn from your bank account. The invoice you receive following a policy change will include future withdrawal amounts. If you need to adjust or stop your next scheduled EFT withdrawal, please contact us at least 3 days prior to the scheduled withdrawal date at the telephone number shown below. o If you selected installment billing and pay the premiums for your first policy term on time, at renewal, your account may qualify for our "Equal Installment" feature. This means that the percentage due for each installment, including the initial renewal installment, will be the same throughout the policy term — helping you better manage cash flow. Equal installments will continue as long as you pay your premiums on time and no cancellation notices are issued for any policy on your account. If you no longer qualify for Equal Installments, future renewals will be billed based on the payment plan you selected, which includes a higher initial installment amount. o If your policy is eligible for renewal, your bill for the upcoming policy term will be sent to you approximately 30 days prior to your policy's renewal date. If your insurance needs change, please contact us at least 60 days prior to your renewal date so we can properly address any adjustments needed. o One bill convenience -- you have the option of combining all eligible Hartford policies on one single bill allowing you to make one payment for all policies on your account as payments are due. You're In Control In addition to selecting a bill plan option that best meets your budget, you have the flexibility to decide how your payments are made ... o Repetitive EFT: Sign up for Repetitive EFT payments and have payments automatically withdrawn from your bank account. This option saves you money by reducing the amount of the installment service fee. o Pay Online: Register at www.thehartford.com/servicecenter. Online Bill Pay is Quick, Easy and Secure! o Pay by Check: Send a check with your remittance stub in the envelope provided with your bill. o Pay by Phone: Call toll -free 1-866-467-8730. Should you have any questions about your bill, please call Customer Service toll -free number: 1-866-467-8730 - 7AM — 7PM CST. We look forward to being of service to you. Form 100722 11th Rev. Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V'° --� Risk janagement Analyst IMPORTANT NOTICE TO POLICYHOLDERS THE HARTFORD CYBER CENTER WEBSITE ACCESS Thank you for choosing The Hartford for your business insurance needs. You are receiving this Notice because you purchased a business owner's policy from The Hartford, (your Policy was issued by The Hartford writing company identified on your policy Declarations page) which includes access to The Hartford Cyber Center. This portal was created because we recognize that businesses face a variety of cyber-related exposures and need help managing the related risks. These exposures include data breaches, computer virus attacks and cyber extortion threats. Through The Hartford Cyber Center, you have access to: o A panel of third party incident response service providers o Third party cybersecurity pre -incident service providers and a list of approved services to help protect your business before a cyber-threat occurs o Risk management tools, including self -assessments, best practice guides, templates, sample incident response plans, and data breach cost calculators o White papers, blogs and webinars from leading privacy and security practitioners o Up-to-date cyber-related news and events, including examples of privacy and security related events Accessing The Hartford Cyber Center is easy 1. Visit www.thehartford.com/cybercenter 2. Enter policyholder information 3. Access code: 952689 4. Login to The Hartford Cyber Center This Notice does not amend or otherwise affect the provisions of your business owner's policy. Coverage Options: The Hartford offers a variety of endorsements to your business owner's policy that can help protect your business from a broad range of cyber-related threats. Please review your coverage with your insurance agent or broker to determine the most appropriate cyber coverages and limits for your business. Claims Reporting: If you have a claim, you can report it by calling The Hartford's toll -free claims line at 1-800-327-3636. Should you have any questions, please contact your insurance agent, broker or you may contact us directly. We appreciate your business and look forward to being of continued service to you. Please be aware that: o The Hartford Cyber Center is a proprietary web portal exclusively provided to customers of The Hartford. Please do not share the access code with anyone outside your organization. o Registration is required to access the Cyber Center. You may register as many users as necessary. o Contacting a service provider about any issue does not constitute providing The Hartford notice of a claim as required under your insurance policy. Read your insurance policy and discuss any questions with your agent or broker. The Hartford Cyber Center provides third party service provider references and materials for educational purposes only. The Hartford does not specifically endorse any such service provider within The Hartford Cyber Center and hereby disclaims all liability with respect to use of or reliance on such service providers. All service providers are independent contractors and not agents of The Hartford. The Hartford does not warrant the performance of the service providers, even if such services are covered under your Business Owners Policy. We strongly encourage you to conduct your own assessments of the service providers' ser adequacy of such services for your particular needs. w RAMwagementDMsian Jy/ F\'x REVIEWED & APPROVED BY.- Form SS 89 93 07 16 �� V © 2016, The Hartford -- Wsk Pjanagement Analpt IMPORTANT NOTICE TO POLICYHOLDERS - PERSONAL AND ADVERTISING INJURY EXCLUSION - LIMITED Thank you for trusting The Hartford with your Business Insurance needs. Your policy may have previously had SS 50 50, Personal and Advertising Injury Exclusion - Limited attached. Please be advised that SS 50 50 will no longer be attached due to your class and business operations. The elimination of SS 50 50 from your policy will result in a broadening of coverage. If you have any questions regarding this notice, feel free to reach out to your Hartford representative. ew cF RAMwagementDMsian Form SS 90 37 09 19 , ►��D & APPROVED BY.- . v"° © 2019, The Hartford —_-- W.Wjanagementftal st Spectrum` Business Owner's Policy THE HARTFORD Form SS 00 01 03 14 Risk MmWmentDMsian REVIEWED & APPROVED BY: --� Tlyst RF5k Pjanagement An THE HARTFORD PRODUCER COMPENSATION NOTICE You can review and obtain information on The Hartford's producer compensation practices at www.TheHartford.com or at 1-800-592-5717. Form G-3418-0 �40 1°x REVIEWED & APPROVED BY.- V"° --� RFsk janagement Analyst POLICY NUMBER: 59 SBA RV9040 THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE Terrorism Premium: $ $733.00 A. Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act, as amended (TRIA), we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for "certified acts of terrorism" under TRIA. The portion of your premium attributable to such coverage is shown in the Schedule of this endorsement. B. The following definition is added with respect to the provisions of this endorsement: 1. A "certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of TRIA, to be an act of terrorism under TRIA. The criteria contained in TRIA for a "certified act of terrorism" include the following: a. The act results in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to TRIA; and Lei C. United States or to influence the policy or affect the conduct of the United States Government by coercion C. Disclosure Of Federal Share Of Terrorism Losses The United States Department of the Treasury will reimburse insurers for a portion of insured losses, as indicated in the table below, attributable to "certified acts of terrorism" under TRIA that exceeds the applicable insurer deductible: Calendar Year Federal Share of Terrorism Losses 2015 85% 2016 84% 2017 83% 2018 82% 2019 81 % 2020 or later 80% The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the However, if aggregate industry insured losses under premises of an United States mission; and TRIA exceed $100 billion in a calendar year, the The act is a violent act or an act that is Treasury shall not make any payment for any dangerous to human life, property or portion of the amount of such losses that exceeds infrastructure and is committed by an $100 billion. The United States government has not individual or individuals as part of an effort charged any premium for their participation in to coerce the civilian population of the covering terrorism losses. Q µow NCF RAMmWmentDMsi°n Form SS 83 76 01 15 REVIEWED & APPROVED BY.- © 2015 ,The Hartford i v (Includes copyrighted material of the Insurance Services Office, Inc., with its Wsk Pjanagement Analpt D. Cap On Insurer Liability for Terrorism Losses If aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. In accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. E. Application of Other Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Form, Coverage Part or Policy. F. All other terms and conditions remain the same. Form SS 83 76 01 15 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst IMPORTANT NOTICE TO POLICYHOLDERS ERISA - EMPLOYEE DISHONESTY You are receiving this notice because your renewal policy contains ERISA-EMPLOYEE DISHONESTY. The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets rules and standards of conduct for private sector employee benefit plans and those that invest and manage their assets. One of ERISA's requirements is that people who handle plan funds and other property must be covered by a fidelity bond to protect the plan from losses due to fraud or dishonesty. Please be advised that on or before the beginning of each plan year, the plan administrator or other plan fiduciary must ensure that the plan has the legally required bonding amount for the individuals who will handle the plan's funds and other property. If necessary, the plan administrator or other plan fiduciary may need to obtain appropriate adjustments or additional protection to ensure that the coverage will be in compliance for the new plan year. If you wish to adjust the amount of your ERISA fidelity bond, please reach out to your agent or Hartford representative. ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- Form SS 90 30 06 18 �� V ©2018, The Hartford Wsk Pjanagement Analpt IMPORTANT NOTICE TO POLICYHOLDERS To help your insurance keep pace with increasing costs, we have increased your amount of insurance ... giving you better protection in case of either a partial, or total loss to your property. If you feel the new amount is not the proper one, please contact your agent or broker. Form PC-374-0 Printed in U.S.A. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst IMPORTANT NOTICE TO NORTH CAROLINA POLICYHOLDERS THIS NOTICE APPLIES UNLESS THIS POLICY IS SPECIFICALLY ENDORSED TO PROVIDE COVERAGE AT ONE OR MORE LOCATIONS FOR LOSS FROM FLOODS, EARTHQUAKES, MUDSLIDES, MUDFLOWS OR LANDSLIDES. THIS NOTICE APPLIES IF YOU HAVE A WINDSTORM OR HAIL EXCLUSION ENDORSEMENT ON YOUR POLICY AS SHOWN IN THE DECLARATIONS. WARNING: THIS PROPERTY INSURANCE POLICY DOES NOT PROTECT YOU AGAINST LOSSES FROM FLOODS, EARTHQUAKES, MUDSLIDES, MUDFLOWS, LANDSLIDES, WINDSTORM OR HAIL. YOU SHOULD CONTACT YOUR INSURANCE COMPANY OR AGENT TO DISCUSS YOUR OPTIONS FOR OBTAINING COVERAGE FOR THESE LOSSES. THIS IS NOT A COMPLETE LISTING OF ALL OF THE CAUSES OF LOSSES NOT COVERED UNDER YOUR POLICY. YOU SHOULD READ YOUR ENTIRE POLICY TO UNDERSTAND WHAT IS COVERED AND WHAT IS NOT COVERED. RAMwagmedDMsiun 1°x REVIEWED & APPROVEDSY: Form G-3253-2 Al v' © 2012, The Hartford WskPjanagementAnalyst 40 This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any 90 other Forms and Endorsements issued to be a part of the Policy. This insurance is provided by the stock RV insurance company of The Hartford Insurance Group shown below. SBA INSURER: SENTINEL INSURANCE COMPANY, LIMITED ONE HARTFORD PLAZA, HARTFORD, CT 06155 COMPANY CODE: A THE Policy Number: 59 SBA RV9040 SC HARTFORD SPECTRUM POLICY DECLARATIONS Named Insured and Mailing Address (No., Street, Town, State, Zip Code) BAY SPROUTS LLC SEE FORM SS 12 35 6800 OWENSMOUTH AVE STE 350 CANOGA PARK CA 91303 Policy Period: From 11/13/20 To 11/13/21 1 YEAR 12:01 a.m., Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire. Name of Agent/Broker: FIRSTMARK INSURANCE GROUP INC Code: 305815 Previous Policy Number: 59 SBA RV9040 Named Insured is: LIMITED LIAB CORP Audit Period: NON-AUDITABLE Type of Property Coverage: SPECIAL Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we agree with you to provide insurance as stated in this policy. TOTAL ANNUAL PREMIUM IS: $37, 372 IN RECOGNITION OF THE MULTIPLE COVERAGES INSURED WITH THE HARTFORD, YOUR POLICY PREMIUM INCLUDES AN ACCOUNT CREDIT. Countersigned by Form SS 00 02 12 06 Process Date: 0 8 / 18 / 2 0 Authorized Representative 08/18/20 Date cF Risk MmRgementDMsian Page 001 (CONTINUED ON }� °x RE�AEWED&APPROVmSY: Policy Expirati `� --� Wksk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 001 Building: ool 11800 FOOTHILL BLVD LOS ANGELES CA 91342 Description of Business: Delicatessen Deductible: $ 500 PER OCCURRENCE WINDSTORM OR HAIL: 5% (FORM SS 82 23) BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST INCL IN BLKT PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES $ 10,000 OUTSIDE THE PREMISES $ 10,000 ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 002 (CONTINUED �,' Process Date: 08/18/20 Policy Expiratior Wsk Management Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 001 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION RESTAURANT STRETCH FORM: SS 04 11 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. TENANT IMPROVEMENTS AND INCL IN BLKT BETTERMENTS: LIMITED FUNGI, BACTERIA OR VIRUS $ 50,000 COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: 30 DAYS ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY.- Form SS 00 02 12 06 Page 003 (CONTINUED O 1" "° Process Date: 08/18/20 Policy Expirati -m-- Wsk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 002 Building: ool 2500 N MAIN ST SANTA ANA CA 92705 Description of Business: Delicatessen Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST INCL IN BLKT PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES $ 10,000 OUTSIDE THE PREMISES $ 10,000 ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 004 (CONTINUED -'� V Process Date: 08/18/20 Policy Expiratior Wsk Management Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 002 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION RESTAURANT STRETCH FORM: SS 04 11 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. TENANT IMPROVEMENTS AND INCL IN BLKT BETTERMENTS: LIMITED FUNGI, BACTERIA OR VIRUS $ 50,000 COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: 30 DAYS ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY.- Form SS 00 02 12 06 Page 005 (CONTINUED O 1" "° Process Date: 08/18/20 Policy Expirati -m-- Wsk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 003 Building: ool 557 MCREYNOLDS RD SAULSALITO CA 94965 Description of Business: Delicatessen Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST INCL IN BLKT PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES $ 10,000 OUTSIDE THE PREMISES $ 10,000 ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 006 (CONTINUED -'� V Process Date: 08/18/20 Policy Expiratior Wsk Management Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 003 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION RESTAURANT STRETCH FORM: SS 04 11 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. TENANT IMPROVEMENTS AND INCL IN BLKT BETTERMENTS: LIMITED FUNGI, BACTERIA OR VIRUS $ 50,000 COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: 30 DAYS ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY.- Form SS 00 02 12 06 Page 007 (CONTINUED O I"" "° Process Date: 08/18/20 Policy Expirati -m-- Wsk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 005 Building: ool 600 E WASHINGTON ST PHOENIX AZ 85004 Description of Business: Delicatessen Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST INCL IN BLKT PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES $ 10,000 OUTSIDE THE PREMISES $ 10,000 ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 008 (CONTINUED -'� V Process Date: 08/18/20 Policy Expiratior Wsk Management Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 005 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION RESTAURANT STRETCH FORM: SS 04 11 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. TENANT IMPROVEMENTS AND INCL IN BLKT BETTERMENTS: LIMITED FUNGI, BACTERIA OR VIRUS $ 50,000 COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: 30 DAYS ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY.- Form SS 00 02 12 06 Page 009 ( CONTINUED O I �" "° Process Date: 08/18/20 Policy Expirati -m-- Wsk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 006 Building: ool 200 W ISLAND AVE SAN DIEGO CA 92101 Description of Business: Delicatessen Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST INCL IN BLKT PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES $ 10,000 OUTSIDE THE PREMISES $ 10,000 ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 010 (CONTINUED -'� V Process Date: 08/18/20 Policy Expiratior Wsk Management Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 006 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION RESTAURANT STRETCH FORM: SS 04 11 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. TENANT IMPROVEMENTS AND INCL IN BLKT BETTERMENTS: LIMITED FUNGI, BACTERIA OR VIRUS $ 50,000 COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: 30 DAYS ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY.- Form SS 00 02 12 06 Page 011 ( CONTINUED O I �" "° Process Date: 08/18/20 Policy Expirati -m-- Wsk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 007 Building: ool 301 N WASHINGTON ST NAPERVILLE IL 60540 Description of Business: Delicatessen Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST INCL IN BLKT PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES $ 10,000 OUTSIDE THE PREMISES $ 10,000 ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 012 (CONTINUED �,' Process Date: 08/18/20 Policy Expiratior Wsk Management Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 007 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION RESTAURANT STRETCH FORM: SS 04 11 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. TENANT IMPROVEMENTS AND INCL IN BLKT BETTERMENTS: LIMITED FUNGI, BACTERIA OR VIRUS $ 50,000 COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: 30 DAYS ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY.- Form SS 00 02 12 06 Page 013 ( CONTINUED O I �" "° Process Date: 08/18/20 Policy Expirati -m-- Wsk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 008 Building: ool 1805 N 30TH ST COLORADO SPRINGS CO 80904 Description of Business: Delicatessen Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST INCL IN BLKT PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES $ 10,000 OUTSIDE THE PREMISES $ 10,000 ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 014 (CONTINUED -'� V Process Date: 08/18/20 Policy Expiratior Wsk Management Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 008 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION RESTAURANT STRETCH FORM: SS 04 11 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. TENANT IMPROVEMENTS AND INCL IN BLKT BETTERMENTS: LIMITED FUNGI, BACTERIA OR VIRUS $ 50,000 COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: 30 DAYS ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY.- Form SS 00 02 12 06 Page 015 ( CONTINUED O I �" "° Process Date: 08/18/20 Policy Expirati -m-- Wsk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 010 Building: ool 1801 E CHESTNUT AVE SANTA ANA CA 92701 Description of Business: Delicatessen Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST INCL IN BLKT PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES $ 10,000 OUTSIDE THE PREMISES $ 10,000 ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 016 (CONTINUED -'� V Process Date: 08/18/20 Policy Expiratior Wsk Management Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 010 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION RESTAURANT STRETCH FORM: SS 04 11 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. TENANT IMPROVEMENTS AND INCL IN BLKT BETTERMENTS: LIMITED FUNGI, BACTERIA OR VIRUS $ 50,000 COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: 30 DAYS ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY.- Form SS 00 02 12 06 Page 017 ( CONTINUED O 1 " "° Process Date: 08/18/20 Policy Expirati -m-- Wsk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 011 Building: ool 480 N ARROYO BLVD PASADENA CA 91103 Description of Business: Delicatessen Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST INCL IN BLKT PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES $ 10,000 OUTSIDE THE PREMISES $ 10,000 ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 018 (CONTINUED -'� V Process Date: 08/18/20 Policy Expiratior Wsk Management Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 011 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION RESTAURANT STRETCH FORM: SS 04 11 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. TENANT IMPROVEMENTS AND INCL IN BLKT BETTERMENTS: LIMITED FUNGI, BACTERIA OR VIRUS $ 50,000 COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: 30 DAYS ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY.- Form SS 00 02 12 06 Page 019 ( CONTINUED O I �" "° Process Date: 08/18/20 Policy Expirati -m-- Wsk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 012 Building: ool 3200 CALIFORNIA ST SAN FRANCISCO CA 94118 Description of Business: Delicatessen Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST INCL IN BLKT PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES $ 10,000 OUTSIDE THE PREMISES $ 10,000 ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 020 (CONTINUED �,' Process Date: 08/18/20 Policy Expiratior Wsk Management Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 012 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION RESTAURANT STRETCH FORM: SS 04 11 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. TENANT IMPROVEMENTS AND INCL IN BLKT BETTERMENTS: LIMITED FUNGI, BACTERIA OR VIRUS $ 50,000 COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: 30 DAYS ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 021 (CONTINUED ON 1" Is Process Date: 08/18/20 Policy Expirati -m-- Wsk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 013 Building: ool 201 E HARGETT ST RALEIGH NC 27601 Description of Business: Delicatessen Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING NO COVERAGE BUSINESS PERSONAL PROPERTY REPLACEMENT COST INCL IN BLKT PERSONAL PROPERTY OF OTHERS REPLACEMENT COST NO COVERAGE MONEY AND SECURITIES INSIDE THE PREMISES $ 10,000 OUTSIDE THE PREMISES $ 10,000 ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 022 (CONTINUED �,' Process Date: 08/18/20 Policy Expiratior Wsk Management Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 013 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION RESTAURANT STRETCH FORM: SS 04 11 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. TENANT IMPROVEMENTS AND INCL IN BLKT BETTERMENTS: LIMITED FUNGI, BACTERIA OR VIRUS $ 50,000 COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: 30 DAYS ew cF Risk MwagementDMsian ke/ ,'q REVIEWED & APPROVED BY. - Form SS 00 02 12 06 Page 023 (CONTINUED ON 1" Is Process Date: 08/18/20 Policy Expirati -m-- Wsk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO ALL LOCATIONS BUSINESS INCOME AND EXTRA EXPENSE COVERAGE 12 MONTHS ACTUAL LOSS SUSTAINED COVERAGE INCLUDES THE FOLLOWING COVERAGE EXTENSIONS: ACTION OF CIVIL AUTHORITY: 30 DAYS EXTENDED BUSINESS INCOME: 12 CONSECUTIVE MONTHS FORM SS 40 91 BLANKET BUILDING AND BUSINESS PERSONAL PROPERTY $ 3,014,300 LOCATIONS WITH A SPECIFIED LIMIT FOR BLDG OR BPP ARE NOT SUBJECT TO THE BLANKET LIMIT EQUIPMENT BREAKDOWN COVERAGE COVERAGE FOR DIRECT PHYSICAL LOSS DUE TO: MECHANICAL BREAKDOWN, ARTIFICIALLY GENERATED CURRENT AND STEAM EXPLOSION THIS ADDITIONAL COVERAGE INCLUDES THE FOLLOWING EXTENSIONS HAZARDOUS SUBSTANCES $ 50,000 EXPEDITING EXPENSES $ 50,000 MECHANICAL BREAKDOWN COVERAGE ONLY APPLIES WHEN BUILDING OR BUSINESS PERSONAL PROPERTY IS SELECTED ON THE POLICY IDENTITY RECOVERY COVERAGE $ 15,000 FORM SS 41 12 ew cF Risk MwagementDMsian 40 ,'q REVIEWED & APPROVED BY: Form SS 00 02 12 06 Page 024 (CONTINUED ON Process Date:08/18/20 Policy Expir Wsk Management Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 BUSINESS LIABILITY LIMITS OF INSURANCE LIABILITY AND MEDICAL EXPENSES $1, 000, 000 MEDICAL EXPENSES -ANY ONE PERSON $ 10,000 PERSONAL AND ADVERTISING INJURY $1, 000, 000 DAMAGES TO PREMISES RENTED TO YOU $1, 000, 000 ANY ONE PREMISES AGGREGATE LIMITS PRODUCTS -COMPLETED OPERATIONS $2, 000, 000 GENERAL AGGREGATE $2, 000, 000 BUSINESS LIABILITY OPTIONAL COVERAGES HIRED/NON-OWNED AUTO LIABILITY $1,000,000 UMBRELLA LIABILITY - SEE SCHEDULE ATTACHED ew cF Risk MwagementDMsian k40 1'x REVIEWED & APPROVED BY: Form SS 00 02 12 06 Page 025 (CONTINUED 0 �,'" Process Date: 08/18/20 Policy Expirat Wsk Pjanagement Analpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 BUSINESS LIABILITY OPTIONAL COVERAGES (Continued) EMPLOYEE BENEFITS LIABILITY COVERAGE: FORM SS 40 50 EACH CLAIM AGGREGATE CYBERFLEX COVERAGE FORM SS 40 26 UNMANNED AIRCRAFT LIABILITY IS EXCLUDED SEE FORM: SS 42 06 Form SS 00 02 12 06 Process Date: 0 8 / 18 / 2 0 LIMITS OF INSURANCE $1,000,000 $2,000,000 ew cF RAMwagementDMsian ,'q REVIEWED & APPROVED BY. - Page 026 (CONTINUED ON �,'" . ` ., Policy Expirati R.Wjanagementf alpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 ADDITIONAL INSUREDS: THE FOLLOWING ARE ADDITIONAL INSUREDS FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 TYPE MANAGER LESSOR NAME SEE FORM IH 12 00 TYPE PERSON ORGANIZATION NAME SEE FORM IH 12 00 LOCATION 003 BUILDING 001 TYPE MANAGER LESSOR NAME SEE FORM IH 12 00 LOCATION 005 BUILDING 001 TYPE MANAGER LESSOR NAME SEE FORM IH 12 00 LOCATION 007 BUILDING 001 TYPE MANAGER LESSOR NAME SEE FORM IH 12 00 LOCATION 011 BUILDING 001 TYPE MANAGER LESSOR NAME SEE FORM IH 12 00 Form SS 00 02 12 06 Process Date: 0 8 / 18 / 2 0 ew cF RAMwagementDMsian \'x REVIEWED & APPROVED BY. - Page 027 (CONTINUED ON �,'" . ` ., Policy Expirati WskPjanagementf alpt SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 Form Numbers of Forms and Endorsements that apply: SS 00 01 03 14 SS 00 05 10 08 SS 00 07 07 05 SS 00 08 04 05 SS 00 45 12 06 SS 00 60 09 15 SS 00 61 07 19 SS 00 64 09 16 SS 84 04 10 15 SS 12 35 03 12 SS 01 09 02 14 SS 01 21 02 20 SS 01 23 01 18 SS 01 33 11 13 SS 01 54 01 20 SS 42 06 03 17 SS 04 11 09 07 SS 04 19 04 09 SS 04 22 07 05 SS 04 30 07 05 SS 04 38 09 09 SS 04 39 07 05 SS 04 41 03 18 SS 04 42 03 17 SS 04 44 07 05 SS 04 45 07 05 SS 04 46 09 14 SS 04 47 04 09 SS 04 80 03 00 SS 04 86 03 00 SS 14 23 10 03 SS 40 18 07 05 SS 40 26 03 17 SS 40 50 10 08 SS 40 91 11 08 SS 40 93 07 05 SS 41 12 12 17 SS 41 32 09 06 SS 41 51 10 09 SS 41 63 06 11 IH 10 01 09 86 SS 05 47 09 15 SS 50 57 04 05 SS 51 11 03 17 SS 12 04 03 92 SS 50 19 01 15 SS 00 46 09 19 IH 99 40 04 09 IH 99 41 04 09 SX 80 01 06 97 SS 82 23 09 15 SS 83 76 01 15 SS 89 93 07 16 IH 12 00 11 85 ADDITIONAL INSURED - MANAGER/LESSOR IH 12 00 11 85 ADDITIONAL INSURED - PERSON -ORGANIZATION IH 12 00 11 85 ENDT 003, EFFECTIVE DATE IS 03/01/2018 cF RiskMmWmentDMsian Jy/ ,'q REVIEWED & APPROVED BY: Form SS 00 02 12 06 Page 028 I "' "° Process Date: 08/18/20 Policy ExpiratirtisknrangementnTlyst SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 59 SBA RV9040 SUPPLEMENTAL DECLARATIONS: A service fee of $ 7.00 is charged for each installment when your premium is paid in installments. The service fee is $ 5.00 per withdrawal when you select an electronic fund transfer payment plan. The service fee will be added to the premium amount shown on your premium billing statement. Form SS 00 45 12 06 Process Date: 0 8 / 18 / 2 0 RAMwagmedDMsiun REVIEWED & APPROVEDSY: Policy Expira --� Wsk Pjanagement Analyst POLICY NUMBER: 59 SBA RV9040 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF THE DECLARATIONS - ADDITIONAL PERSONS OR ORGANIZATIONS DESIGNATED AS NAMED INSUREDS The following person(s) or organization(s) are added to the Declarations as Named Insureds: BAY SPROUTS LLC BEAN SPROUTS LOS ANGELES BEAN SPROUTS SANTA ANA DBA BEAN SPROUTS CAFE AND COOKING SCHOOL Form SS 12 35 03 12 SEQ. NO. o o 1 Page 001 Process Date: 0 8 / 18 / 2 0 © 2012, The Hartford w RAMwagementDMsian Expirat }g 1L REVIEWED & APPROVED BY.- --� Risk janagement Analyst RESTAURANT STRETCH SUMMARY SUMMARY OF COVERAGE LIMITS This is a summary of the Coverages and the Limits of Insurance provided by the Restaurant Stretch Coverage form SS 04 11 which is included in this policy. No coverage is provided by this summary. Refer to coverage form SS 04 11 to determine the scope of your insurance protection. The Limit of Insurance for the following Additional Coverages are in addition to any other limit of insurance provided under this policy: Coverage Accounts Receivable - On/Off-Premises Brands and Labels Claims Expense Computer Fraud Computers and Media Debris Removal Employee Dishonesty (including ERISA) Fine Arts Forgery Laptop Computers - Worldwide Coverage Lost Keys Off Premises Service - Direct Damage Outdoor Signs Pairs and Sets Personal Property of Others Property at Other Premises Salespersons' Samples Sewer and Drain Back Up Sump Overflow or Sump Pump Failure Temperature Change Tenant Building and Business Personal Property Coverage - Required by Lease Transit Property in the Care of Carriers for Hire Unauthorized Business Card Use Valuable Papers and Records - On/Off-Premises Limit $ 25,000 Up to Business Personal Property Limit $ 10,000 $ 5,000 $ 25,000 $ 25,000 $ 10,000 $ 10,000 $ 10,000 $ 10,000 $ 2,500 $ 10,000 Full Value Up to Business Personal Property Limit $ 10,000 $ 10,000 $ 1,000 Included up to Covered Property Limits $ 15,000 $ 10,000 $ 20,000 $ 10,000 $ 2,500 $ 25,000 The Limits of Insurance for the following Coverage Extensions are a replacement of the Limit of Insurance provided under the Standard Property Coverage Form or the Special Property Coverage Form, whichever applies to the policy: Coverage Newly Acquired or Constructed Property - 180 Days Building Business Personal Property Business Income and Extra Expense Outdoor Property Personal Effects Property Off -Premises Form SS 84 04 10 15 © 2015, The Hartford Limit $1,000,000 $ 500,000 $ 500,000 $ 20,000 aggregate/ $1,000 per item $ 25,000 $ 15,000 ew cF RAMwagementDMsian ke/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst The following changes apply only if Business Income and Extra Expense are covered under this policy. The Limits of Insurance for the following Business Income and Extra Expense Coverages are in addition to any other Limit of Insurance provided under this policy: Coverage Limit Business Income Extension for Off -Premises Utility Services $ 25,000 Business Income Extension for Web Sites $ 10,000/7 days Business Income from Dependent Properties $ 50,000 Food Contamination $ 25,000 The following Limit of Insurance for the following Business Income Coverage is a replacement of the Limit of Insurance provided under the Standard Property Coverage Form or the Special Property Coverage Form, whichever applies to the policy: Coverage Extended Business Income Limit 60 Days The following changes apply only if the Special Property Coverage Form applies to this policy. The Limits of Insurance for the following Additional Coverages are in addition to any other limit of insurance provided under this policy: Coverage Money and Securities The following changes apply to Loss Payment Conditions: Coverage Valuation Changes Commodity Stock "Finished Stock" Mercantile Stock - Sold Page 2 of 2 Limit $ 10,000 inside the premises/ $ 10,000 outside the premises Limit Included Included Included ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst Form SS 00 05 10 08 COMMON POLICY CONDITIONS Risk MmWmentDMsian REVIEWED & APPROVED BY: v © 2008, The Hartford —_-- Ri.Wjanagementftalpt QUICK REFERENCE - SPECTRUM POLICY DECLARATIONS and COMMON POLICY CONDITIONS I. DECLARATIONS Named Insured and Mailing Address Policy Period Description and Business Location Coverages and Limits of Insurance II. COMMON POLICY CONDITIONS Beginning on Page A. Cancellation 1 B. Changes 1 C. Concealment, Misrepresentation Or Fraud 2 D. Examination Of Your Books And Records 2 E. Inspections And Surveys 2 F. Insurance Under Two Or More Coverages 2 G. Liberalization 2 H. Other Insurance - Property Coverage 2 I. Premiums 2 J. Transfer Of Rights Of Recovery Against Others To Us 2 K. Transfer Of Your Rights And Duties Under This Policy 3 L. Premium Audit 3 Form SS 00 05 10 08 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst COMMON POLICY CONDITIONS All coverages of this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 5 days before the effective date of cancellation if any one of the following conditions exists at any building that is Covered Property in this policy: (1) The building has been vacant or unoccupied 60 or more consecutive days. This does not apply to: (a) Seasonal unoccupancy; or (b) Buildings in the course of construction, renovation or addition. Buildings with 65% or more of the rental units or floor area vacant or unoccupied are considered unoccupied under this provision. (2) After damage by a Covered Cause of Loss, permanent repairs to the building: (a) Have not started; and (b) Have not been contracted for, within 30 days of initial payment of loss. (3) The building has: (a) An outstanding order to vacate; (b) An outstanding demolition order; or (c) Been declared unsafe by governmental authority. (4) Fixed and salvageable items have been or are being removed from the building and are not being replaced. This does not apply to such removal that is necessary or incidental to any renovation or remodeling. (5) Failure to: (a) Furnish necessary heat, water, sewer service or electricity for 30 consecutive days or more, except during a period of seasonal unoccupancy; or (b) Pay property taxes that are owing and have been outstanding for more than one year following the date due, except that this provision will not apply where you are in a bona fide dispute with the taxing authority regarding payment of such taxes. b. 10 days before the effective date of cancellation if we cancel for nonpayment of premium. c. 30 days before the effective date of cancellation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is canceled, we will send the first Named Insured any premium refund due. Such refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be sufficient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. ew cF RAMwagementDMsian Form SS 00 05 10 08 J_/ ,qq REVIEWED & APPROVED BY: © 2008, The Hartford �� "" v (Includes copyrighted material of Insurance Services Office, Inc. with its per --_-- Wsk Management Analpt COMMON POLICY CONDITIONS C. Concealment, Misrepresentation Or Fraud This policy is void in any case of fraud by you as it relates to this policy at any time. It is also void if you or any other insured, at any time, intentionally conceal or misrepresent a material fact concerning: 1. This policy; 2. The Covered Property; 3. Your interest in the Covered Property; or 4. A claim under this policy. D. Examination Of Your Books And Records We may examine and audit your books and records as they relate to the policy at any time during the policy period and up to three years afterward. E. Inspections And Surveys 1. We have the right but are not obligated to: a. Make inspections and surveys at any time; b. Give you reports on the conditions we find; and c. Recommend changes. 2. Any inspections, surveys, reports or recommendations will relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of any person. We do not represent or warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. This condition applies not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations on our behalf. F. Insurance Under Two Or More Coverages If two or more of this policy's coverages apply to the same loss or damage, we will not pay more than the actual amount of the loss or damage. G. Liberalization If we adopt any revision that would broaden the coverage under this policy without additional premium within 45 days prior to, or at any time during, the policy period, the broadened coverage will immediately apply to this policy. H. Other Insurance - Property Coverage If there is other insurance covering the same loss or damage, we will pay only for the amount of covered loss or damage in excess of the amount Page 2 of 3 due from that other insurance, whether you can collect on it or not. But we will not pay more than the applicable Limit of Insurance. I. Premiums 1. The first Named Insured shown in the Declarations: a. Is responsible for the payment of all premiums; and b. Will be the payee for any return premiums we pay. 2. The premium shown in the Declarations was computed based on rates in effect at the time the policy was issued. If applicable, on each renewal, continuation or anniversary of the effective date of this policy, we will compute the premium in accordance with our rates and rules then in effect. 3. With our consent, you may continue this policy in force by paying a continuation premium for each successive one-year period. The premium must be: a. Paid to us prior to the anniversary date; and b. Determined in accordance with Paragraph 2. above. Our forms then in effect will apply. If you do not pay the continuation premium, this policy will expire on the first anniversary date that we have not received the premium. 4. Changes in exposures or changes in your business operation, acquisition or use of locations that are not shown in the Declarations may occur during the policy period. If so, we may require an additional premium. That premium will be determined in accordance with our rates and rules then in effect. J. Transfer Of Rights Of Recovery Against Others To Us Applicable to Property Coverage: If any person or organization to or for whom we make payment under this policy has rights to recover damages from another, those rights are transferred to us to the extent of our payment. That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: 1. Prior to a loss to your Covered Property; or 2. After a loss to your Covered Property only if, at time of loss, that party is one of the following: ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst COMMON POLICY CONDITIONS a. Someone insured by this insurance; b. A business firm: (1) Owned or controlled by you; or (2) That owns or controls you; or c. Your tenant. You may also accept the usual bills of lading or shipping receipts limiting the liability of carriers. This will not restrict your insurance. K. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual Named Insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. L. Premium Audit a. We will compute all premiums for this policy in accordance with our rules and rates. b. The premium amount shown in the Declarations is a deposit premium only. At the close of each audit period we will compute the earned premium for that period. Any additional premium found to be due as a result of the audit are due and payable on notice to the first Named Insured. If the deposit premium paid for the policy term is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must maintain all records related to the coverage provided by this policy and necessary to finalize the premium audit, and send us copies of the same upon our request. Our President and Secretary have signed this policy. Where required by law, the Declarations page has also been countersigned by our duly authorized representative. scn�. Lisa Levin, Secretary Form SS 00 05 10 08 Douglas Elliot, President cF IZAManagmedDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM Form SS 00 07 07 05 Risk MmWmentDMsian REVIEWED & APPROVED BY: v ©2005, The Hartford —_-- W.Wjanagementftalpt QUICK REFERENCE SPECIAL PROPERTY COVERAGE FORM READ YOUR POLICY CAREFULLY SPECIAL PROPERTY COVERAGE FORM Beginning on Page A. COVERAGES 1 Covered Property 1 Property Not Covered 1 Covered Causes of Loss 2 Limitations 2 Additional Coverages 3 Coverage Extensions 13 B. EXCLUSIONS 16 C. LIMITS OF INSURANCE 18 D. DEDUCTIBLES 19 E. PROPERTY LOSS CONDITIONS 19 Abandonment 20 Appraisal 20 Duties in the Event of Loss or Damage 20 Legal Action Against Us 20 Loss Payment 20 Recovered Property 22 Resumption of Operations 22 Vacancy 22 F. PROPERTY GENERAL CONDITIONS 23 Control of Property 23 Mortgage Holders 23 No Benefit to Bailee 24 Policy Period, Coverage Territory 24 G. PROPERTY DEFINITIONS 24 �40 1°x REVIEWED & APPROVED BY: Form SS 00 07 07 05 1� "° --� W. janagement Analyst SPECIAL PROPERTY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties, and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we," "us" and 'bur" refer to the Company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to the SECTION G - PROPERTY DEFINITIONS. A. COVERAGE (b) Materials, equipment, supplies and We will pay for direct physical loss of or physical temporary structures, on or within damage to Covered Property at the premises 1,000 feet of the "scheduled described in the Declarations (also called premises", used for making "scheduled premises" in this policy) caused by or additions, alterations or repairs to resulting from a Covered Cause of Loss. the buildings or structures. 1. Covered Property Covered Property as used in this policy, means the following types of property for which a Limit of Insurance is shown in the Declarations: a. Buildings, meaning only building(s) and structure(s) described in the Declarations, including: (1) Completed additions; (2) Permanently installed: (a) Fixtures; (b) Machinery; and (c) Equipment; (3) Outdoor fixtures; (4) Your personal property in apartments, rooms or common areas furnished by you as landlord; (5) Building Glass, meaning glass that is part of a building or structure; (6) Personal property owned by you that is used to maintain or service the buildings or structures on the premises, including: (a) Fire extinguishing equipment; (b) Outdoor furniture; (c) Floor coverings; and (d) Appliances used for refrigerating, ventilating, cooking, dishwashing or laundering; and (7) If not covered by other insurance: (a) Additions under construction, alterations and repairs to the buildings or structures; Form SS 00 07 07 05 b. Business Personal Property located in or on the building(s) described in the Declarations at the "scheduled premises" or in the open (or in a vehicle) within 1,000 feet of the "scheduled premises", including: (1) Property you own that is used in your business; (2) Tools and equipment owned by your employees, which are used in your business operations; (3) Property of others that is in your care, custody or control; (4) "Tenant Improvements and Betterments"; and (5) Leased personal property for which you have contractual responsibility to insure, unless otherwise provided for under Personal Property of Others. 2. Property Not Covered Covered Property does not include: a. Aircraft, automobiles, motor trucks and other vehicles subject to motor vehicle registration; b. Automobiles held for sale; c. "Money", bullion, numismatic and philatelic property and bank notes or "securities" except as provided in any Additional Coverages or Optional Coverages. Lottery tickets held for sale and postage stamps in current use and having face value are not "securities". d. Contraband, or property in the course of illegal transportati ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v --� Risk Pjanagement Analyst SPECIAL PROPERTY COVERAGE FORM e. Land (including land on which the property is located), water, growing crops or lawns; f. Outdoor fences, radio or television antennas (including satellite dishes), including their lead in wiring, masts or towers, signs (other than signs attached to buildings), trees, shrubs or plants (other then those held for sale or sold but not delivered), except as any of these may be provided in the: (1) Outdoor Property Coverage Extension; or (2) Outdoor Signs Optional Coverage; g. Watercraft (including motors, equipment and accessories) while afloat; h. The cost to research, replace or restore the information on "valuable papers and records", except as may be provided in any Coverage Extensions or Optional Coverages. i. "Data" and "software" which exists on electronic "media" including the cost to research, replace or restore them, except as may be provided for in any Additional Coverages or Optional Coverages. j. Accounts, bills, food stamps, other evidences of debt, accounts receivable or "valuable papers and records"; except as otherwise provided for in this policy. 3. Covered Causes of Loss RISKS OF DIRECT PHYSICAL LOSS unless the loss is: a. Excluded in Section B., EXCLUSIONS; or b. Limited in Paragraph A.4. Limitations; that follow. 4. Limitations a. We will not pay for direct loss of or damage to: (1) Property that is missing, where the only evidence of the direct physical loss or physical damage is a shortage disclosed on taking inventory, or other instances where there is no physical evidence to show what happened to the property. This limitation does not apply to the Additional Coverage for "Money" and "Securities". (2) Property that has been transferred to a person or to a place outside the "scheduled premises" on the basis of unauthorized instructions. (3) The interior of any building or structure caused by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless: (a) The building or structure first sustains physical damage by a Page 2 of 25 Covered Cause of Loss to its roof or walls through which the rain, snow, sleet, ice, sand or dust enters; or (b) The direct physical loss or physical damage is caused by or results from thawing of snow, sleet, or ice on the building or structure. b. Pets and animals are covered only if: (1) They are inside the building; and (2) They are owned by others and boarded by you, or owned by you and held for sale or sold but not delivered. And then we will pay only if they are killed, stolen, or their destruction is made necessary by a "specified cause of loss". c. For direct physical loss or physical damage by "theft", the following types of property are covered only up to the limits shown: (1) $2,500 for furs, fur garments and garments trimmed with fur; (2) $5,000 for jewelry, watches, watch movements, jewels, pearls, precious and semi-precious stones, bullion, gold, silver, platinum and other precious alloys or metals. This limit does not apply to jewelry and watches worth $500 or less per item; (3) $2,500 for patterns, dies, molds and forms; and (4) $500 for stamps, lottery tickets held for sale and letters of credit. d. Unless specifically provided under a separate endorsement and with a specific Limit of Insurance indicated in the Declarations, we will not pay for direct physical loss of or physical damage to "perishable stock" caused by or resulting from: (1) A change in temperature or humidity resulting from: (a) Mechanical breakdown or failure of: (i) Stationary heating plants; or (ii) Refrigerating, cooling, or humidity control apparatus or equipment; (b) Artificially generated electric current, including electric arcing, that disturbs electrical devices, appliances or wires; or (c) Complete or partial failure of electric power on your "scheduled premises" Msian (2) Contamination �� Jy, \ i REVIEWED & APPROVED BY.- .° --� Rusk Pjanagement Analpt SPECIAL PROPERTY COVERAGE FORM 5. Additional Coverages a. Collapse (1) With respect to Buildings: (a) Collapse means an abrupt falling down or caving in of a building or any part of a building with the result that the building cannot be occupied for its intended purpose; (b) A building or any part of a building that is in danger of falling down or caving in is not considered to be in a state of collapse; (c) A part of a building that is standing is not considered to be in a state of collapse even if it has separated from another part of the building; (d) A building that is standing or any part of a building that is standing is not considered to be in a state of collapse even if it shows evidence of cracking, bulging, sagging, bending, leaning, settling, shrinkage, or expansion. (2) We will pay for direct physical loss or physical damage caused by or resulting from risks of collapse of a building or any part of a building that is insured by this policy caused only by one or more of the following: (a) "Specified cause of loss" or breakage of building glass, if such loss or breakage was covered by this policy; (b) Decay that is hidden from view, unless the presence of such decay was known to an insured prior to collapse; (c) Insect or vermin damage that is hidden from view, unless the presence of such damage is known to an insured prior to collapse; (d) Weight of people or personal property; (e) Weight of rain that collects on a roof; and (f) Use of defective material or methods in construction, remodeling or renovation if the collapse occurs during the course of the construction, remodeling or renovation. Form SS 00 07 07 05 The criteria set forth in Paragraphs (1)(a) through (1)(d) do not limit the coverage otherwise provided under this Additional Coverage for the Causes of Loss listed in Paragraph (2)(a), (2)(d), and (2)(e). (3) If the collapse is caused by a Covered Cause of Loss listed in Paragraphs (2)(b) through (2)(f), we will pay for direct physical loss of or physical damage to the property listed below, but only if such physical loss or physical damage is a direct result of the collapse of a building insured under this policy, and the property is property covered under this policy: (a) Awnings; gutters and downspouts; yard fixtures; outdoor swimming pools; piers, wharves and docks; beach or diving platforms or appurtenances; retaining walls; walks, roadways and other paved surfaces. (4) If personal property abruptly falls down or caves in and such collapse is not the result of collapse of a building, we will pay for loss or damage to Covered Property caused by such collapse of personal property only if (a) The collapse was caused by a cause of loss listed in Paragraphs (2)(a) through (2)(f) of this Additional Coverage; (b) The personal property which collapses is inside a building; and (c) The property which collapses is not of a kind listed in Paragraph (3) above, regardless of whether that kind of property is considered to be personal property or real property. The coverage stated in this Paragraph (4) does not apply to personal property if marring or scratching is the only damage to that personal property caused by the collapse. Collapse of personal property does not mean cracking, bulging, sagging, bending, leaning, settling, shrinkage or expansion. (5) This Additional Coverage, Collapse, will not increase the Limits of Insurance pro\ coded in this nolicv_ cF RAMmWmentDMsian Jy/ 1'x REVIEWED & APPROVED BY.- 1,,; "° wd --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM b. Debris Removal (1) We will pay your expense to remove debris of Covered Property caused by or resulting from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the earlier of: (a) The date of direct physical loss or physical damage; or (b) The end of the policy period. (2) The most we will pay under this additional Coverage is 25% of the amount we pay for the direct loss of or physical damage to Covered Property plus the deductible in this policy applicable to that physical loss or physical damage. But this limitation does not apply to any additional Debris Removal limit provided in the Limits of Insurance section. (3) This Additional Coverage does not apply to costs to: (a) Extract "pollutants and contaminants" from land; or (b) Remove, restore or replace polluted or contaminated land or water. c. Equipment Breakdown (1) We will pay for direct physical loss or physical damage caused by or resulting from an Equipment Breakdown Accident to Equipment Breakdown Property. Equipment Breakdown Accident means: (a) Mechanical breakdown, including rupture or bursting caused by centrifugal force. (b) Artificially generated electric current, including electric arcing, that disturbs electrical devices, appliances or wires. (c) Explosion of steam boilers, steam piping, steam engines or steam turbines owned or leased by you, or operated under your control. (d) Physical loss or physical damage to steam boilers, steam pipes, steam engines or steam turbines Page 4 of 25 caused by or resulting from any condition or event inside such boilers or equipment. (e) Physical loss or physical damage to hot water boilers or other water heating equipment caused by or resulting from any condition or event inside such boilers or equipment. Equipment Breakdown Property means Covered Property built to operate under vacuum or pressure, other than weight of contents, or used for the generation, transmission or utilization of energy. The following is not Equipment Breakdown Property: (a) Any structure, foundation, cabinet, compartment or air supported structure building; (b) Any insulating or refractory material; (c) Any sewer piping, any underground vessels or piping, any piping forming a part of a sprinkler system, water piping other than boiler feed water piping, boiler condensate return piping, or water piping forming a part of a refrigerating or air conditioning system; (d) Any vehicle or any equipment mounted on a vehicle. As used here, vehicle means any machine or apparatus that is used for transportation or moves under its own power. Vehicle includes, but is not limited to, car, truck, bus, trailer, train, aircraft, watercraft, forklift, bulldozer, tractor or harvester. However, any property that is stationary, permanently installed at a "scheduled premises" and that receives electrical power from an external power source will not be considered a vehicle. (e) Any equipment manufactured by you for sale. (2) Coverage Extensions The following coverage extensions apply only to direct physical loss or physical damage caused by or resulting from an Equipment Breakdown Accident: ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM (a) Hazardous Substances We will pay in any one occurrence for the additional cost, not to exceed $50,000, to repair or replace Covered Property because of contamination by a hazardous substance. This includes the expenses to clean up or dispose of such property. Hazardous substance means any substance that is hazardous to human health or that has been declared by a government agency to be hazardous to human health. Additional cost in this extension means those beyond what would have been required had no hazardous substance been involved. This limit is part of and not in addition to the Limits of Insurance for Covered Property. (b) Expediting Expenses With respect to your damaged Covered Property, we will pay in any one occurrence, up to $50,000, for the reasonable and necessary additional expenses you incur to: (i) Make temporary repairs; or (ii) Expedite permanent repairs or permanent replacement. (c) Defense If a claim or "suit" is brought against you alleging that you are liable for damage to property of another in your care, custody or control directly caused by Equipment Breakdown we will either: (i) Settle the claim or "suit"; or (ii) Defend you against the claim or "suit," but keep for ourselves the right to settle it at any point. (d) Supplementary Payments We will pay, with respect to any claim or "suit" we defend: (i) All expenses we incur; (ii) The cost of bonds to release attachments, but only for bond Form SS 00 07 07 05 amounts within the Limit of Insurance. We do not have to furnish these bonds; (iii) All reasonable expenses incurred by you at our request to assist us in the investigation or defense of the claim or "suit" including actual loss of earnings up to $100 a day because of time off from work; (iv) All costs taxed against you in any "suit" we defend; (v) Prejudgment interest awarded against you on that part of the judgment we pay. If we make an offer to pay the applicable Limit of Insurance, we will not pay any prejudgment interest based on that period of time after the offer; and (vi) All interest on the full amount of any judgment that accrues after entry of the judgment and before we have paid, offered to pay, or deposited in court the part of the judgment that is within the Limit of Insurance shown in the Declarations. These payments will not reduce the Limit of Insurance shown in the Declarations. (e) Business Income and Extra Expense Extension The Business Income and Extra Expense Additional Coverages are extended to provide coverage for a tenant who has a loss of income from the lack of heating, cooling or power as a result of equipment breakdown to mechanical, electrical or pressure equipment of the building owner. (f) If Equipment Breakdown Property requires replacement due to an Equipment Breakdown Accident, we will pay your additional cost to replace it with equipment that is better for the environment, safer or more efficient than the equipment being replaced. However, we will not pay more than 125% of what the cost would have been to repair or replace with nrnnertv nt cF RAMmWmentDMsian Jy/ 1'x REVIEWED & APPROVED BY.- 1,,; "° wd --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM comparable material and quality. This coverage does not increase any of the applicable limits. This coverage does not apply to any property indicated as being valued on an Actual Cash Value basis. If you wish to retrofit air conditioning or refrigeration equipment that utilizes a refrigerant containing CFC (chlorofluorocarbon) substances to accept a non-CFC refrigerant or replace the system with a system using a non-CFC refrigerant, we will consider this better for the environment. Any associated Business Income or Extra Expense will be included in determining the additional cost, if Business Income and Extra Expense apply to this policy. (3) Additional Condition - Bankruptcy The bankruptcy or insolvency of you or your estate will not relieve us of any obligation under this Additional Coverage. (4) Jurisdictional Inspections: If any boiler or pressure vessel requires inspection to comply with state or municipal boiler and pressure vessel regulations, we agree to perform such inspection on your behalf. d. Fire Department Service Charge When the fire department is called to save or protect Covered Property from a Covered Cause of Loss, we will pay up to $25,000 in any one occurrence for your liability for fire department service charges: (1) Assumed by contract or agreement prior to loss; or (2) Required by local ordinance. e. Fire Extinguisher Recharge We will pay to cover your expenses for recharge of your hand fire extinguishers when they are emptied while fighting fire. f. Forgery (1) We will pay for loss resulting directly from forgery or alteration of any check, draft, promissory note, or similar written promises, orders or directions to pay a sum certain in "money" that you or your Page 6 of 25 agent has issued, or that was issued by someone who impersonates you or your agent. This includes written instruments required in conjunction with any credit, debit, or charge card issued to you or any "employee" for business purposes. (2) If you are sued for refusing to pay any Covered Instrument on the basis that it has been forged or altered, and you have our written consent to defend against the "suit", we will pay for any reasonable expenses that you incur and pay in that defense. (3) We will pay for loss resulting directly from your having accepted in good faith, in exchange for merchandise, ,'money" or services: (a) Money orders, including counterfeit money orders, of any United States or Canadian post office, express company or national or state (or Canadian) chartered bank that are not paid upon presentation; and (b) Counterfeit United States or Canadian paper currency. (4) The most we will pay in any one occurrence, including legal expenses, under this Additional Coverage is $5,000, unless a higher Limit of Insurance is shown in the Declarations. g. Glass Expense We will pay for necessary expenses incurred to: (1) Put up temporary plates or board up openings if repair or replacement of damaged glass is delayed; (2) Repair or replace encasing frames; and (3) Remove or replace obstructions when repairing or replacing glass that is part of a building. This does not include removing or replacing window displays. h. Lock and Key Replacement We will pay up to $1,000 in any one occurrence for the re -keying of locks or the repair or replacement of locks at "scheduled premises" following the theft or the attempted theft of keys by burglars. Money and Securities (1) We will pa "securities" y for loss of "move " and us cF RAMmWmentDMsian Jy/ \'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM at a bank or savings institution, within your living quarters or the living quarters of your partners or any employee having use and custody of the property, at the "scheduled premises", or in transit between any of these places, resulting directly from: (a) "Theft"; (b) Disappearance; or (c) Destruction. (2) In addition to the Limitations and Exclusions applicable to property coverage, we will not pay for loss: (a) Resulting from accounting or arithmetical errors or omissions; (b) Due to the giving or surrendering of property in any exchange or purchase; or (c) Of property contained in any "money" -operated device unless a continuous recording instrument in the device records the amount of "money" deposited in the "money" - operated device. (3) The most we will pay for loss in any one occurrence is: (a) The limit shown in the Declarations for Inside the Premises for "money" and "securities" while: (i) In or on the "scheduled premises"; or (ii) Within a bank or savings institution; and (b) The limit shown in the Declarations for Outside the Premises for "money" and "securities" while anywhere else. (4) All loss: (a) Caused by one or more persons; or (b) Involving a single act or series of related acts; is considered one occurrence. (5) You must keep records of all "money" and "securities" so we can verify the amount of any loss or damage. j. Ordinance or Law (1) If a Covered Cause of Loss occurs to covered Building property, we will pay on a "scheduled premises" any of the following costs that are caused by enforcement of an ordinance or law: Form SS 00 07 07 05 Undamaged Part (a) For loss to the undamaged portion of the Building that requires the demolition of parts of the same property not damaged by a Covered Cause of Loss provided that any such ordinance or law resulting in this type of loss: (i) Regulates the construction or repair of buildings, or establishes zoning or land use requirements at the "scheduled premises"; and (ii) Is in force at the time of the loss. The most we will pay in any one occurrence for this coverage is $25,000 as a Limit of Insurance. Demolition Cost (b) The cost to demolish and clear the site of undamaged parts of the property caused by enforcement of a building, zoning or land use ordinance or law. The most we will pay in any one occurrence for this coverage is $25,000 as a Limit of Insurance. Increased Cost of Construction (c) The increased cost to repair, rebuild or reconstruct the covered property, caused by enforcement of a building, zoning or land use ordinance or law. The most we will pay in any one occurrence for this coverage is $25,000 as a Limit of Insurance. "Tenants Improvements and Betterment" (d) The increased cost to repair, rebuild or reconstruct "tenant's improvements and betterments" caused by enforcement of building, zoning or land use ordinance or law. The most we will pay in any one occurrence for this coverage is $25,000 as a Limit of Insurance. (2) Additional Exclusions We will not pay under this Additional Coverage for: (a) The enforcement of any ordinance or law which requires the demolition reconstru RA�DMSiUn Aw F Jy/ \'x REVIEWED & APPROVED BY.- --� Risk Pjanagement Analyst SPECIAL PROPERTY COVERAGE FORM remediation of property due to contamination by "pollutants and contaminants" or due to the presence, growth, proliferation, spread of any activity of "fungi", wet or dry rot, bacteria or virus; or (b) The costs associated with the enforcement of any ordinance or law which requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants or contaminants", "fungi", wet or dry rot, bacteria or virus. (c) Loss caused by, resulting from, contributed to or aggravated by earthquake or volcanic eruption. (d) Loss due to an ordinance or law that: (i) You were required to comply with before the loss even if the building was undamaged; and (ii) You failed to comply with. (3) Additional Limitations — Loss to Undamaged Portion of Building Subject to the limit stated in Paragraph A.5.j.(1)(a), the insurance provided under this Additional Coverage for loss in value to the undamaged portion of the building is limited as follows: (a) If Replacement Cost applies and the property is repaired or replaced on the same or another premises, we will not pay more for physical loss of or physical damage to designated Building property, including loss caused by enforcement of an ordinance or law, than: (i) The amount you actually spend to repair, rebuild or reconstruct the Building, but not for more than the amount it would cost to restore the Building on the same premises; and (ii) The amount it would cost to restore the undamaged portion to the same height, floor area, style and comparable quality of the original property insured. Page 8 of 25 (b) If the Building(s) Full Value Endorsement applies and the property is repaired or replaced on the same or another premises, we will not pay more for physical loss of or physical damage to designated Building property, including loss caused by enforcement of an ordinance or law, than: (i) The amount you actually spend to repair, rebuild or reconstruct the Building, but not for more than the amount it would cost to restore the Building on the same premises; and (ii) The amount it would cost to restore the undamaged portion to the same height, floor area, style and comparable quality of the original property insured. (c) If Replacement Cost or the Building(s) Full Value Endorsement applies and the property is not repaired or replaced, or if Actual Cash Value applies, then we will not pay more for physical loss of or physical damage to designated Building property, including loss caused by enforcement of an ordinance or law, than the lesser of: (i) The Actual Cash Value of the Building at the time of loss; or (ii) The Limit of Insurance applicable to the covered Building property stated in Paragraph A.5.j.(1)(a). (4) Additional Limitation — Demolition Cost We will not pay more than the lesser of: (a) The amount actually spent to demolish and clear the site of the "scheduled premises"; or (b) The applicable Demolition Cost Limit of Insurance as stated in Paragraph A.5.j.(1)(b). (5) Additional Limitation — Increased Cost of Construction The insurance provided under this Additional Coverage for increased cost of construction is limited as follows: (a) We will no cF RAMmWmentDMsian Jy/ \'x REVIEWED & APPROVED BY: V"° --� Risk Pjanagement Analyst SPECIAL PROPERTY COVERAGE FORM (i) Until the property is actually repaired or replaced, at the same or another premises; and (ii) Unless the repairs or replacements are made as soon as reasonably possible after the physical loss or physical damage, not to exceed two years. We may extend this period in writing during the two years. (b) If the Building is repaired or replaced at the same premises, or if you elect to rebuild at another premises, the most we will pay is the lesser of: (i) The increased cost of construction at the same premises; or (ii) The applicable Increased Cost of Construction Limit of Insurance stated in Paragraph A.5.j.(1)(c). (c) If the ordinance or law requires relocation to another premises, the most we will pay is the lesser of: (i) The Increased Cost of Construction at the new premises; or (ii) The applicable Increased Cost of Construction Limit of Insurance stated in Paragraph A.5.j.(1)(c). k. "Pollutants and Contaminants" Clean Up and Removal We will pay your expense to extract "pollutants and contaminants" from land or water at the "scheduled premises" if the discharge, dispersal, seepage, migration, release or escape of the "pollutants and contaminants" is caused by or results from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the earlier of: (1) The date of direct physical loss or physical damage; or (2) The end of the policy period. The most we will pay in any one occurrence for each location under this Additional Coverage is $15,000 for the sum of all such expenses arising out of Covered Causes of Loss. Form SS 00 07 07 05 I. Preservation of Property If it is necessary to move Covered Property from the "scheduled premises" to preserve it from direct physical loss or physical damage by a Covered Cause of Loss, we will pay for any direct physical loss of or physical damage to that property: (1) While it is being moved or while temporarily stored at another location; and (2) Only if the direct physical loss or physical damage occurs within 45 days after the property is first moved. m. Theft Damage to Building This Additional Coverage applies only to premises where you are a tenant and are responsible in the lease for physical loss or physical damage to the building you lease, rent, or occupy that is caused by or results from "theft", burglary or robbery. We will pay for direct physical loss or physical damage directly resulting from "theft", burglary or robbery (except loss by fire or explosion) to a building: (1) You occupy, including personal property that is used to maintain or service the building; or (2) Containing covered personal property if you are legally liable for such physical loss or physical damage. But we will not pay for such physical loss of or physical damage to property that is away from the "scheduled premises". n. Water Damage, Other Liquid, Powder or Molten Material Damage If direct physical loss or physical damage caused by or resulting from covered water or other liquid, powder or molten material damage loss occurs, we will also pay the cost to tear out and replace any part of the building or structure to repair damage to the system or appliance from which the water or other substance escapes. We will not pay the cost to repair any defect that caused the direct physical loss or physical damage except as provided in paragraph A.5.c., Equipment Breakdown of this coverage form. But we will pay the cost to repair or replace damaged parts of fire extinguishing equipment if the damage: (1) Results in discharge of any substance from an au - system; or ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- ,v --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM (2) Is directly caused by freezing. o. Business Income (1) We will pay for the actual loss of Business Income you sustain due to the necessary suspension of your "operations" during the "period of restoration". The suspension must be caused by direct physical loss of or physical damage to property at the "scheduled premises", including personal property in the open (or in a vehicle) within 1,000 feet of the "scheduled premises", caused by or resulting from a Covered Cause of Loss. (2) With respect to the requirements set forth in the preceding paragraph, if you occupy only part of the site at which the "scheduled premises" are located, your "scheduled premises" also means: (a) The portion of the building which you rent, lease or occupy; and (b) Any area within the building or on the site at which the "scheduled premises" are located, but only if that area services, or is used to gain access to, the "scheduled premises". (3) We will only pay for loss of Business Income that occurs within 12 consecutive months after the date of direct physical loss or physical damage. This Additional Coverage is not subject to the Limits of Insurance. (4) Business Income means the: (a) Net Income (Net Profit or Loss before income taxes) that would have been earned or incurred if no direct physical loss or physical damage had occurred; and (b) Continuing normal operating expenses incurred, including payroll. (5) With respect to the coverage provided in this Additional Coverage, suspension means: (a) The partial slowdown or complete cessation of your business activities; or Page 10 of 25 (b) That part or all of the "scheduled premises" is rendered untentantable as a result of a Covered Cause of Loss if coverage for Business Income applies to the policy. p. Extra Expense (1) We will pay reasonable and necessary Extra Expense you incur during the "period of restoration" that you would not have incurred if there had been no direct physical loss or physical damage to property at the "scheduled premises", including personal property in the open (or in a vehicle) within 1,000 feet, caused by or resulting from a Covered Cause of Loss. (2) With respect to the requirements set forth in the preceding paragraph, if you occupy only part of the site at which the "scheduled premises" are located, your "scheduled premises" also means: (a) The portion of the building which you rent, lease or occupy; and (b) Any area within the building or on the site at which the "scheduled premises" are located, but only if that area services, or is used to gain access to, the "scheduled premises". (3) Extra Expense means expense incurred: (a) To avoid or minimize the suspension of business and to continue 'operations": (i) At the "scheduled premises"; or (ii) At replacement premises or at temporary locations, including: (aa)Relocation expenses; and (bb)Cost to equip and operate the replacement or temporary location, other than those costs necessary to repair or to replace damaged stock and equipment. (b) To minimize the suspension of business if you cannot continue "operations". (c) (i) To property; ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM (ii) To research, replace or restore the lost information on damaged "valuable papers and records"; to the extent it reduces the amount of loss that otherwise would have been payable under this Additional Coverage or Additional Coverage o., Business Income. We will only pay for Extra Expense that occurs within 12 consecutive months after the date of direct physical loss or physical damage. This Additional Coverage is not subject to the Limits of Insurance. (4) With respect to the coverage provided in this Additional Coverage, suspension means: (a) The partial slowdown or complete cessation of your business activities; or (b) That part or all of the "scheduled premises" is rendered untentantable as a result of a Covered Cause of Loss if coverage for Extra Expense applies to the policy. (5) Limitation This Extra Expense Coverage does not apply to: (a) Any deficiencies in insuring building or business personal property; or (b) Any expense related to any recall of products you manufacture, handle or distribute. q. Civil Authority (1) This insurance is extended to apply to the actual loss of Business Income you sustain when access to your "scheduled premises" is specifically prohibited by order of a civil authority as the direct result of a Covered Cause of Loss to property in the immediate area of your "scheduled premises". (2) The coverage for Business Income will begin 72 hours after the order of a civil authority and coverage will end at the earlier of: Form SS 00 07 07 05 (a) When access is permitted to your "scheduled premises"; or (b) 30 consecutive days after the order of the civil authority. r. Extended Business Income (1) If the necessary suspension of your "operations" produces a Business Income loss payable under this policy, we will pay for the actual loss of Business Income you incur during the period that: (a) Begins on the date property is actually repaired, rebuilt or replaced and 'operations" are resumed; and (b) Ends on the earlier of: (i) The date you could restore your 'operations" with reasonable speed, to the condition that would have existed if no direct physical loss or damage occurred; or (ii) 30 consecutive days after the date determined in (1)(a) above. Loss of Business Income must be caused by direct physical loss or physical damage at the "scheduled premises" caused by or resulting from a Covered Cause of Loss. (2) With respect to the coverage provided in this Additional Coverage, suspension means: (a) The partial slowdown or complete cessation of your business activities; and (b) That a part or all of the "scheduled premises" is rendered untenantable as a result of a Covered Cause of Loss. s. Business Income from Dependent Properties (1) We will pay for the actual loss of Business Income you sustain due to direct physical loss or physical damage at the premises of a dependent property caused by or resulting from a Covered Cause of Loss. The most we will pay under this Additional Coverage is $5,000 in any one occurrence unless a higher Limit of Insurance is indicated in the Declarations. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM (2) We will reduce the amount of your Business Income loss, other than Extra Expense, to the extent you can resume 'operations", in whole or in part, by using any other available: (a) Source of materials; or (b) Outlet for your products. (3) If you do not resume 'operations", or do not resume 'operations" as quickly as possible, we will pay based on the length of time it would have taken to resume 'operations" as quickly as possible. (4) Dependent Property means property owned, leased or operated by others whom you depend on to: (a) Deliver materials or services to you or to others for your account. But services do not include: (i) Water, communication, power services or any other utility services; or (ii) Any type of web site, or Internet service. (b) Accept your products or services; (c) Manufacture your products for delivery to your customers under contract for sale; or (d) Attract customers to your business premises. The dependent property must be located in the coverage territory of this policy. (5) The coverage period for Business Income under this Additional Coverage: (a) Begins 72 hours after the time of direct physical loss or physical damage caused by or resulting from a Covered Cause of Loss at the premises of the dependent property; and (b) Ends on the date when the property at the premises of the dependent property should be repaired, rebuilt or replaced with reasonable speed and similar quality. (6) The Business Income coverage period, as stated in Paragraph (5), does not include any increased period required due to the enforcement of any ordinance or law that: Page 12 of 25 (a) Regulates the construction, use or repair, or requires the tearing down of any property; or (b) Requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify, or neutralize, or in any way respond to, or assess the effects "pollutants." (7) The definition of Business Income contained in the Business Income Additional Coverage also applies to this Business Income From Dependent Properties Additional Coverage. It. Tenant Glass This Additional Coverage applies only to premises where you are a tenant and are responsible in the lease for such damage. We will cover loss to glass, which is in your care, custody or control and for which the lease holds you responsible. The glass must be part of a building described in the Declarations or at a location that would be included in Coverage Extension b. Newly Acquired or Constructed Property. The most that we will pay in any one occurrence for each location under this Additional Coverage is $25,000. u. Leasehold Improvements If your lease is cancelled in accordance with a valid lease provision as the direct result of a Covered Cause of Loss to property at the location in which you are a tenant, and you cannot legally remove "Tenant Improvements and Betterments", we will extend Business Personal Property coverage to apply to the unamortized value of "Tenants Improvement and Betterment" that remain and that you were forced to abandon. The most we will pay in any one occurrence for loss under this Additional Coverage is $25,000. v. Lease Assessment Your Business Personal Property is extended to apply to your share of any assessment charged to all tenants by the building owner as a result of direct physical damage caused by or resulting from a Covered Cause of Loss to building property you occupy as agreed to in your written lease agreement. We will pay no more than $2,500 in any one occurrence for this Additional Coverage. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM 6. Coverage Extensions Except as otherwise provided, the following Extensions apply to property located in or on the building at the "scheduled premises" or in the open (or in a vehicle) within 1,000 feet of the "scheduled premises". All Coverage Extensions are subject to the terms, conditions and exclusions of this policy, except as otherwise provided. In addition to the Limits of Insurance, you may extend the insurance provided by this policy as follows: a. Accounts Receivable (1) You may extend the insurance that applies to your Business Personal Property, to apply to your accounts receivable. We will pay for: (a) All amounts due from your customers that you are unable to collect; (b) Interest charges on any loan required to offset amounts you are unable to collect pending our payment of these amounts; (c) Collection expenses in excess of your normal collection expenses that are made necessary by the physical loss or physical damage; and (d) Other reasonable expenses that you incur to reestablish your records of accounts receivable; that result from direct physical loss of or physical damage to your records of accounts receivable. (2) Paragraph A.3., Covered Causes of Loss, and Section B., Exclusions, do not apply to this Additional Coverage except for: (a) Paragraph 13.1.b., Governmental Action; (b) Paragraph 13.1.c., Nuclear Hazard; and (c) Paragraph 13.1.e., War and Military Action. (3) Additional Exclusions (a) Dishonest acts by you, anyone else with an interest in the records of accounts receivable, or your or their employees or authorized Form SS 00 07 07 05 representatives, or anyone entrusted with the records of accounts receivable, whether or not acting alone or in collusion with other persons or occurring during the hours of employment. This exclusion does not apply to a carrier for hire. (b) Alteration, falsification, concealment or destruction of records of accounts receivable done to conceal the wrongful giving, taking or withholding of "money," "securities," or other property. This exclusion applies only to the extent of the wrongful giving, taking or withholding. (c) Bookkeeping, accounting or billing errors or omissions. (d) Electrical or magnetic injury, disturbance or erasure of electronic recordings. But we will pay for direct physical loss or physical damage caused by Lightning. (e) Voluntary parting with any property by you or anyone entrusted with the property if induced to do so by any fraudulent scheme, trick, device or false pretense. (f) Unauthorized instructions to transfer property to any person or to any place. (4) We will not pay for direct physical loss or physical damage that requires any audit of records or any inventory computation to prove its factual existence. (5) The most we will pay in any one occurrence for direct physical loss of or physical damage to your accounts receivable at each "scheduled premises" is $25,000. (6) The most we will pay in any one occurrence for direct physical loss of or physical damage to accounts receivables away from the "scheduled premises", including while in transit, is $25,000. b. Arson and "Theft" Reward (1) In the event that a covered fire loss was the result of an act of arson, we will reimburse you for rewards you pay for informatio for that act of ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY. - I .° --� Rt janagement Analpt SPECIAL PROPERTY COVERAGE FORM (2) In the event of a covered "theft" loss, The most we will pay in any one we will reimburse you for rewards you occurrence for loss or damage under pay for information leading to this Extension is 25% of the Limit of convictions for the "theft" loss. Insurance for Building shown in the The most we will pay to reimburse you in Declarations, but not more than any one occurrence for arson or "theft" $500,000 at each premises. rewards is $10,000. (2) You may extend the insurance that This is additional insurance. The applies to Business Personal Property deductible does not apply to these to apply to: reimbursements. c. Data and Software (a) Property at any premises you acquire or construct; We will pay up to $10,000 in any one (b) Business Personal Property, occurrence to cover your costs to "data" including such property that you research, replace or restore or "software" newly acquire, located at your which exists or existed on "media" newly constructed building, or electronic or magnetic that is lost or damaged as a result of direct physical (c) Business Personal Property that loss or physical damage to "computer you newly acquire, located at the equipment" at the "scheduled premises". "scheduled premises". d. Garages, Storage Buildings and Other This extension does not apply to: Appurtenant Structures (a) Personal Property that you (1) You may extend the insurance that temporarily acquire in the course applies to Building to apply to garages, of installing or performing work on storage buildings and other such property; appurtenant structures, except outdoor (b) Personal property of others that fixtures, at the "scheduled premises". you temporarily acquire in the The most we will pay in any one course of your wholesaling activity. occurrence for direct physical loss or (c) Merchandise held for sale, except physical damage under this Extension as provided under Paragraph C.6. is $50,000 at each "scheduled Business Personal Property Limit premises". — Seasonal Increase. (2) You may extend the insurance that The most we will pay in any one applies to Business Personal Property occurrence for direct physical loss or in garages, storage buildings and other physical damage under this Extension appurtenant structures at the is $250,000 at each premises. "scheduled premises". (3) You may extend the insurance that The most we will pay in any one applies to Business Income and Extra occurrence for direct physical loss or Expense to apply to newly acquired or physical damage under this Extension constructed locations. is $5,000 at each "scheduled The most we will pay in any one premises". occurrence under this Extension is e. Newly Acquired or Constructed Property $50,000. (1) You may extend the insurance that (4) If Covered Property is moved to a new applies to Building to apply to: premises endorsed onto this policy, from a "scheduled premises" being endorsed (a) Your new buildings while being built off this policy, the Limit of Insurance on the "scheduled premises"; and applicable to that vacated premises will (b) Buildings you acquire at locations apply proportionately to both premises as other than the "scheduled the property is moved. This coverage premises", intended for: applies to up to 180 days after the move (i) Similar use as the Building begins or upon completion of the move, described in the Declarations; or whichever is sooner. This coverage does not apply to Business Personal (ii) Use as a warehouse. Property while �y �� u�" cF ILLi3RMwag'm2dDMsiOR \'x REVIEWED & APPROVED BY.- Page 14 of 25 Jy/ �� ` V --� Wsk Pjanagement Analyst SPECIAL PROPERTY COVERAGE FORM f �17 (5) Insurance under this Extension for each newly acquired or constructed property will end when any of the following first occurs: (a) This policy expires; (b) 180 days after you acquire or begin to construct the property, or (c) You report values to us. We will charge you additional premium for values reported from the day construction begins or you acquire the property. Outdoor Property You may extend the insurance provided by this policy to apply to your outdoor: (1) Fences, signs (other than signs attached to buildings), trees, shrubs and plants caused by or resulting from any of the following causes of loss: (a) Fire; (b) Lightning; (c) Explosion; (d) Riot or Civil Commotion; and (e) Aircraft. The most we will pay in any one occurrence for direct physical loss or physical damage, including debris removal expense, under this Extension is $10,000 but not more than $1,000 for any one tree, shrub or plant. (2) Radio and television antennas (including satellite dishes) caused by or resulting from any of the following causes of loss: (a) Fire; (b) Lightning; (c) Windstorm; (d) Ice, Snow, Sleet or Hail; (e) Explosion; (f) Riot or Civil Commotion; and (g) Aircraft. The most we will pay in any one occurrence for direct physical loss or physical damage, including debris removal expense, under this Extension is $2,000. Personal Effects You may extend the insurance that applies to Business Personal Property to apply to personal effects owned by you, your officers, your partners, "managers", "members", or your employees. Form SS 00 07 07 05 The most we will pay in any one occurrence for physical loss or physical damage under this Extension is $10,000 at each "scheduled premises". h. Property Off -Premises (1) You may extend the insurance that applies to Building to apply to such property that is temporarily at a location you do not own, lease or operate. This Extension applies only if physical loss or physical damage is caused by or resulting from a Covered Cause of Loss. This Extension does not apply to property in course of transit. The most we will pay in any one occurrence under this coverage extension is $5,000. (2) You may extend the insurance that applies to Business Personal Property to apply to such property, other than Accounts Receivable, "money" and "securities" while: (a) In the course of transit and more than 1,000 feet from the "scheduled premises". Property must be in or on, but not permanently attached to or installed in, a motor vehicle you own, lease or operate while between points in the coverage territory; or (b) Temporarily at a premises you do not own, lease or operate. (c) At a premises owned, leased, operated or used by you and the Business Personal Property is a vending machine. (d) In or on, but not permanently attached to or installed in, motor vehicles operated by your employees in the course of your business operations. (e) On temporary public display, or while being used at fairs, exhibitions, expositions, or trade shows or while in transit to and from these temporary sites. The most we will pay in any one occurrence under this Extension is $2,500. i. Valuable Papers and Records - Cost of Research You may extend the insurance that applies to Business Personal Property to apply to your costs to research, replace or restore the lost information on lost or damaged "valuable papers duplicates do not E ew cF RAMwagzmentDMsian Jy/ \'x REVIEWED & APPROVED BY. - I .° --� Rusk Pjanagement Analpt SPECIAL PROPERTY COVERAGE FORM The most we will pay in any one occurrence under this Extension is $25,000 at each "scheduled premises". For "valuable papers and records" not at the "scheduled premises", including while in transit, the most we will pay in any one occurrence is $25,000. B. EXCLUSIONS 1. We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. a. Earth Movement (1) Earthquake, meaning a shaking or trembling of the earth's crust, caused by underground tectonic forces resulting in breaking, shifting, rising, settling, sinking or lateral movement; (2) Landslide, including any earth sinking, rising or shifting related to such event; (3) Mine subsidence, meaning subsidence of a man-made mine, whether or not mining activity has ceased; (4) Earth sinking (other than sinkhole collapse), rising or shifting including soil conditions which cause settling, cracking or other disarrangement of foundations or other parts of realty. Soil conditions include contraction, expansion, freezing, thawing, erosion, improperly compacted soil, and the action of water under the ground surface; But if Earth Movement, as described in Paragraphs (1) through (4) above, results in fire or explosion, we will pay for the physical loss or physical damage caused by that fire or explosion. (5) Volcanic eruption, meaning the eruption, explosion or effusion of a volcano. But if physical loss or physical damage by fire or volcanic action results, we will pay for that resulting physical damage. Volcanic action means direct physical loss or physical damage resulting from the eruption of a volcano when the physical loss or physical damage is caused by: (a) Airborne volcanic blast or airborne shock waves; (b) Ash, dust, or particulate matter; or (c) Lava flow. Page 16 of 25 (d) All volcanic eruptions that occur within any 168-hour period will constitute a single occurrence. Volcanic action does not include the cost to remove ash, dust, or particulate matter. That does not cause direct physical loss or physical damage to Covered Property. b. Governmental Action Seizure or destruction of property by order of governmental authority. But we will pay for acts of destruction ordered by governmental authority and taken at the time of a fire to prevent its spread, if the fire would be covered under this policy. c. Nuclear Hazard Nuclear reaction or radiation, or radioactive contamination however caused. But if physical loss or physical damage by fire results, we will pay for that resulting physical loss or physical damage. d. Power Failure The failure of power or other utility service supplied to the "scheduled premises", however caused, if the failure occurs away from the "scheduled premises". Failure includes lack of sufficient capacity and reduction in supply necessary to maintain normal operations. But if physical loss or physical damage by a Covered Cause of Loss results, we will pay for that resulting physical loss or physical damage. e. War and Military Action (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. f. Water (1) Flood, including surface water, waves, overflow other bodies whether drivE the accumulation of waves, tides, tidal of streams or any ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM (2) Mudslide or mud flow; (3) Water that backs up from a sewer or drain; or (4) Water under the ground surface pressing on, or flowing or seeping through: (a) Foundations, walls, floors or paved surfaces; (b) Basements, whether paved or not; or (c) Doors, windows or other openings. But if loss or damage by fire, explosion or sprinkler leakage results, we will pay for that resulting physical loss or physical damage. (5) Water damage caused by or resulting from earthquake or volcanic eruption: (a) Earthquake means a shaking or trembling of the earth's crust, caused by underground tectonic forces resulting in breaking, shifting, rising, settling, sinking or lateral movement or other movement; (b) Volcanic eruption means the eruption, explosion or effusion of a volcano. g. Neglect Neglect of an insured to use all reasonable means to save and preserve property from further damage at and after the time of loss. 2. We will not pay for physical loss or physical damage caused by or resulting from: a. Consequential Losses: Delay, loss of use or loss of market. ?1 e b Smoke, Vapor, Gas: Smoke, vapor or gas f. from agricultural smudging or industrial operations. c. Miscellaneous Types of Loss: (1) Wear and tear; g• (2) Rust, corrosion, fungus, decay, deterioration, hidden or latent defect or any quality in property that causes it to damage or destroy itself; h (3) Smog; (4) Settling, cracking, shrinking or expansion; (5) Nesting or infestation, or discharge or i. release of waste products or secretions, by insects, birds, rodents, mold, spore or other animals; Form SS 00 07 07 05 (6) The following causes of loss to personal property: (a) Dampness or dryness of atmosphere; (b) Changes in or extremes of temperature; or (c) Marring or scratching. But if physical loss or physical damage by the "specified causes of loss", building glass breakage or Equipment Breakdown Accident results, we will pay for that resulting physical loss or physical damage. Frozen Plumbing: Water, other liquids, powder or molten material that leaks or flows from plumbing, heating, air conditioning or other equipment (except fire protective systems) caused by or resulting from freezing, unless: (1) You do your best to maintain heat in the building or structure; or (2) You drain the equipment and shut off the supply if the heat is not maintained. Dishonesty: Dishonest or criminal act by you, any of your partners, "members", officers, "managers", employees, directors, trustees, authorized representatives or anyone to whom you entrust the property for any purpose: (1) Acting alone or in collusion with others; or (2) Whether or not occurring during the hours of employment. This exclusion does not apply to acts of destruction by your employees; but theft by employees is not covered. False Pretense: Voluntary parting with any property by you or anyone else to whom you have entrusted the property if induced to do so by any fraudulent scheme, trick, device or false pretense. Exposed Property: Rain, snow, ice or sleet to personal property in the open, except as provided in the Coverage Extension for Outdoor Property. Collapse: Collapse, except as provided in the Additional Coverage for Collapse. But if loss or damage by a Covered Cause of Loss results at the "scheduled premises", we will pay for that resulting loss or damage. Pollution: We will not pay for loss or damage caused by or resulting from the discharge, disper release or esca Aw RAMwagemedDMsian F Jy/ \'x REVIEWED & APPROVED BY.- ---P Risk Pjanagement Analyst SPECIAL PROPERTY COVERAGE FORM contaminants" unless the discharge, dispersal, seepage, migration, release or escape is itself caused by any of the "specified causes of loss." But if physical loss or physical damage by the "specified causes of loss" results, we will pay for the resulting physical loss or physical damage caused by the "specified cause of loss." 3. We will not pay for loss or damage caused by or resulting from any of the following. But if physical loss or physical damage by a Covered Cause of Loss results, we will pay for that resulting physical loss or physical damage. a. Weather conditions: Weather conditions. This exclusion only applies if weather conditions contribute in any way with a cause or event excluded in paragraph 1. above to produce the physical loss or physical damage. b. Acts or Decisions: Acts or decisions, including the failure to act or decide, of any person, group, organization or governmental body. c. Negligent Work: Faulty, inadequate or defective: (1) Planning, zoning, development, surveying, siting; (2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance of part or all of any property on or off the "scheduled premises". 4. Business Income and Extra Expense Exclusions. We will not pay for: a. Any Extra Expense, or increase of Business Income loss, caused by or resulting from: (1) Delay in rebuilding, repairing or replacing the property or resuming "operations", due to interference at the location of the rebuilding, repair or replacement by strikers or other persons; or (2) Suspension, lapse or cancellation of any license, lease or contract. But if the suspension, lapse or cancellation is directly caused by the suspension of "operations', we will cover such loss that affects your Business Income during the "period of restoration". b. Any other consequential loss. Page 18 of 25 5. Equipment Breakdown Exclusion We will not pay for physical loss or physical damage caused by or resulting from any of the following tests: (a) A hydrostatic, pneumatic or gas pressure test of any boiler or pressure vessel; or (b) An insulation breakdown test of any type of electrical equipment. C. LIMITS OF INSURANCE 1. The most we will pay for physical loss or physical damage in any one occurrence is the applicable Limit of Insurance shown in the Declarations. 2. The most we will pay for physical loss of or physical damage to outdoor signs attached to buildings is $5,000 per sign in any one occurrence. 3. The limits applicable to: a. Coverage Extensions; and b. The following Additional Coverages: (1) Accounts Receivable, (2) Fire Department Service Charges, (3) Fire Extinguisher Recharge, and (4) "Pollutants and Contaminants" Clean Up and Removal are in addition to the Limits of Insurance. 4. Payments under the following Additional Coverages will not increase the applicable Limit of Insurance: a. Preservation of Property; or b. Debris Removal; but if: (1) The sum of direct physical loss or physical damage and Debris Removal expense exceeds the Limit of Insurance; or (2) The Debris Removal expense exceeds the amount payable under the 25% limitation in the Debris Removal Additional Coverage. We will pay up to an additional $10,000 for each location stated in the Declarations in any one occurrence under the Debris Removal Additional Coverage. 5. Building Limit -Automatic Increase a. The Limit of Insurance for Buildings will automatically increase annually by 8%. b. The amount of increase will be: (1) The Limit of Insurance for Buildings that applied on the ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM inception date, policy anniversary date, or the date of any other policy change amending the Buildings limit, times (2) The percentage of annual increase shown above, expressed as a decimal (.08); times (3) The number of days since the beginning of the current policy year or the effective date of the most recent policy change amending the Limit of Insurance for Buildings, divided by 365. Example: The applicable Limit of Insurance for Buildings is $100,000. The annual percentage increase is 8%. The number of days since the beginning of the policy period (or last policy change) is 146. The amount of increase is: $100,000 X .08 X 146 divided by 365 = $3,200 6. Business Personal Property Limit - Seasonal Increase a. The Limit of Insurance for Business Personal Property will automatically increase by 25% to provide for seasonal variations. b. This increase will apply only if all Limits of Insurance shown in the Declarations for Business Personal Property at the "scheduled premises" is at least 100% of your average monthly values during the lesser of: (1) The 12 months immediately preceding the date the physical loss or physical damage occurs; or (2) The period of time you have been in business as of the date the physical loss or physical damage occurs. D. DEDUCTIBLES 1. We will not pay for physical loss or physical damage in any one occurrence until the amount of physical loss or physical damage exceeds the Deductible shown in the Declarations. We will then pay the amount of loss or damage in excess of the Deductible up to the applicable Limit of Insurance. 2. Except as otherwise listed, the deductible applicable to Additional Coverages and Coverage Extensions is the Special Property Coverage Form is $250. 3. A $250 deductible applies to the following Glass Coverages, unless Glass Coverage is provided under a separate coverage form: Form SS 00 07 07 05 a. Building Glass b. Glass Expense c. Tenant Glass 4. Unless a separate deductible is shown in the Declarations, the deductible applicable to the following Additional Coverages or Coverage Extensions is $250, whether the coverage is provided under this coverage form, provided on a separate coverage form or the coverage is provided in a form that includes a package of coverages, such as a Stretch endorsement: a. Accounts Receivable; b. Fine Arts c. Outdoor Signs; and d. "Valuable Papers and Records"; 5. Unless a separate deductible is shown in the Declarations, the deductible applicable to the following Additional Coverages or Coverage Extensions is $100, whether the coverage is provided under this coverage form, provided on a separate coverage form or the coverage is provided in a form that includes a package of coverages, such as a Stretch endorsement: a. Employee Dishonesy; and b. Temperature Change. 6. No deductible applies to the following Coverage Extensions and Additional Coverages: a. Fire Extinguisher Recharge; b. Preservation of Property; c. Fire Department Service Charge; d. Business Income, Extra Expense, Civil Authority and Extended Business Income; e. Arson Reward; and f. Lock and Key Replacement 6. The Deductible applicable to the following Additional Coverages is the policy deductible or the deductible shown in the Declarations for the following coverage: a. Equipment Breakdown; b. Ordinance or Law Coverage; and c. Leasehold Improvements. 7. Each deductible applicable to this policy shall be applied separately but only to the coverage specified, and the total deductible for all losses in any one occurrence shall be the highest deductible amount that applies to the occurrence. E. PROPERTY LOSS CONDITIONS 1. Abandonment There can be no aba to us. cF RAMmWmentDMsian REVIEWED & APPROVED BY.- v --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM 2. Appraisal If we and you disagree on the amount of loss, either may make written demand for an appraisal of the loss. In that event, each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a. Pay its chosen appraiser; and b. Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. 3. Duties In The Event Of Loss Or Damage You must see that the following are done in the event of loss of or damage to Covered Property: a. Notify the police if a law may have been broken. b. Give us prompt notice of the physical loss or physical damage. Include a description of the property involved. c. As soon as possible, give us description of how, when and where the physical loss or physical damage occurred. d. Take all reseasonable steps to protect the Covered Property from further damage by a Covered Cause of Loss. If feasible, set the damaged property aside in the best possible order for examination. Also, keep a record of your expenses for emergency and temporary repairs, for consideration in the settlement of the claim. This will not increase the Limits of Insurance. e. At our request, give us complete inventories of the damaged and undamaged property. Include quantities, costs, values and amount of loss claimed. f. Permit us to inspect the property and records proving the loss or damage. Also permit us to take samples of damaged property for inspection, testing and analysis. g. If requested, permit us to question you under oath at such times as may be reasonably required about any matter relating to this insurance or your claim, including your books and records. In such event, your answers must be signed. Page 20 of 25 h. Send us a signed, sworn statement of loss containing the information we request to investigate the claim. You must do this within 60 days after our request. We will supply you with the necessary forms. i. Cooperate with us in the investigation or settlement of the claim. j. Resume part or all of your 'operations" as quickly as possible. 4. Legal Action Against Us No one may bring a legal action against us under this insurance unless: a. There has been full compliance with all of the terms of this insurance; and b. The action is brought within 2 years after the date on which the direct physical loss or physical damage occurred. 5. Loss Payment In the event of physical loss or physical damage covered by this policy: a. At our option we will either: (1) Pay the value of physically lost or physically damaged property, as described in paragraph d. below; (2) Pay the cost of repairing or replacing the physically lost or physically damaged property, plus any reduction in value of repaired items; (3) Take all or any part of the property at an agreed or appraised value; or (4) Repair, rebuild or replace the property with other property of like kind and quality. b. We will give notice of our intentions within 30 days after we receive the sworn statement of loss. c. We will not pay you more than your financial interest in the Covered Property. d. We will determine the value of Covered Property as follows: (1) At replacement cost (without deduction for depreciation), except as provided in (2) through (7) below. (a) You may make a claim for physical loss or physical damage covered by this insurance on an actual cash value basis instead of on a replacement cost basis. In the event you elect to have physical loss or physical damage settled on an actual may still ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM replacement cost basis if you notify us of your intent to do so within 180 days after the physical loss or physical damage. (b) We will not pay on a replacement cost basis for any physical loss or physical damage: (i) Until the physically lost or physically damaged property is actually repaired or replaced; and (ii) Unless the repairs or replacement are made as soon as reasonably possible after the physical loss or physical damage. However, if the cost to repair or replace the damaged property is $2,500 or less, we will settle the loss according to the provisions of Paragraphs d.(1)(a) and d.(1)(b) above whether or not the actual repair or replacement is complete. (c) We will not pay more for physical loss or physical damage on a replacement cost basis than the least of: (i) The cost to replace, on the same premises, the physically lost or physically damaged property with other property of comparable material and quality and which is used for the same purpose; or (ii) The amount you actually spend that is necessary to repair or replace the physically lost or physically damaged property. (2) If the Actual Cash Value - Buildings option applies, as shown in the Declarations, paragraph (1) above does not apply to Buildings. Instead, we will determine the value of Buildings at actual cash value. (3) The following property at actual cash value: (a) Manuscripts; (b) Works of art, antiques or rare articles, including etchings, pictures, statuary, objects of marble, bronzes, porcelains and bric-a-brac. Form SS 00 07 07 05 (c) Household contents, except personal property in apartments or rooms furnished by you as landlord. (4) Glass at the cost of replacement with safety glazing material if required by law. (5) "Tenants' Improvements and Betterments" at: (a) Replacement cost if you make repairs promptly. (b) A proportion of your original cost if you do not make repairs promptly. We will determine the proportionate value as follows: (i) Multiply the original cost by the number of days from the physical loss or physical damage to the expiration of the lease; and (ii) Divide the amount determined in (i) above by the number of days from the installation of improvements to the expiration of the lease. If your lease contains a renewal option, the expiration of the renewal option period will replace the expiration of the lease in this procedure. (c) Nothing, if others pay for repairs or replacement. (6) "Valuable Papers and Records", at the cost of: (a) Blank materials for reproducing the records; and (b) Labor to transcribe or copy the records. (7) "Money" and "Securities": (a) "Money" at its face value; and (b) "Securities" at their value at the close of business on the day the loss is discovered. (8) The value of United States Government Internal Revenue taxes and custom duties and refundable state and local taxes paid or fully determined on the following property held for sale will not be considered in determining the value of Covered Property: (a) Distilled spirits; (b) Wines; ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: v --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM (c) Rectified products; or (d) Beer. (9) Applicable to Accounts Receivable: (a) If you can not accurately establish the amount of the accounts receivable outstanding as of the time of physical loss or physical damage the following method will be used: (i) Determine the total of the average monthly value of accounts receivable for 12 months immediately preceding the month in which the direct physical loss or physical damage occurred; and (ii) Adjust the total determined in paragraph (i) above for any normal fluctuations in the value of accounts receivable for the month in which the direct physical loss or physical damage occurred for any demonstrated variance from the average of that month. (b) The following will be deducted from the total value of accounts receivable, however that value is established: (i) The value of the accounts for which there is no physical loss or physical damage; (ii) The value of the accounts that you are able to re-establish or collect; (ii) A value to allow for probable bad debts that you are normally unable to collect; and (iv) All unearned interest and services charged. e. Our payment for physical loss of or physical damage to personal property of others will only be for the account of the owners of the property. We may adjust losses with the owners of physically lost or physically damaged property if other than you. If we pay the owners, such payment will satisfy your claims against us for the owners' property. We will not pay the owners more than their financial interest in the Covered Property. Page 22 of 25 f. We may elect to defend you against suits arising from claims of owners of property. We will do this at our expense. g. We will pay for covered physical loss or physical damage within 30 days after we receive the sworn statement of loss, if: (1) You have complied with all of the terms of this policy; and (2) (a) We have reached agreement with you on the amount of loss, or (b) An appraisal award has been made. h. The following condition applies to any loss payment for Extra Expense: We will deduct from the total Extra Expense to be paid: (1) The salvage value that remains of any property bought for temporary use during the Period of Restoration, once business operations are resumed; and (2) Any Extra Expense that is paid for by other insurance. 6. Recovered Property If either you or we recover any property after loss settlement, that party must give the other prompt notice. At your option, you may retain the property. But then you must return to us the amount we paid to you for the property. We will pay recovery expenses and the expenses to repair the recovered property, subject to the Limits of Insurance. 7. Resumption of Operations In the event of physical loss or physical damage at the "scheduled premises" you must resume all or part of your "operations" as quickly as possible. We will reduce the amount of your: a. Business Income loss, other than Extra Expense, to the extent you can resume your "operations", in whole or in part, by using damaged or undamaged property (including merchandise or stock) at the "scheduled premises" or elsewhere. b. Extra Expense loss to the extent you can return "operations" to normal and discontinue such Extra Expense. 8. Vacancy a. Description of Terms (1) As used in this Vacancy Condition, the term building and the term vacant have the meanings set forth in Paragraphs. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM (a) and (b) below: (a) When this policy is issued to a tenant, and with respect to that tenant's interest in Covered Property, building means the unit or suite rented or leased to the tenant. Such building is vacant when it does not contain enough business personal property to conduct customary operations. (b) When this policy is issued to the owner or general lessee of a building, building means the entire building. Such building is vacant unless at least 31 % of its total square footage is: (i) Rented to a lessee or sub- lessee and used by the lessee or sub -lessee to conduct its customary operations; and/or (ii) Used by the building owner to conduct customary operations. (2) Buildings under construction or renovation are not considered vacant. b. Vacancy Provisions If the building where physical loss or physical damage occurs has been vacant for more than 60 consecutive days before that physical loss or physical damage occurs: (1) We will not pay for any physical loss or physical damage caused by any of the following even if they are Covered Causes of Loss: (a) Vandalism; (b) Sprinkler leakage, unless you had protected the system against freezing; (c) Building glass breakage; (d) Water damage; (e) Theft; or (f) Attempted theft. (2) With respect to Covered Causes of Loss other than those listed in b.(1)(a) through b.(1)(f) above, we will reduce the amount we would otherwise pay for the physical loss or physical damage by 15%. Form SS 00 07 07 05 F. PROPERTY GENERAL CONDITIONS 1. Control of Property Any act or neglect of any person other than you beyond your direction or control will not affect this insurance. The breach of any condition of this Coverage Form at one or more locations will not affect coverage at any location where, at the time of physical loss or physical damage, the breach of condition does not exist. 2. Mortgage Holders a. The term mortgage holder includes trustee b. We will pay for covered physical loss of or physical damage to buildings or structures to each mortgage holder shown in the Declarations in their order of precedence, as interests may appear. c. The mortgage holder has the right to receive loss payment even if the mortgage holder has started foreclosure or similar action on the building or structure. d. If we deny your claim because of your acts or because you have failed to comply with the terms of this policy, the mortgage holder will still have the right to receive loss payment if the mortgage holder: (1) Pays any premium due under this policy at our request if you have failed to do so; (2) Submits a signed, sworn statement of loss within 60 days after receiving notice from us of your failure to do so; and (3) Has notified us of any change in ownership, occupancy or substantial change in risk known to the mortgage holder. All of the terms of this policy will then apply directly to the mortgage holder. e. If we pay the mortgage holder for any physical loss or physical damage and deny payment to you because of your acts or because you have failed to comply with the terms of this policy: (1) The mortgage holder's rights under the mortgage will be transferred to us to the extent of the amount we pay; and (2) The mortgage holder's rights to recover the full amount of the mortgage holder's claim will not be impaired. At our option, we may pay to the mortgage holder the whole principal on the mortgage plus any accrued interest. In this event, your mortgage an to us and you v RknmWmentDMsian mortgage debt to �_J�N REVIEWED&APPROVEDSY: VI --� Risk Pjanagement Analyst SPECIAL PROPERTY COVERAGE FORM f. If we cancel this policy, we will give written notice to the mortgage holder at least: (1) 10 days before the effective date of cancellation if we cancel for your non payment of premium; or (2) 30 days before the effective date of cancellation if we cancel for any other reason. g. If we elect not to renew this policy, we will give written notice to the mortgage holder at least 10 days before the expiration date of this policy. 3. No Benefit to Bailee No person or organization, other than you, having custody of Covered Property will benefit from this insurance. 4. Policy Period, Coverage Territory Under this form: a. We cover physical loss or physical damage commencing: (1) During the policy period shown in the Declarations; and (2) Within the coverage territory or, with respect to property in transit, while it is between points in the coverage territory. But we do not cover physical loss or physical damage that is also covered by a preceding policy. b. The coverage territory is: (1) The United States of America (including its territories and possessions); (2) Puerto Rico; and (3) Canada. 5. Additional Conditions The following conditions apply to paragraph A.5.u., Forgery Additional Coverage: a. We will treat mechanically reproduced facsimile signatures the same as handwritten signatures. b. You must include with your proof of loss any instrument involved in that loss, or, if that is not possible, an affidavit setting forth the amount and cause of loss. c. The Coverage Territory is revised to cover loss you sustain anywhere in the world. G. PROPERTY DEFINITIONS 1. "Computer" means a programmable electronic device that can store, retrieve and process "data". Page 24 of 25 2. "Computer Equipment" means "computers", "peripheral devices", "media", and manuals that are purchased to be used in conjunction with hardware and "software". 3. "Counterfeit" means an imitation of an actual valid original which is intended to deceive and to be taken as the original. 4. "Data" means information or facts stored in a "computer's" memory, on "software" or on "media". 5. "Finished Stock" means stock you have manufactured. "Finished Stock" does not include stock you have manufactured that is held for sale on the premises of any retail outlet insured under this policy. 6. "Manager" means a person serving in a directorial capacity for a limited liability company. 7. "Media" means the material used solely with the "computer" or "peripheral device" upon which "software" or "data" is stored, such as tapes, CD-ROMs or disks. 8. "Member" means an owner of a limited liability company represented by its membership interest, who also may serve as a "manager". 9. "Messenger' means you, any any of your partners or any employee while having care and custody of the property outside your premises. 10. "Money" means: a. Currency, coins and bank notes whether or not in current use; and b. Travelers checks, registered checks and money orders held for sale to the public. 11. "Operations" means your business activities occurring at the "scheduled premises" and tenantability of the "scheduled premises". 12. "Period of Restoration" means the period of time that: a. Begins with the date of direct physical loss or physical damage caused by or resulting from a Covered Cause of Loss at the "scheduled premises", and b. Ends on the date when: (1) The property at the "scheduled premises" should be repaired, rebuilt or replaced with reasonable speed and similar quality; (2) The date when your business is resumed at a ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst SPECIAL PROPERTY COVERAGE FORM "Period of Restoration" does not include 19. "Specified Cause of Loss" means the following: any increased period required due to Fire; lightning; explosion, windstorm or hail; enforcement of any law that: smoke; aircraft or vehicles; riot or civil a. Regulates the construction, use or repair, commotion; vandalism; leakage from fire or required the tearing down of any extinguishing equipment; sinkhole collapse; property; or volcanic action; falling objects; weight of snow, b. Regulates the prevention, control, repair, ice or sleet; water damage. clean up or restoration of environmental a. Sinkhole collapse means the sudden damage. sinking or collapse of land into The expiration date of this policy will not cut underground empty spaces created by the short the "period of restoration". action of water on limestone or dolomite. It does not include the cost of fillingsinkholes. 13. "Peripheral Device" means any physical unit used to operate the "computer' that cannot be used for purposes other than as part of the b. Falling objects does not include loss of or computer's system, such as tape or disk damage to: drives, printers, or modems. (1) Personal property in the open; or 14. "Perishable Stock" means personal property: (2) The interior of a building or structure, a. Maintained under controlled conditions for or property inside a building or its preservation; and structure, unless the roof or an outside wall of the building or structure is first b. Susceptible to physical loss or physical damaged by a falling object. damage if the controlled conditions change. c. Water damage means accidental discharge or leakage of water or steam as 15. "Pollutants and Contaminants" means any the direct result of the breaking or cracking solid, liquid, gaseous or thermal irritant or of any part of a system or appliance contaminant, including smoke, vapors, soot, containing water or steam. fumes, acids, alkalis, chemicals and waste, or any other material which causes or threatens 20. "Suit" means a civil proceeding and includes: to cause physical loss, physical damage, a. An arbitration proceeding in which impurity to property, unwholesomeness, damages are claimed and to which you undesirability, loss of marketability, loss of use must submit or do submit with our consent; of property, or which threatens human health or or welfare. Waste includes materials to be b. Any other alternative dispute resolution recycled, reconditioned or reclaimed. proceeding in which damages are claimed 16. "Scheduled Premises" means any premises and to which you submit with our consent. listed by location address in the Scheduled 21. "Tenant Improvements and Betterments" Premises section of the Declarations. means fixtures, alterations, installations or 17. "Securities" means negotiable and additions made a part of the Building you nonnegotiable instruments or contracts occupy but do not own and that you cannot representing either "money" or other property legally remove; and and includes: a. Which are made at your expense; or a. Tokens, tickets except Lottery Tickets, b. That you acquired from the prior tenant at revenue and other non -postage stamps your expense. whether or not in current use; and 22. "Theft" means the act of stealing. b. Evidences of debt issued in connection with credit or charge cards, which are not 23. "Valuable papers and records" means of your own issue; inscribed, printed or written documents, manuscripts or records, including abstracts, but does not include "money." books, deeds, drawings, films, maps or 18. "Software" means instructions or programs that mortgages. are stored on "media" and which instruct the But "valuable papers and records" does not hardware as to how to process "data". mean "money" and "securities", "data" and "software" or the mate " " and "software" is reco RA g tDMs� w F\'x Jy/ REVIEWED & APPROVED BY.- Form SS 00 07 07 05 �� ` V � v --� Wsk Pjanagement Analyst BUSINESS LIABILITY COVERAGE FORM Form SS 00 08 04 05 Risk MmWmentDMsian REVIEWED & APPROVEDSY: "° © 2005, The Hartford ----` Risk PjanagementAnaly5t QUICK REFERENCE BUSINESS LIABILITY COVERAGE FORM READ YOUR POLICY CAREFULLY BUSINESS LIABILITY COVERAGE FORM Beginning on Page A. COVERAGES 1 Business Liability 1 Medical Expenses 2 Coverage Extension - Supplementary Payments 2 B. EXCLUSIONS 3 C. WHO IS AN INSURED 10 D. LIABILITY AND MEDICAL EXPENSES LIMITS OF INSURANCE 14 E. LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS 15 1. Bankruptcy 15 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit 15 3. Financial Responsibility Laws 16 4. Legal Action Against Us 16 5. Separation Of Insureds 16 6. Representations 16 7. Other Insurance 16 8. Transfer Of Rights Of Recovery Against Others To Us 17 F. OPTIONAL ADDITIONAL INSURED COVERAGES 18 Additional Insureds 18 G. LIABILITY AND MEDICAL EXPENSES DEFINITIONS 20 ew cF RAMwagementDMsian �40 1°x REVIEWED & APPROVED BY: V"° Form SS 00 08 04 05 ------ Rusk janagement Analpt BUSINESS LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the stock insurance company member of The Hartford providing this insurance. The word "insured" means any person or organization qualifying as such under Section C. - Who Is An Insured. Other words and phrases that appear in quotation marks have special meaning. Refer to Section G. - Liability And Medical Expenses Definitions. A. COVERAGES (a) The "bodily injury" or "property 1. BUSINESS LIABILITY COVERAGE (BODILY damage" is caused by an INJURY PROPERTY DAMAGE PERSONAL "occurrence" that takes place in the AND ADVERTISING INJURY) "coverage territory"; Insuring Agreement (b) The "bodily injury" or "property damage" occurs during the policy a. We will pay those sums that the insured period; and becomes legally obligated to pay as (c) Prior to the policy period, no insured damages because of "bodily injury", listed under Paragraph 1. of Section "property damage" or "personal and C. — Who Is An Insured and no advertising injury" to which this insurance "employee" authorized by you to give applies. We will have the right and duty to or receive notice of an "occurrence" defend the insured against any "suit" or claim, knew that the "bodily injury" seeking those damages. However, we will or "property damage" had occurred, have no duty to defend the insured against in whole or in part. If such a listed any "suit" seeking damages for "bodily insured or authorized "employee" injury", "property damage" or "personal and knew, prior to the policy period, that advertising injury" to which this insurance the "bodily injury" or "property does not apply. damage" occurred, then any We may, at our discretion, investigate any continuation, change or resumption "occurrence" or offense and settle any claim of such "bodily injury" or "property or "suit" that may result. But: damage" during or after the policy (1) The amount we will pay for damages is period will be deemed to have been limited as described in Section D. - known prior to the policy period. Liability And Medical Expenses Limits (2) To "personal and advertising injury" Of Insurance; and caused by an offense arising out of your (2) Our right and duty to defend ends when business, but only if the offense was we have used up the applicable limit of committed in the "coverage territory" insurance in the payment of judgments, during the policy period. settlements or medical expenses to which c. "Bodily injury" or "property damage" will be this insurance applies. deemed to have been known to have No other obligation or liability to pay sums or occurred at the earliest time when any perform acts or services is covered unless insured listed under Paragraph 1. of Section explicitly provided for under Coverage C. — Who Is An Insured or any "employee" Extension - Supplementary Payments. authorized by you to give or receive notice b. This insurance applies: of an "occurrence" or claim: (1) To "bodily injury" and "property (1) Reports all, or any part, of the "bodily "property damage" only if: injury" or damage" to us or any other insurer; y e cF ILLi3RMwag'm2dDMsiOR \'x REVIEWED & APPROVED BY: Form SS 00 08 04 05 Jy/ Is © 2005, The Hartford ----� Wsk Pjanagement Analpt BUSINESS LIABILITY COVERAGE FORM (2) Receives a written or verbal demand or claim for damages because of the "bodily injury" or "property damage"; or (3) Becomes aware by any other means that "bodily injury" or "property damage" has occurred or has begun to occur. d. Damages because of "bodily injury" include damages claimed by any person or organization for care, loss of services or death resulting at any time from the "bodily injury". e. Incidental Medical Malpractice (1) "Bodily injury" arising out of the rendering of or failure to render professional health care services as a physician, dentist, nurse, emergency medical technician or paramedic shall be deemed to be caused by an "occurrence", but only if: (a) The physician, dentist, nurse, emergency medical technician or paramedic is employed by you to provide such services; and (b) You are not engaged in the business or occupation of providing such services. (2) For the purpose of determining the limits of insurance for incidental medical malpractice, any act or omission together with all related acts or omissions in the furnishing of these services to any one person will be considered one 'occurrence". 2. MEDICAL EXPENSES Insuring Agreement a. We will pay medical expenses as described below for "bodily injury" caused by an accident: (1) On premises you own or rent; (2) On ways next to premises you own or rent; or (3) Because of your operations; provided that: (1) The accident takes place in the "coverage territory" and during the policy period; (2) The expenses are incurred and reported to us within three years of the date of the accident; and (3) The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require. Page 2 of 24 b. We will make these payments regardless of fault. These payments will not exceed the applicable limit of insurance. We will pay reasonable expenses for: (1) First aid administered at the time of an accident; (2) Necessary medical, surgical, x-ray and dental services, including prosthetic devices; and (3) Necessary ambulance, hospital, professional nursing and funeral services. 3. COVERAGE EXTENSION - SUPPLEMENTARY PAYMENTS a. We will pay, with respect to any claim or "suit" we investigate or settle, or any "suit" against an insured we defend: (1) All expenses we incur. (2) Up to $1,000 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which Business Liability Coverage for "bodily injury" applies. We do not have to furnish these bonds. (3) The cost of appeal bonds or bonds to release attachments, but only for bond amounts within the applicable limit of insurance. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. (5) All costs taxed against the insured in the "suit". (6) Prejudgment interest awarded against the insured on that part of the judgment we pay. If we make an offer to pay the applicable limit of insurance, we will not pay any prejudgment interest based on that period of time after the offer. (7) All interest on the full amount of any judgment that accrues after entry of the judgment and before we have paid, offered to pay, or deposited in court the part of the judgment that is within the applicable limit of insurance. Any amounts paid under (1) through (7) above will not reduce the limits of insurance. ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst BUSINESS LIABILITY COVERAGE FORM b. If we defend an insured against a "suit" and an indemnitee of the insured is also named as a party to the "suit", we will defend that indemnitee if all of the following conditions are met: (1) The "suit" against the indemnitee seeks damages for which the insured has assumed the liability of the indemnitee in a contract or agreement that is an "insured contract"; (2) This insurance applies to such liability assumed by the insured; (3) The obligation to defend, or the cost of the defense of, that indemnitee, has also been assumed by the insured in the same "insured contract"; (4) The allegations in the "suit" and the information we know about the "occurrence" are such that no conflict appears to exist between the interests of the insured and the interest of the indemnitee; (5) The indemnitee and the insured ask us to conduct and control the defense B. of that indemnitee against such "suit" and agree that we can assign the same counsel to defend the insured and the indemnitee; and (6) The indemnitee: (a) Agrees in writing to: (i) Cooperate with us in the investigation, settlement or defense of the "suit"; (ii) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the "suit"; (iii) Notify any other insurer whose coverage is available to the indemnitee; and (iv) Cooperate with us with respect to coordinating other applicable insurance available to the indemnitee; and (b) Provides us with written authorization to: (i) Obtain records and other information related to the "suit"; and (ii) Conduct and control the defense of the indemnitee in such "suit". Form SS 00 08 04 05 So long as the above conditions are met, attorneys' fees incurred by us in the defense of that indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Notwithstanding the provisions of Paragraph 1.b.(b) of Section B. — Exclusions, such payments will not be deemed to be damages for "bodily injury" and "property damage" and will not reduce the Limits of Insurance. Our obligation to defend an insured's indemnitee and to pay for attorneys' fees and necessary litigation expenses as Supplementary Payments ends when: (1) We have used up the applicable limit of insurance in the payment of judgments or settlements; or (2) The conditions set forth above, or the terms of the agreement described in Paragraph (6) above, are no longer met. EXCLUSIONS 1. Applicable To Business Liability Coverage This insurance does not apply to: a. Expected Or Intended Injury (1) "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property; or (2) "Personal and advertising injury" arising out of an offense committed by, at the direction of or with the consent or acquiescence of the insured with the expectation of inflicting "personal and advertising injury". b. Contractual Liability (1) "Bodily injury" or "property damage"; or (2) "Personal and advertising injury" for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages because of: (a) "Bodily injury", "property damage" or "personal and advertising injury" that the in absen Ride ManagementDMsian N agree }40 Fro REVIEWED & APPROVED BY: x ., V --� WA Pjanagement Analpt BUSINESS LIABILITY COVERAGE FORM (b) "Bodily injury" or "property damage" assumed in a contract or agreement that is an "insured contract", provided the "bodily injury" or "property damage" occurs subsequent to the execution of the contract or agreement. Solely for the purpose of liability assumed in an "insured contract", reasonable attorneys' fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of "bodily injury" or "property damage" provided: (i) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same "insured contract", and (ii) Such attorneys' fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. c. Liquor Liability "Bodily injury" or "property damage" for which any insured may be held liable by reason of: (1) Causing or contributing to the intoxication of any person; (2) The furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol; or (3) Any statute, ordinance or regulation relating to the sale, gift, distribution or use of alcoholic beverages. This exclusion applies only if you are in the business of manufacturing, distributing, selling, serving or furnishing alcoholic beverages. d. Workers' Compensation And Similar Laws Any obligation of the insured under a workers' compensation, disability benefits or unemployment compensation law or any similar law. e. Employer's Liability "Bodily injury" to: (1) An "employee" of the insured arising out of and in the course of: (a) Employment by the insured; or Page 4 of 24 (b) Performing duties related to the conduct of the insured's business, or (2) The spouse, child, parent, brother or sister of that "employee" as a consequence of (1) above. This exclusion applies: (1) Whether the insured may be liable as an employer or in any other capacity; and (2) To any obligation to share damages with or repay someone else who must pay damages because of the injury. This exclusion does not apply to liability assumed by the insured under an "insured contract". f. Pollution (1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": (a) At or from any premises, site or location which is or was at any time owned or occupied by, or rented or loaned to any insured. However, this subparagraph does not apply to: (i) "Bodily injury" if sustained within a building and caused by smoke, fumes, vapor or soot produced by or originating from equipment that is used to heat, cool or dehumidify the building, or equipment that is used to heat water for personal use, by the building's occupants or their guests; (ii) "Bodily injury" or "property damage" for which you may be held liable, if you are a contractor and the owner or lessee of such premises, site or location has been added to your policy as an additional insured with respect to your ongoing operations performed for that additional insured at that premises, site or location and such premises, site or location is not and never was owned or occupied by, or rented or loaned to. anv insured. other the Ride ManagementDMsian Aw F Jy/ \'x REVIEWED & APPROVED BY.- V"° --� RFsk janagement Analyst BUSINESS LIABILITY COVERAGE FORM (iii) "Bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire"; (b) At or from any premises, site or location which is or was at any time used by or for any insured or others for the handling, storage, disposal, processing or treatment of waste; (c) Which are or were at any time transported, handled, stored, treated, disposed of, or processed as waste by or for: (i) Any insured; or (ii) Any person or organization for whom you may be legally responsible; (d) At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the "pollutants" are brought on or to the premises, site or location in connection with such operations by such insured, contractor or subcontractor. However, this subparagraph does not apply to: (i) "Bodily injury" or "property damage" arising out of the escape of fuels, lubricants or other operating fluids which are needed to perform the normal electrical, hydraulic or mechanical functions necessary for the operation of "mobile equipment" or its parts, if such fuels, lubricants or other operating fluids escape from a vehicle part designed to hold, store or receive them. This exception does not apply if the "bodily injury" or "property damage" arises out of the intentional discharge, dispersal or release of the fuels, lubricants or other operating fluids, or if such fuels, lubricants or other operating fluids are brought on or to the premises, site or location with the intent that they be discharged, dispersed or Form SS 00 08 04 05 released as part of the operations being performed by such insured, contractor or subcontractor; (ii) "Bodily injury" or "property damage" sustained within a building and caused by the release of gases, fumes or vapors from materials brought into that building in connection with operations being performed by you or on your behalf by a contractor or subcontractor; or (iii) "Bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire"; or (e) At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants". (2) Any loss, cost or expense arising out of any: (a) Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (b) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". However, this paragraph does not apply to liability for damages because of "property damage" that the insured would have in the absence of such request, demand, order or statutory or regulatory requirement, or such claim or "suit" by or on behalf of a governmental authority. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst BUSINESS LIABILITY COVERAGE FORM g. Aircraft, Auto Or Watercraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft owned or operated by or rented or loaned to any insured. Use includes operation and 'loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft that is owned or operated by or rented or loaned to any insured. This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used to carry persons for a charge; (3) Parking an "auto" on, or on the ways next to, premises you own or rent, provided the "auto" is not owned by or rented or loaned to you or the insured; (4) Liability assumed under any "insured contract" for the ownership, maintenance or use of aircraft or watercraft; (5) "Bodily injury" or "property damage" arising out of the operation of any of the equipment listed in Paragraph f.(2) or f.(3) of the definition of "mobile equipment"; or (6) An aircraft that is not owned by any insured and is hired, chartered or loaned with a paid crew. However, this exception does not apply if the insured has any other insurance for such "bodily injury" or "property damage", whether the other insurance is primary, excess, contingent or on any other basis. h. Mobile Equipment "Bodily injury" or "property damage" arising out of: (1) The transportation of "mobile equipment" by an "auto" owned or operated by or rented or loaned to any insured; or Page 6 of 24 (2) The use of "mobile equipment" in, or while in practice or preparation for, a prearranged racing, speed or demolition contest or in any stunting activity. i. War "Bodily injury", "property damage" or "personal and advertising injury", however caused, arising, directly or indirectly, out of: (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. j. Professional Services "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or failure to render any professional service. This includes but is not limited to: (1) Legal, accounting or advertising services; (2) Preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; (3) Supervisory, inspection, architectural or engineering activities; (4) Medical, surgical, dental, x-ray or nursing services treatment, advice or instruction; (5) Any health or therapeutic service treatment, advice or instruction; (6) Any service, treatment, advice or instruction for the purpose of appearance or skin enhancement, hair removal or replacement or personal grooming; (7) Optical or hearing aid services including the prescribing, preparation, fitting, demonstration or distribution of ophthalmic lenses and similar products or hearing aid devices; ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst BUSINESS LIABILITY COVERAGE FORM (8) Optometry or optometric services including but not limited to examination of the eyes and the prescribing, preparation, fitting,demonstration or distribution of ophthalmic lenses and similar products; (9) Any: (a) Body piercing (not including ear piercing); (b) Tattooing, including but not limited to the insertion of pigments into or under the skin; and (c) Similar services; (10) Services in the practice of pharmacy; and (11) Computer consulting, design or programming services, including web site design. Paragraphs (4) and (5) of this exclusion do not apply to the Incidental Medical Malpractice coverage afforded under Paragraph 1.e. in Section A. - Coverages. k. Damage To Property "Property damage" to: (1) Property you own, rent or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3) Property loaned to you; (4) Personal property in the care, custody or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations; or (6) That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Form SS 00 08 04 05 Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises, including the contents of such premises, rented to you for a period of 7 or fewer consecutive days. A separate Limit of Insurance applies to Damage To Premises Rented To You as described in Section D. - Limits Of Insurance. Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. Paragraphs (3) and (4) of this exclusion do not apply to the use of elevators. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraphs (3) and (4) of this exclusion do not apply to "property damage" to borrowed equipment while not being used to perform operations at a job site. Paragraph (6) of this exclusion does not apply to "property damage" included in the "products -completed operations hazard". I. Damage To Your Product "Property damage" to "your product" arising out of it or any part of it. m. Damage To Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products -completed operations hazard". This exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. n. Damage To Impaired Property Or Property Not Physically Injured "Property damage" to "impaired property" or property that has not been physically injured, arising out of: (1) A defect, deficiency, inadequacy or dangerous condition in "your product" or "your work"; or (2) A delay or failure by you or anyone acting on your behalf to perform a contract or agreement in accordance with its terms. This exclusion does not apply to the loss of use of other property arising out of sudden and accidental physical injury to "your product" been put to its ew cF RAMwagemedDMsian Jy/ \'x REVIEWED & APPROVED BY: I .° --� Rt janagement Analpt BUSINESS LIABILITY COVERAGE FORM o. Recall Of Products, Work Or Impaired Property Damages claimed for any loss, cost or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal or disposal of: (1) "Your product"; (2) "Your work"; or (3) "Impaired property"; if such product, work or property is withdrawn or recalled from the market or from use by any person or organization because of a known or suspected defect, deficiency, inadequacy or dangerous condition in it. p. Personal And Advertising Injury "Personal and advertising injury": (1) Arising out of oral, written or electronic publication of material, if done by or at the direction of the insured with knowledge of its falsity; (2) Arising out of oral, written or electronic publication of material whose first publication took place before the beginning of the policy period; (3) Arising out of a criminal act committed by or at the direction of the insured; (4) Arising out of any breach of contract, except an implied contract to use another's "advertising idea" in your "advertisement"; (5) Arising out of the failure of goods, products or services to conform with any statement of quality or performance made in your "advertisement"; (6) Arising out of the wrong description of the price of goods, products or services; (7) Arising out of any violation of any intellectual property rights such as copyright, patent, trademark, trade name, trade secret, service mark or other designation of origin or authenticity. However, this exclusion does not apply to infringement, in your "advertisement", of (a) Copyright; (b) Slogan, unless the slogan is also a trademark, trade name, service mark or other designation of origin or authenticity; or Page 8 of 24 (c) Title of any literary or artistic work; (8) Arising out of an offense committed by an insured whose business is: (a) Advertising, broadcasting, publishing or telecasting; (b) Designing or determining content of web sites for others; or (c) An Internet search, access, content or service provider. However, this exclusion does not apply to Paragraphs a., b. and c. under the definition of "personal and advertising injury" in Section G. — Liability And Medical Expenses Definitions. For the purposes of this exclusion, placing an "advertisement" for or linking to others on your web site, by itself, is not considered the business of advertising, broadcasting, publishing or telecasting; (9) Arising out of an electronic chat room or bulletin board the insured hosts, owns, or over which the insured exercises control; (10) Arising out of the unauthorized use of another's name or product in your e-mail address, domain name or metatags, or any other similar tactics to mislead another's potential customers; (11) Arising out of the violation of a person's right of privacy created by any state or federal act. However, this exclusion does not apply to liability for damages that the insured would have in the absence of such state or federal act; (12) Arising out of: (a) An "advertisement" for others on your web site; (b) Placing a link to a web site of others on your web site; (c) Content from a web site of others displayed within a frame or border on your web site. Content includes information, code, sounds, text, graphics or images; or (d) Computer code, software or programming used to enable: (i) Your web site; or ine Df � cF Risk MmRgemendDMsian 1'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst BUSINESS LIABILITY COVERAGE FORM (13) Arising out of a violation of any anti- trust law; (14) Arising out of the fluctuation in price or value of any stocks, bonds or other securities; or (15) Arising out of discrimination or humiliation committed by or at the direction of any "executive officer", director, stockholder, partner or member of the insured. q. Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data". r. Employment -Related Practices "Bodily injury" or "personal and advertising injury" to: (1) A person arising out of any: (a) Refusal to employ that person; (b) Termination of that person's employment; or (c) Employment -related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation or discrimination directed at that person; or (2) The spouse, child, parent, brother or sister of that person as a consequence of "bodily injury" or "personal and advertising injury" to the person at whom any of the employment -related practices described in Paragraphs (a), (b), or (c) above is directed. This exclusion applies: (1) Whether the insured may be liable as an employer or in any other capacity; and (2) To any obligation to share damages with or repay someone else who must pay damages because of the injury. s. Asbestos (1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of the "asbestos hazard". (2) Any damages, judgments, settlements, loss, costs or expenses that: Form SS 00 08 04 05 (a) May be awarded or incurred by reason of any claim or suit alleging actual or threatened injury or damage of any nature or kind to persons or property which would not have occurred in whole or in part but for the "asbestos hazard"; (b) Arise out of any request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, encapsulate, contain, treat, detoxify or neutralize or in any way respond to or assess the effects of an "asbestos hazard"; or (c) Arise out of any claim or suit for damages because of testing for, monitoring, cleaning up, removing, encapsulating, containing, treating, detoxifying or neutralizing or in any way responding to or assessing the effects of an "asbestos hazard". t. Violation Of Statutes That Govern E- Mails, Fax, Phone Calls Or Other Methods Of Sending Material Or Information "Bodily injury", "property damage", or "personal and advertising injury" arising directly or indirectly out of any action or omission that violates or is alleged to violate: (1) The Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law; (2) The CAN-SPAM Act of 2003, including any amendment of or addition to such law; or (3) Any statute, ordinance or regulation, other than the TCPA or CAN-SPAM Act of 2003, that prohibits or limits the sending, transmitting, communicating or distribution of material or information. Damage To Premises Rented To You — Exception For Damage By Fire, Lightning or Explosion Exclusions c. through h. and k. through o. do not apply to damage by fire, lightning or explosion to premises rented to you or temporarily occupied by you with permission of the owner. A separate Limit of Insurance applies to this coverage as described in Section D. - Liability And Medical Expenses Limits Of Insurance. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst BUSINESS LIABILITY COVERAGE FORM 2. Applicable To Medical Expenses Coverage We will not pay expenses for "bodily injury": a. Any Insured To any insured, except "volunteer workers". b. Hired Person To a person hired to do work for or on behalf of any insured or a tenant of any insured. c. Injury On Normally Occupied Premises To a person injured on that part of premises you own or rent that the person normally occupies. d. Workers' Compensation And Similar Laws To a person, whether or not an "employee" of any insured, if benefits for the "bodily injury" are payable or must be provided under a workers' compensation or disability benefits law or a similar law. e. Athletics Activities To a person injured while practicing, instructing or participating in any physical exercises or games, sports or athletic contests. f. Products -Completed Operations Hazard Included with the "products -completed operations hazard". g. Business Liability Exclusions Excluded under Business Liability Coverage. C. WHO IS AN INSURED 1. If you are designated in the Declarations as: a. An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. c. A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. d. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. Page 10 of 24 e. A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. 2. Each of the following is also an insured: a. Employees And Volunteer Workers Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), or to a co -"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co - "employee" or that "volunteer worker" as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. If you are not in the business of providing professional health care services, Paragraph (d) does not apply to any nurse, emergency medical technician or paramedic employed by you to provide such services. (2) "Property " (a) Ownec RAMmWme dDMsian Jy/ \'x REVIEWED & APPROVED BY. - I .° --� Rt janagement Analpt BUSINESS LIABILITY COVERAGE FORM (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by you, any of your "employees", "volunteer workers", any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). b. Real Estate Manager Any person (other than your "employee" or "volunteer worker"), or any organization while acting as your real estate manager. c. Temporary Custodians Of Your Property Any person or organization having proper temporary custody of your property if you die, but only: (1) With respect to liability arising out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Legal Representative If You Die Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this insurance. e. Unnamed Subsidiary Any subsidiary and subsidiary thereof, of yours which is a legally incorporated entity of which you own a financial interest of more than 50% of the voting stock on the effective date of this Coverage Part. The insurance afforded herein for any subsidiary not shown in the Declarations as a named insured does not apply to injury or damage with respect to which an insured under this insurance is also an insured under another policy or would be an insured under such policy but for its termination or upon the exhaustion of its limits of insurance. 3. Newly Acquired Or Formed Organization Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain financial interest of more than 50% of the voting stock, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; and Form SS 00 08 04 05 b. Coverage under this provision does not apply to: (1) "Bodily injury" or "property damage" that occurred; or (2) "Personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. 4. Operator Of Mobile Equipment With respect to "mobile equipment" registered in your name under any motor vehicle registration law, any person is an insured while driving such equipment along a public highway with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability arising out of the operation of the equipment, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an insured with respect to: a. "Bodily injury" to a co -"employee" of the person driving the equipment; or b. "Property damage" to property owned by, rented to, in the charge of or occupied by you or the employer of any person who is an insured under this provision. 5. Operator of Nonowned Watercraft With respect to watercraft you do not own that is less than 51 feet long and is not being used to carry persons for a charge, any person is an insured while operating such watercraft with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability arising out of the operation of the watercraft, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an insured with respect to: a. "Bodily injury" to a co -"employee" of the person operating the watercraft; or b. "Property damage" to property owned by, rented to, in the charge of or occupied by you or the employer of any person who is an insured under this provision. 6. Additional Insureds When Required By Written Contract, Written Agreement Or Permit The person(s) or organization(s) identified in Paragraphs a. t insureds when ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst BUSINESS LIABILITY COVERAGE FORM contract, written agreement or because of a (e) Any failure to make such permit issued by a state or political inspections, adjustments, tests or subdivision, that such person or organization servicing as the vendor has be added as an additional insured on your agreed to make or normally policy, provided the injury or damage occurs undertakes to make in the usual subsequent to the execution of the contract or course of business, in connection agreement, or the issuance of the permit. with the distribution or sale of the A person or organization is an additional products; insured under this provision only for that (f) Demonstration, installation, period of time required by the contract, servicing or repair operations, agreement or permit. except such operations performed However, no such person or organization is an at the vendor's premises inconnection with the sale of the additional insured under this provision if such product; person or organization is included as an additional insured by an endorsement issued (g) Products which, after distribution by us and made a part of this Coverage Part, or sale by you, have been labeled including all persons or organizations added or relabeled or used as a as additional insureds under the specific container, part or ingredient of any additional insured coverage grants in Section other thing or substance by or for F. — Optional Additional Insured Coverages. the vendor; or a. Vendors (h) "Bodily injury" or "property damage" arising out of the soles) Any person(s) or organization(referred to negligence of the vendor for its below as vendor), but only with respect to own acts or omissions or those of "bodily injury" or "property damage" arising its employees or anyone else out of "your products" which are distributed acting on its behalf. However, this or sold in the regular course of the vendor's exclusion does not apply to: business and only if this Coverage Part provides coverage for "bodily injury" or (i) The exceptions contained in "property damage" included within the Subparagraphs (d) or (f); or "products -completed operations hazard". (ii) Such inspections, adjustments, (1) The insurance afforded to the vendor tests or servicing as the vendor is subject to the following additional has agreed to make or normally exclusions: undertakes to make in the usual This insurance does not apply to: course of business, in connection with the distribution (a) "Bodily injury" or "property or sale of the products. damage" for which the vendor is (2) This insurance does not apply to any obligated to pay damages by insured person or organization from reason of the assumption of whom you have acquired such products, liability in a contract or agreement. or any ingredient, part or container, This exclusion does not apply to entering into, accompanying or liability for damages that the containing such products. vendor would have in the absence of the contract or agreement; b. Lessors Of Equipment (b) Any express warranty (1) Any person or organization from unauthorized by you; whom you lease equipment; but only with respect to their liability for "bodily (c) Any physical or chemical change injury", "property damage" or in the product made intentionally "personal and advertising injury" by the vendor; caused, in whole or in part, by your (d) Repackaging, except when maintenance, operation or use of unpacked solely for the purpose of equipment leased to you by such inspection, demonstration, testing, person or organization. or the substitution of parts under instructions from the manufacturer, and then repackaged in the µ ILLR i3R M&T7Agm2dDLVIBIOR original container; �40 F,qq REVIEWED & APPROVED BY. - Page 12 of 24 aW—W.Wjanagementftalpt BUSINESS LIABILITY COVERAGE FORM (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after you cease to lease that equipment. c. Lessors Of Land Or Premises (1) Any person or organization from whom you lease land or premises, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land or premises leased to you. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: (a) Any 'occurrence" which takes place after you cease to lease that land or be a tenant in that premises; or (b) Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. d. Architects, Engineers Or Surveyors (1) Any architect, engineer, or surveyor, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (a) In connection with your premises; or (b) In the performance of your ongoing operations performed by you or on your behalf. (2) With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, including: (a) The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities. Form SS 00 08 04 05 e. Permits Issued By State Or Political Subdivisions (1) Any state or political subdivision, but only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: (a) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality; or (b) 'Bodily injury" or "property damage" included within the "products - completed operations hazard". f. Any Other Party (1) Any other person or organization who is not an insured under Paragraphs a. through e. above, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (a) In the performance of your ongoing operations; (b) In connection with your premises owned by or rented to you; or (c) In connection with "your work" and included within the "products - completed operations hazard", but only if (i) The written contract or written agreement requires you to provide such coverage to such additional insured; and (ii) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products - completed operations hazard". (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure tc architectu services, cF RAMmWmentDMsian Jy/ 1'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst BUSINESS LIABILITY COVERAGE FORM (a) The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or (b) Supervisory, inspection, 3 architectural or engineering activities. The limits of insurance that apply to additional insureds are described in Section D. — Limits Of Insurance. How this insurance applies when other insurance is available to an additional insured is described in the Other Insurance Condition in Section E. — Liability And Medical Expenses General Conditions. No person or organization is an insured with respect to the conduct of any current or past 4 partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. D. LIABILITY AND MEDICAL EXPENSES LIMITS OF INSURANCE 1. The Most We Will Pay 5 The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 2. Aggregate Limits The most we will pay for: a. Damages because of "bodily injury" and "property damage" included in the "products -completed operations hazard" is the Products -Completed Operations Aggregate Limit shown in the 6 Declarations. b. Damages because of all other "bodily injury", "property damage" or "personal and advertising injury", including medical expenses, is the General Aggregate Limit shown in the Declarations. This General Aggregate Limit applies separately to each of your "locations" owned by or rented to you. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway or right-of-way of a railroad. Page 14 of 24 This General Aggregate limit does not apply to "property damage" to premises while rented to you or temporarily occupied by you with permission of the owner, arising out of fire, lightning or explosion. Each Occurrence Limit Subject to 2.a. or 2.b above, whichever applies, the most we will pay for the sum of all damages because of all "bodily injury", "property damage" and medical expenses arising out of any one 'occurrence" is the Liability and Medical Expenses Limit shown in the Declarations. The most we will pay for all medical expenses because of "bodily injury" sustained by any one person is the Medical Expenses Limit shown in the Declarations. Personal And Advertising Injury Limit Subject to 2.b. above, the most we will pay for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization is the Personal and Advertising Injury Limit shown in the Declarations. Damage To Premises Rented To You Limit The Damage To Premises Rented To You Limit is the most we will pay under Business Liability Coverage for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning or explosion, while rented to you or temporarily occupied by you with permission of the owner. In the case of damage by fire, lightning or explosion, the Damage to Premises Rented To You Limit applies to all damage proximately caused by the same event, whether such damage results from fire, lightning or explosion or any combination of these. How Limits Apply To Additional Insureds The most we will pay on behalf of a person or organization who is an additional insured under this Coverage Part is the lesser of: a. The limits of insurance specified in a written contract, written agreement or permit issued by a state or political subdivision; or b. The Limits of Insurance shown in the Declarations. Such amount shall addition to the Lirr the Declarations d be a part of and not in cF RAMmWmentDMsian Jy/\'x REVIEWED & APPROVED BY.- .,; V"° --� Risk janagement Analyst BUSINESS LIABILITY COVERAGE FORM If more than one limit of insurance under this policy and any endorsements attached thereto applies to any claim or "suit", the most we will pay under this policy and the endorsements is the single highest limit of liability of all coverages applicable to such claim or "suit". However, this paragraph does not apply to the Medical Expenses limit set forth in Paragraph 3. above. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. E. LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS 1. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part. 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit a. Notice Of Occurrence Or Offense You or any additional insured must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. Notice Of Claim If a claim is made or "suit" is brought against any insured, you or any additional insured must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You or any additional insured must see to it that we receive a written notice of the claim or "suit" as soon as practicable. c. Assistance And Cooperation Of The Insured You and any other involved insured must: Form SS 00 08 04 05 (1) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit"; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation, settlement of the claim or defense against the "suit"; and (4) Assist us, upon our request, in the enforcement of any right against any person or organization that may be liable to the insured because of injury or damage to which this insurance may also apply. d. Obligations At The Insured's Own Cost No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. e. Additional Insured's Other Insurance If we cover a claim or "suit" under this Coverage Part that may also be covered by other insurance available to an additional insured, such additional insured must submit such claim or "suit" to the other insurer for defense and indemnity. However, this provision does not apply to the extent that you have agreed in a written contract, written agreement or permit that this insurance is primary and non-contributory with the additional insured's own insurance. f. Knowledge Of An Occurrence, Offense, Claim Or Suit Paragraphs a. and b. apply to you or to any additional insured only when such "occurrence", offense, claim or "suit" is known to: (1) You or any additional insured that is an individual; (2) Any partner, if you or an additional insured is a partnership; (3) Any manager, if you or an additional insured is a limited liability company; (4) Any "executive officer" or insurance manager, if you or an additional insured is a corporation; (5) Any trustee, if you or an additional insured is a trust; or (6) Any elected or appointed official, if you or an add subdivisio ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY: I .° --� Rt janagement Analpt BUSINESS LIABILITY COVERAGE FORM This Paragraph f. applies separately to you and any additional insured. 3. Financial Responsibility Laws a. When this policy is certified as proof of financial responsibility for the future under the provisions of any motor vehicle financial responsibility law, the insurance provided by the policy for "bodily injury" liability and "property damage" liability will comply with the provisions of the law to the extent of the coverage and limits of insurance required by that law. b. With respect to "mobile equipment" to which this insurance applies, we will provide any liability, uninsured motorists, underinsured motorists, no-fault or other coverage required by any motor vehicle law. We will provide the required limits for those coverages. 4. Legal Action Against Us No person or organization has a right under this Coverage Form: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Form unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this insurance or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. 5. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this policy to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom a claim is made or "suit" is brought. 6. Representations a. When You Accept This Policy By accepting this policy, you agree: (1) The statements in the Declarations are accurate and complete; (2) Those statements are based upon representations you made to us; and Page 16 of 24 (3) We have issued this policy in reliance upon your representations. b. Unintentional Failure To Disclose Hazards If unintentionally you should fail to disclose all hazards relating to the conduct of your business at the inception date of this Coverage Part, we shall not deny any coverage under this Coverage Part because of such failure. 7. Other Insurance If other valid and collectible insurance is available for a loss we cover under this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when b. below applies. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. b. Excess Insurance This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis: (1) Your Work That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (2) Premises Rented To You That is fire, lightning or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (3) Tenant Liability That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; (4) Aircraft, Auto Or Watercraft If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section A. — Coverages. (5) Property Damage To Borrowed Equipment Or Use Of Elevators If the loss arises out of "property damage" to borrowed equipment or the use of elevators to the extent not subject to Coverage ew cF RAMwagmedDMsiun Jy/ \'x REVIEWED & APPROVED BY. - I .° --� Rusk Pjanagement Analpt BUSINESS LIABILITY COVERAGE FORM (6) When You Are Added As An Additional Insured To Other Insurance That is other insurance available to you covering liability for damages arising out of the premises or operations, or products and completed operations, for which you have been added as an additional insured by that insurance; or (7) When You Add Others As An Additional Insured To This Insurance That is other insurance available to an additional insured. However, the following provisions apply to other insurance available to any person or organization who is an additional insured under this Coverage Part: (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract, written agreement or permit that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. (b) Primary And Non -Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non-contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under this Coverage Part to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. Form SS 00 08 04 05 When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self - insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 8. Transfer Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person o agreement or woRAMwagmedDMsiun prior to the inju }_ F°x RE�AEWED&APPROVED BY.- V"° --� Risk Pjanagement Analyst BUSINESS LIABILITY COVERAGE FORM F. OPTIONAL ADDITIONAL INSURED 3. Additional Insured - Grantor Of Franchise COVERAGES WHO IS AN INSURED under Section C. is If listed or shown as applicable in the Declarations, amended to include as an additional insured one or more of the following Optional Additional the person(s) or organization(s) shown in the Insured Coverages also apply. When any of these Declarations as an Additional Insured - Optional Additional Insured Coverages apply, Grantor Of Franchise, but only with respect to Paragraph 6. (Additional Insureds When Required their liability as grantor of franchise to you. by Written Contract, Written Agreement or Permit) 4. Additional Insured - Lessor Of Leased of Section C., Who Is An Insured, does not apply Equipment to the person or organization shown in the a. WHO IS AN INSURED under Section C. is Declarations. These coverages are subject to the amended to include as an additional terms and conditions applicable to Business insured the person(s) or organization(s) Liability Coverage in this policy, except as shown in the Declarations as an Additional provided below: Insured — Lessor of Leased Equipment, 1. Additional Insured - Designated Person Or but only with respect to liability for "bodily Organization injury", "property damage" or "personal WHO IS AN INSURED under Section C. is and advertising injury" caused, in whole or amended to include as an additional insured in part, by your maintenance, operation or the person(s) or organization(s) shown in the use of equipment leased to you by such Declarations, but only with respect to liability person(s) or organization(s). for "bodily injury", "property damage" or b. With respect to the insurance afforded to "personal and advertising injury" caused, in these additional insureds, this insurance whole or in part, by your acts or omissions or does not apply to any 'occurrence" which the acts or omissions of those acting on your takes place after you cease to lease that behalf: equipment. a. In the performance of your ongoing 5. Additional Insured - Owners Or Other operations; or Interests From Whom Land Has Been b. In connection with your premises owned Leased by or rented to you. a. WHO IS AN INSURED under Section C. is 2. Additional Insured - Managers Or Lessors amended to include as an additional Of Premises insured the person(s) or organization(s) shown in the Declarations as an Additional a. WHO IS AN INSURED under Section C. is Insured — Owners Or Other Interests From amended to include as an additional insured Whom Land Has Been Leased, but only the person(s) or organization(s) shown in the with respect to liability arising out of the Declarations as an Additional Insured - ownership, maintenance or use of that part Designated Person Or Organization; but only of the land leased to you and shown in the with respect to liability arising out of the Declarations. ownership, maintenance or use of that part of the premises leased to you and shown in the b. With respect to the insurance afforded to Declarations. these additional insureds, the following additional exclusions apply: b. With respect to the insurance afforded to these additional insureds, the following This insurance does not apply to: additional exclusions apply: (1) Any 'occurrence" that takes place This insurance does not apply to: after you cease to lease that land; or (1) Any 'occurrence" which takes place (2) Structural alterations, new after you cease to be a tenant in that construction or demolition operations premises; or performed by or on behalf of such person or organization. (2) Structural alterations, new construction or demolition operations 6. Additional Insured - State Or Political performed by or on behalf of such Subdivision — Permits person or organization. a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the s shown in the C ew cF RAMwagmedD"siun \'x REVIEWED & APPROVED BY: Jy/ ,. V " v Page 18 of 24 aW—W.Wjanagementftalpt BUSINESS LIABILITY COVERAGE FORM Insured — State Or Political Subdivision - Permits, but only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: (1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality; or (2) "Bodily injury" or "property damage" included in the "product -completed operations" hazard. 7. Additional Insured —Vendors a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) (referred to below as vendor) shown in the Declarations as an Additional Insured - Vendor, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business and only if this Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard". b. The insurance afforded to the vendor is subject to the following additional exclusions: (1) This insurance does not apply to: (a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; Form SS 00 08 04 05 (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in Subparagraphs (d) or (f); or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 8. Additional Insured — Controlling Interest WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured — Controlling Interest, but only with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain or control while you lease or occupy these premises. cF RAMmWmentDMsian Jy/ 1'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst BUSINESS LIABILITY COVERAGE FORM This insurance does not apply to structural The limits of insurance that apply to additional alterations, new construction and demolition insureds are described in Section D. — Limits Of operations performed by or for that person or Insurance. organization. How this insurance applies when other insurance 9. Additional Insured — Owners, Lessees Or is available to an additional insured is described in Contractors — Scheduled Person Or the Other Insurance Condition in Section E. — Organization Liability And Medical Expenses General a. WHO IS AN INSURED under Section C. is Conditions. amended to include as an additional G. LIABILITY AND MEDICAL EXPENSES insured the person(s) or organization(s) DEFINITIONS shown in the Declarations as an Additional Insured — Owner, Lessees Or Contractors, 1. "Advertisement" means the widespread public but only with respect to liability for "bodily dissemination of information or images that injury", "property damage" or "personal has the purpose of inducing the sale of goods, and advertising injury" caused, in whole or products or services through: in part, by your acts or omissions or the a. (1) Radio; acts or omissions of those acting on your (2) Television; behalf: (3) Billboard; (1) In the performance of your ongoing (4) Magazine; operations for the additional insured(s); or (5) Newspaper; (2) In connection with "your work" b. The Internet, but only that part of a web performed for that additional insured site that is about goods, products or and included within the "products- services for the purposes of inducing the completed operations hazard", but sale of goods, products or services; or only if this Coverage Part provides c. Any other publication that is given coverage for "bodily injury" or widespread public distribution. "property damage" included within the However, "advertisement" does not include: products -completed operations hazard". a. The design, printed material, information or images contained in, on or upon the b. With respect to the insurance afforded to packaging or labeling of any goods or these additional insureds, this insurance products; or does not apply to "bodily injury", "property b. An interactive conversation between or damage" or "personal an advertising injury" arising out of the rendering of, or among persons through a computer network. the failure to render, any professional 2. "Advertising idea" means any idea for an architectural, engineering or surveying "advertisement". services, including: 3. "Asbestos hazard" means an exposure or (1) The preparing, approving, or failure to threat of exposure to the actual or alleged prepare or approve, maps, shop properties of asbestos and includes the mere drawings, opinions, reports, surveys, presence of asbestos in any form. field orders, change orders, designs or 4. "Auto" means a land motor vehicle, trailer or drawings and specifications; or semi -trailer designed for travel on public (2) Supervisory, inspection, architectural roads, including any attached machinery or or engineering activities. equipment. But "auto" does not include 10. Additional Insured — Co -Owner Of Insured "mobile equipment". Premises 5. "Bodily injury" means physical: WHO IS AN INSURED under Section C. is a. Injury; amended to include as an additional insured b. Sickness; or the person(s) or Organization(s) shown in the c. Disease Declarations as an Additional Insured — Co - Owner Of Insured Premises, but only with sustained by a person and, if arising out of the respect to their liability as co-owner of the above, mental anguish or death at any time. premises shown in the Declarations. 6. "Coverage territory y e cF ILLi3RMwag'm2dDMsiOR 1°x REVIEWED & APPROVED BY.- Jy/ Pp Page 20 of 24 ----� Rusk janagement Analpt BUSINESS LIABILITY COVERAGE FORM a. The United States of America (including its b. You have failed to fulfill the terms of a territories and possessions), Puerto Rico contract or agreement; and Canada; if such property can be restored to use by: b. International waters or airspace, but only if a. The repair, replacement, adjustment or the injury or damage occurs in the course removal of "your product" or "your work"; of travel or transportation between any or places included in a. above; b. Your fulfilling the terms of the contract or c. All other parts of the world if the injury or agreement. damage arises out of: 12. "Insured contract" means: (1) Goods or products made or sold by you in the territory described in a. above; a. A contract for a lease of premises. However, that portion of the contract for a (2) The activities of a person whose home lease of premises that indemnifies any is in the territory described in a. person or organization for damage by fire, above, but is away for a short time on lightning or explosion to premises while your business; or rented to you or temporarily occupied by (3) "Personal and advertising injury" you with permission of the owner is offenses that take place through the subject to the Damage To Premises Internet or similar electronic means of Rented To You limit described in Section communication D. — Liability and Medical Expenses Limits provided the insured's responsibility to pay of Insurance. damages is determined in the United States of b. A sidetrack agreement; America (including its territories and c. Any easement or license agreement, possessions), Puerto Rico or Canada, in a including an easement or license "suit" on the merits according to the agreement in connection with construction substantive law in such territory, or in a or demolition operations on or within 50 settlement we agree to. feet of a railroad; 7. "Electronic data" means information, facts or d. Any obligation, as required by ordinance, programs: to indemnify a municipality, except in a. Stored as or on; connection with work for a municipality; b. Created or used on; or e. An elevator maintenance agreement; or c. Transmitted to or from f. That part of any other contract or computer software, including systems and agreement pertaining to your business applications software, hard or floppy disks, (including an indemnification of a CD-ROMS, tapes, drives, cells, data municipality in connection with work processing devices or any other media which performed for a municipality) under which are used with electronically controlled you assume the tort liability of another equipment. party to pay for "bodily injury" or "property 8. "Employee" includes a "leased worker". damage" to a third person or organization, "Employee" does not include a "temporary provided the "bodily injury" or "property worker". damage" is caused, in whole or in part, by you or by those acting on your behalf. 9. "Executive officer" means a person holding Tort liability means a liability that would be any of the officer positions created by your imposed by law in the absence of any charter, constitution, by-laws or any other contract or agreement. similar governing document. Paragraph f. includes that part of any 10. "Hostile fire" means one which becomes contract or agreement that indemnifies a uncontrollable or breaks out from where it was railroad for "bodily injury" or "property intended to be. damage" arising out of construction or 11. "Impaired property" means tangible property, demolition operations within 50 feet of any other than "your product" or "your work", that railroad property and affecting any railroad cannot be used or is less useful because: bridge or trestle, tracks, road -beds, tunnel, a. It incorporates "your product" or "your work" underpass or crossing. that is known or thought to be defective, However, Par deficient, inadequate or dangerous; or that part of an ew cF RAMwagmedD"siun Jy/ \'x REVIEWED & APPROVED BY.- ,. V " v Form SS 00 08 04 05 -----� R.Wjanagement ftalpt BUSINESS LIABILITY COVERAGE FORM (1) That indemnifies an architect, (1) Power cranes, shovels, loaders, engineer or surveyor for injury or diggers or drills; or damage arising out of: (2) Road construction or resurfacing (a) Preparing, approving or failing to equipment such as graders, scrapers prepare or approve maps, shop or rollers; drawings, opinions, reports, e. Vehicles not described in a., b., c., or d. surveys, field orders, change above that are not self-propelled and are orders, designs or drawings and maintained primarily to provide mobility to specifications; or permanently attached equipment of the (b) Giving directions or instructions, following types: or failing to give them, if that is the (1) Air compressors, pumps and primary cause of the injury or generators, including spraying, damage; or welding, building cleaning, (2) Under which the insured, if an geophysical exploration, lighting and architect, engineer or surveyor, well servicing equipment; or assumes liability for an injury or (2) Cherry pickers and similar devices damage arising out of the insured's used to raise or lower workers; rendering or failure to render professional services, including those f. Vehicles not described in a., b., c., or d. listed in (1) above and supervisory, above maintained primarily for purposes inspection, architectural or other than the transportation of persons or engineering activities. cargo. 13. "Leased worker" means a person leased to However, self-propelled vehicles with the you by a labor leasing firm under an following types of permanently attached agreement between you and the labor leasing equipment are not "mobile equipment" but firm, to perform duties related to the conduct of will be considered "autos": your business. "Leased worker" does not (1) Equipment, of at least 1,000 pounds include a "temporary worker". gross vehicle weight, designed 14. "Loading or unloading" means the handling of primarily for: property: (a) Snow removal; a. After it is moved from the place where it is (b) Road maintenance, but not accepted for movement into or onto an construction or resurfacing; or aircraft, watercraft or "auto"; (c) Street cleaning; b. While it is in or on an aircraft, watercraft or (2) Cherry pickers and similar devices "auto"; or mounted on automobile or truck c. While it is being moved from an aircraft, chassis and used to raise or lower watercraft or "auto" to the place where it is workers; and finally delivered; (3) Air compressors, pumps and but "loading or unloading" does not include the generators, including spraying, movement of property by means of a mechanical welding, building cleaning, device, other than a hand truck, that is not geophysical exploration, lighting and attached to the aircraft, watercraft or "auto". well servicing equipment. 15. "Mobile equipment" means any of the following 16. "Occurrence" means an accident, including types of land vehicles, including any attached continuous or repeated exposure to substantially machinery or equipment: the same general harmful conditions. a. Bulldozers, farm machinery, forklifts and 17. "Personal and advertising injury" means injury, other vehicles designed for use principally including consequential "bodily injury", arising off public roads; out of one or more of the following offenses: b. Vehicles maintained for use solely on or a. False arrest, detention or imprisonment; next to premises you own or rent; b. Malicious prosecution; c. Vehicles that travel on crawler treads; d. Vehicles, whether self-propelled or not, on which are permanently mounted: RA�DMsiun Aw F Jy/ 1°x REVIEWED & APPROVED BY.- Pp 1" X Page 22 Of 24 aW—W.Wjanagementftalpt BUSINESS LIABILITY COVERAGE FORM c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that the person occupies, committed by or on behalf of its owner, landlord or lessor; d. Oral, written or electronic publication of material that slanders or libels a person or organization or disparages a person's or organization's goods, products or services; e. Oral, written or electronic publication of material that violates a person's right of privacy; f. Copying, in your "advertisement", a person's or organization's "advertising idea" or style of "advertisement"; g. Infringement of copyright, slogan, or title of any literary or artistic work, in your "advertisement"; or h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person. 18. "Pollutants" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 19. "Products -completed operations hazard"; a. Includes all "bodily injury" and "property damage" occurring away from premises you own or rent and arising out of "your product" or "your work" except: (1) Products that are still in your physical possession; or (2) Work that has not yet been completed or abandoned. However, "your work" will be deemed to be completed at the earliest of the following times: (a) When all of the work called for in your contract has been completed. (b) When all of the work to be done at the job site has been completed if your contract calls for work at more than one job site. (c) When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor working on the same project. Form SS 00 08 04 05 Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as completed. The "bodily injury" or "property damage" must occur away from premises you own or rent, unless your business includes the selling, handling or distribution of "your product" for consumption on premises you own or rent. b. Does not include "bodily injury" or "property damage" arising out of: (1) The transportation of property, unless the injury or damage arises out of a condition in or on a vehicle not owned or operated by you, and that condition was created by the "loading or unloading" of that vehicle by any insured; or (2) The existence of tools, uninstalled equipment or abandoned or unused materials. 20. "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of "occurrence" that caused it. As used in this definition, "electronic data" is not tangible property. 21. "Suit" means a civil proceeding in which damages because of "bodily injury", "property damage" or "personal and advertising injury" to which this insurance applies are alleged. "Suit" includes: a. An arbitration proceeding in which such damages are claimed and to which the insured must submit or does submit with our consent; or b. Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent. 22. "Temporary worker" means a person who is furnished to you to substitute for a permanent "employee" on leave or to meet seasonal or short-term workload conditions. 23. "Volunteer worker" a. Is not your "err Aw RAMwagemedDMs;an F Jy/ \'x REVIEWED & APPROVED BY: i V"° --� RFsk janagement Analyst BUSINESS LIABILITY COVERAGE FORM b. Donates his or her work; c. Acts at the direction of and within the scope of duties determined by you; and d. Is not paid a fee, salary or other compensation by you or anyone else for their work performed for you. 24. "Your product": a. Means: (1) Any goods or products, other than real property, manufactured, sold, handled, distributed or disposed of by: (a) You; (b) Others trading under your name; or (c) A person or organization whose business or assets you have acquired; and (2) Containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products. b. Includes: (1) Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your product"; and Page 24 of 24 (2) The providing of or failure to provide warnings or instructions. c. Does not include vending machines or other property rented to or located for the use of others but not sold. 25. "Your work": a. Means: (1) Work or operations performed by you or on your behalf; and (2) Materials, parts or equipment furnished in connection with such work or operations. b. Includes: (1) Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your work"; and (2) The providing of or failure to provide warnings or instructions. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS LIABILITY COVERAGE FORM AMENDATORY ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM A. Sub -subparagraphs 1.p. (7), (8), (15) of Paragraph 2., of Section B. Exclusions are deleted and replaced with the following: p. Personal and Advertising Injury: (7) (a) Arising out of any actual or alleged infringement or violation of any intellectual property right, such as copyright, patent, trademark, trade name, trade secret, service mark or other designation of origin or authenticity; or (b) Any injury or damage alleged in any claim or "suit" that also alleges an infringement or violation of any intellectual property right, whether such allegation of infringement or violation is made by you or by any other party involved in the claim or "suit", regardless of whether this insurance would otherwise apply. However, this exclusion does not apply if the only allegation in the claim or "suit" involving any intellectual property right is limited to: (1) Infringement, in your "advertisement", of: (a) Copyright; (b) Slogan; or (c) Title of any literary or artistic work; or (2) Copying, in your "advertisement", a person's or organization's "advertising idea" or style of "advertisement". (8) Arising out of an offense committed by an insured whose business is: (a) Advertising, broadcasting, publishing or telecasting; (b) Designing or determining content of web sites for others; or Form SS 00 60 09 15 (c) An Internet search, access, content or service provider. However, this exclusion does not apply to Paragraphs a., b. and c. of the definition of "personal and advertising injury' under the Definitions Section. For the purposes of this exclusion, the placing of frames, borders or links, or advertising, for you or others anywhere on the Internet, is not by itself, considered the business of advertising, broadcasting, publishing or telecasting. (15) Arising out of any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information.This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of any access to or disclosure of any person's or organization's confidential or personal information. B. Subparagraph 1.r. of Section B. Exclusions is deleted and replaced with the following: r. Employment -Related Practices "Personal and advertising injury" to: (1) A person arising out of any "employment — related practices"; ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst (2) The spouse, child, parent, brother or sister of that person as a consequence of "personal and advertising injury" to that person at whom any "employment -related practices" are directed. This exclusion applies: (a) Whether the injury -causing event described in the definition of "employment -related practices" occurs before employment, during employment or after employment of that person; (b) Whether the insured may be liable as an employer or in any other capacity; and (c) To any obligation to share damages with or repay someone else who must pay damages because of the injury. C. Subparagraph 1.q. "Electronic Data" of Section B. Exclusions is deleted and replaced with the following: q. Access Or Disclosure Of Confidential Or Personal Information And Data -related Liability (1) Damages, other than damages because of "personal and advertising injury", arising out of any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information; or (2) Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate electronic data. However, unless Paragraph (1) above applies, this exclusion does not apply to damages because of "bodily injury". As used in this exclusion, electronic data means information, facts or computer programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), on hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other repositories of computer software which are used with electronically controlled equipment. The term computer programs, referred to in the foregoing description of electronic data, means a set of related electronic instructions which direct the operations and functions of a computer or device connected to it, which enable the computer or device to receive, process, store, retrieve or send data. D. Sub -subparagraph 7.b.(1) Other Insurance of Section E. Liability and Medical Expenses General Conditions is deleted and replaced with the following: b. Excess Insurance (1) Your Work That is Fire, Extended Coverage, Builder's Risk, Installation Risk, Owner Controlled Insurance Program or OCIP, Wrap Up Insurance or similar coverage for "your work". E. Subparagraph 17. c. "Personal and Advertising Injury" of Section G, Liability and Medical Expenses Definitions is deleted and replaced with the following: "Personal and advertising injury" means injury, including consequential "bodily injury", arising out of one or more of the following offenses: This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which F is described in Paragraph (1) or (2) above. Page 2 of 2 c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that a person or organization occupies, committed by or on behalf of its owner, landlord or lessor; Subparagraph 17.h. of Section G, Liability and Medical Expenses Definitions deleted. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIAL PROPERTY COVERAGE AMENDATORY ENDORSEMENT This endorsement modifies insurance provided under the following: SPECIAL PROPERTY COVERAGE FORM A. The following changes are made to Paragraph A.5., Additional Coverages: 1. Paragraph f., Forgery is deleted and replaced with the following: f. Forgery (1) We will pay for loss resulting directly from forgery or alteration of any check, draft, promissory note, or bill of exchange or similar written promise of payment in "money" that you or your agent has issued, or that was issued by someone who impersonates you or your agent. This includes written instruments required in conjunction with any credit, debit, or charge card issued to you or any employee for business purposes. (2) If you are sued for refusing to pay the check, draft, promissory note, or bill of exchange or similar written promise of payment in "money" on the basis that it has been forged or altered, and you have our written consent to defend against the "suit", we will pay for any reasonable expenses that you incur and pay in that defense. (3) We will pay for loss resulting directly from your having accepted in good faith, in exchange for merchandise, ,'money" or services: (a) Money orders, including counterfeit money orders, issued by any post office, express company or bank that are not paid upon presentation; and (b) Counterfeit United States or Canadian paper currency. (4) For the purpose of this Coverage Extension, check includes a substitute check as defined in the Check Clearing for the 21st Century Act and will be treated the same as the original it replaced. (5) We will treat mechanically reproduced facsimile signatures the same as handwritten signatures. (6) The most we will pay in any one occurrence, including legal expenses, under this Additional Coverage is $5,000, unless a higher Limit of Insurance is shown in the Declarations. 2. Paragraph i.(2)(c) of the Money and Securities Additional Coverage is deleted and replaced with the following: (c) Loss or damage to "money" and "securities" following and directly related to the use of any "computer" to fraudulently cause a transfer of that property. B. The following changes are made to Section B., EXCLUSIONS 1. Paragraph 1.a., Earth Movement is amended to add the following: This Exclusion applies regardless of whether any of the following is caused by weather, an act of nature, by an artificial, man-made or other cause. 2. The following is exclusion is added to Paragraph 1.: Electronic Vandalism or Corruption of "Electronic Data" or Corruption of "Computer Equipment" ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- Form SS 00 61 07 19 �� V © 2019, The Hartford Wsk Pjanagement Analpt This exclusion does not apply to Electronic Vandalism, form SS 14 29 or Electronic Vandalism, form SS 40 08 if either form has been made part of this policy. (1) Destruction or corruption of "electronic data" caused by a virus, malicious code or similar instruction introduced into or enacted on a computer system (including "electronic data") or a network to which it is connected, designed to damage or destroy any part of the system or disrupt its normal operation. (2) Unauthorized viewing, copying or use of electronic data (or any proprietary or confidential information or intellectual property in any form) by any person, even if such activity is characterized as "theft"; (3) Errors or omissions in programming or processing "electronic data"; (4) Errors or deficiency in design, installation, maintenance, repair or modification of your computer system or any computer system or network to which your system is connected or on which your system depends (including "electronic data"); (5) Manipulation of your computer system, including "electronic data", by an employee, volunteer worker or contractor, for the purpose of diverting or destroying "electronic data" or causing fraudulent or illegal transfer of any property; (6) Interruption in normal computer function or network service or function due to insufficient capacity to process transactions or to an overload of activity on the system or network; (7) Unexplained or indeterminable failure, malfunction or slowdown of a computer system, including "electronic data" and the inability to access or properly manipulate the "electronic data"; (8) Complete or substantial failure, disablement or shutdown of the Internet, regardless of the cause; (9) The inability of a computer system to correctly recognize, process, distinguish, interpret or accept one or more dates or times. But if direct physical loss or direct physical damage occurs to Covered Property from a resulting Covered Cause of Loss, we will Page 2 of 3 pay for that resulting direct physical loss or direct physical damage. Mere loss of use or loss of functionality of any property is not considered physical loss or physical damage. 3. Paragraph 2. is deleted and replaced with the following: We will not pay for loss or damage caused by or resulting from: a. Consequential Losses: Delay, loss of use or loss of market. b. Smoke, Vapor, Gas: Smoke, vapor or gas from agricultural smudging or industrial operations. c. Miscellaneous Types of Loss: (1) Wear and tear; (2) Rust, corrosion, fungus, decay, deterioration, hidden or latent defect or any quality in property that causes it to damage or destroy itself; (3) Smog; (4) Settling, cracking, shrinking or expansion; (5) Nesting or infestation, or discharge or release of waste products or secretions, by insects, birds, rodents, mold, spore or other animals; (6) The following causes of loss to personal property: (a) Dampness or dryness of atmosphere; (b) Changes in or extremes of temperature; or (c) Marring or scratching. But if physical loss or physical damage by the "specified causes of loss", building glass breakage or Equipment Breakdown Accident results, we will pay for that resulting physical loss or physical damage. d. Frozen Plumbing: Water, other liquids, powder or molten material that leaks or flows from plumbing, heating, air conditioning or other equipment (except fire protective systems) caused by or resulting from freezing, unless: (1) You do your best to maintain heat in the building or structure; or (2) You drain the equipment and shut off the supply if the heat is not maintained. e. Dishonesty: Dis you, any of yot officers, "ma cF RAMmWmentDMsian Jy/ 1'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst directors, trustees, authorized representatives or anyone to whom you entrust the property for any purpose: (1) Acting alone or in collusion with others; or (2) Whether or not occurring during the hours of employment. This exclusion does not apply to acts of destruction by your employees; but theft by employees is not covered. f. False Pretense: Voluntary parting with any property by you or anyone else to whom you have entrusted the property if induced to do so by any fraudulent scheme, trick, device or false pretense. g. Exposed Property: Rain, snow, ice or sleet to personal property in the open, except as provided in the Coverage Extension for Outdoor Property. h. Collapse: Collapse, except as provided in the Additional Coverage for Collapse. But if loss or damage by a Covered Cause of Loss results at the "scheduled premises", we will pay for that resulting loss or damage. i. Pollution: We will not pay for loss or damage caused by or resulting from the discharge, dispersal, seepage, migration, release or escape of "pollutants and contaminants" unless the discharge, dispersal, seepage, migration, release or escape is itself caused by any of the "specified causes of loss." But if physical loss or physical damage by the "specified causes of loss" results, we will pay for the resulting physical loss or physical damage caused by the "specified cause of loss." Form SS 00 61 07 19 C. Definition 4., "Data", of Section G., PROPERTY DEFINITIONS is deleted and replaced with the following. 4. "Electronic data" means information, facts or computer programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), on hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other repositories of computer software which are used with electronically controlled equipment. The term computer programs, referred to in the foregoing description of electronic data, means a set of related electronic instructions which direct the operations and functions of a "computer" or device connected to it, which enable the "computer" or device to receive, process, store, retrieve or send data. "Electronic data" it is not considered physical property under this Coverage Part and is covered only as expressly provided for in this Coverage Part. Any such coverage does not indicate that "electronic data" is considered to be tangible property subject to physical loss or physical damage for purposes of any business interruption coverage or other coverage that requires physical loss or physical damage. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS LIABILITY COVERAGE FORM AMENDATORY ENDORSEMENT - SUPPLEMENTARY PAYMENTS This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM A. Sub -subparagraph 3.a.(5) of Paragraph 3., Section A. Coverages is deleted and replaced with the following: 3. Coverage Extension - Supplementary Payments: a. (5) All court costs taxed against the insured in the "suit". However, these payments do not include attorneys' fees or attorneys' expenses taxed against the insured. ew cF RAMwagementDMsian �e 77 1°x REVIEWED & APPROVED BY.- Form SS 00 64 09 16 �� v © 2016, The Hartford W �-- W. rjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NORTH CAROLINA CHANGES This endorsement modifies insurance provided under the following: COMMON POLICY CONDITIONS STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM BUSINESS LIABILITY COVERAGE FORM MORTGAGEHOLDERS ERRORS AND OMISSIONS COVERAGE FORM A. The following changes apply to the Common Policy Conditions form. 1. Cancellation Paragraph A.2. Cancellation is deleted and replaced by the following: 2. Cancellation Requirements a. Policies In Effect Less Than 60 Days If this policy has been in effect for less than 60 days, we may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: (1) 15 days before the effective date of cancellation if we cancel for nonpayment of premium; or (2) 30 days before the effective date of cancellation if we cancel for any other reason. b. Policies In Effect More Than 60 Days If this policy has been in effect for 60 days or more, or is a renewal of a policy we issued, we may cancel this policy prior to the: (1) Expiration of the policy term; or (2) Anniversary date, stated in the policy only for one or more of the following reasons: (a) Nonpayment of premium; (b) An act or omission by the insured or his or her representative that constitutes material misrepresentation or nondisclosure of a material fact in obtaining this policy, continuing this policy or Form SS 01 09 02 14 © 2014, The Hartford presenting a claim under this policy; (c) Increased hazard or material change in the risk assumed that could not have been reasonably contemplated by the parties at the time of assumption of the risk; (d) Substantial breach of contractual duties, conditions or warranties that materially affects the insurability of the risk; (e) A fraudulent act against us by the insured or his or her representative that materially affects the insurability of the risk; (f) Willful failure by the insured or his or her representative to institute reasonable loss control measures that materially affect the insurability of the risk after written notice by us; (g) Loss of facultative reinsurance, or loss of or substantial changes in applicable reinsurance as provided in G.S. 58-41-30; (h) Conviction of the insured of a crime arising out of acts that materially affect the insurability of the risk; (i) A determination by the Commissioner of Insurance that the continuation of the policy would place us in violation of the laws of North Carolina; or Q) Yot req ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst corporate charter, articles of incorporation or by-laws when we are a company organized for the sole purpose of providing members of an organization with insurance coverage in North Carolina. We will mail or deliver written notice of cancellation to the first Named Insured at least: (i) 15 days before the effective date of cancellation if we cancel for nonpayment of premium; or (ii) 30 days before the effective date of cancellation if we cancel for any other reason. c. Cancellation for nonpayment of premium will not become effective if you pay the premium amount due before the effective date of cancellation. d. We may also cancel this policy for any reason not stated above provided we obtain your prior written consent. 2. The following provisions are added and supersede any other provisions to the contrary: M. Nonrenewal 1. If we elect not to renew this policy, we will mail or deliver to the first Named Insured shown in the Declarations written notice of nonrenewal at least 45 days prior to the: a. Expiration of the policy if this policy has been written for one year or less; or b. Anniversary date if this policy has been written for more than one year or for an indefinite term. 2. We need not mail or deliver the notice of nonrenewal if you have: a. Insured property covered under this policy, under any other insurance policy; b. Accepted replacement coverage; or c. Requested or agreed to nonrenewal of this policy. 3. If notice is mailed, proof of mailing will be sufficient proof of notice. Page 2 of 3 N. Notice of Cancellation or Nonrenewal The written notice of cancellation or nonrenewal will: 1. Be mailed or delivered to the first Named Insured and any designated mortgagee or loss payee at their addresses shown in the policy, or if not indicated in the policy, at their last known addresses; and 2. State the reason or reasons for cancellation or nonrenewal. B. The following changes apply to the Standard Property or Special Property Coverage Form. 1. Exclusion If loss or damage to Covered Property in the Beach Territory is caused by or results from Windstorm or Hail, the following additional exclusion applies: We will not pay for loss or damage to: 1. Paint; or 2. Waterproofing material; applied to the exterior of Buildings. We will not include the value of paint or waterproofing material to determine the value of Covered Property. The Beach Territory consists of localities south and east of the Inland Waterway: 1. From the South Carolina line to Fort Macon (Beaufort Inlet), 2. From there south and east of Core, Pamlico, Roanoke and Currituck Sounds to the Virginia line, generally known as the Outer Banks. 2. Appraisal Paragraph E.2. Appraisal is deleted and replaced by the following: 2. Appraisal If we and you disagree on the value of the property or the amount of loss, either may make written demand for an appraisal of the loss. In this event, each party will select a competent and impartial appraiser. You and we must notify the other of the appraiser selected within 20 days of the written demand for appraisal. The two appraisers will select an umpire. If the ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst appraisers do not agree on the selection of an umpire within 15 days, they must request selection of an umpire by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be the appraised value of the property or amount of loss. If you make a written demand for an appraisal of the loss, each party will: a. Pay its chosen appraiser; and b. Bear the other expenses of the appraisal and umpire equally. 3. Legal Action Against Us Paragraph EA. Legal Action Against Us is deleted and replaced by the following: No one may bring a legal action against us under this insurance unless: 1. There has been full compliance with all of the terms of this insurance; and 2. The action is brought within 3 years after the date on which the direct physical loss or damage occurred. 4. Loss Payment Subparagraph E.5.d.(1)(b) Loss Payment is deleted and replaced by the following: 5. Loss Payment (b) We will not pay on a replacement cost basis for any loss or damage: (i) Until the lost or damaged property is actually repaired or replaced: i. On the described premises; or ii. At some other location in the State of North Carolina; and (ii) Unless the repairs or replacement are made as soon as reasonably possible after the loss or damage. 5. The following condition is added to E. Property Loss Conditions: 9. Time Period For Performance Of Contractual Obligations Whenever a state of disaster is proclaimed for the state of North Carolina or for an area within this state in accordance with state law, or whenever a major disaster is declared for North Carolina or an area within this state by the President of the Form SS 01 09 02 14 United States under the Stafford Act or its successors, the following provisions apply: 1. If the Covered Property that has sustained loss or damage is located within the geographic area designated in the disaster declaration or proclamation, the time period for your submission of a proof of loss (as set forth in the Duties In The Event Of Loss Or Damage Condition or similar provision in this policy or in an endorsement attached to this policy) shall be extended by a time period not exceeding the earlier of : a. The expiration of the disaster proclamation or declaration and all renewals of the proclamation; or b. The expiration of the Insurance Commisioner's order declaring action for this specific disaster, as determined by the Insurance Commisioner. 2. Except as otherwise provided in Paragraph 1., the following applies if you or we reside in or are located in the geographic area designated in the disaster declaration or proclamation: If this policy or an endorsement attached to this policy or an endorsement attached to this policy impose a time limitation on you or us for a performance of: a. A premium or debt payment; or b. Any other duty or any act (including transmittal of information), under the terms of this policy and such performance would be required during the time period prior to the expiration of the Insurance Commissioner's order declaring action for the specific disaster, as determined by the Insurance Commissioner, your performance and our performance is subject to a deferral period of 30 days. The Commissioner of Insurance may extend such deferral period. C. The following changes apply to the Mortgageholders Errors and Omissions Coverage Form. 1. Legal Action Against Us Subparagraph (2) of 1.5.a. Legal Action Against Us is deleted and replaced by the following: (2) The action is brought within 3 years after the date on which the direct physical loss or damage occurred. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES This endorsement modifies insurance provided under the following: COMMON POLICY CONDITIONS SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM BUSINESS LIABILITY COVERAGE FORM EMPLOYMENT PRACTICES LIABILITY COVERAGE FORM A. Paragraphs 2. and 3. of the Cancellation Common Policy Condition are replaced by the following: 2. All Policies in Effect for 60 Days Or Less: If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured at the mailing address shown in the policy and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a. 10 days before the effective date of cancellation if we cancel for: (1) Nonpayment of premium; or (2) Discovery of fraud or material misrepresentation by: (a) Any insured or his or her representative in obtaining this insurance; or (b) You or your representative in pursuing a claim under this policy. b. 30 days before the effective date of cancellation if we cancel for any other reason. 3. All Policies in Effect For More Than 60 Days a. If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following, or as permitted under applicable California law: (1) Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks. (2) Discovery of fraud or material misrepresentation by: (a) Any insured or his or her representative in obtaining this insurance; or Form SS 01 21 02 20 (b) You or your representative in pursuing a claim under this policy. (3) A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. (4) Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative, which materially increase any of the risks insured against. (5) Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6) A determination by the Commissioner of Insurance that the: (a) Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b) Continuation of the policy coverage would: i. Place us in violation of California law or the laws of the state where we are domiciled; or ii. Threaten our solvency. (7) A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, unless changed © 2019, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with cF RAMmWmentDMsian REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst b. We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: (1) 10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud, or (2) 30 days before the effective date of cancellation if we cancel for any other reason listed in paragraph 3.a. B. The following provision is added to the Cancellation Common Policy Condition: 7. Residential Property This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit, if such coverage is written under this policy: a. If such coverage has been in effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in b. and c. below. b. We may not cancel solely because the first Named Insured has: (1) Accepted an offer of earthquake coverage; or (2) Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included and earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but fails to pay the earthquake policy premium surcharge authorized by the CEA. c. We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage under the Special Property Coverage Form, which excludes loss or damage caused by or resulting from corrosive soil conditions. If a state of emergency under California Law is declared and the residential property is located in any ZIP Code within or adjacent to the fire perimeter, as determined by California Law, we may not cancel this policy for one year, beginning Page 2 of 5 from the date the state of emergency is declared, solely because the dwelling or other structure is located in an area in which a wild fire has occurred. However, we may cancel: a. When you have not paid the premium, at any time by letting you know at least 10 days before the date cancellation takes effect; b. If willful or grossly negligent acts or omissions by the named insured, or his or her representatives, are discovered that materially increase any of the risks insured against; or c. If there are physical changes in the property insured against, beyond the catastrophe- damaged condition of the structures and surface landscape, which result in the property becoming uninsur- able. C. The following is added and supersedes any provisions to the contrary: NONRENEWAL 1. Subject to the provisions of paragraphs C.2. and C.3. below, if we elect not to renew this policy, we will mail or deliver written notice stating the reason for nonrenewal to the first Named Insured shown in the Declarations and to the producer of record, at least 60 days but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured, and to the producer of record, at the mailing address shown in the policy. 2. Residential Property This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household property contained in a residential unit, if such coverage is written under this policy. a. We may elect not to renew such coverage for any reason, except as provided in b., c. and d. below: b. We will not refuse to renew such coverage solely because the first Named Insured has accepted an offer of earthquake coverage. However, the following applies only to insurers who are associated participating insurers as established by Cal. Ins. Code Section 10089.16. We may elect not to renew such c Insured ha R`�`�D"s�` F1°x REVIEWED & APPROVED BY. earthquake c ;. following rea ' W"' --� Wsk Pjanagement Analyst (1) The nonrenewal is based on sound year, beginning from the date the state of underwriting principles that relate to emergency is declared, solely because the coverages provided by this policy the dwelling or other structure is located and that are consistent with the in an area in which a wildfire has approved rating plan and related occurred. documents filed with the Department However, we may nonrenew: of Insurance as required by existing (1) If willful or grossly negligent acts or law; omissions by the named insured, or (2) The Commissioner of Insurance finds his or her representatives, are that the exposure to potential losses discovered that materially increase will threaten our solvency or place us any of the risk insured against. in a hazardous condition. A (2) If losses unrelated to the post disaster hazardous condition in which we loss condition of the property have make claims payments for losses occurred that would collectively resulting from an earthquake that render the risk ineligible for renewal; occurred within the preceding two or years and that required a reduction in policyholder surplus of at least 25% (3) If there are physical changes in the for payment of those claims; or property insured against, beyond the catastrophe -damaged condition of the (3) We have: structures and surface landscape, (a) Lost or experienced a substantial which result in the property becoming reduction in the availability or uninsurable. scope of reinsurance coverage; or 3. We are not required to send notice of (b) Experienced a substantial nonrenewal in the following situations: increase in the premium charged a. If the transfer or renewal of a policy, for reinsurance coverage of our without any changes in terms, conditions, residential property insurance or rates, is between us and a member of policies; and our insurance group. the Commissioner has approved b. If the policy has been extended for 90 a plan for the nonrenewals that is days or less, provided that notice has fair and equitable, and that is been given in accordance with paragraph responsive to the changes in our C.1. reinsurance position. c. If you have obtained replacement c. We will not refuse to renew such coverage coverage, or if the first Named Insured solely because the first Named Insured has has agreed, in writing, within 60 days of cancelled or did not renew a policy, issued by the termination of the policy, to obtain the California Earthquake Authority that that coverage. included an earthquake policy premium d. If the policy is for a period of no more surcharge. than 60 days and you are notified at the d. We will not refuse to renew such coverage time of issuance that it will not be solely because corrosive soil conditions exist renewed. on the premises. This restriction (d) applies e. If the first Named Insured requests a only if coverage is subject to the Special change in the terms or conditions or risks Property Coverage Form, which excludes loss covered by the policy within 60 days of or damage caused by or resulting from the end of the policy period. corrosive soil conditions. If a state of emergency under California Law f. If we have made a written offer to the first is declared and the residential property is Named Insured, in accordance with the located in any ZIP Code within or adjacent to time frames shown in paragraph CA., to the fire perimeter, as determined by California renew the policy under changed terms or Law, we may not nonrenew this policy for one conditions or at an increased premium rate, when the increase exceeds 25%. If there is an appraisal, we will still retain our right to deny the claim. Form SS 01 21 02 20 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst D. The Concealment, Misrepresentation Or Fraud Condition is replaced by the following with respect to loss of damage caused by fire: We do not provide coverage to the insured who, whether before or after a loss, has committed fraud or intentionally concealed or misrepresented any material fact or circumstance concerning: 1. This Coverage Part; 2. The Covered Property; 3. That insured's interest in the Covered Property; or 4. A claim under this Coverage Part or Coverage Form. E. The Concealment, Misrepresentation Or Fraud Condition is replaced by the following with respect to loss of damage caused by a Covered Cause of Loss other than fire: This Coverage Part is void if any insured, whether before or after a loss, has committed fraud or intentionally concealed or misrepresented any material fact or circumstance concerning: 1. This Coverage Part; 2. The Covered Property; 3. That insured's interest in the Covered Property; or 4. A claim under this Coverage Part or Coverage Form. F. The Other Insurance - Property Coverage Condition is replaced by the following: If there is other insurance covering the same loss or damage, we will pay our share of the covered loss or damage. Our share is the proportion that the applicable limit of insurance bears to the limits of insurance of all insurance covering on same basis. G. Paragraph E.2., Appraisal of the Standard and Special Property Form is deleted and replaced by the following: 2. If we and you disagree on the value of the property or the amount of loss, either may make written request for an appraisal of the loss. If the request is accepted, each party will select a competent and impartial appraiser. Each party shall notify the other of the appraiser selected within 20 days of the request. The two appraisers will select an umpire. If they cannot agree within 15 days, either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a. Pay its chosen appraiser; and b. Bear the other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain our right to deny the claim. H. With respect to an "Open Policy", the Loss Payment Condition of the Standard and Special Property Form is amended by the following: 1. The following changes are made to Section E. PROPERTY LOSS CONDITIONS: a. Paragraph 5.d.(1)(b) of the Loss Payment condition is deleted and replaced by: (b) We will not pay on a replacement cost basis for any loss or damage until the lost or damaged property is actually repaired or replaced, and then only subject to deduction for depreciation. Prior to such repair or replacement, and in accordance with the terms applicable in this Paragraph 5., Loss Payment, we will pay the actual cash value of the lost or damaged property as described in Paragraph 2. below. If the actual cash value does not exhaust the applicable Limit of Insurance, we will then pay the difference between the actual cash value and the replacement cost, provided that the repair or replacement is completed: (i) Within 12 months after our payment of the actual cash value; or (ii) Within 36 months after our payment of the actual cash value if the loss or damage relates to a state of emergency under California Law. The following provision applies to real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit. If you, acting in good faith and with reasonable diligence, encounter a delay or delays in approval for, or reconstruction of, the residence that are beyond your control, we shall provide one or more additional extensions of six months for good cause. Circumstances beyond your control include, but are not limited to: (i) cF RAMmVmentDMsian \'x REVIEWED & APPROVED BY.- V"° --� Risk Pjanagement Analyst Page 4 of 5 (iii) The unavailability of contractors to perform the necessary work. The foregoing provisions do not constitute a waiver of our right to deny the claim for any valid reason or to restrict payment in cases of suspected fraud. 2. The following provision is added: Provision Applicable to California Actual cash value is determined as follows: In the event of a partial or total loss to a building or structure, actual cash value is calculated as shown below, whichever is less: (1) The amount it would cost to repair, rebuild or replace the property less a fair and reasonable deduction for physical depreciation of the components of the building or structure that are normally subject to repair or replacement during its useful life. Physical depreciation is based upon the condition of the property at the time of the loss; or (2) The limit of Insurance applicable to the property. Form SS 01 21 02 20 b. In the event of a partial or total loss to Covered Property other than a building or structure, actual cash value is calculated as the lesser of the following: (1) The amount it would cost to repair or replace the property less a fair and reasonable deduction for physical depreciation, based on the condition of the property at the time of loss; or (2) The Limit of Insurance applicable to the property. I. With respect to this endorsement, the following definition is added to Section G. PROPERTY DEFINITIONS: "Open Policy" means a policy under which the value of Covered Property is not fixed at policy inception, but is determined at the time of loss in accordance with policy provisions on valuation. The term 'open policy" does not apply to Covered Property that is subject to an Agreed Value clause or similar clause that establishes an agreed value prior to loss, unless such clause has expired. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ILLINOIS CHANGES This endorsement modifies insurance provided under the following: COMMON POLICY CONDITIONS MORTGAGEHOLDERS ERRORS AND OMISSIONS COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM BUSINESS LIABILITY COVERAGE FORM Provisions A. through C. of this endorsement modify the COMMON POLICY CONDITIONS. A. The Cancellation Common Policy Condition is replaced by the following: Cancellation 1. The first Named Insured shown in the Declarations may cancel this policy by mailing to us advance written notice of cancellation. 2. If this policy has been in effect for 60 days or less, except as provided in Paragraphs 8. and 9. below, we may cancel this policy by mailing written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or b. 30 days before the effective date of cancellation if we cancel for any other reason. 3. If this policy has been in effect for more than 60 days, except as provided in Paragraphs 8. and 9. below, we may cancel this policy only for one or more of the following reasons: a. Nonpayment of premium; b. The policy was obtained through a material misrepresentation; c. You have violated any of the terms and conditions of the policy; d. The risk originally accepted has measurably increased; e. Certification to the Director of Insurance of the loss of reinsurance by the insurer which provided coverage to us for all or a substantial part of the underlying risk insured; or f. A determination by the Director of Insurance that the continuation of the policy could place us in violation of the insurance laws of this State. If we cancel this policy based on one or more of the above reasons except for nonpayment of premium, we will mail written notice at least 60 days before the effective date of cancellation. When cancellation is for nonpayment of premium, we will mail written notice at least 10 days before the effective date of cancellation. 4. We will mail our notice to you, together with our reason for cancellation, at your last mailing address known to us. Proof of mailing will be sufficient proof of notice. 5. Notification of cancellation will also be sent to your broker, if known, or agent of record, if known, and to the mortgagee or Iienholder listed on the Policy. 6. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 7. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 8. Real Property Other Than Residential Properties Occupied By 4 Families Or Less: The following applies only if this policy covers real property other than residential property occupied by 4 families or less: If any one or more of the following conditions exists at any building that is Covered Property in this policy, we may cancel this policy by mailing to you written notice of cancellation at least 10 days before the effective date of cancellation, if: ew cF RAMwagementDMsian Form SS 01 23 01 18 40 ``x ► E�AEW=D & APPROVED sr: © 2018, The Hartford v (Includes copyrighted material of Insurance Services Office, Inc., with its r Wsk Pjanagement Analpt a. After a fire loss, permanent repairs to the building have not started within 60 days of satisfactory adjustment of loss, unless the delay is due to a labor dispute or weather conditions. b. The building has been unoccupied 60 or more consecutive days. This does not apply to: (1) Seasonal unoccupancy; or (2) Buildings under repair, construction or reconstruction, if properly secured against unauthorized entry. c. The building has: (1) An outstanding order to vacate; (2) An outstanding demolition order; or (3) Been declared unsafe in accordance with the law. d. Heat, water, sewer service or public lighting have not been connected to the building for 30 consecutive days or more. The policy will terminate 10 days following receipt of the written notice by the named insured(s). 9. Residential Properties Occupied By 4 Families Or Less: The following applies if this policy covers residential properties occupied by 4 families or less: If this policy has been in effect for 60 days, or if this is a renewal policy, we may only cancel this policy for one or more of the following reasons: a. Nonpayment of premium; b. The policy was obtained by misrepresentation or fraud; or c. Any act that measurably increases the risk originally accepted. If we cancel this policy based on one or more of the above reasons except for nonpayment of premium, we will mail written notice at least 30 days before the effective date of cancellation. When cancellation is for nonpayment of premium, we will mail written notice at least 10 days before the effective date of cancellation. B. Paragraph H., Other Insurance - Property Coverage is replaced by the following: Other Insurance - Property Coverage 1. You may have other insurance subject to the same plan, terms, conditions, and provisions as the insurance under this Coverage Form. If you do, we will pay our share of the covered loss or damage. Our share is the proportion that the applicable Limit of Insurance under this Coverage Form bears to the Limits of Insurance of all insurance covering on the same basis. Page 2 of 4 2. If there is other insurance covering the same loss or damage, other than that described in 1. above, we will pay only for the amount of covered loss or damage in excess of the amount due from that other insurance, whether you can collect on it or not. But we will not pay more than the applicable Limit of Insurance. C. The following Conditions are added: Nonrenewal 1. If we decide not to renew or continue this policy, we will mail you written notice, stating the reason for nonrenewal. Proof of mailing will be sufficient proof of notice. 2. Except as provided in Paragraph 6. below, we will mail you notice of nonrenewal at least 60 days before the end of the policy period. 3. If we offer to renew or continue 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 have not accepted our offer. 4. If we fail to mail proper written notice of nonrenewal and you obtain other insurance, this policy will end on the effective date of that insurance. 5. The following provision applies to policies other than those described in Paragraph 6.: Notification of nonrenewal will also be sent to your broker, if known, or agent of record, if known, and the mortgagee or lienholder listed on the Policy. 6. The following provision applies only if this policy covers residential properties occupied by 4 families or less: a L� If this policy has been issued to you and in effect with us for 5 or more years, we may not fail to renew this policy unless: (1) The policy was obtained by misrepresentation or fraud and we mail you notice of nonrenewal at least 30 days before the end of the policy period as provided in 1. above; (2) The risk originally accepted has measurably increased and we mail you notice of nonrenewal at least 30 days before the end of the policy period as provided in 1. above; or (3) You received 60 days' notice of our intent not to renew as provided in 1. above. If this policy has been issued to you and in effect with us fo cF RAMmVmentDMsian Jy/ 1'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst not fail to renew this policy unless you b. Household or personal property that is received 30 days' notice as provided in 1. usual or incidental to the occupancy of any above. premises used for residential purposes. c. Notification of nonrenewal will also be sent 2. The second paragraph of Paragraph E.2. to your broker, if known, or agent of record, PROPERTY LOSS CONDITIONS is replaced if known, and to the last known mortgagee by the following: or lienholder. a. Each party will pay its own appraiser and d. The nonrenewal shall not become effective bear the other expenses of the appraisal until at least 30 days from the proof of and umpire equally, except as provided in mailing date of the notice to you. b. below. D. The following Exclusion is added to Paragraph 13.2., b. We will pay your appraiser's fee and the EXCLUSIONS, of the SPECIAL PROPERTY umpire's appraisal fee, if the following COVERAGE FORM or the STANDARD PROPERTY conditions exist: COVERAGE FORM. (1) You demanded the appraisal; and 1. We will not pay for loss or damage arising out of (2) The full amount of loss, as set by your any act committed: appraiser, is agreed to by our appraiser a. By or at the direction of any insured; and or by the umpire. b. With the intent to cause a loss. 3. Paragraph C., Concealment, Misrepresentation In the event of such a loss, no insured is entitled Or Fraud of the COMMON POLICY to coverage, even insureds who did not commit CONDITIONS is replaced by the following: or conspire to commit the act causing the loss. C. Concealment, Misrepresentation Or 2. However, this exclusion will not apply to deny Fraud payment to an innocent co-insured who did not 1. This policy is void if you or any insured cooperate in or contribute to the creation of the commit fraud or conceal or loss if: misrepresent a fact in the process a. The loss arose out of a pattern of criminal leading to the issuance of this domestic violence; and insurance, and such fraud, concealment b. The perpetrator of the loss is criminally or misrepresentation is stated in the prosecuted for the act causing the loss. policy or endorsement or in the writtenapplication for this policy and: 3. If we pay a claim pursuant to Paragraph D.2., a. Was made with actual intent to our payment to the insured is limited to that deceive; or insured's insurable interest in the property less any payments we first made to a mortgagee or b. Materially affected either our other party with a legal secured interest in the decision to provide this insurance or property. In no event will we pay more than the the hazard we assumed. Limit of Insurance. However, this condition will not serve as E. The following applies to the MORTGAGEHOLDERS a reason to void this policy after the ERRORS AND OMISSIONS COVERAGE FORM, policy has been in effect for one year or SPECIAL PROPERTY COVERAGE FORM or the one policy term, whichever is less. STANDARD PROPERTY COVERAGE FORM. 2. We do not provide coverage under this The following is added to the Legal Action Against Policy to you or any other insured who, Us Condition: at any time subsequent to the issuance The 2 year period for legal action against us is of this insurance, commit fraud or intentionally conceal or misrepresent a extended by the number of days between the date material fact relating to: the proof of loss is filed with us and the date we deny the claim in whole or in part. a. This Policy; F. The following applies to the SPECIAL PROPERTY b. The Covered Property; COVERAGE FORM or the STANDARD PROPERTY c. Your interest in the Covered COVERAGE FORM. Property; or 1. If this policy covers property described in a. and d. A claim under this Policy. b. below, Paragraphs 2. and 3. apply: 3. Notwithstanding the limitations stated in a. Real property used principally for residential C.1. above, we may cancel this policy in purposes up to and including a four family accordance dwelling; or A. Cancel Risk POLICY CO GF �D`a` "� Jy/ \'x REVIEWED & APPROVED BY.- .. V Form SS 01 23 01 18 W. janagement Analpt G. The following applies to the BUSINESS LIABILITY COVERAGE FORM. The term "spouse" is replaced by the following: Spouse or party to a civil union recognized under Illinois law. Page 4 of 4 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COLORADO CHANGES This endorsement modifies insurance provided under the following: COMMON POLICY CONDITIONS BUSINESS LIABILITY COVERAGE FORM A. The following changes apply to the Common Policy Conditions Form. 1. Cancellation Paragraph A.2. Cancellation is deleted and replaced by the following: 2. If this policy has been in effect for less than 60 days, we may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a) 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or b) 30 days before the effective date of cancellation if we cancel for any other reason. 2. The following is added to Paragraph A. Cancellation: 8. Cancellation of Policies in Effect for 60 Days or More a. If this policy has been in effect for 60 days or more, or is a renewal of a policy we issued, we may cancel this policy by mailing through first-class mail to the first Named Insured written notice of cancellation: (1) Including the actual reason, at least 10 days before the effective date of cancellation, if we cancel for nonpayment of premium; or (2) At least 45 days before the effective date of cancellation if we cancel for any other reason. b. We may only cancel this policy based on one or more of the following reasons: (1) Nonpayment of premium; (2) A false statement knowingly made by the insured on the application for insurance; or (3) A substantial change in the exposure or risk other than that indicated in the application and underwritten as of the effective date of the policy unless the first Named Insured has notified us of the change and we accept such change. 3. Paragraph C., Concealment, Misrepresentation Or Fraud is replaced by the following: We will not pay for any loss or damage in any case of: 1. Concealment or misrepresentation of a material fact; or 2. Fraud committed by you or any other insured at anytime and relating to coverage under this policy. 4. The following is added and supersedes any other provision to the contrary: Nonrenewal If we decide not to renew this policy, we will mail through first-class mail to the first Named Insured shown in the Declarations written notice of the nonrenewal at least 45 days before the expiration date, or its anniversary date if it is a policy written for a term of more than one year or with no fixed expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. ew cF RAMwagementDMsian Form SS 01 33 11 13 _/ ,qq REVIEWED & APPROVED BY: © 2013, The Hartford ��' ., v (Includes copyrighted material of Insurance Services Office, Inc. with its per --_-- Wsk Management Analpt 5. The following Condition is added: Increase In Premium Or Decrease In Coverage We will not increase the premium unilaterally or decrease the coverage benefits on renewal of this policy unless we mail through first-class mail written notice of our intention, including the actual reason, to the first Named Insured's last mailing address known to us, at least 45 days before the effective date. Any decrease in coverage during the policy term must be based on one or more of the following reasons; 1. Nonpayment of premium; 2. A false statement knowingly made by the insured on the application for insurance; or 3. A substantial change in the exposure or risk other than that indicated in the application and underwritten as of the effective date of the policy unless the first Named Insured has notified us of the change and we accept such change. If notice is mailed, proof of mailing will be sufficient proof of notice. Page 2 of 2 B. The following changes apply to the Business Liability Coverage Form. 1. The term "spouse" is replaced by the following: Spouse or party to a civil union recognized under Colorado law. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARIZONA CHANGES This endorsement modifies insurance provided under the following: COMMON POLICY CONDITIONS STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM PROVISIONS A., B., C., D., E., F., and G. APPLY TO THE COMMON POLICY CONDITIONS: A. The following is added to paragraph A of the Cancellation Condition (and applies except in situations where B, below, applies): 8. Cancellation of Policies in effect For 60 Days Or More: If this policy has been in effect for 60 days or more, or if this policy is a renewal of a policy we issued, we may cancel this policy only for one or more of the following reasons: a. Nonpayment of premium; b. Your conviction of a crime arising out of acts increasing the hazard insured against; c. Acts or omissions, by you or your representative, constituting fraud or material misrepresentation in the procurement of this policy, in continuing this policy or in presenting a claim under this policy; d. Substantial change in the risk assumed, except to the extent that we should have reasonably foreseen the change or contemplated the risk in writing the contract; e. Substantial breach of contractual duties or conditions; f. Loss of reinsurance applicable to the risk insured against resulting from termination of treaty or facultative reinsurance initiated by our reinsurer or reinsurers; g. Determination by the Director of Insurance that the continuation of the policy would place us in violation of the insurance laws of this state or would jeopardize our solvency; or h. Acts or omissions by you or your representative which materially increase the hazard insured against. If we cancel this policy based on one or more of the above reasons, we will mail by certified mail or by first-class mail using Intelligent Mail barcode or another similar tracking method used or approved by the United States Postal Service to the first Named Insured and mail to the agent, if any, written notice of cancellation stating the reasons for cancellation. We will mail this notice to the last mailing addresses known to us at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or b. 45 days before the effective date of cancellation if we cancel for any of the other reasons. B. If the Standard Property or Special Property Coverage Form provides coverage for: 1. Real Property which is used predominately for residential purposes and consists of one through four dwelling units; and/or 2. Personal Property (except business or farm personal property) of a person residing in such real property; The following provisions apply (instead of those provided in item A. above) with respect to cancellation of such coverage: Form SS 01 54 01 20 Page 1 of 4 © 2019, The Hartford (Includes copyrighted material of Insurance Services Office, Inc. with its pe ew cF RAMwagmedD"siun Jy/ \'x REVIEWED & APPROVED BY: I .° --� Rt janagement Analpt If this policy has been in effect for 60 days or more, mailing addresses known to us at least 45 days or is a renewal of a policy we issued, we may prior to the expiration date of this policy. cancel only for one or more of the following 2. If notice is mailed, proof of mailing will be reasons: sufficient proof of notice. a. Nonpayment of premium; 3. If either one of the following occurs, we are not b. Your conviction of a crime arising out of acts required to provide written notice of increasing the hazard insured against; nonrenewal c. Acts or omissions by you or your representative a. We or a company within the same constituting fraud or material misrepresentation insurance group has offered to issue a in obtaining the policy, continuing the policy, or renewal policy; or presenting a claim under the policy; b. You have obtained replacement coverage d. Discovery of grossly negligent acts or or agreed in writing to do so. omissions by you substantially increasing any 4. If written notice of nonrenewal is mailed less of the hazards insured against; than 45 days prior to expiration of this policy e. Substantial change in the risk assumed by us, and neither 3.a. or 3.b applies, the coverage since the policy was issued, except to the shall remain in effect until 45 days after the extent that we should reasonably have foreseen notice is mailed. Earned premium for any the change or contemplated the risk in writing period of coverage that extends beyond the the contract; expiration date of this policy shall be f. A determination by the Director of Insurance considered pro rata based upon the previous that the continuation of the policy would place year's rate. us in violation of the insurance laws of this D. If the Standard Property or Special Property state; or Form provides coverage for: g. Your failure to take reasonable steps to 1. Real property which is used predominantly for eliminate or reduce any conditions in or on the residential purposes and consists of one insured premises which contributed to a loss in through four dwelling units; and/or the past or will increase the probability of future 2. Personal property (except business or farm losses. personal property) of a person residing in such If we cancel this policy based on one or more of real property; these reasons, we will mail written notice of The following provisions apply (instead of those cancellation, stating the reason(s) for cancellation, provided in item C. above) with respect to by certified mail or by first-class mail using nonrenewal of such coverage: Intelligent Mail barcode or another similar tracking method used or approved by the United States 1. If we elect not to renew, we will mail written Postal Service to the first Named Insured. We will notice of nonrenewal by certified mail or by mail this notice to the last mailing address known to first-class mail using Intelligent Mail barcode or us, at least: another similar tracking method used or (1) 10 days before the effective date of approved by the United States Postal Service, cancellation if we cancel for nonpayment of to the first Named Insured. We will mail this notice, stating the reason(s) for nonrenewal, to premium. the last mailing address known to us, at least (2) 45 days before the effective date of 45 days before the end of the policy period. cancellation, if we cancel for any of the Proof of mailing will be sufficient proof of other reasons. notice. C. The following is added and supersedes any 2. If either one of the following occurs, we are not provision to the contrary, (and applies except in required to provide notice of nonrenewal: situations where D., below, applies): a. You have agreed to nonrenewal; or Nonrenewal b. You have accepted replacement coverage. 1. If we elect not to renew this policy, we will mail 3. If our nonrenewal is based on the condition of by certified mail or by first-class mail using the premises, you will be given 30 days' notice Intelligent Mail barcode or another similar to remedy the identified conditions. If the tracking method used or approved by the identified conditions are remedied, coverage United States Postal Service to the first Named will be renewed. If the identified conditions are Insured, and mail to the agent, if any, written not remedied to our satisfaction, you will be notice of nonrenewal. We will mail this notice, given an additional 30 days, upon payment of stating the reason(s) for nonrenewal, to the last premium, to correc eR cF ILLi3R M&T7Agm2dDLVIBI0R Jy/ \'x REVIEWED & APPROVED BY.- Page 2 of 4 . V ,_---P W. fjanagement Analyst E. The following Common Policy Condition is 3. Where, if the true facts had been known to us added: as required either by the application for the Renewal policy or otherwise, we in good faith would either; 1. If we elect to renew this policy and the renewal is subject to any of the following: a. Not have issued the policy; a. Increase in premium; b. Not have issued the policy in as large an amount; or b. Change in deductible; c. Not have provided coverage with respect c. Reduction in limits of insurance; or to the hazard resulting in the loss. d. Substantial reduction in coverage; G. The following is added to Paragraph J. Transfer we will mail or deliver written notice of the Of Rights Of Recovery Against Others To Us: change(s) to the first Named Insured, at the last If we pay an insured for a loss described in mailing address known to us, at least 30 days Paragraph 1.2, below, the rights of the insured to before the anniversary or expiration date of the recover damages from the perpetrator of the policy. domestic violence are transferred to us to the 2. If renewal is subject to any condition described extent of our payment. Following the loss, the in 1.a. through 1.d. above, and we fail to insured may not waive such rights to recover provide notice 30 days before the anniversary against the perpetrator of the domestic violence. or expiration date of this policy, the following PROVISIONS H AND I APPLY TO THE PROPERTY procedures apply: COVERAGE FROM: a. The present policy will remain in effect until H. Paragraph A.5.d. of the Special Property the earlier of the following: Coverage Form and paragraph AA.b. of the (1) 30 days after the date of mailing or Standard Property Coverage Form on Fire delivery of the notice; or Department Service Charge does not apply (2) The effective date of replacement I. The following exclusion and related provisions are coverage obtained by the first Named added to Paragraph B.2. Exclusions: Insured. Intentional Loss b. If the first Named Insured elects not to 1. With respect to loss caused by fire: renew, any earned premium for the period a. We will not pay for loss or damage arising of extension of the terminated policy will be out of any act committed: calculated pro rata at the lower of the following rates: (1) By or at the direction of the insured; (1) The rates applicable to the terminated and policy; or (2) With the intent to cause a loss. (2) The rates presently in effect. b. However, this exclusion will not apply to c. If the first Named Insured accepts the deny an insured's claim for an otherwise renewal, the premium increase, if any, and covered property loss under this policy if other changes are effective the day such loss is caused by another insured following this policy's anniversary or under this policy and the insured making expiration date. this claim: F. Paragraph C. Concealment, Misrepresentation Or Fraud is replaced by the following: Concealment, Misrepresentation of Fraud: We will not pay for any loss or damage in any case involving misrepresentations, omissions, concealment of facts or incorrect statements: 1. That are fraudulent; 2. That are material either to the acceptance of the risk, or to the hazard assumed by us; and Form SS 01 54 01 20 (1) Did not cooperate in or contribute to the creation of the loss; and (2) Cooperates in any investigation relating to the loss. We may apply reasonable standards of proof for such claims. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst 2. With respect to loss caused by a peril other than fire: a. We will not pay for loss or damage arising out of any act committed: (1) By or at the direction of any insured; and (2) With the intent to cause a loss. b. However, this exclusion will not apply to deny an insured's claim for an otherwise covered property loss under this Policy if such loss is caused by an act of domestic violence by another insured under this Policy and the insured making the claim: Page 4 of 4 (1) Did not cooperate in or contribute to the creation of the loss; and (2) Cooperates in any investigation relating to the loss. We may apply reasonable standards of proof for such claims. 3. If we pay a claim pursuant to Paragraph 1.1.b. or 1.2.b. of this endorsement, our payment to the insured is limited to that insured's insurable interest in the property as reduced by any payments we first made to a mortgagee or other party with a secured interest in the property. In no event will we pay more than the Limit of Insurance. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst POLICY NUMBER: 59 SBA RV9040 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UNMANNED AIRCRAFT - LIABILITY ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM SCHEDULE Option 1: If an "X" is shown in this box, Bodily Injury and Property Damage coverage for Unmanned Aircraft applies and the Unmanned Aircraft Exclusion in Paragraph A.1.g.(1) of this endorsement does not apply. Option 2: If an "X" is shown in this box, Personal And Advertising Injury coverage for Unmanned Aircraft applies and the Unmanned Aircraft - Personal And Advertising Injury Exclusion in Paragraph A.2. of this endorsement does not apply. Except as otherwise stated in this endorsement or the schedule above, the terms and conditions of the policy apply to the insurance stated below. A. The following changes are made to Section B.1., EXCLUSIONS: 1. Paragraph g., Aircraft, Auto or Watercraft, is deleted and replaced with the following: g. Aircraft, Auto or Watercraft (1) Unmanned Aircraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". Use includes operation and "loading or unloading". This Paragraph g.(1) applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". (2) Aircraft (Other Than Unmanned Aircraft), Auto Or Watercraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft (other than "unmanned aircraft), "auto" or watercraft Form SS 42 06 03 17 Process Date: 0 8 / 18 / 2 0 owned or operated by or rented or loaned to any insured. Use includes operation and 'loading or unloading". This Paragraph g.(2) applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft (other than "unmanned aircraft), "auto" or watercraft that is owned or operated by or rented or loaned to any insured. Paragraph g. (2) does not apply to: (a) A watercraft while ashore on premises you own or rent; (b) A watercraft you do not own that is: (i) Less than 51 feet long; and (ii) Not being used to carry persons for a charge; (c) Parking an "auto" on, or on the ways next to, premises you own or rent, provided the "auto" is not owned by or rented or loaned to you or the insured; (d) Liability assumed under any "insured contract" for the ownership, maintenance or use of aircraft or watercraft; cF RAMmWmentDMsian Jy/ \'x REVIEWED & APPROVED BY.- ,v Policy Ex� Wsk Pjanagement Analpt (e) "Bodily injury" or "property damage" B. The following changes apply to Section G. arising out of the operation of any of LIABILITY AND MEDICAL EXPENSES the equipment listed in Section G DEFINITIONS: Liability and Medical Expenses 1. The following definition is added: Definitions, Paragraph 15 f. (2) or f. (3) of the definition of "mobile "Unmanned aircraft" means an aircraft that is equipment"; or not: (f) An aircraft (other than unmanned a. Designed; aircraft) that is not owned by any b. Manufactured; or insured and is hired, chartered or c. Modified after manufacture loaned with a paid crew. However, this exception does not apply if the to be controlled directly by a person from within insured has any other insurance for or on the aircraft. such "bodily injury" or "property damage", whether the other insurance is primary, excess, contingent or on any other basis. 2. The following is added to Section B. EXCLUSIONS Paragraph p., Personal and Advertising Injury: Unmanned Aircraft - Personal and Advertising Injury Arising out of the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the offense which caused the "personal and advertising injury' involved the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". However, this exclusion does not apply if the only allegation in the claim or "suit" involves an intellectual property right which is limited to: (a) Infringement, in your "advertisement", of: (i) Copyright; (ii) Slogan; or (iii) Title of any literary or artistic work; or (b) Copying, in your "advertisement", a person's or organization's "advertising idea" or style of "advertisement". ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° Page 2 of 2 Rusk janagement Analpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RESTAURANT STRETCH This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the policy apply to the insurance stated below. A. The following changes apply to the Standard Property Coverage Form, Additional Coverages, AA., or to the Special Property Coverage Form, Additional Coverages, A.5.: 1. Accounts Receivable The following Additional Coverage is added: a. We will pay up to $25,000 in any one occurrence as a Limit of Insurance to apply at each "scheduled premises" to cover direct physical loss of or physical damage to your records of accounts receivable. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. b. We will pay up to $25,000 in any one occurrence as a Limit of Insurance to cover direct physical loss of or physical damage to your records of accounts receivable that are not located at the "scheduled premises" or in transit. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. This Additional Coverage is subject to the provisions of the Accounts Receivable Coverage, Form SS 04 39, with the exception of the Limit of Insurance provision contained in that form. Accounts Receivable Coverage, Form SS 04 39 is made a part of this policy whether or not Accounts Receivable coverage is indicated in the Declarations. 2. Brands and Labels The following Additional Coverage is added: In the event of covered physical loss or physical damage to merchandise that is branded or labeled, we will take all or part of the physically damaged property at an agreed or appraised value and we will pay for: a. Expenses you incur to: (1) Stamp salvage on the merchandise or its containers, if the stamp will not physically damage the merchandise; or (2) Remove the brands or labels, if doing so will not physically damage the merchandise. You must relabel the merchandise and its containers to comply with the law. b. Any reduction in the salvage value of the physically damaged merchandise as the result of the removal of the brand or label. This Additional Coverage is included within the Business Personal Property Limit of Insurance. 3. Claim Expenses The following Additional Coverage is added: In the event of covered loss or physical damage we will pay up to $10,000 in any one occurrence as an additional Limit of Insurance to cover reasonable expenses incurred by you at our specific request to assist us in: a. The investigation of a claim or suit; or b. The determination of the amount of loss, such as taking inventory, or auditing business records. 4. Computer Fraud Form SS 04 11 09 07 © 2007, The Hartford The following Additional Coverage is added: We will pay up to $5,000 in any one occurrence for physical loss of or physical damage to ,'money", "securities", and other property having intrinsic value resulting directly from computer fraud. Computer fraud means any act of stealing property following and directly related to the use of any comp ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- v --� Risk janagement Analyst transfer of that property from inside your premises or from a banking institution or similar safe depository, to a person (other than a "messenger") outside those premises or to a place outside those premises. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. 5. Computers and Media The following Additional Coverage is added: We will pay up to $25,000 in any one occurrence as a Limit of Insurance to apply anywhere in the Coverage Territory to cover direct physical loss of or physical damage to your computer systems. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. This Additional Coverage is subject to the provisions of Computers and Media, Form SS 04 41, with the exception of the Limit of Insurance provision contained in that form. Computers and Media, Form SS 04 41 is made a part of this policy whether or not Computers and Media coverage is indicated in the Declarations. 6. Debris Removal The following Additional Coverage is added: In Limits of Insurance, CA.b., the additional limit of insurance for the Debris Removal Additional Coverage is increased to $25,000 in any one occurrence. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. 7. Employee Dishonesty (including ERISA) The following Additional Coverage is added: We will pay up to $10,000 in any one occurrence as a Limit of Insurance to cover loss from employee dishonesty. This includes ERISA coverage. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. This Additional Coverage is subject to the provisions of the Employee Dishonesty Coverage, Form SS 04 42, with the exception of the Limit of Insurance provision contained in that form. Employee Dishonesty Coverage, Form SS 04 42 is made a part of this policy whether or not Employee Dishonesty Coverage is indicated in the Declarations. 8. Fine Arts The following Additional Coverage is added: We will pay up to $10,000 in any one occurrence as a Limit of Insurance at each "scheduled premises" to apply to Fine Arts. This Limit of Page 2 of 7 Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. This Additional Coverage is subject to the provisions of Fine Arts Coverage Form, Form SS 04 22, with the exception of the following: a. The requirement contained under Paragraph A.1., Under A. Coverage, to list and describe Fine Arts in the Declarations or Shedule is deleted when Fine Arts are covered under this Stretch endorsement; and b. The Limit of Insurance provision does not apply. c. Paragraph D.1. Valuation is deleted and replaced by the following: The value of Fine Arts will be the market value at the time of physical loss or physical damage. Fine Arts Coverage, Form SS 04 22 is made a part of this policy whether or not Fine Arts Coverage is indicated in the Declarations. 9. Forgery The following Additional Coverage is added: We will pay up to $10,000 in any one occurrence as a Limit of Insurance to cover loss from forgery of covered instruments, money orders, credit cards, and counterfeit money. This Additional Coverage is subject to the provisions of Forgery Coverage, Form SS 04 86, with the exception of the Limit of Insurance provision contained in that form. Forgery Coverage, Form SS 04 86 is made a part of this policy, whether or not Forgery Coverage is indicated in the Declarations. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. 10. Laptop Computers -Worldwide Coverage The following Additional Coverage is added: We will pay up to $10,000 in any one occurrence as a Limit of Insurance to apply to laptop, palmtop, personal digital assistants (PDAs), and similar portable computer equipment and accessories anywhere in the world, including while in transit. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. Limitation: We will not pay for direct loss or physical damage caused by, from, or arising out of the theft of this while in transit as checked baaaaae. This Additional provisions of C physical resulting property ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst SS 04 41, with the exception of the Limit of Insurance provision contained in that form. Computers and Media, Form SS 04 41 is made a part of this policy whether or not Computers and Media coverage is indicated in the Declarations. 11. Lost Keys The following Additional Coverage is added: We will pay up to $2,500 in any one occurrence as an additional amount of insurance to cover the loss of your keys used to secure the "scheduled premises" due to theft. We will not pay more than the least of the following: a. Re -key the locks, b. Install new lock cylinders, c. Provide new master keys, or d. Replace existing locks with new locks of like kind and quality. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. 12. Off -Premises Utility Services - Direct Damage The following Additional Coverage is added: We will pay up to $10,000 in any one occurrence as a Limit of Insurance to apply at each "scheduled premises" to cover direct physical loss or physical damage to Covered Property caused by the interruption of utility services. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. This Additional Coverage is subject to the provisions of Off -Premises Utility Services - Direct Damage, Form SS 40 18, with the exception of the Utility Services Limit of Insurance contained in that form. Off -Premises Utility Services — Direct Damage, Form SS 40 18 is made a part of this policy, whether or not Off -Premises Utility Services — Direct Damage coverage is indicated in the Declarations. 13. Outdoor Signs The following Additional Coverage is added and supersedes any other coverage for signs in this policy: We will pay up to full value of outdoor signs at each "scheduled premises" to cover direct physical loss of or physical damage to outdoor signs. This Additional Coverage is subject to the provisions of Outdoor Signs, Form SS 04 44, with the exception of the Limit of Insurance provision and paragraph E. of that form. Outdoor Signs, Form SS 04 44 is made a part of this policy whether or not Outdoor Signs coverage is indicated in the Declarations. Form SS 04 11 09 07 This Additional Coverage is in addition to any recoverable Limits of Insurance applicable to Building or Business Personal Property. 14. Pairs or Sets The following Additional Coverage is added: If pairs or sets of stock are damaged by a Covered Cause of Loss, we will pay any reduction in value of the undamaged parts of such damaged pairs or sets. As used in this Additional Coverage, the term stock means merchandise held in storage or for sale, raw materials, and goods in -process or finished. This coverage is included within the Business Personal Property Limit of Insurance. 15. Personal Property of Others The following Additional Coverage is added: We will pay up to $10,000 in any one occurrence as a Limit of Insurance at each "scheduled premises" to apply to personal property of others that is in your care, custody or control. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. This Additional Coverage is subject to the provisions of Personal Property of Others, Form SS 04 45, with the exception of the statement concerning Limit of Insurance applicable to Personal Property of Others shown in the Declarations, contained in that form. Personal Property of Others, Form SS 04 45 is made a part of this policy whether or not Personal Property of Others coverage is indicated in the Declarations. 16. Property at Other Premises The following Additional Coverage is added: We will pay up to $10,000 in any one occurrence to extend coverage for Business Personal Property at any premises not described in the Declarations. This includes property that you have sold under an installation agreement and for which your responsibility continues until the property is accepted by the customer. This Extension does not apply to: a. Property in the care, custody or control of your salespersons; b. Property at any fair or exhibition; c. Property in transit; or d. Property temporarily stored at any premises not described in the Declarations. This Limit of Insuran Limit of Insurance t ew cF RAMwagementDi skm policy for this covers =y �°i REVIEWED&APPROVED BY.- ., . V --� Rusk Pjanagement Analpt 17. Salespersons' Samples The following Additional Coverage is added: We will pay up to $1,000 in any one occurrence as an additional Limit of Insurance to extend Business Personal Property to cover: a. Samples of your stock in trade (including containers); and b. Similar property of others; but only while such property is in: a. Your custody while you are acting as a sales representative; or b. The custody of your sales representative or agents. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. 18. Sewer and Drain Back Up The following Additional Coverage is added: We will pay for direct physical loss or physical damage to Covered Property solely caused by water that backs up from a sewer or drain. This coverage is included within the Covered Property Limits of Insurance. THIS IS NOT FLOOD INSURANCE We will not pay for water or other materials that back up from any sewer or drain when it is caused by any flood. This applies regardless of the proximity of the flood to Covered Property. Flood includes the accumulation of surface water, waves, tides, tidal waves, overflow of streams or other bodies of water, or their spray, all whether driven by wind or not that enters the sewer or drain system. 19. Sump Overflow or Sump Pump Failure The following Additional Coverage is added: The maximum we will pay in any one occurrence is $15,000 for any loss, including Business Income or Extra Expense, resulting from physical loss or physical damage to Covered Property that is caused by or resulting from water that overflows due to the failure of a sump pump, sump pump well, or any other type of system designed to remove subsurface water from the foundation area if the failure is directly or indirectly the result of a Covered Cause of Loss. Failure means an abrupt cessation of normal functioning. This Limit of Insurance is the maximum we will pay regardless of any other coverage provided under this policy. This Additional Coverage is subject to the terms and conditions of this policy with the exception of: Page 4 of 7 a. Paragraph B.1.f., Power Failure, of the Standard Property Coverage Form and Paragraph B.1.d., Power Failure, of the Special Property Coverage Form; and b. Paragraph B.1.h.(4), Water, of the Standard Property Coverage Form and Paragraph B.1.f.(4), Water, of the Special Property Coverage Form. THIS IS NOT FLOOD INSURANCE We will not pay for water or other materials that overflow from a sump when the overflow is caused by any flood. This applies regardless of the proximity of the flood to Covered Property. Flood includes the accumulation of surface water, waves, tides, tidal waves, overflow of streams or other bodies of water, or their spray, all whether driven by wind or not that enters the sewer or drain system. 20. Temperature Change The following Additional Coverage is added: We will pay up to $10,000 in any one occurrence as a Limit of Insurance to apply at each "scheduled premises" to cover direct physical loss of or physical damage to perishable stock caused by or resulting from a change of temperature or contamination by a refrigerant. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. This Additional Coverage is subject to the provisions of the Temperature Change Coverage, Form SS 04 46, with the exception of the Limit of Insurance provision contained in that form. Temperature Change, Form SS 04 46 is made a part of this policy whether or not Temperature Change coverage is indicated in the Declarations. 21. Tenant Building and Business Personal Property Coverage - Required by Lease The following Additional Coverage is added: The maximum we will pay in any one occurrence is $20,000 as a Limit of Insurance to apply to direct physical loss of or physical damage to Building and Business Personal Property for which you have a contractual responsibility to insure. This includes building fixtures, machinery and equipment. 22. Transit Property in the Care of Carriers for Hire The following Additional Coverage is added: We will pay up to $10,000 in any one occurrence as a Limit of Insurance to apply to direct physical loss of or physical transit at your risk. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst addition to any other Limit of Insurance that may be provided by this policy for this coverage. This Additional Coverage is subject to the provisions of Transit Property in the Care of Carriers for Hire, Form SS 04 30, with the exception of the Limit of Insurance provision contained in that form. Transit Property in the Care of Carriers for Hire, Form SS 04 30 is made a part of this policy whether or not Transit Property in the Care of Carriers for Hire is indicated in the Declarations. 23. Unauthorized Business Card Use The following Additional Coverage is added: The maximum we will pay in any one occurrence is $2,500 as a Limit of Insurance to cover loss resulting from the theft or unauthorized use of your Business Credit, Debit or Charge Cards, including the reasonable legal expenses you incur. The Business Credit, Debit or Charge Cards must be issued to you or registered in your name or the business name and be used solely for business purposes. Limitation. We will not pay for the theft or unauthorized use of Business Credit, Debit or Charge Cards entrusted to others or your employees. 24. Valuable Papers and Records The following Additional Coverage is added: a. We will pay up to $25,000 in any one occurrence as a Limit of Insurance to apply at each "scheduled premises" to cover direct physical loss of or physical damage to your valuable papers and records. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. b. We will pay up to $25,000 in any one occurrence as a Limit of Insurance to cover direct physical loss of or physical damage to your valuable papers and records that are not located at the "scheduled premises" or in transit. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. This Additional Coverage is subject to the provisions of the Valuable Papers and Records Coverage, Form SS 04 47, with the exception of the Limit of Insurance provision contained in that form. Valuable Papers and Records Coverage, Form SS 04 47 is made a part of this policy whether or not Valuable Papers and Records coverage is indicated in the Declarations. Form SS 04 11 09 07 B. The following changes apply to the Standard Property Coverage Form, Coverage Extensions, A.5., or to the Special Property Coverage Form, Coverage Extensions, A.6.. The Limits of Insurance stated in the paragraphs below replace the Limits of Insurance stated in the Standard Property Coverage Form or the Special Property Coverage Form for the coverages provided under this section. Except as otherwise stated, any other Limit of Insurance purchased under this policy as an option for the following coverages is in addition to the Limit of Insurance stated below: 1. Newly Acquired or Constructed Property The following changes are made to Newly Acquired or Constructed Property: a. Building (1) The most we will pay in any one occurrence in subparagraph (1) is increased from $500,000 to $1,000,000 at each premises. (2) The Limit of Insurance stated above is the maximum Limit of Insurance available for this coverage under this policy. b. Business Personal Property (1) The most we will pay in any one occurrence in subparagraph (2) is increased from $250,000 to $500,000 at each premises. (2) The Limit of Insurance stated above is the maximum Limit of Insurance available for this coverage under this policy. c. Business Income and Extra Expense (1) If Business Income or Extra Expense are provided under this policy, the most we will pay in any one occurrence in subparagraph (3) is increased from $50,000 to $500,000 in any one occurrence at each premises. (2) The Limit of Insurance stated above is the maximum Limit of Insurance available for this coverage under this policy. 2. Outdoor Property In the Outdoor Property Coverage Extension, the most we will pay in any one occurrence is increased to $20,000, but not more than $1,000 for any one tree, shrub or plant. 3. Personal Effects In the Personal Effects Coverage Extension, the most we will pay in any one occurrence is ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst increased from $10,000 to $25,000 at each "scheduled premises." The Limit of Insurance stated above is the maximum Limit of Insurance available for this coverage under this policy. 4. Property Off -Premises In the Personal Property Off -Premises Coverage Extension, the most we will pay in any one occurrence in subparagraph A.6.h.(2) is increased from $2,500 to $15,000. C. The following changes apply only if Business Income and Extra Expenses are covered under this policy. These changes apply to the Standard Property Coverage Form, Additional Coverages, AA., or to the Special Property Coverage Form, Additional Coverages, A.5.: 1. Business Income Extension for Off -Premises Utility Services The following Additional Coverage is added: We will pay up to $25,000 in any one occurrence as a Limit of Insurance to apply at each "scheduled premises" to cover loss of Business Income and Extra Expense caused by or resulting from the interruption of utility services. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. This Additional Coverage is subject to the provisions of Business Income Extension for Off -Premises Utility Services, Form SS 04 19, with the exception of the Limit of Insurance provision contained in that form. Business Income Extension for Off -Premises Utility Services, Form SS 04 19 is made a part of this policy whether or not Business Income Extension for Off -Premises Utility Services coverage is indicated in the Declarations. 2. Business Income Extension for Web Sites The following Additional Coverage is added We will pay up to $10,000 in any one occurrence as a Limit of Insurance to cover loss of Business Income you sustain due to the necessary interruption of business operations caused by direct physical loss of or physical damage to your Web Site operation at the premises of a vendor acting as your service provider. This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. Such interruption must be caused by or result from a Covered Cause of Loss. a. Coverage Time Period We will only pay for loss you sustain during the 7-day period immediately following the first 12 hours after the Covered Cause of Loss. Page 6 of 7 b. Conditions This coverage applies only: (1) If you have a back-up copy of your Web Page stored at a location other than the site of the Web Site vendor. (2) To the extent that Business Income is permanently lost. 3. Business Income from Dependent Properties The following Additional Coverage is added: We will pay for the loss of your Business Income and Extra Expense due to direct physical damage at the premises of any dependent property caused by or resulting from a Covered Cause of Loss. The most we will pay under this endorsement for this coverage is $50,000 regardless of the number of dependent properties involved in any one occurrence. This Limit of Insurance is in addition to any other Limit shown in the Declarations for specific Dependent Properties. This additional coverage is subject to the provisions of Business Income from Dependent Properties, Form SS 04 78, with the exception of the Limit of Insurance provision contained in that form. Business Income from Dependent Properties, Form SS 04 78 is made a part of this policy whether or not Business Income from Dependent Properties coverage is indicated in the Declarations. There is no requirement for Dependent Properties to be scheduled for the coverages provided by this Stretch endorsement to apply. 4. Extended Business Income In the Extended Business Income Additional Coverage, paragraph 4J.(1)(b)(ii) of the Standard Property Coverage Form and paragraph 5.r.(1)(b)(ii) of the Special Property Coverage Form are amended to read as follows: (b) 60 consecutive days after the date determined in (a) above. 5. Food Contamination The following Additional Coverage is added: We will pay the actual loss of Business Income and Extra Expense if your 'operations" at any "scheduled premises" are ordered by a government authority to be suspended due to the discovery of or the suspicion of "food contamination". This additional coverage is subject to the provisions of Food Contamination Coverage, Form SS 41 32, with the exception of Paragraph C., Limit of Insurance, which is deleted and replaced by the folio ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst The most we will pay under this Additional Coverage, regardless of the number of occurrences or locations involved in any one order by a governmental authority is $25,000. This Limit of Insurance is in addition to any other Limit shown in the Declarations for Food Contamination Coverage. Food Contamination Coverage, Form SS 41 32 is made a part of this policy whether or not Food Contamination Coverage is indicated in the Declarations. D. The following Additional Coverage only applies if your policy is written with the Special Property Coverage Form. 1. Money and Securities Paragraph A.5.i.(3) is deleted and replaced with the following: (3) The most we will pay for loss in any one occurrence is: (a) $10,000 for Inside the Premises for "money" and "securities" while: (i) In or on the "scheduled premises"; or (ii) Within a bank or financial institution; and (b) $10,000 for loss Outside the Premises for "money" and "securities" while anywhere else. Form SS 04 11 09 07 This Limit of Insurance is in addition to any other Limit of Insurance that may be provided by this policy for this coverage. E. The following changes apply to Paragraph E.5.d., Loss Payment, of the Standard Property Coverage Form and the Special Property Coverage Form: 1. Valuation Changes The following are added to the Loss Payment Property Loss Condition E.5.d.: (10)Commodity Stock We will determine the value of merchandise and raw materials that are bought and sold at an established market exchange. We will determine the value at: (a) The posted market price as of the time and place of loss; (b) Less discounts and expenses you otherwise would have had. (11)"Finished Stock" We will determine the value of goods that you have manufactured at the selling price less discounts and expenses you otherwise would have had. (12)Mercantile Stock - Sold We will determine the value of goods you have sold but not delivered at the selling price less discounts and expenses you otherwise would have had. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS INCOME EXTENSION FOR OFF -PREMISES UTILITY SERVICES This endorsement modifies insurance provided under the following: SPECIAL PROPERTY COVERAGE FORM This insurance applies only when Business Income and Extra Expense is shown in the Declarations as applicable. Except as otherwise stated in this endorsement, the terms and conditions of the policy apply to the insurance stated below. A. BUSINESS INCOME EXTENSION FOR OFF - PREMISES UTILITY SERVICES This Coverage Extension applies only when the Business Income Additional Coverage is included in this policy. C. LIMIT OF INSURANCE The most we will pay in any one occurrence for loss under this extension is the limit of insurance shown in the Declarations at each "scheduled premises". D. ADDITIONAL DEFINITIONS 1. "Water Supply Services", meaning the following types of property supplying water to the "scheduled premises": We will pay for loss of Business Income or Extra Expense at the "scheduled premises" caused by the 2 interruption of service to the "scheduled premises". The interruption must result from direct physical loss or physical damage by a Covered Cause of Loss to the following property not on "scheduled premises": 1. "Water Supply Services"; 2. "Communication Supply Services"; or 3. "Power Supply Services". B. WAITING PERIOD We will only pay for loss you sustain after the first 12 consecutive hours following the direct physical loss of or physical damage to the off -premises property to which this endorsement applies. We will not pay for any reduction in business income or extra expense after electricity, steam or gas has been restored to the "scheduled premises". Form SS 04 19 04 09 a. Pumping stations; and b. Water mains. "Communication Supply Services", meaning property, including overhead transmission lines supplying communication services, including telephone, radio, microwave or television services, to the "scheduled premises", such as: a. Communication transmission lines, including optic fiber transmission lines; b. Coaxial cables; and c. Microwave radio relays except satellites. 3. "Power Supply Services", meaning the following types of property supplying electricity, steam or gas, including overhead transmission lines to the "scheduled premises": a. Utility generating plants; b. Switching stations; c. Substations; d. Transformers; and e. Transmission Lines. © 2009, The Hartford ew cF RAMwagementDMsian ke/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FINE ARTS This endorsement modifies insurance provided under the following: SPECIAL PROPERTY COVERAGE FORM This insurance applies only when the property is covered under the Special Property Coverage Form. Except as otherwise stated in this endorsement, the terms and conditions of the policy apply to the insurance stated below. The following changes are made to the Special Property Coverage Form: A. Under A. Coverage: 1. The following paragraph is added to 1. Covered Property: Fine Arts listed and described in the Declarations or Schedule which are: a. Owned by you; or b. Owned by others, and in your care, custody and control; and c. Located at the "scheduled premises", or in transit to and from the "scheduled premises", or at your residence. 2. The following is added to Paragraph 2. Property Not Covered with respect to coverage afforded by this endorsement: Property on exhibition at fairgrounds or at any type of exposition, unless such locations are listed and described in the Declarations or Schedule. 3. The following special Limitation provision applies to property covered by this endorsement: Art glass windows, glassware, statuary, marbles, bric-a-brac, porcelains and other articles of fragile or brittle nature are covered against loss by breakage only if loss or damage is caused by "specified causes of loss." 4. Section B. EXCLUSIONS do not apply to coverage afforded under this endorsement, except for: (1) Governmental Action; (2) Nuclear Hazard; and (3) War and Military Action. 5. Additional Exclusions We will not pay for physical loss or physical damage caused by or resulting from: a. Delay, loss of use, loss of market, or any other causes of consequential loss; b. Wear and tear, depreciation or obsolescence; c. Rust, corrosion, fungus, decay, deterioration, hidden or latent defect, or any quality in property that causes it to damage or destroy itself; d. Insects, birds, rodents or other animals. e. Dishonest acts by: (1) You or any of your partners; (2) Your directors or trustees; (3) Your authorized representatives or employees; or (4) Anyone, other than a carrier for hire, to whom you entrusted the Covered Property, including their employees, for any purpose: Whether acting alone or in collusion with others; and Whether or not occurring during the hours of employment. Form SS 04 22 07 05 © 2005, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst f. Voluntary parting with any property whether or not induced to do so by any fraudulent scheme, trick, device or false pretense. g. Unauthorized instructions to transfer property to any person or to any place. h. Theft from any unattended vehicle unless at the time of theft its windows, doors and compartments were closed and locked and there are visible signs that the theft was the result of forced entry. But this exclusion does not apply to property in the custody of a carrier for hire. i. Processing or work performed upon the property. B. Limits of Insurance Section C. LIMITS OF INSURANCE is replaced by the following: The most we will pay for physical loss or physical damage in any one occurrence for property covered under this endorsement is the Limit of Insurance shown in the Declarations for "Fine Arts", but no more than $25,000 for any one item of "Fine Arts". C. Deductible We will adjust loss in any one occurrence under this endorsement as a single loss. The only deductible amount that applies under this coverage is the larger of: 1. $250; or 2. The amount shown in the Declarations as a deductible applicable to this coverage. D. Additional Conditions 1. Valuation The following is added to Section E. PROPERTY LOSS CONDITIONS: The value of Covered Property will be the amount shown in the Declarations or Schedule for each item of Covered Property, which is agreed to be the value of the item. Page 2 of 2 2. Pair or Set In case of total loss to an item of Covered Property which is part of a pair or set, we agree to pay you the full amount of the pair or set as shown in the Declarations or Schedule and you agree to surrender the remaining item(s) of the pair or set to us. 3. Packing You agree that Covered Property will be packed and unpacked by competent packers. E. Additional Definition The following definition is added to Section H. DEFINITIONS: "Fine Arts" meaning paintings, etchings, pictures, tapestries, art glass windows, valuable rugs, statuary, marbles, bronzes, antique furniture, rare books, antique silver, manuscripts, porcelains, rare glass, bric-a-brac, and similar property of rarity, historical value or artistic merit. F. Recovered Property If either you or we recover any property after loss settlement, that party must give the other prompt notice. At your option, you may retain the property. But then you must return to us the amount we paid to you for the property. We will pay recovery expenses and the expenses to repair the Covered Property, subject to the Limit of Insurance. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TRANSIT COVERAGE - PROPERTY IN THE CARE OF CARRIERS FOR HIRE This endorsement modifies insurance provided under the following: SPECIAL PROPERTY COVERAGE FORM Except as otherwise stated in this endorsement the 2. The Transit Coverage — Property in the Care of terms and conditions of the policy and of the Special Carriers for Hire also applies to: Property Coverage Form apply to the insurance stated a. Expenses to Inspect, Repackage and below. Reship Damaged Shipments A. With respect to this Transit Coverage — Property in the Care of Carriers for Hire only, the following changes are made to the Special Property Coverage Form: 1. Under A.4. Limitations, subparagraph c.(3) which limits coverage for patterns, dies, molds and forms, is deleted. 2. Under B. Exclusions a. Exclusions 1.a. (Earth Movement) and 1.f. (Water) do not apply to property in transit. b. Exclusions 2.e. (Dishonesty) and 2.g. (Exposed Property) do not apply to property in custody of a carrier for hire. c. Exclusion 2.f. (False Pretense) does not apply to loss or damage caused by your good faith acceptance of false bills of lading or shipping receipts. d. The following Exclusion is added: We will not pay for physical loss or physical damage caused by or resulting from poor or insufficient packaging or packing. B. Transit Coverage — Property in the Care of Carriers for Hire 1. The insurance that applies to your Business Personal Property and Personal Property of Others is extended to apply to shipments of that property while in transit at your risk, by motor vehicle, railroad car or aircraft between points within the Coverage Territory. This includes property you have sold and for which your responsibility continues until it is delivered. Form SS 04 30 07 05 © 2005, The Hartford The necessary additional expenses you incur to inspect, repackage and reship Covered Property which is physically damaged as a result of a Covered Cause of Loss. b. Expenses to Protect Covered Property from Spoilage or Change in Temperature The necessary additional expense you incur to temporarily store Covered Property in a temperature controlled environment in order to avoid or minimize physical loss or physical damage to such property from spoilage or change in temperature. Such temporary storage must be made necessary by the sudden and accidental breakdown of heating or refrigeration unit(s) on transporting conveyances. This additional expense will not include: (1) Expenses to repair or replace heating or refrigeration unit(s); (2) Costs or penalties due to detention or delay of any vehicles, trailers, conveyances or containers; or (3) Costs for additional wages, room, board or meals. c. F.O.B. Shipments Outgoing shipments where the risk of physical loss or physical damage is transferred to the buyer when such property leaves your premises. You must use collect the amoi. ew cF R'�`�DMsiun Jy/ \'x REVIEWED & APPROVED BY. - I .° --� Rt janagement Analpt before making a claim under this Transit Coverage. We will not make payment until you grant us the right of recovery against the buyer. d. Loading and Unloading Shipments during loading or unloading and within 500 feet of any transporting conveyance. e. Return Shipments Outgoing shipments which have been rejected by the consignee or are not deliverable, while: (1) In due course of transit, being returned to you; or (2) Up to 10 days after delivery or attempted delivery awaiting return shipment to you. Payment under paragraphs a., b., c., d. and e. above will not increase the Transit Coverage Limit of Insurance. C. Under this Transit Coverage — Property in the Care of Carriers for Hire, we will not pay for: 1. Property in the care, custody or control of your salespersons. 2. Mail shipments in the custody of the U.S. Postal Service. 3. Property of Others for which you are responsible as a: a. Carrier for hire; or b. Carloader, consolidator, broker, freight forwarder, shipping association, or other arranger of transportation. 4. Property in or on a motor vehicle you own, lease or operate. D. Limit of Insurance The Limit of Insurance shown in the Declarations for Transit Coverage — Property in the Care of Carriers for Hire is the most we will pay for all physical loss or physical damage in any one occurrence to property insured under this endorsement. Page 2 of 2 E. Deductible We will not pay for physical loss or physical damage in any one occurrence until the amount of physical loss or physical damage exceeds $250. We will then pay the amount of physical loss or physical damage in excess of $250 up to the applicable Limit of Insurance. F. Additional Conditions 1. Valuation Property Loss Condition E.5. is deleted and replaced by the following: a. Valuation (1) Property You Own The value of Covered Property will be the amount of invoice plus accrued charges, prepaid charges and charges since shipment; or (2) In the absence of an invoice, the value of Covered Property will be its actual cash value, with proper deduction for depreciation, at the point of destination on the date of expected arrival. b. Property of Others The most we will pay for Covered Property owned by others is the lesser of: (1) Your legal liability for direct physical loss or physical damage to such property; or (2) What we would pay if you had owned the property. 2. Impairment of Rights of Recovery We will not pay for physical loss or physical damage, if you impair our rights to recover damages from any carrier for hire. But you may accept from carriers for hire bills of lading, receipts or contracts of transportation which contain a limitation of value. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. HIRED AUTO AND NON -OWNED AUTO This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM This coverage is subject to all provisions in the moved from the place where they are BUSINESS LIABILITY COVERAGE FORM not accepted by the "insured" for movement into expressly modified herein: or onto the covered "auto"; or c. After the "pollutants" or any property in A. Amended Coverage: which the "pollutants" are contained are moved from the covered "auto" to the place Coverage is extended to "bodily injury" and where they are finally delivered, disposed of "property damage" arising out of the use of a "hired or abandoned by the "insured". auto and "non -owned auto. Paragraph a. above does not apply to fuels, B. Paragraph B. EXCLUSIONS is amended as lubricants, fluids, exhaust gases or other follows: similar "pollutants" that are needed for or 1. Exclusion g. Aircraft, Auto or Watercraft does result from the normal electrical, hydraulic not apply to a "hired auto" or a "non -owned or mechanical functioning of the covered auto". "auto" or its parts, if: 2. Exclusion e. Employers Liability does not (1) The "pollutants" escape, seep, migrate, apply to "bodily injury" to domestic "employees" or are discharged or released directly not entitled to workers' compensation benefits from an "auto" part designed by its or to liability assumed by the "insured" under an manufacturer to hold, store, receive, or "insured contract". dispose of such "pollutants"; and 3. Exclusion f. Pollution is replaced by the (2) The "bodily injury" and "property following: damage" does not arise out of the "Bodily injury" or "property damage" arising out operation of any equipment listed in of the actual, alleged or threatened discharge, paragraphs 15.b. and 15.c. of the dispersal, seepage, migration, release or definition of "mobile equipment". escape of "pollutants": Paragraphs b. and c. above do not apply to a. That are, or that are contained in any "accidents" that occur away from premises property that is: owned by or rented to an "insured" with (1) Being transported or towed by, handled, respect to "pollutants" not in or upon a "auto" or handled for movement into, onto or covered if: from, the covered "auto"; (1) The "pollutants" or any property in (2) Otherwise in the course of transit by or which the "pollutants" are contained are on behalf of the "insured"; or upset, overturned or damaged as a result of the maintenance or use of a (3) Being stored, disposed of, treated or covered "auto"; and processed in or upon the covered "auto". b. Before the "pollutants" or any property in which the "pollutants" are contained are Form SS 04 38 09 09 e cF RAM&T7Ag'mCYI DMsiOR J_/ ,qq REVIEWED & APPROVED BY: © 2009, The Hartford .. v (Includes copyrighted material of ISO Properties, Inc., with its permiss --_--- Wsk Management Analpt (2) The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage as a result of the maintenance or use of a covered "auto". D. 4. With respect to this coverage, the following additional exclusions apply: a. Fellow employee Coverage does not apply to "bodily injury" to any fellow "employee" of the "insured" arising out of the operation of an "auto" owned by the "insured" in the course of the fellow "employee's" employment. b. Care, custody or control Coverage does not apply to "property damage" involving property owned or transported by the "insured" or in the "insured's" care, custody or control. C. With respect to "hired auto" and "non -owned auto" coverage, Paragraph C. WHO IS AN INSURED is deleted and replaced by the following: The following are "insureds": a. You. b. Your "employee" while using with your permission: (1) An "auto" you hire or borrow; or (2) An "auto" you don't own, hire or borrow in your business or personal affairs; or (3) An "auto" hired or rented by your "employee" on your behalf and at your direction. c. Anyone else while using a "hired auto" or "non - owned auto" with your permission except: (1) The owner or anyone else from whom you hire or borrow an "auto". (2) Someone using an auto while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (3) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from an "auto". (4) A partner (if you are a partnership), or a member (if you are a limited liability Page 2 of 3 company) for an "auto" owned by him or her or a member of his or her household. d. Anyone liable for the conduct of an "insured" described above but only to the extent of that liability. With respect to the operation of a "hired auto" and "non -owned auto", the following additional conditions apply: 1. OTHER INSURANCE a. Except for any liability assumed under an "insured contract" the insurance provided by this Coverage Form is excess over any other collectible insurance. However, if your business is the selling, servicing, repairing, parking or storage of "autos", the insurance provided by this endorsement is primary when covered "bodily injury" or "property damage" arises out of the operation of a customer's "auto" by you or your "employee". b. When this Coverage Form and any other Coverage Form or policy covers on the same basis, either excess or primary, we will pay only our share. Our share is the proportion that the Limit of Insurance of our Coverage Form bears to the total of the limits of all the Coverage Forms and policies covering on the same basis. 2. TWO OR MORE COVERAGE FORMS OR POLICIES ISSUED BY US If the Coverage Form and any other Coverage Form or policy issued to you by us or any company affiliated with us apply to the same "accident", the aggregate maximum Limit of Insurance under all the Coverage Forms or policies shall not exceed the highest applicable Limit of Insurance under any one Coverage Form or policy. This condition does not apply to any Coverage Form or policy issued by us or an affiliated company specifically to apply as excess insurance over this Coverage Form. E. The following definitions are added: G. LIABILITY AND MEDICAL EXPENSES DEFINITIONS: 1. "Hired auto" means any "auto" you lease, hire, rent or borrow. This does not include any auto you lease, hire, rent or borrow from any of your "employees", your partners (if you are a partnership), members (if you are a limited liability company), ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst or your "executive officers" or members of their households. This does not include a long-term leased "auto" that you insure as an owned "auto" under any other auto liability insurance policy or a temporary substitute for an "auto" you own that is out of service because of its breakdown, repair, servicing or destruction. 2. "Non -owned auto " means any "auto" you do not own, lease, hire, rent or borrow which is used in connection with your business. This includes: a. "Autos" owned by your "employees" your partners (if you are a partnership), members (if you are a limited liability company), or your "executive officers", or members of their households, but only while used in your business or your personal affairs. b. Customer's "auto" that is in your care, custody or control for service. Form SS 04 38 09 09 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ACCOUNTS RECEIVABLE This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM This coverage applies only when it is indicated in the Declarations. The provisions of this policy apply to the coverage stated in this endorsement, except as indicated below. A. When shown in the Declarations as applicable, the Limit of Insurance stated in paragraph A.5.a.(1), Accounts Receivable, in the Standard Property Coverage Form and A.6.a.(1), Accounts Receivable, in the Special Property Coverage Form is replaced by the Limit of Insurance for Accounts Receivable shown in the Declarations. All other terms and conditions of the Accounts Receivable Coverage Extension apply to this Optional Coverage. B. Limit of Insurance The most we will pay under this coverage extension in any one occurrence is the Limit of Insurance shown in the Declarations for Accounts Receivable. C. Deductible D. Additional Conditions (1) If you cannot accurately establish the value of accounts receivable outstanding as of the time of direct physical loss or physical damage the following method will be used: (a) Determine the total of the average monthly value of accounts receivable for the 12 months immediately preceding the month in which the direct physical loss or physical damage occurred; and (b) Adjust that total for any normal fluctuations in the value of accounts receivable for the month in which the direct physical loss or physical damage occurred or for any demonstrated variance from the average for that month. (2) The following will be deducted from the total value of accounts receivable, however that value is established: We will not pay for loss in any one occurrence (a) The value of the accounts for which there is unless the amount of loss exceeds the policy no loss or damage; deductible stated in the Declarations. We will then (b) The value of the accounts that you are able pay the amount of loss in excess of the Deductible, to reestablish or collect; up to the Limit of Insurance. (c) A value to allow for probable bad debts that you are normally unable to collect; and (d) All unearned interest and service charges. ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY. - Form SS 04 39 07 05 Is © 2005, The Hartford `----' WskPjana9ementAnalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMPUTERS AND MEDIA This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM The provisions of this policy apply to the coverage (2) Power Failure; stated in this endorsement, except as indicated below. (3) Airport security check, or radio or A. Computer Equipment, Electronic Data and telephone line interference; or Software (4) Electromagnetic disturbance outside 1. Coverage the "computer system". We will pay for direct physical loss of or b. Head crash, meaning physical damage to physical damage, to "computer equipment" disks, tapes or hardware caused by a and the cost to research, replace or restore contact of electromagnetic heads (which physically lost or physically damaged read or write information) with such disks "electronic data" and "software" subject to the or tapes; Limit of Insurance shown in the Declarations c. Damage caused by a "computer virus"; for Computers and Media while anywhere and within the coverage territory, and while in d. Theft of "computer equipment" away from transit, but only if: the "scheduled premises". Theft means a. Owned by you; or an act of stealing or an attempt to steal. b. Owned by others but in your care, custody Theft includes loss of property from a and control regardless of whether you use known place when it is likely that the it for personal or business needs. property has been stolen. 2. Property Not Covered 4. Exclusion "Computer Equipment" as used in this optional We will not pay to research, replace or restore coverage does not include: physically lost or physically damaged electronic data or software which is a. Source documents, other than manuals licensed, leased or rented to others. purchased with hardware or "software"; 5. Deductible b. Worksheets and printouts; We will not pay for loss or damage in any one c. Property held for sale or lease; occurrence to "computer equipment" until the d. Property leased or rented to others; or amount of loss or damage exceeds $250, e. "Money", deeds, notes, "securities" or unless a separate deductible is stated in the other financial instruments, including such Declarations for Computers and Media instruments in electronic form. Coverage. 3. Extended Causes of Loss B. Additional Coverage Direct physical loss or physical damage to your 1. Business Income and Extra Expense "computer equipment", "electronic data" or Coverage "software", or "computer equipment", If Business Income and Extra Expense "electronic data" or "software" of others in your Coverage is included in this policy then the care, custody or control is extended to include following applies. the following: a. Coverage a. Electromagnetic injury caused by: (1) Blackout or brownout; Form SS 04 41 03 18 © 2018, The Hartford (1) Coverage under this endorsement applies t cF RAMwagementDMsian 1'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst Coverages and Coverage Extensions in the Standard or Special Property Coverage Form with respect to "computer equipment", "electronic data" and "software": (a) Business Income; (b) Extra Expense; (c) Civil Authority; (d) Extended Business Income; and (e) Newly Acquired or Constructed Property Coverage. (2) Coverage under this endorsement does not apply to any other Additional Coverage or Coverage Extension. b. Coverage Limitations The following limitations apply only if the physical loss or physical damage is a direct result of the Extended Causes of Loss for "computer equipment", "software" and "electronic data" as indicated below. (1) Limit of Insurance This Additional Coverage is included in the Limit of Insurance for Computers and Media shown in the Declarations when the actual loss of business income and extra expense you incur due to the necessary suspension (slowdown or cessation) of your operations is a result of: (a) A cause of loss included in A.3.a., b. or c., Extended Causes of Loss, of this endorsement; or (b) Physical damage or physical loss to "computer equipment", "electronic data", and "software" that was away from the scheduled premises at the time of loss. This is not an additional limit of insurance. (2) Waiting Period We will not pay for any covered Business Income loss you sustain under this provision due to physical loss or physical damage to "electronic data", or "software" caused by a "computer virus" which results in the necessary suspension (slowdown or cessation) of your business described in the Declarations during the first 12 hours that immediately follow the start of such suspension. This Waiting Period applies independent of the deductible applicable to "Computer Equipment". 2. Equipment Breakdown Coverage The Additional Coverage for Equipment Breakdown applies to "computer equipment", Page 2 of 3 "electronic data", and "software" when this endorsement is attached to the Special Property Coverage Form and Equipment Breakdown Additional Coverage is included on the policy. C. Exclusion of Certain Computer Related Losses The provisions of this endorsement do not override or in any way affect the application of the Exclusion of Certain Computer Related Losses if such exclusion is endorsed to or otherwise made a part of this policy. That exclusion addresses the inability of a "computer system" to correctly recognize process, distinguish, interpret or accept one or more dates or times. D. Exclusions 1. Section B. Exclusions, of the Standard or Special Property Coverage Form do not apply to coverage provided by this endorsement, except for the exclusions of: a. Earth Movement; b. Governmental Action; c. Nuclear Hazard; d. War and Military Action; and e. Water. 2. Additional Exclusions We will not pay for loss or damage caused by or resulting from: a. Input, programming or processing errors; b. Mechanical breakdown or failure, however head crash will not be considered as a mechanical breakdown or failure. This exclusion does not apply to "computer equipment", "electronic data", and "software" when this endorsement is attached to the Special Property Coverage Form and Equipment Breakdown Additional Coverage is included on the policy; c. Faulty construction, materials or workmanship; d. Error, omission or deficiency in design; e. Rust, corrosion, deterioration, hidden or latent defect or any quality in property that causes it to damage or destroy itself; f. Dryness or dampness of atmosphere; changes in or extremes of temperature; g. Wear and tear, marring or scratching; h. Insects, birds, rodents, or other animals; i. Obsolescence; j. Dishonest or criminal acts by you, any of your partners, employees, trustees, authorized representatives or anyone to whom you e purpose, wh collusion with ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst k. Unexplained disappearance, however we will cover theft of "computer equipment" as provided in provision A.3.d.; I. Unlawful trade, or seizure by orders of governmental authority; m. Delay or loss of market; and n. Theft of laptop, palmtop or similar portable property while in transit as checked baggage. E. Limit of Insurance The most we will pay for physical loss or physical damage in any one occurrence is the Limit of Insurance for Computers and Media shown in the Declarations. F. Loss Payment This Loss Payment condition is applicable to the "computer equipment", "electronic data", and "software" coverage provided by this endorsement. We will determine the value of Covered Property as follows: "Computers," "peripheral devices", "media", and manuals at the full cost to repair or replace the property subject to the Limit of Insurance. However, we will not pay more for physical loss or physical damage on a replacement cost basis than the lesser of and the following: a. The amount necessary to replace the item with similar property possessing the minimum characteristics necessary to perform the same functions when replacement with identical property is not possible or practical. b. The amount necessary to repair or replace the item with one substantially identical to the physically lost or physically damaged item. In the event of a covered total loss to one or more items, we will allow up to 20% over the current replacement cost as described in this provision, as an Optional Upgrade Allowance for the purchase of new Form SS 04 41 03 18 property with upgraded processing or performance characteristics. This Optional Upgrade Allowance will, at our option, be payable after you have purchased the replacement property and have provided us with written proof of such purchases; or c. If the item is not repaired or replaced, we will not pay more than the actual cash value of the item at the time of physical loss or physical damage. If you elect this option, you have the right to make further claim within 180 days after loss for any additional payment on a replacement cost basis. 2. In the event of physical loss or physical damage to "electronic data" or "software", we will pay the reasonable amount you actually spend to reproduce, restore, or replace the physically lost or physically damaged "electronic data" or "software". This includes the cost of computer consultation services for restoration and the cost of research to reconstruct lost or damaged information. But we will not pay more than the Limit of Insurance for Computers and Media specified in the Declarations. 3. In the event of physical loss or physical damage to any part of "computer equipment", "electronic data" or "software", we will pay only what it would cost to replace, reproduce, or restore the physically lost or physically damaged part. G. Additional Definitions 1. "Computer Virus" means a program, which is intentionally created to cause damage or disruption in the computer operations of a party using or coming in contact in any way with the program. 2. "Computer System" includes "computer", "peripheral devices", "software", and "electronic data" necessary for the "computer" to function for its intended purpose. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYEE DISHONESTY COVERAGE This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the policy apply to the insurance stated below. A. COVERAGE 1. The following is added to Paragraph A.5., Additional Coverages, of the Special Property Coverage Form: Employee Dishonesty Coverage (1) We will pay for loss of, and loss from damage to, Covered Property resulting directly from the Covered Causes of Loss. Covered Property, solely as used in this Additional Coverage, means "money", "securities", and other tangible property of intrinsic value and not otherwise excluded. Covered Causes of Loss means dishonest acts committed by an "employee", except you, whether identified or not, acting alone or in collusion with other persons, with the manifest intent to: (a) Cause you to sustain loss; and also (b) Obtain financial benefit (other than salaries, commissions, fees, bonuses, promotions, awards, profit sharing or pensions or other employee benefits earned in the normal course of employment) for: (i) That "employee"; or (ii) Any person or organization intended by the "employee" to receive that benefit. (2) Employee Dishonesty Additional Coverages: (a) We will pay for loss of Covered Property arising out of a Covered Form SS 04 42 03 17 © 2017, The Hartford Cause of Loss caused by any "employee" while temporarily outside the Coverage Territory for a period of not more than 90 days. (b) We will pay for any loss of Covered Property arising out of a Covered Cause of Loss caused by your "employee" while at the premises of your client or customer. Any claim for loss sustained by any client or customer and covered by this policy may only be made by you in your Proof of Loss. No third party has a direct right against this insurance and no third party may make a direct claim against us as the writer of your insurance. (3) Coverage under the Employee Retirement Income Security Act of 1974, as amended ("ERISA") (a) We will pay for loss of, and loss from damage to, Covered Property resulting directly from the Covered Causes of Loss. Covered Property, solely as applicable to ERISA coverage, means the funds or other property of any employee pension benefit plan or employee welfare benefit plan that: (i) Is subject to (and not exempt from) the bond requirement set forth in Section 412 of ERISA, and (ii) You establish and maintain for your employees (a "Plan") and which is not otherwise excluded. applicab cF RAMmWmentDMsian Jy/ \'x REVIEWED & APPROVED BY.- V"° --� Risk Pjanagement Analyst means an act of fraud or dishonesty committed by an "employee", except you, whether identified or not, acting alone or in collusion with other persons, that results in a loss to a Plan of funds or other property which is used or may be used to pay benefits under the Plan. "Covered Causes of Loss" does not include investment losses or any other loss resulting from a breach of fiduciary duty under ERISA or a prohibited transaction as defined by ERISA and for which coverage is not required by Section 412 of ERISA. (b) Welfare and Pension Plan ERISA Compliance In compliance with certain provisions of the ERISA: (i) For the purposes of this insurance, the Plans you establish and maintain for the benefit of your employees shall be Named Insureds under this Employee Dishonesty Coverage. (ii) "Employee" includes any natural person you employ and any owner, officer, trustee or director of your company who "handles" the funds or other property of the Plan (as defined in 29 C.F.R. 2580.412-6) including, but not limited to, the Plan Administrator. "Employee" does not include any third party (including but not limited to a broker, independent contractor, record keeper, payroll provider, trustee or other fiduciary) who provides services to you or to a Plan. (iii) If any Plan is insured jointly with any other entity under this insurance, you or the Plan Administrator must select a Limit of Insurance under this Employee Dishonesty Coverage Form that is sufficient to provide an amount of insurance for each Plan that is at least equal to that required if each Plan were separately insured. (iv) If the insured first named in the Declarations is an entity other than a Plan, any payment we make to that insured for loss sustained by any Plan must be Page 2 of 3 paid promptly into such plan for the use and benefit of the Plan(s) sustaining the loss. (v) If two or more Plans are insured under this insurance, any payment we make for loss either sustained by two or more plans, or of commingled funds or other property of two or more Plans that arises out of one occurrence, is to be shared by each Plan sustaining loss in the proportion that the amount of insurance required for each such Plan under ERISA provisions bears to the total of those amounts. (4) Theft Limitation Exception Limitation AA.c., of the Special Property Coverage Form does not apply to coverage provided by this endorsement. (5) Additional Exclusions (a) Employee Terminated Under Prior Insurance We will not pay for loss caused by any "employee" of yours, or predecessor in interest of yours, for whom similar prior insurance has been terminated and not reinstated since the last such termination. (b) Insurance Operations We will not pay for direct or indirect loss resulting from contractual or extra -contractual liability sustained by you in connection with the issuance of contracts or purported contracts of insurance, indemnity or suretyship. (c) Inventory Shortages We will not pay loss, or that part of any loss, the proof of which as to its existence or amount is dependent upon: (i) An inventory computation; or A profit and loss computation (d) Partners We will pay only for loss caused by any partner or member of a limited liability corporation that is in excess of the sum of: (i) Any amounts you owe that partner or member; and he value of that partner's or enN ete ew cF RAMwagzmentDMsian Jy/ \'x REVIEWED & APPROVED BY. - I .° --� Rt janagement Analpt you organization's books on the date of discovery of the loss by anyone in your organization not involved in the Employee Dishonesty; and (iii) Any applicable deductible amount. (e) Trading Loss We will not pay for loss resulting directly or indirectly from trading, whether in your name or in a genuine or fictitious account if such loss does not result from dishonesty or fraud. (6) Additional Conditions (a) Termination As To Any "Employee" This insurance is terminated as to any "employee": (i) Immediately upon discovery by you, or any of your partners, officers or directors not in collusion with the "employee", of any dishonest or fraudulent act committed by that "employee" whether before or after becoming employed by you; or (ii) On the date specified in a notice mailed to you. That date will be at least 30 days after the date of mailing. The mailing of notice to you at the last mailing address known to us will be sufficient proof of notice. Delivery of notice is the same as mailing. Form SS 04 42 03 17 (7) Limit of Insurance The most we will pay for each occurrence of loss under this Additional Coverage is the Employee Dishonesty Limit of Insurance stated in the Declarations. (8) Deductible We will not pay for loss in any one occurrence unless the amount of loss exceeds the Deductible shown Paragraph D.5. the Special Property Coverage Form, unless a separate Deductible for Employee Dishonesty applies and is stated in the Declarations. We will then pay the amount of the loss in excess of the Deductible, up to the Limit of Insurance. No deductible applies to the coverage granted in Paragraph A.1.(3) of this endorsement. (9) Occurrence Definition As used in this Additional Coverage, occurrence means all loss caused by, or involving, one or more "employees", whether the result of a single act or series of acts. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM This coverage applies only when it is indicated in the Declarations. The provisions of this policy apply to the coverage stated in this endorsement, except as indicated below. A. We will pay for direct physical loss of or physical damage to all outdoor signs at the "scheduled premises": (1) Owned by you; or (2) Owned by others but in your care, custody and control. B. Paragraph A.3., Covered Causes of Loss, and Section B., Exclusions, do not apply, to this Optional Coverage, except for: (1) Governmental Action; (2) Nuclear Hazard; and (3) War and Military Action. Form SS 04 44 07 05 C. Additional Exclusion We will not pay for physical loss or physical damage caused by or resulting from: (1) Wear and tear; (2) Hidden or latent defect; (3) Rust; (4) Corrosion; or (5) Mechanical breakdown. D. Limit of Insurance The most we will pay for physical loss or physical damage in any one occurrence is the Limit of Insurance for Outdoor Signs shown in the Declarations. E. The provisions of this Optional Coverage supersede all other references to outdoor signs in this policy. © 2005, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PERSONAL PROPERTY OF OTHERS This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM This coverage applies only when it is indicated in the Declarations. The provisions of this policy apply to the coverage stated in this endorsement, except as indicated below. We will pay, on replacement cost basis, for direct physical loss or physical damage by a Covered Cause of Loss to Personal Property of Others that is in your care, custody and control. The most we will pay for direct physical loss or physical damage in any one occurrence is the Limit of Insurance applicable to Personal Property of Others shown in the Declarations. ew cF RAManagementDMsian Form SS 04 45 07 05 J_/ ``x REVIEWED & APPROVED BY.- ., . V © 2005, The Hartford ` —�Y` Wsk Pjanagement Analpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEMPERATURE CHANGE This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM This coverage applies only when it is indicated in the Declarations. The provisions of this policy apply to the coverage stated in this endorsement, except as indicated below. A. We will pay for direct physical loss of or physical damage to "perishable stock" at the "scheduled premises" caused by or resulting from: 1. A change in temperature or humidity resulting from: (a) Mechanical breakdown or failure of: (1) Stationary heating plants; or (2) Refrigerating, cooling or humidity control apparatus or equipment; But only while such plants, equipment or apparatus are at the "scheduled premises". (b) Complete or partial failure of electric power, either on or away from your "scheduled premises". Such failure of power must be due to conditions beyond your control; or 2. Contamination by a refrigerant. B. SELLING PRICE We will determine the value of finished "perishable stock" in the event of direct physical loss or physical damage at the selling price, as if no physical loss or physical damage had occurred less discounts and expenses you otherwise would have had. C. We will not pay for direct physical loss of or physical damage to "perishable stock" located: 1. On buildings; 2. In the open; or 3. In vehicles, other than trailers used for storage located within 1000 feet of the "scheduled premises'. D. EXCLUSIONS 1. The following exclusions under SECTION B - EXCLUSIONS are deleted: (a) Ordinance or Law; (b) Power Failure; and (c) Mechanical Breakdown in the Standard Property Coverage Form. 2. The following exclusions are added: We will not pay for direct physical loss or physical damage caused by or resulting from: (a) The disconnecting of any of the following systems from the source of power: (1) Refrigerating; (2) Cooling; or (3) Humidity control. (b) The loss of electrical power caused by the shutting off of any switch or other device used to control the flow of electric power or current. (c) The inability of an electrical utility company, your stationary heating plant or any other power source to provide sufficient heat or power due to: (1) Lack of fuel; (2) Lack of capacity to make enough heat or power; or (3) Order of the government. (d) Breaking of any glass that is a permanent part of a refrigerating, cooling or humidity control unit. E. DEDUCTIBLE We will not pay for loss in any one occurrence unless the amount of loss exceeds the deductible stated in paragraph D.5. of the Standard Property Coverage Form or D.5. of the Special Property Coverage Form., unless a different deductible is stated in the Form SS 04 46 09 14 © 2014, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst Declarations for Temperature Change. We will then pay the amount of loss in excess of the deductible, up to the Limit of Insurance. F. LIMIT OF INSURANCE The most we will pay for direct physical loss or physical damage in any one occurrence is the Limit of Insurance for Temperature Change shown in the Declarations. G. ADDITIONAL CONDITIONS 1. We will pay for direct physical loss or physical damage under this Optional Coverage only when: (a) Such physical loss or physical damage is not covered elsewhere in this policy or any other policy that insures the "perishable stock" at the "scheduled premises"; and (b) This Temperature Change coverage is shown as a specific item of insurance in the Declarations. 2. In the event of physical loss or physical damage, none of the other coverages under this policy or any other policy will share in its payment unless the provisions of the policy are similar to the provisions of this Optional Coverage. 3. We will not pay more than the Limit of Insurance shown in the Declarations for the Temperature Change. Page 2 of 2 H. ADDITIONAL DEFINITIONS For the purpose of this insurance: 1. "Mechanical breakdown" means: (a) Breaking or separation of any mechanical part(s) other than gas pipes or lines; or (b) Burning out of any electrical motor servicing such unit; and requiring replacement of the damaged parts to become functional. But "mechanical breakdown" does not mean faulty operation or failure of equipment which results in temperature change but does not require replacement of broken parts. We will not pay for direct physical loss or physical damage to "perishable stock" caused by such faulty operation or failure of equipment. 2. "Perishable stock" means personal property: (a) Maintained under controlled conditions for its preservation; and (b) Susceptible to direct physical loss or physical damage if the controlled conditions change. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VALUABLE PAPERS AND RECORDS This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM This coverage applies only when it is indicated in the D. Declarations. The provisions of this policy apply to the coverage stated in this endorsement, except as indicated below. A. We will pay for direct physical loss of or physical damage to the following types of property at the "scheduled premises" that is your property or property of others in your care, custody or control: Valuable Papers and Records, meaning inscribed, E. printed or written: (1) Documents; (2) Manuscripts; (3) Records including patient records; or (4) X-Rays including abstracts, books, deeds, drawings, films, maps or mortgages. But Valuable Papers and Records does not include: (1) Property that cannot be reproduced, replaced or restored; (2) "Money" and "Securities"; (3) Converted data; or (4) Programs or instructions used in your data processing operations, including the material on which the data is recorded. F B. Limit of Insurance The most we will pay for direct physical loss or physical damage in any one occurrence is the Limit of Insurance for Valuable Papers and Records shown in the Declarations. G. C. Deductible We will not pay for loss in any one Occurrence unless the amount of loss exceeds the policy deductible stated in the Declarations. We will then pay the amount of loss in excess of the Deductible, up to the Limit of Insurance. Under this Optional Coverage we will not pay for property: (1) Held as samples or for delivery after sale; (2) In storage away from the premises shown in the Declarations; or (3) If such property can not be replaced with other property of like kind and quality. With respect to this Optional Coverage, Coverage Extension A.5.h., Property Off -Premises in the Standard Property Coverage Form and Coverage Extension A.6.h., Property Off -Premises in the Special Property Coverage Form are replaced by the following: 1. You may apply the insurance provided under this Optional Coverage to Valuable Papers and Records while such property is not at the "scheduled premises", including while in transit. The most we will pay for direct physical loss or physical damage under this Coverage Extension is 25% of the Limit of Insurance shown in the Declarations for Valuable Papers and Records but not more than $25,000. 2. However, if Valuable Papers and Records — Off - Premises is scheduled in the Declarations, then the limit in E.1. above is replaced by the limit of insurance shown in the Declarations for Valuable Papers and Records — Off -Premises. The Valuable Papers and Records Coverage Extension, paragraph A.5.i. in the Standard Property Coverage Form and paragraph A.6.i. in the Special Property Coverage Form., do not apply to any premises where this Optional Coverage applies. With respect to coverage provided by this endorsement, paragraph E.5.d.(6) in the Standard Property Coverage Form and in the Special Property Coverage Form are replaced by the following: (6) We will determine the value of "Valuable Papers and Records" at the cost of: a Form SS 04 47 04 09 © 2009, The Hartford Blank materials for reproducing the records; and ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst b. The reasonable cost to research, replace or restore the lost information. H. Section B. Exclusions does not apply to this Optional Coverage except for: (1) Governmental Action; (2) Nuclear Hazard; and (3) War and Military Action. I. Additional Exclusions We will not pay for direct physical loss or physical damage caused by or resulting from any of the following: (1) Dishonest acts by: (a) You, or your employees or authorized representatives; (b) Anyone else with an interest in the property, or their employees or authorized representatives; or Page 2 of 2 (c) Anyone else to whom the property is entrusted. This exclusion applies whether or not such persons are acting alone or in collusion with other persons or such acts occur during the hours of employment. But this exclusion does not apply to a carrier for hire. (2) Errors or omissions in processing or copying. But we will pay for direct physical loss or physical damage caused by resulting fire or explosion. (3) Electrical or magnetic injury, disturbance or erasure of electronic recordings. But we will pay for direct physical loss or physical damage caused by lightning. (4) Voluntary parting with any property by you or anyone entrusted with the property if induced to do so by any fraudulent scheme, trick, device or false pretense. (5) Unauthorized instructions to transfer property to any person or to any place. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CRIME COMMON CONDITIONS AND EXCLUSIONS This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM The following conditions are added the Standard Property 3. Joint Insured Coverage Form and the Special Property Coverage a. If more than one Insured is named in the Form. Declarations, the first named Insured will act A. CRIME COMMON CONDITIONS for itself and for every other Insured for all 1. Consolidation - Merger purposes of this insurance. If the first named Insured ceases to be covered, then the next If through consolidation or merger with, or named Insured will become the first named purchase of assets of, some other entity: Insured. a. Any additional persons become "employees" ; b. If any Insured or partner or officer of that or Insured has knowledge of any information b. You acquire the use and control of any relevant to this insurance, that knowledge is additional premises; considered knowledge of every Insured. any insurance afforded for "employees" or c. An "employee" of any Insured is considered to premises also applies to those additional be an "employee" of every Insured. "employees" and premises, but only if you: d. If this insurance or any of its coverages is (1) Give us written notice within 60 days canceled or terminated as to any Insured, loss thereafter; and sustained by that Insured is covered only if (2) Pay us an additional premium. discovered no later than one year from the date of that cancellation or termination. 2. Discovery Period for Loss e. We will not pay more for loss sustained by We will pay only for covered loss discovered no more than one Insured than the amount we later than one year from the end of the policy would pay if all the loss had been sustained period. by one Insured. Discovery of loss occurs when you first become 4. Legal Action Against Us aware of facts which would cause a reasonable person to assume that a loss covered by this The following replaces the Legal Action Against Us policy has been, or may be incurred even though in the Property Loss Conditions: the exact amount or the details of the loss may not No one may bring a legal action against us under then be known. this Coverage Part unless: Discovery also occurs when you receive notice of a. There has been full compliance with all of the an actual or potential claim against you alleging terms of this Coverage Part; and facts, which if true, would be a covered loss under b. The action is brought within 2 years after the this policy. date on which you discover the loss . Form SS 04 80 03 00 © 2000, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v --� Risk Pjanagement Analyst 5. Loss Sustained During Prior Insurance a. If you, or any predecessor in interest, sustained loss during the period of any prior insurance that you or the predecessor in interest could have recovered under that insurance except that the time within which to discover loss had expired, we will pay for it under this insurance, provided: (1) This insurance became effective at the time of cancellation or termination of the prior insurance; and (2) The loss would have been covered by this insurance had it been in effect when the acts or events causing the loss were committed or occurred. b. The insurance under this Condition is part of, not in addition to, the Limits of Insurance applying to this insurance and is limited to the lesser of the amount recoverable under: (1) This insurance as of its effective date; or (2) The prior insurance had it remained in effect. 6. Non -Cumulation of Limit of Insurance Regardless of the number of years this insurance remains in force or the number of premiums paid, no Limit of Insurance cumulates from year to year or period to period. 7. Loss Covered Under This Insurance and Prior Insurance Issued by Us or Any Affiliate If any loss is covered under this policy and under any prior canceled or terminated insurance that we or any affiliate had issued to you or any predecessor in interest, we will not pay more that the highest single Limit of Insurance. We will settle such claim as follows: a. We will first pay the Limit of Insurance applicable under this policy subject to this policy's applicable deductible; then b. If the Limit of Insurance under that prior policy is equal to or less than the Limit of Insurance under this policy, we will make no further payment; or c. If the Limit of Insurance under that prior policy is higher than the Limit of Insurance under this policy, we will then pay for any remaining part of the loss. But in no event will our total payment for loss be more than would be payable under the policy with the highest Limit of Insurance. Page 2 of 3 We will also apply any deductible under that prior policy to the extent it exceeds the deductible under this policy. 8. Ownership of Property, Interests Covered The property covered under this insurance is limited to property: a. That you own or hold; or b. For which you are legally liable. However, this insurance is for your benefit only. It provides no rights or benefits to any other person or organization. 9. Policy Period a. The Policy Period is stated in the Declarations. b. Subject to the Loss Sustained During Prior Insurance condition, A.5. above, we will pay only for loss that you sustain through acts committed or events occurring during the Policy Period. 10. Recoveries The following replaces the Recovered Property in the Property Loss Conditions: a. Any recoveries less the cost of obtaining them, made after settlement of loss covered by this insurance will be distributed as follows: (1) To you, until you are reimbursed for any loss that you sustain that exceeds the Limit of Insurance and the Deductible Amount, if any; (2) Then to us, until we are reimbursed for the settlement made; (3) Then to you, until you are reimbursed for that part of the loss equal to the Deductible Amount, if any. b. Recoveries do not include any recovery: (1) From insurance, suretyship, reinsurance, security or indemnity taken for our benefit; or (2) Of original "securities" after duplicates of them have been issued. B. CRIME COMMON EXCLUSIONS The following are Exclusions replace the Exclusions in Section B: 1. Governmental Action We will not pay for loss resulting from seizure or destruction of property by order of governmental authority. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v --� Risk Pjanagement Analyst 2. Indirect Loss We will not pay for loss that is an indirect result of any act or occurrence covered by this insurance including, but not limited to, loss resulting from: a. Your inability to realize income that you would have realized had there been no loss of, or loss from damage to, Covered Property. b. Payment of damages of any type for which you are legally liable. But, we will pay compensatory damages arising directly from a loss covered under this insurance. c. Payment of costs, fees or other expenses you incur in establishing either the existence or the amount of loss under this insurance. 3. Legal Expenses We will not pay for expenses related to any legal action. 4. Nuclear Hazard We will not pay for loss resulting from nuclear reaction, nuclear radiation or radioactive contamination, or any related act or incident. 5. War and Similar Actions We will not pay for loss resulting from war, whether or not declared, warlike action, insurrection, rebellion or revolution, or any related act or incident. C. CRIME COMMON DEFINTIONS The following is added to Definitions "Employee" means: 1. Any natural person: a. While in your service (and for 60 days after termination of service); and b. Whom you compensate directly by salary, wages or commissions; and c. Whom you have the right to direct and control while performing services for you; 2. Any natural person employed by an employment contractor while that person is subject to your direction and control and performing services for you excluding, however, any such person while having care and custody of property outside the premises; Form SS 04 80 03 00 3. Any natural person who is your partner or member of a limited liability corporation. 4. Any natural person, whether or not compensated, while performing services for you as the chairman or a member of any committee; 5. Any natural person who is a non -compensated officer; 6. Any natural person who is a director or trustee while acting as a member of any of your elected or appointed committees or while acting within the scope of the usual duties of an "employee"; 7. Any natural person who is a non-compens ated volunteer, other than one who is a fund solicitor, while performing services for you that are usual to the duties of an "employee"; 8. Any natural person who is a former employee, director, partner, member, representative or trustee retained as a consultant while performing services for you; 9. Any natural person who is a student intern who is pursuing studies or acting within the scope of the usual duties of an "employee" ; 10. Any natural person, who is a student enrolled in your facility, while handling or has possession of property or funds in connection with sanctioned student activities; 11. The spouses of and children over 18 years old who reside with any "employee" who is a building manager, superintendent or janitor. Each family is deemed to be, collectively, one "employee" for the purposes of this insurance, except that any Termination Condition applies individually to the spouse and children. "Employee" does not mean: (1) An agent, broker, factor, commission merchant, consignee, independent contractor or representative of the same general character; or (2) Any manager, director, partner, member or trustee, except while acting within the scope of the usual duties of an "employee" . ew cF RAMwagementDMsian Jy/ & REVIEWED & APPROVED BY.- v --� Risk Management Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FORGERY COVERAGE (Including Credit Cards, Currency and Money Orders) This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the policy apply to the insurance stated below. The following is added to Additional Coverages: A. FORGED OR ALTERED INSTRUMENTS COVERAGE 1. Covered Property Covered Property means the following instruments: a. Checks, drafts, promissory notes, or similar written promises, orders or directions to pay a sum certain in "money" that are: (1) Made or drawn by or drawn upon you; (2) Made or drawn by one acting as your agent; or that are purported to have been so made or drawn; and b. Written instruments required in conjunction with any credit, debit or charge card issued to you or any "employee" for business purposes. 2. Covered Causes of Loss Covered Causes of Loss means forgery or alteration. 3. Legal Expense Additional Coverage If you are sued for refusing to pay any Covered Instrument on the basis that it has been forged or altered, and you have our written consent to defend against the suit, we will pay for any reasonable legal expenses that you incur and pay in that defense. This payment is in addition to the applicable Limit of Insurance. The Deductible does not apply to this Coverage Extension. 4. Additional Conditions The following conditions apply in addition to the Common Policy Conditions and the Crime Common Conditions and Exclusions Form. a. We will treat mechanically reproduced facsimile signatures the same as handwritten signatures. b. You must include with your proof of loss any instrument involved in that loss, or, if that is not possible, an affidavit setting forth the amount and cause of loss. c. The Coverage Territory is revised to cover loss you sustain anywhere in the world. 5. Exclusion The following Exclusion applies in addition to the Exclusions in the Crime Common Conditions and Exclusions. Form SS 04 86 03 00 © 2000, The Hartford We will not pay for loss resulting from any dishonest or criminal act committed by any of your "employees" , directors, or trustees: a. Acting alone or in collusion with other persons; or b. While performing services for you or otherwise. ew cF RAMwagementDMsian Jy/,'q REVIEWED & APPROVED BY.- v --� Risk Pjanagement Analyst B. COUNTERFEIT CURRENCY AND MONEY ORDERS COVERAGE 1. Covered Property Covered Property means the following: We will pay for loss directly resulting from a. Money orders, including counterfeit money orders, of any United States or Canadian post office, express company or national or state (or Canadian) chartered bank that are not paid upon presentation; and b. Counterfeit United States or Canadian paper currency. 2. Covered Causes of Loss Covered Causes of Loss means the acceptance of Covered Property in good faith, in exchange for merchandise, money or services, during the regular course of business. 3. Exclusions The following Exclusion applies in addition to the Exclusions in the Crime Common Conditions and Exclusions. a. We will not pay for loss resulting from any dishonest or criminal act committed by any of your "employees" , directors, trustees or authorized representatives: (1) Acting alone or in collusion with other persons; or (2) While performing services for you or otherwise. Page 2 of 2 b. We will not pay for loss resulting from the giving or surrendering of property in any exchange or purchase. c. We will not pay for loss resulting from your, or anyone acting on your express or implied authority, being induced by any dishonest act to voluntarily part with title to or possession of any property. C DEDUCTIBLE We will not pay for loss in any one Occurrence unless the amount of loss exceeds the Deductible stated in the Declarations. We will then pay the amount of loss in excess of the Deductible, up to the Limit of Insurance. D. LIMIT OF INSURANCE The most we will pay for each Occurrence of loss under this Endorsement is the Forgery Limit of Insurance stated in the Declarations. The Additional Coverages are included in this Limit of Insurance. E. OCCURRENCE DEFINITION 1. For Forged or Altered Instruments Coverage, Occurrence means all loss caused by any person or in which that person is involved, whether the loss involves one or more instruments of Covered Property. 2. For Counterfeit Currency and Money Order Coverage, Occurrence means an: a. Act or series of related acts involving one or more persons; or b. Act or event, or series of related acts or events not involving any person. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v --� Risk Pjanagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET BUILDING AND BUSINESS PERSONAL PROPERTY AT ALL LOCATIONS This endorsement modifies insurance provided under the following: SPECIAL PROPERTY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the policy apply to the insurance stated below. This change applies only to the premises stated in the Declarations for Blanket Limit. In the event of covered loss or damage to Buildings and/or Business Personal Property, the applicable Limit of Insurance is revised to be equal to the sum of all the Limits of Insurance for Building and Business Personal Property at the premises designated for Blanket Limit. eGF �D Form SS 14 23 10 03 ��/ 1°x REVIEWED & APPROVED SY: © 2003, The Hartford --� W. janagement Analpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OFF -PREMISES UTILITY SERVICES - DIRECT DAMAGE This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM Except as otherwise stated in this endorsement, the B. ADDITIONAL DEFINITIONS terms and conditions of the policy apply to the 1. "Water Supply Services", meaning the insurance stated below. following types of property supplying water to the "scheduled premises": A. DIRECT DAMAGE EXTENSION FOR OFF- a. Pumping stations; and PREMISES UTILITY SERVICES This Coverage Extension applies only to the "scheduled premises" shown in the Declarations with a Utility Services Limit of Insurance. The Utility Services Limit of Insurance is part of, not in addition to, the Limit of Insurance stated in the Declarations as applicable to the Covered Property. We will pay for direct physical loss of or physical damage to Covered Property described in the Declarations caused by the interruption of utility service to the "scheduled premises". The interruption must result from direct physical loss or physical damage by a Covered Cause of Loss to the following property, not on the "scheduled premises": 1. "Water Supply Services"; 2. "Communication Supply Services"; or 3. "Power Supply Services". Form SS 40 18 07 05 b. Water mains. 2. "Communication Supply Services", meaning property supplying communication services, including telephone, radio, microwave or television services, including overhead transmission lines to the "scheduled premises", such as: a. Communication transmission lines, including optic fiber transmission lines; b. Coaxial cables; and c. Microwave radio relays except satellites. 3. "Power Supply Services", meaning the following types of property supplying electricity, steam or gas, including overhead transmission lines to the "scheduled premises": a. Utility generating plants; b. Switching stations; © 2005, The Hartford c. Substations; d. Transformers; and e. Transmission Lines. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CYBERFLEX COVERAGE This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM This endorsement modifies coverage under the (2) Copying in your "advertisement", a Business Liability Coverage Form for your web site or person's or organization's internet related activities. "advertising idea" or style of A. Exclusion 1.p. "Personal and Advertising Injury" "advertisement". (Section B. - EXCLUSIONS) is modified as follows: 2. Paragraph (9) does not apply. 1. Paragraphs (4), (5) and (7) are deleted and replaced by the following: (4) Arising out of any breach of contract, except an implied contract to use another's "advertising idea" in your "advertisement" or on "your web site"; (5) Arising out of the failure of goods, products or services to conform with any statement of quality or performance made in your "advertisement" or on "your web site"; (7) (a) Arising out of any actual or alleged infringement or violation of any intellectual property rights, such as copyright, patent, trademark, trade name, trade secret, service mark or other designation of origin or authenticity; or (b) Any injury or damage alleged in any claim or "suit" that also alleges an infringement or violation of any intellectual property right, whether such allegation of infringement or violation is made against you or any other party involved in the claim or "suit", regardless of whether this insurance would otherwise apply. However, this exclusion does not apply if the only allegation in the claim or "suit" involving any intellectual property right is limited to: (1) Infringement in your "advertisement", of: (a) Copyright; (b) Slogan; or (c) Title of any literary or artistic work; or 3. Subparagraphs (a), (b) and (c) of Paragraph (12) do not apply. B. Section G. - LIABILITY AND MEDICAL EXPENSES DEFINITIONS is amended as follows: 1. Paragraph b. of definition 1. "advertisement" is deleted and replaced by: "Advertisement" means the widespread public dissemination of information or images that has the purpose of inducing the sale of goods, products or services through: b. The Internet; 2. Paragraphs f. and g. of the definition of "personal and advertising injury' are deleted and replaced by the following: "Personal and advertising injury' means injury, including consequential "bodily injury", arising out of one or more of the following offenses: f. Copying, in your "advertisement" or on "your web site", a person's or organization's "advertising idea" or style of "advertisement"; g. Infringement of copyright, slogan, or title of any literary or artistic work, in your "advertisement" or on "your web site"; or 3. The following is added to the definition of "personal and advertising injury": As used in this definition, oral, written or electronic publication includes publication of material in your care, custody or control by someone not authorized to access or distribute that material. 4. The following definition is added: Form SS 40 26 03 17 © 2017, The Hartford "Your web site" means a web page or set of interconnected web pages prepared and maintained by you, or by others on your behalf, for the purposes of promoting your goods or services, that is accessible over n rmmnl ItPr nPt\tinrk cF RiskMmWmentDMsian ke7 1'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYEE BENEFITS LIABILITY - OCCURRENCE This endorsement modifies insurance provided under the following: -IIb'iI►1**21l_1-]IIIVC0160= GL'[r1=1111MOINIT, If shown in the Declarations as applicable, the following b. This insurance applies to an "employee coverage applies. This coverage is subject to the benefits injury" only if: provisions of the Business Liability Coverage Form except as provided below. (1) The "employee benefits injury" is committed in the "coverage territory"; A. SECTION A — COVERAGES is amended as follows and 1. The following is added: EMPLOYEE BENEFITS LIABILITY Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "employee benefits injury" committed by the insured, or of any other person for whose acts the insured is legally liable, to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking damages to which this insurance does not apply. We may at our discretion, investigate any act, error or omission and settle any "claim" or "suit" that my result. But: (1) The amount we will pay for "damages" is limited as described in SECTION D - LIMITS OF INSURANCE; and (2) Our right and duty to defend ends when we have used up the applicable limit of insurance in the payment of judgments or settlements. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under subsection 3. Coverage Extension - Supplementary Payments (SECTION A — COVERAGES) of the Business Liability Coverage Form. (2) The "employee benefits injury" is committed during the policy period. c. All "claims" for damages made by an "employee" because of an "employee benefits injury", or a series of related "employee benefits injuries", including damages claimed by such "employee's" dependents and beneficiaries, will be deemed to constitute a single "claim" for purposes of application of the Each Claim Limit of liability. 2. For purposes of the coverage provided by this endorsement, subsection 3. Coverage Extension — Supplementary Payments, paragraphs 3.a.(2) and 3.b. (SECTION A — COVERAGES) do not apply. B. EXCLUSIONS SECTION B — EXCLUSIONS is amended to add the following: 3. Applicable to Employee Benefits Liability This insurance does not apply to: a. ERISA Damages for which any insured is liable because of liability imposed on a fiduciary by the Employee Retirement Income Security Act of 1974, as now or hereafter amended, or by any similar federal, state or local laws. Form SS 40 50 10 08 ew cF RAMwagzmentDMsian Jy/ \'x REVIEWED & APPROVED BY: © 2008, The Hartford �� "" v (Includes copyrighted material of the Insurance Services Office, Inc. with its Wsk Pjanagement Analpt b. Bodily Injury, Property Damage or Personal and Advertising Injury "Bodily injury," "property damage," "personal injury" or "advertising injury." c. Dishonest, Fraudulent, Criminal or Malicious Act Damages arising out of any intentional, dishonest, fraudulent, criminal or malicious act, error or omission, committed by any insured, including the willful or reckless violation of any statute. d. Inadequacy of Performance of Investment Advice Given With Respect to Participation Any claim based on: (1) Failure of any investment to perform; (2) Errors in providing information on past performance of investment vehicles; or (3) Advice given to any person with respect to that person's decision to participate or not to participate in any plan included in the "employee benefit program." e. Available Benefits Any "claim" for benefits to the extent that such benefits are available with reasonable effort of the insured from the applicable funds accrued or other collectible insurance. f. Insufficiency of Funds Damages arising out of an insufficiency of funds to meet any obligations under any j. Employment -Related Practices Damages arising out of any wrongful termination of employment, discrimination, or other employment -related practices. C. SECTION C - WHO IS AN INSURED is amended as follows: plan included in the "employee benefit D program". g. Failure to Perform a Contract Damages arising out of the failure of performance of any contract by any insurer. h. Worker's Compensation and Similar Laws Any "claim" arising out of your failure to comply with the mandatory provisions of any worker's compensation, unemployment compensation insurance, social security or disability benefits law or similar law. Taxes, Fines or Penalties Taxes, fines or penalties, including those imposed under the Internal Revenue Code or any similar law. Page 2 of 4 Paragraphs 2. and 3. are deleted and replaced by the following: 2. Each of the following is also an insured: a. Each of your "employees" who is or was authorized to administer your "employee benefit program". b. Any persons, organizations or "employees" having temporary authorization to administer your "employee benefit program" if you die, but only until your legal representative is appointed. c. Your legal representative if you die, but only with respect to his, her or its duties as such. That representative will have all your rights and duties under this Endorsement. 3. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if no other similar insurance applies to that organization. However: a. Coverage under this provision is afforded until the ninetieth (90th) day after you acquire or form the organization or the end of the policy period, whichever is earlier. b. Coverage under this provision does not apply to any "employee benefits injury" that was committed before you acquired or formed the organization. SECTION D - LIMITS OF INSURANCE is deleted and replaced with the following: D. LIMITS OF INSURANCE 1. The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. "Claims" made or "suits" brought; c. Persons or organizations making "claims" or bringing "suits"; d. "Employee benefits injury"; or e. Benefits included in your "employee benefit program". 2. The Employee Benefits Liability Aggregate Limit is the most we will pay for all damages because of " negligently comr ew cF RAMwagmedD"siun of your "employ =� x RE�AEWED&APPROVED BY. v --� Rt janagement Analpt 3. Subject to the Employee Benefits Liability Aggregate Limit, the Each Claim Limit is the most we will pay for all damages sustained by any one "employee", including damages sustained by such "employee's" dependents and beneficiaries, as a result of: a. An "employee benefits injury"; or b. A series of related "employee benefits injuries" negligently committed in the "administration" of your "employee benefit program". However, the amount paid under this Endorsement shall not exceed, and will be subject to, the limits and restrictions that apply to the payment of benefits in any plan included in the "employee benefit program". The Limits of Insurance of this Endorsement apply separately to each consecutive annual period and to any remaining period of less than twelve (12) months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than twelve (12) months. In that case the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. E. SECTION E — LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS is amended as follows: Subsection 2. is deleted and replaced by the following: 2. Duties in The Event of "Employee Benefits Injury", "Claim" or "Suit" a. You must see to it that we are notified as soon as practicable of an "employee benefits injury" which may result in a "claim." To the extent possible, notice should include: (1) What the "employee benefits injury" was and when it occurred; and (2) The names and addresses of anyone who may suffer damages as a result of the "employee benefits injury". b. If a "claim" is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the "claim" or "suit" and the date received; (2) Notify us as soon as practicable of such "claim"; and Form SS 40 50 10 08 (3) Notify us immediately of such "suit". c. You and any other involved insured must: (1) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the "claim" or "suit"; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation, settlement or defense of the "claim" or "suit"; and (4) Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of "employee benefits injury" to which this insurance may also apply. d. No insureds will, except at their own cost, voluntarily make a payment, assume any obligation or incur any expense, without our consent. F. SECTION G — LIABILITY AND MEDICAL EXPENSES DEFINITIONS is amended as follows: 1. Solely with respect to coverage provided by this Endorsement, the definitions of "employee" and "suit" are deleted and replaced by the following: a. "Employee" means a person actively employed, on leave of absence, disabled, or retired. "Employee" includes a "leased worker". "Employee" does not include a "temporary worker". b. "Suit" means a civil proceeding in which damages because of an "employee benefits injury" to which this insurance applies are alleged. "Suit" includes: (1) An arbitration proceeding in which such damages are claimed and to which you must submit or do submit with our consent; or (2) Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent. 2. Solely with respect to coverage provided by this Endorsement, the following definitions are added: a. "Administration" means: (1) Providing information to "employees", including their dependents and beneficiaries, with respect to eligibility for or scope programs"; ew cF RAMwagemedDMsian Jy/ \'x REVIEWED & APPROVED BY: I .° --� Rt janagement Analpt (2) Handling records in connection with "employee benefits programs"; or (3) Effecting, continuing or terminating any "employee's" participation in any benefit plan included in the "employee benefits program." b. "Cafeteria plans" means plans authorized by applicable law to allow employees to elect to pay for certain benefits with pre-tax dollars. c. "Claim" means any demand, or "suit", made by any "employee" or an "employee's" dependents and beneficiaries, for damages as a result of an "employee benefits injury. d. "Employee benefits injury" means injury that arises out of any negligent act, negligent error or negligent omission in the "administration" of your "employee benefits program." e. "Employee benefit program" means a program providing some or all of the following benefits to "employees", whether provided through a "cafeteria plan" or otherwise: (1) Group life insurance, group accident, group health insurance, group dental insurance group vision and group hearing plans, and flexible spending accounts, provided that no one other than an "employee" may subscribe for such benefits and such benefits are made generally available to those "employees" who satisfy the plan's eligibility requirements; Page 4 of 4 (2) Profit sharing plans, employee savings plans, employee stock ownership plans, pension plans and stock subscription plans, provided that no other than an "employee" may subscribe to such benefits and such benefits are made generally available to those "employees" who satisfy the plan's eligibility requirements; (3) Unemployment insurance, social security benefits, workers' compensation and disability benefits; (4) Vacation plans, including buy and sell programs; leave of absence programs, including military, maternity, family and civil leave; tuition assistance plans; transportation and health club subsidies; and (5) Any other similar benefits designated in the Declarations or added thereto by endorsement. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXTENDED BUSINESS INCOME This endorsement modifies insurance provided under the following: SPECIAL PROPERTY COVERAGE FORM This coverage applies only when it is indicated in the declarations. The provisions of this policy apply to the coverage stated in this endorsement, except as indicated below: Additional Coverage of Extended Business Income, Paragraph A.5.r.(1)(b), is deleted and replaced by the following: (b) Ends on the date you could restore your 'operations" with reasonable speed to the condition that would have existed if no direct physical loss or damage occurred; or, until the number of consecutive days or months indicated in the declarations has elapsed after the date determined in (1)(a) above, whichever is earlier. This replaces and supersedes any other Extended Business Income provision in the policy. ew cF RAMwagementDMsian Form SS 40 91 11 08 J_/ ,qq REVIEWED & APPROVED BY.- ., . V © 2008, The Hartford —_-- Wsk Pjanagement Analpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED FUNGI, BACTERIA OR VIRUS COVERAGE This endorsement modifies insurance provided under the following: SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM PERSONAL PROPERTY OF OTHERS COMPUTERS AND MEDIA COVERAGE A. Fungi, Bacteria or Virus Exclusions 1. Paragraph A.5.i.(5). of the Increased Cost of Construction Additional Coverage of the Standard Property Coverage Form is replaced by the following: (5) Under this Additional Coverage, we will not pay for: (a) The enforcement of any ordinance or law which requires demolition, repair, replacement, reconstruction, remodeling, or remediation of property due to contamination by "pollutants" or due to the presence, growth, proliferation, spread or any activity of "fungi", wet or dry rot, bacteria or virus; or (b) Any costs associated with the enforcement of an ordinance or law which requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to or assess the effects of "pollutants", "fungi", wet or dry rot, bacteria or virus. 2. The following exclusion is added to Paragraph B.1. Exclusions of the Standard Property Coverage Form and the Special Property Coverage Form; Paragraph F., Additional Exclusions of Computers and Media, form SS 04 41, and to form SS 04 45, Personal Property of Others: Form SS 40 93 07 05 i. "Fungi", Wet Rot, Dry Rot, Bacteria And Virus We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss: (1) Presence, growth, proliferation, spread or any activity of "fungi", wet rot, dry rot, bacteria or virus. (2) But if "fungi", wet rot, dry rot, bacteria or virus results in a "specified cause of loss" to Covered Property, we will pay for the loss or damage caused by that "specified cause of loss". This exclusion does not apply: (1) When "fungi", wet or dry rot, bacteria or virus results from fire or lightning; or (2) To the extent that coverage is provided in the Additional Coverage — Limited Coverage for "Fungi", Wet Rot, Dry Rot, Bacteria and Virus with respect to loss or damage by a cause of loss other than fire or lightning. This exclusion applies whether or not the loss event results in widespread damage or affects a substantial area. B. The following Additional Coverage is added to Paragraph A.4. of the Standard Property Coverage Form or Paragraph A.5. of the Special Property Coverage Form, and applies to the optional coverage form SS 04 41, Computers and Media and SS 04 45, Personal Property of Others and form: © 2005, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst 1. Limited Coverage For "Fungi", Wet Rot, (1) occurrences of "specified causes of Dry Rot, Bacteria and Virus loss" (other than fire or lightning); and a. The coverage described in 1.b. below only (2) Equipment Breakdown Accident that applies when the "fungi", wet or dry rot, occurs to Equipment Breakdown bacteria or virus is the result of one or Property; more of the following causes that occurs which take place in a 12-month period during the policy period and only if all (starting with the beginning of the reasonable means were used to save and present annual policy period). preserve the property from further damage at the time of and after that occurrence. With respect to a particular occurrence of loss which results in "fungi", wet or dry rot, (1) A "specified cause of loss" other than bacteria or virus, we will not pay more fire or lightning; than the total of $50,000 unless a higher (2) Equipment Breakdown Accident Limit of Insurance is shown in the occurs to Equipment Breakdown Declarations, even if the "fungi", wet or dry Property, if Equipment Breakdown rot, bacteria, or virus continues to be applies to the affected premises. present or active, or recurs, in a later b. We will pay for loss or damage by "fungi", policy period. wet rot, dry rot, bacteria and virus. As d. The coverage provided under this Limited used in this Limited Coverage, the term Coverage does not increase the applicable loss or damage means: Limit of Insurance on any Covered (1) Direct physical loss or direct physical Property. If a particular occurrence results damage to Covered Property caused by in loss or damage by "fungi", wet rot, dry "fungi", wet rot, dry rot, bacteria or virus, rot, bacteria or virus, and other loss or including the cost of removal of the damage, we will not pay more, for the total "fungi", wet rot, dry rot, bacteria or virus; of all loss or damage, than the applicable Limit of Insurance on the affected Covered (2) The cost to tear out and replace any part Property. of the building or other property as needed to gain access to the "fungi", wet If there is covered loss or damage to rot, dry rot, bacteria or virus; and Covered Property, not caused by "fungi", (3) The cost of testing performed after wet rot, dry rot, bacteria or virus, loss removal, repair, replacement or payment will not be limited by the terms of restoration of the damaged property is this Limited Coverage, except to the extent completed, provided there is a reason that "fungi", wet or dry rot, bacteria or virus to believe that "fungi", wet rot, dry rot, causes an increase in the loss. Any such bacteria or virus are present. increase in the loss will be subject to the terms of this Limited Coverage. c. Unless a higher Limit of Insurance is shown in the Declarations for Limited "Fungi", e. The terms of this Limited Coverage do not Bacteria or Virus Coverage, the coverage increase or reduce the coverage for Water described under this Limited Coverage is no Damage provided under provision B.1.h., more than the Limit of Insurance stated in the Exclusion — Water Damage of the Standard Declarations for Building and Business Property Coverage Form or Additional Personal Property, but not greater than Coverage provision A.5.n., Water Damage, $50,000. Other Liquid, Powder or Molten Material Damage of the Special Property Coverage If form SS 04 41, Computers and Media, Form. and form SS 04 45, Personal Property of Others, are made a part of this policy, then f. The following applies only if a Time Element the Limits of Insurance for Computers and Coverage applies to the "scheduled Media, and Personal Property of Others is premises" and only if the suspension of included within this coverage limit. This 'operations" satisfies all the terms and coverage is made applicable to separate conditions of the applicable Time Element "scheduled premises" as described in the Coverage. Declarations. Regardless of the number (1) If the loss which resulted in "fungi", of claims, this limit is the most we will pay wet or dry rot, bacteria or virus does per "scheduled premises" for the total of not in itse all loss or damage arising out of all of "operati RiskMmWmatDMsian is necessa °; R�Euve°& BY. Page 2 of 3 — -- Wsk Pjanagement Analpt property caused by "fungi", wet or dry rot, bacteria or virus, then our payment under the Time Element Coverage is limited to the amount of loss and expense sustained in a period of not more than 30 days unless another number of days is indicated in the Declarations. The days need not be consecutive. If a covered suspension of 'operations" was caused by loss or damage other than "fungi", wet or dry rot, bacteria or virus, but remediation of "fungi", wet or dry rot, bacteria or virus prolongs the "period of restoration", we will pay for loss and expense sustained during the delay (regardless of when such a delay occurs during the "period of restoration"), but such coverage is limited to 30 days unless another number of days is indicated in the Declarations. The days need not be consecutive. C. Fungi Definition 1. "Fungi" means any type or form of fungus, including mold or mildew, and any mycotoxins, spores, scents or by-products produced or released by fungi. Form SS 40 93 07 05 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IDENTITY RECOVERY COVERAGE FOR BUSINESSOWNERS AND EMPLOYEES IDENTITY THEFT CASE MANAGEMENT SERVICE AND EXPENSE REIMBURSEMENT This endorsement modifies insurance provided under the following: SPECIAL PROPERTY COVERAGE FORM A. The following is added to paragraph 5. Additional Coverages (Section A. - Coverage): IDENTITY RECOVERY COVERAGE We will provide the Case Management Service and Expense Reimbursement Coverage indicated below if all of the following requirements are met: 1. There has been an "identity theft" involving the personal identity of an "identity recovery insured" under this policy; and 2. Such "identity theft" is first discovered by the "identity recovery insured" during the policy period for which this Identity Recovery coverage is applicable; and 3. Such "identity theft" is reported to us as soon as practicable but in no event later than 60 days after it is first discovered by the "identity recovery insured." If all three of the requirements listed above have been met, then we will provide the following to the "identity recovery insured": 1. Case Management Service Services of an "identity recovery case manager" as needed to respond to the "identity theft"; and 2. Expense Reimbursement Reimbursement of necessary and reasonable "identity recovery expenses" incurred as a direct result of the "identity theft." This coverage is additional insurance. B. The following additional exclusions are added to Section B. - Exclusions and apply to this coverage: EXCLUSIONS We do not cover loss or expense arising from any of the following: 1. Theft of a professional or business identity. 2. Any fraudulent, dishonest or criminal act by an "identity recovery insured" or any person aiding or abetting an "identity recovery insured", or by any authorized representative of an "identity recovery insured", whether acting alone or in collusion with others. However, this exclusion shall not apply to the interests of an "insured" who has no knowledge of or involvement in such fraud, dishonesty or criminal act. 3. Loss other than "identity recovery expenses". 4. An "identity theft" that is first discovered by the "identity recovery insured" prior to or after the policy period for which this coverage applies. This exclusion applies whether or not such "identity theft" began or continued during the period of coverage. 5. An "identity theft" that is not reported to us within 60 days after it is first discovered by the "identity recovery insured." 6. An "identity theft" that is not reported in writing to the police. Form SS 41 12 12 17 © 2017, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst C. LIMITS OF INSURANCE 1. Case Management Service is available as needed for any one "identity theft" for up to 12 consecutive months from the inception of the service. Expenses we incur to provide Case Management Service do not reduce the amount of limit available for Expense Reimbursement coverage. 2. Expense Reimbursement coverage is subject to a limit of $15,000 annual aggregate per "identity recovery insured." Regardless of the number of claims, this limit is the most we will pay for the total of all loss or expense arising out of all "identity thefts" to any one "identity recovery insured" which are first discovered by the "identity recovery insured" during a 12- month period starting with the beginning of the present annual policy period. If an "identity theft" is first discovered in one policy period and continues into other policy periods, all loss and expense arising from such "identity theft" will be subject to the aggregate limit applicable to the policy period when the "identity theft" was first discovered. a. Legal costs as provided under paragraph d. of the definition of "identity recovery expenses" are part of, and not in addition to, the Expense Reimbursement coverage limit. b. Lost Wages and Child and Elder Care Expenses as provided under paragraphs e. and f. of the definition of "identity recovery are jointly subject to a sublimit of $250 per day, not to exceed $5,000 in total. This sublimit is part of, and not in addition to, the Expense Reimbursement coverage limit. Coverage is limited to lost wages and expenses incurred within 12 months after the first discovery of the "identity theft" by the "identity recovery insured". c. Mental Health Counseling as provided under paragraph g. of the definition of "identity recovery expenses" is subject to a sublimit of $1,000. This sublimit is part of, and not in addition to, the Expense Reimbursement coverage limit. Coverage is limited to counseling that takes place within 12 months after the first discovery of the "identity theft" by the "identity recovery insured". D. DEDUCTIBLE Case Management Service is not subject to a deductible. Expense Reimbursement coverage is subject to a deductible of $250. Any one "identity recovery insured" shall be responsible for only one deductible under this Identity Recovery Coverage during anyone policy period. Page 2 of 3 E. The following additional conditions are added to Section F. - Property General Conditions and apply to this coverage: CONDITIONS 1. Assistance and Claims For assistance, the "identity recovery insured" should call the Identity Recovery Help Line at 1-866-989-2905. The Identity Recovery Help Line can provide the "identity recovery insured" with: a. Information and advice for how to respond to a possible "identity theft"; and b. Instructions for how to submit a service request for Case Management Service and/or a claim form for Expense Reimbursement Coverage. In some cases, we may provide Case Management services at our expense to an "identity recovery insured" prior to a determination that a covered "identify theft" has occurred. Our provision of such services is not an admission of liability under the policy. We reserve the right to deny further coverage or service if, after investigation, we determine that a covered "identify theft" has not occurred. As respects Expense Reimbursement Coverage, the "identity recovery insured" must send to us, within 60 days after our request, receipts, bills or other records that support his or her claim for "identity recovery expenses." 2. Services The following conditions apply as respects any services provided by us or our designees to any "identity recovery insured" under this endorsement: a. Our ability to provide helpful services in the event of an "identity theft" depends on the cooperation, permission and assistance of the "identity recovery insured." b. All services may not be available or applicable to all individuals. For example, "identity recovery insureds" who are minors or foreign nationals may not have credit records that can be provided or monitored. Service in Canada will be different from service in United States and Puerto Rico in accordance with local conditions. c. We do not warrant or guarantee that our services will end or eliminate all problems associated with an "identity theft" or prevent future "identity thefts." ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst F. With respect to the provisions of this endorsement only, the following definitions are added to Section G. - Property Definitions: DEFINITIONS 1. "Identity Recovery Case Manager" means one or more individuals assigned by us to assist an "identity recovery insured" with communications we deem necessary for re- establishing the integrity of the personal identity of the "identity recovery insured." This includes, with the permission and cooperation of the "identity recovery insured," written and telephone communications with law enforcement authorities, governmental agencies, credit agencies and individual creditors and businesses. 2. "Identity Theft" means the fraudulent use of the social security number or other method of identifying an "identity recovery insured." This includes fraudulently using the personal identity of an "identity recovery insured" to establish credit accounts, secure loans, enter into contracts or commit crimes. "Identity theft" does not include the fraudulent use of a business name, d/b/a or any other method of identifying a business activity. 3. "Identity Recovery Expenses" means the following when they are reasonable and necessary expenses that are incurred in the United States or Canada as a direct result of an "identity theft": a. Costs for re -filing applications for loans, grants or other credit instruments that are rejected solely as a result of an "identity theft." b. Costs for notarizing affidavits or other similar documents, long distance telephone calls and postage solely as a result of your efforts to report an "identity theft" or amend or rectify records as to your true name or identity as a result of an "identity theft." c. Costs for up to twelve (12) credit reports from established credit bureaus dated within 12 months after your knowledge or discovery of an "identity theft." d. Legal Costs Fees and expenses for an attorney approved by us for: (1) Defending any civil suit brought against an "identity recovery insured" by a creditor or collection agency or entity acting on behalf of a creditor for non- payment of goods or services or default on a loan as a result of an "identity theft"; and Form SS 41 12 12 17 (2) Removing any civil judgment wrongfully entered against an "identity recovery insured" as a result of the "identity theft." e. Lost Wages Actual lost wages of the "identity recovery insured" for time reasonably and necessarily take away from work and away from the work premises. Time away from work includes partial or whole work days. Actual lost wages may include payment for vacation days, discretionary days, floating holidays and paid personal days. Actual lost wages does not include sick days or any loss arising from time taken away from self employment. Necessary time off does not include time off to do tasks that could reasonably have been done during non- working hours. f. Child and Elder Care Expenses Actual costs for supervision of children or elderly or infirm relatives or dependents of the "identity recovery insured" during time reasonably and necessarily taken away from such supervision. Such care must be provided by a professional care provider who is not a relative of the "identity recovery insured". g. Mental Health Counseling Actual costs for counseling from a licensed mental health professional. Such care must be provided by a professional care provider who is not a relative of the "identity recovery insured". 4. "Identity Recovery Insured" means the following: a. A full time employee of the entity insured under this policy; or b. The owner of the entity insured under this policy who meets any of the following criteria: (1) A sole proprietor of the insured entity; (2) A partner in the insured entity; or (3) An individual having an ownership position of 20% or more of the insured entity. An "identity recovery insured" must always be an individual person. The entity insured under this policy is not an "identity recovery insured." All other provisions of this policy apply. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUILDING LIMIT- AUTOMATIC INCREASE REVISION This endorsement modifies insurance provided under the following: SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the policy apply to the insurance stated below. A. Paragraph C.5 Building Limit -Automatic Increase of the SPECIAL PROPERTY COVERAGE FORM or STANDARD PROPERTY COVERAGE FORM is deleted. B. The following is added to Additional Coverages, paragraph A.5 of the SPECIAL PROPERTY COVERAGE FORM or paragraph A.4. of the STANDARD PROPERTY COVERAGE FORM: Building Limit -Automatic Increase a. If the covered loss or damage to Building property at a "scheduled premises" exceeds the Limit of Insurance stated in the Declarations, the Limit of Insurance available for the covered loss or damage in that occurrence will automatically increase by up to 8%. b. The amount of increase will be: (1) The Limit of Insurance for Buildings that applied on the most recent of the policy inception date, policy anniversary date, or the date of any other policy change amending the Building limit, multiplied by (2) The 8% annualized percentage of Automatic Increase, expressed as a decimal (08), multiplied by (3) The number of days since the beginning of the current policy year or the effective date of the most recent policy change amending the Limit of Insurance for Buildings, divided by 365. Example: The applicable Limit of Insurance for Buildings is $100,000. The automatic increase percentage is 8%. The number of days since the beginning of the policy period (or last policy change) is 146. The amount of increase is: $100,000 X .08 X 146 divided by 365 = $3,200 ew cF RAMwagementDMsian Form SS 41 51 10 09 J_/ ,qq REVIEWED & APPROVED BY.- ., . V ©2009, The Hartford —_-- Wsk Pjanagement Analpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - DEFINITION OF INSURED CONTRACT This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Paragraph f. of the definition of "insured contract" in the Liability And Medical Expenses Definitions Section is replaced by the following: f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. includes that part of any contract or agreement that indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road -beds, tunnel, underpass or crossing. However, Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports surveys, field orders, change orders, designs or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. ew cF RAMwagementDMsian Form SS 41 63 06 11 J_/ ,qq REVIEWED & APPROVED BY.- ©2011, The Hartford .. v (Includes copyrighted material of Insurance Services Office, Inc. with its per --_-- Wsk Management Analpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FOOD CONTAMINATION COVERAGE This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM This coverage applies only when it is indicated in the Declarations. The provisions of this policy apply to the coverage stated in this endorsement, except as indicated below. This insurance applies only when Business Income and Extra Expense Additional Coverage is included in the policy. A.COVERAGE We will pay the actual loss of Business Income and Extra Expense if your "operations" at any "scheduled premises" are ordered by a government authority to be suspended due to the discovery of or the suspicion of "food contamination". "Food Contamination" means the incidence of food poisoning to one or more of your patrons that is caused by or results from tainted food you purchased, improperly stored, handled or prepared, or a communicable disease that was transmitted by you or one or more of your employees. Extra Expense coverage is limited to the following: 1. The cost to clean and sanitize your equipment as required by the government authority; 2. The cost to replace food which is or is suspected of being contaminated; and 3. The cost of necessary medical tests or inoculations for your employees to prevent the spread of identified or suspected communicable diseases to your patrons through the ingestion of your food product. Form SS 41 32 09 06 Coverage begins at the time you were notified by the government authority to suspend your "operations" at a "scheduled premises" and ends with the notification to resume "operations" at that same "scheduled premises" from the same government authority. B. ADDITIONAL COVERAGE We will pay up to $2,500 for the cost of advertising to regain customers following the notification to resume "operations" at that same "scheduled premises" by the same government authority. This coverage ends 30 days after the government authority provides you with the notification to resume "operations" at that same "scheduled premises". C. LIMIT OF INSURANCE The most we will pay under this Additional Coverage, regardless of the number of patrons or locations involved in any one order by a governmental authority, is the Limit of Insurance shown in the Declarations for Food Contamination Coverage. D. EXCLUSIONS We will not pay any fines or penalties levied against you by the government authority as the result of the order of suspension due to the discovery of or the suspicion of "food contamination" at your "scheduled premises". © 2006, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PERILS SPECIFICALLY EXCEPTED As used herein, "Peril" means a cause of physical loss or damage to property. It has this meaning whether or not it is called a "Peril" or a "Cause of Loss" in this policy. Even if any of the terms of this policy might be construed otherwise, the following Perils, as described in Paragraphs A. and B. below, are SPECIFICALLY EXCEPTED FROM THIS POLICY. WE DO NOT COVER OR INSURE AGAINST LOSS OR DAMAGE DIRECTLY OR INDIRECTLY CAUSED BY, RESULTING FROM, CONTRIBUTED TO OR AGGRAVATED BY, OR WHICH WOULD NOT HAVE OCCURRED BUT FOR, EITHER OF THESE PERILS: A. ACTS, ERRORS OR OMISSIONS by you or others in: 1. Planning, zoning, developing, surveying, testing or siting property; 2. Establishing or enforcing any building code, or any standard, ordinance or law about the construction, use or repair of any property or materials, or requiring the tearing down of any property, including the removal of its debris; 3. The design, specifications, workmanship, repair, construction, renovation, remodeling, grading or compaction of all or any part of the following: a. Land or buildings or other structures; b. Roads, water or gas mains, sewers, drainage ditches, levees, dams, or other facilities; or c. Other improvements or changes in or additions to land or other property. 4. The furnishing of work, materials, parts or equipment in connection with the design, specifications, workmanship, repair, construction, renovation, remodeling, grading or compaction of any of the above property or facilities; or 5. The maintenance of any of such property or facilities. This exception A. applies whether or not the property or facilities described above are: 1. Covered under this policy; or 2. On or away from the covered premises. Form IH 10 01 09 86 Printed in U.S.A. This exception A. does not reduce the insurance for loss or damage caused directly by a Covered Peril. As used in this endorsement: 1. If this policy is written to cover the risk of loss from specifically named causes. "Covered Peril" means any Peril specifically named as covered; or 2. If written to cover the risk of loss without specifying specifically named causes, "Covered Peril" means any Peril not described above and not otherwise excluded or excepted from the causes of loss covered by this policy. B. COLLAPSE, "CRACKING" OR "SHIFTING" of buildings, other structures or facilities, or their parts, if the collapse, "cracking" or "shifting": 1. Occurs during "earth movement," "volcanic eruption" or "flood" conditions or within 72 hours after they cease; and 2. Would not have occurred but for "earth movement," "volcanic eruption" or "flood." But if loss or damage by a covered Peril ensues at the covered premises, we will pay for that ensuing loss or damage. This exception B. applies whether or not there are other provisions in this policy relating to collapse, "cracking" or "shifting" of buildings, other structures or facilities, or their parts. Any such provision is revised by this endorsement to include this exception. But if this policy specifically covers (by endorsement or in any other way) loss or damage caused by one or more of the following Perils: 1. Earthquake; 2. Flood; 3. Volcanic action; 4. Volcanic eruption; or 5. Sinkhole collapse, this exception B. will not reduce that coverage. As used in this exception B.: Copyright, Hartford Fire Insurance Company, 1986 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v --� Risk Pjanagement Analyst 1. "Cracking" means cracking, separating, shrinking, 5. "Volcanic eruption" means the eruption, explosion bulging, or expanding; or effusion of a volcano. It does not include 2. "Shifting" means shifting, rising, settling, sinking, volcanic action if loss by volcanic action is or lateral or other movement; specifically covered in this policy; 3. "Earth movement" means any earth movement, 6. "Flood" means: including but not limited to "earthquake," landslide, a. Flood, surface water, waves, tides, tidal water, mudflow, erosion, contraction or expansion, tidal waves, high water, and overflow of any subsidence, any movement of earth resulting from body of water, or their spray, all whether water combining with the ground or soil, and any driven by wind or not; other "shifting" of earth; all whether or not b. Release of water held by a dam, levy or dike combined with "flood" or "volcanic eruption." It or by a water or flood control device; does not include sinkhole collapse if loss by s sinkhole collapse is specifically covered in this C. Water that backs up from a sewer or drain; or policy; d. Water under the ground surface pressing on, 4. "Earthquake" means a shaking or trembling of the or flowing, leaking or seeping through: earth's crust, caused by underground volcanic or (1) Foundations, walls, floors or paved tectonic forces or by breaking or "shifting" of rock surfaces; beneath the surface of the ground from natural (2) Basements, whether paved or not; or causes. An "Earthquake" includes all related (3) Doors, windows or other openings. shocks and after shocks; Form IH 10 01 09 86 Printed in U.S.A. Copyright, Hartford Fire Insurance Company, 1986 ew cF RAMwagementDMsian Jy/ & REVIEWED & APPROVED BY.- v --� Risk Management Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - NUCLEAR ENERGY LIABILITY 1. This insurance does not apply: a. To any injury or damage: (1) With respect to which an insured under the policy is also an insured under a nuclear energy liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters or Nuclear Insurance Association of Canada, or any of their successors, or would be an insured under any such policy but for its termination upon exhaustion of its limit of liability; or (2) Resulting from the "hazardous properties" of "nuclear material" and with respect to which: (a) Any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof; or (b) The insured is, or had this policy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization. b. Under any Medical Payments or Medical Expenses Coverage, to expenses incurred with respect to "bodily injury" resulting from the "hazardous properties" of "nuclear material" and arising out of the operation of a "nuclear facility" by any person or organization. c. To any injury or damage resulting from the "hazardous properties" of "nuclear material"; if: (1) The "nuclear material": (a) Is at any "nuclear facility" owned by, or operated by or on behalf of, an insured; or (b) Has been discharged or dispersed therefrom; (2) The "nuclear material" is contained in "spent fuel" or "waste" at any time possessed, handled, used, processed, stored, transported or disposed of by or on behalf of an insured; or (3) The injury or damage arises out of the furnishing by any insured of any "technology services" in connection with the planning, construction, maintenance, operation or use of any "nuclear facility"; or (4) The injury or damage arises out of the furnishing by an insured of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any "nuclear facility"; but if such facility is located within the United States of America, its territories or possessions or Canada, this exclusion (4) applies only to "property damage" to such "nuclear facility' and any property thereat. 2. As used in this exclusion: a. "Byproduct material", "source material" and "special nuclear material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. b. "Computer system and network" means: (1) Leased or owned computer hardware including mobile, networked, and data storage computing equipment; (2) Owned or licensed software; (3) Owned websites; (4) Leased or owned wireless input and output devices; and (5) Electronic backup facilities and data storage repositories employed in conjunction with items 1 through 4 above. c. "Hazardous properties" include radioactive, toxic or explosive properties. d. "Nuclear facility' means: (1) Any "nuclear reactor"; (2) Any equipment or device designed or used for: (a) Separating the isotopes of uranium or plutonium; (b) Processing or utilizing "spent fuel"; or Form SS 05 47 09 15 © 2015, The Hartford (c) Handling, processing or packaging "waste", ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst (3) Any equipment or device used for the processing, fabricating or alloying of "special nuclear material" if at any time the total amount of such material in the custody of the insured at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235; (4) Any structure, basin, excavation, premises or place prepared or used for the storage or disposal of "waste"; and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations. e. "Nuclear material" means "byproduct material", "source material" or "special nuclear material". f. "Nuclear reactor" means any apparatus designed or used to sustain nuclear fission in a self-supporting chain reaction or to contain a critical mass of fissionable material. g. Injury or damage and "property damage" include all forms of radioactive contamination of property. h. "Spent fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a "nuclear reactor". L "Technology services" means: 1. the following services performed for others a. Consulting, analysis, design, installation, training, maintenance, support and repair of or on: software, wireless applications, firmware, shareware, networks, systems, hardware, devices or components; Page 2 of 2 b. Integration of systems; c. Processing of, management of, mining or warehousing of data; d. Administration, management, operation or hosting of: another party's systems, technology or computer facilities; e. Website development; website hosting; f. Internet access services; intranet, extranet or electronic information connectivity services; software application connectivity services; g. Manufacture, sale, licensing, distribution, or marketing of: software, wireless applications, firmware, shareware, networks, systems, hardware, devices or components; h. Design and development of: code, software or programming; L Providing software application: services, rental or leasing; j. Screening, selection, recruitment or placement of candidates for temporary or permanent employment by others as information technology professionals; k. "Telecommunication services"; and I. "Telecommunication products". 2. web -related software and connectivity services performed for others; and 3. activities on the "named insured's" "computer system and network". ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - FUNGI, BACTERIA AND VIRUSES This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM This insurance does not apply to: 1. Injury or damage arising out of or related to the presence of, suspected presence of, or exposure to: a. Fungi, including but not limited to mold, mildew, and yeast; b. Bacteria; c. Viruses; or d. Dust, spores, odors, particulates or byproducts, including but not limited to mycotoxins and endotoxins, resulting from any of the organisms listed in a., b., or c. above; from any source whatsoever. 2. Any loss, cost or expense arising out of the testing for, monitoring of, cleaning up of, removal of, containment of, treatment of, detoxification of, neutralization of, remediation of, disposal of, or any other response to or assessment of, the effects of any of the items in 1.a., b., c. or d. above, from any source whatsoever. However, this exclusion does not apply to "bodily injury" or "property damage" caused by the ingestion of food. eRAMwagmedDMsiun Form SS 50 57 04 05 GF ��/ 1°x REVIEWED & APPROVED SY: © 2005, The Hartford .. v , --� Wsk Pjanagement Analpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - UNMANNED AIRCRAFT (PROPERTY) This endorsement modifies insurance provided under the following: Except as otherwise stated in this endorsement, the to be controlled directly by a person from within terms and conditions of the policy apply to the insurance or on the aircraft and which is owned by you or stated below. owned by others but in your care, custody, or A. COVERAGE control. Paragraph A.2., Property Not Covered, Subparagraph a. is deleted and replaced with the following: a. Aircraft (including "unmanned aircraft"), automobiles, motor trucks and other vehicles subject to motor vehicle registration. C. DEFINITIONS The following changes are made to Section G., PROPERTY DEFINITIONS: 1. The following definition is added: "Unmanned aircraft" means an aircraft that is not: a. Designed; b. Manufactured; or c. Modified after manufacture Form SS 51 11 03 17 "Unmanned aircraft" includes equipment designed for and used exclusively with the "unmanned aircraft", provided such equipment is essential for operation of the "unmanned aircraft" or for executing "unmanned aircraft operations". 2. The following definition is added: "Unmanned aircraft operations" means your business activities in support of the specific operations listed in the Description of Business section of the Declarations. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM UMBRELLA LIABILTY PROVISIONS A. Disclosure Of Federal Share Of Terrorism Losses The United States Department of the Treasury will reimburse insurers for a portion of such insured losses, as indicated in the table below that exceeds the applicable insurer deductible: Calendar Year Federal Share of Terrorism Losses 2015 85% 2016 84% 2017 83% 2018 82% 2019 81 % 2020 or later 80% However, if aggregate industry insured losses, attributable to "certified acts of terrorism" under the federal Terrorism Risk Insurance Act, as amended (TRIA), exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. The United States government has not charged any premium for their participation in covering terrorism losses. B. Cap On Insurer Liability for Terrorism Losses A "certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of federal Terrorism Risk Insurance Act, to be an act of terrorism under TRIA. The criteria contained in TRIA for a "certified act of terrorism" include the following: 1. The act results in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to TRIA; and 2. The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of an United States mission; and 3. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals acting as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. If aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year, and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. In accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. C. Application Of Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Form or Policy, such as losses excluded by the Pollution Exclusion, Nuclear Hazard Exclusion and the War And Military Action Exclusion. ew cF RAMwagementDMsian Form SS 50 19 01 15 _/ ,qq REVIEWED & APPROVED BY.- © 2015, The Hartford ��' ., v (Includes copyrighted material of Insurance Services Office, Inc. with its p Wsk Pjanagement Analpt POLICY NUMBER: 59 SBA RV9040 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGER/LESSOR LOCATION 001 BUILDING 001 DISCOVERY SCIENCE CENTER OF LOS ANGELES 2500 N. MAIN ST. SANTA ANA CA 92705 LOC 011 BLDG 001 KIDSPACE CHILDRENS MUSEUM 480 N ARROYO BLVD PASADENA CA 91103 LOC 003 BLDG 001 BAY AREA DISCOVERY MUSEUM 557 MCREYNOLDS RD SAULSALTIO, CA 94965 GOLDEN GATE NATIONAL RECREATION AREA BUILDING 201 FORT MASON SAN FRANSISCO, CA 94123 LOC 005 BLDG 001 ARIZONA SCIENCE CENTER 600 E WASHINGTON ST PHOENIX, AZ 85004 DUPAGE CHILDRENS MUSEUM 301 N WASHINGTON ST. MAPERVILLE IL 60540 Form IH 12 00 11 85 T SEQ. NO. 002 Printed in U.S.A. Page 001 (CONTINUED ON " cF R`W`DD"`8101 ��/ 1°x REVIEWED & APPROVED BY. - Process Date: 0 8 / 18 / 2 0 Expiration Date: l l / --� Wsk Pjanagement Analpt POLICY NUMBER: 59 SBA RV9040 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGER/LESSOR Form IH 12 00 11 85 T SEQ. NO. 002 Printed in U.S.A. Page 002 (CONTINUED Process Date: 0 8 / 18 / 2 0 Expiration Date: ON e" cF RAManagementDMsian Jy\'x REVIEWED & APPROVED SY.- ., ,. v ` --� W. janagement Analpt POLICY NUMBER: 59 SBA RV9040 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON -ORGANIZATION LOCATION 001 BUILDING 001 CITY OF LOS ANGELES CAO, RISK MANAGEMENT 200 NORTH MAIN STREET, 12TH FLOOR LOS ANGELES CA 90012 Form IH 12 00 11 85 T SEQ. NO. 003 Printed in U.S.A. Page 001 (CONTINUED Process Date: 0 8 / 18 / 2 0 Expiration Date: ON e" cF RAManagementDMsian ke/ ,'q REVIEWED & APPROVED BY.- --� W. janagement Analpt POLICY NUMBER: 59 SBA RV9040 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENDT 003, EFFECTIVE DATE IS 03/01/2018 ENDT 003, EFFECTIVE DATE IS AMENDED TO 02/09/2018 Form IH 12 00 11 85 T SEQ. NO. 004 Printed in U.S.A. Page 001 (CONTINUED ON " cF R`W`DD"`8101 ��/ 1°x REVIEWED & APPROVED BY. - Process Date: 0 8 / 18 / 2 0 Expiration Date: l l / --� W. janagement Analpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NORTH CAROLINA - STANDARD FIRE POLICY PROVISIONS This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM The provisions of the Standard Fire Policy are stated below. State law still requires that they be attached to all policies. If any conditions of this form are construed to be more liberal than any other policy conditions relating to the perils of fire, lightning or removal, the conditions of this form will apply. IN CONSIDERATION OF THE PROVISIONS AND STIPULATIONS HEREIN OR ADDED HERETO AND OF THE PREMIUM SPECIFIED in the Declarations or in endorsements made a part hereof, this Company, for the term of years specified in the Declarations from inception date shown in the Declarations at 12:01 A.M. (Standard Time) to expiration date shown in the Declarations at 12:01 A.M. (Standard Time) at location of property involved, to an amount not exceeding the limit of liability specified in the Declarations, does insure the Insured named in the Declarations and legal representatives, to the extent of the actual cash value of the property at the time of loss, but not exceeding the amount which it would cost to repair or replace the property with material of like kind and quality within a reasonable time after such loss, without allowance for any increased cost of repair or reconstruction by reason of any ordinance or law regulating construction or repair, and without compensation for loss resulting from interruption of business or manufacture, nor in any event more than the interest of the insured, against all DIRECT LOSS BY FIRE, LIGHTNING AND OTHER PERILS INSURED AGAINST IN THIS POLICY INCLUDING REMOVAL FROM PREMISES ENDANGERED BY THE PERILS INSURED AGAINST IN THIS POLICY, EXCEPT AS HEREINAFTER PROVIDED, to the property described in the Declarations while located or contained as described in this policy, or pro rata for five days at each proper place to which any of the property shall necessarily be removed for preservation from the perils insured against in this policy, but not elsewhere. Assignment of this policy shall not be valid except with the written consent of this Company. This policy is made and accepted subject to the foregoing provisions and stipulations and those hereinafter stated, which are hereby made a part of this policy, together with such other provisions, stipulations and agreements as may be added hereto, as provided in this policy. Form SS 12 04 03 92 Printed in U.S.A. Copyright, Hartford Fire Insurance Company, 1992 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v --� Risk Pjanagement Analyst 1 Concealment, This entire policy shall be void if, whether 2 fraud. before or after a loss, the insured has will- 3 fully concealed or misrepresented any ma- 4 terial fact or circumstance concerning this insurance or the 5 subject thereof, or the interest of the insured therein, or in case 6 of any fraud or false swearing by the insured relating thereto. 7 Uninsurable This policy shall not cover accounts, bills, 8 and currency, deeds, evidences of debt, money or 9 excepted property. securities; nor, unless specifically named 10 hereon in writing, bullion or manuscripts. 11 Perils not This Company shall not be liable for loss by 12 included. fire or other perils insured against in this 13 policy caused, directly or indirectly, by: (a) 14 enemy attack by armed forces, including action taken by mili- 15 tary, naval or air forces in resisting an actual or an immediately 16 impending enemy attack; (b) invasion; (c) insurrection; (d) 17 rebellion; (e) revolution; (f) civil war; (g) usurped power; (h) 18 order of any civil authority except acts of destruction at the time 19 of and for the purpose of preventing the spread of fire, provided 20 that such fire did not originate from any of the perils excluded 21 by this policy; (i) neglect of the insured to use all reasonable 22 means to save and preserve the property at and after a loss, or 23 when the property is endangered by fire in neighboring prem- 24 ises-, 0) nor shall this Company be liable for loss by theft. 25 Other insurance. Other insurance may be prohibited or the 26 amount of insurance may be limited by en- 27 dorsement attached hereto. 28 Conditions suspending or restricting insurance. Unless other- 29 wise provided in writing added hereto this Company shall not 30 be liable for loss occurring 31 (a) while the hazard is increased by any means within the con- 32 trol or knowledge of the insured; or 33 (b) while a described building, whether intended for occupancy 34 by owner or tenant, is vacant or unoccupied beyond a period of 35 sixty consecutive days; or 36 (c) as a result of explosion or riot, unless fire ensues, and in 37 that event for loss by fire only. 38 Other perils Any other peril to be insured against or sub- 39 or subjects. ject of insurance to be covered in this policy 40 shall be by endorsement in writing hereon or 41 added hereto. 42 Added provisions. The extent of the appplication of insurance 43 under this policy and of the contribution to 44 be made by this Company in case of loss, and any other pro- 45 vision or agreement not inconsistent with the provisions of this 46 policy, may be provided for in writing added hereto, but no pro- 47 vision may be waived except such as by the terms of this policy 48 is subject to change. 49 Waiver No permission affecting this insurance shall 50 provisions. exist, or waiver of any provision be valid, 51 unless granted herein or expressed in writing 52 added hereto. No provision, stipulation or forfeiture shall be 53 held to be waived by any requirement or proceeding on the part 54 of this Company relating to appraisal or to any examination Form SS 12 04 03 92 Printed in U.S.A. Copyright, Hartford Fire Insurance Company, 1 cF Risk Mwag me dDMsian 1'x REVIEWED & APPROVED BY.- v --� Risk janagement Analyst 55 provided for herein. 56 Cancellation This policy shall be cancelled at any time 57 of policy. at the request of the insured, in which case 58 this Company shall, upon demand and sur- 59 render of this policy, refund the excess of paid premium above 60 the customary short rates for the expired time. This pol- 61 icy may be cancelled at any time by this Company by giving 62 to the insured a five days' written notice of cancellation with 63 or without tender of the excess of paid premium above the pro 64 rata premium for the expired time, which excess, if not ten- 65 dered, shall be refunded on demand. Notice of cancellation shall 66 state that excess premium (if not tendered) will be re- 67 funded on demand. 68 Mortgage If loss hereunder is made payable, in whole 69 interests and or in part, to a designated mortgagee not 70 obligations. named herein as the insured, such interest in 71 this policy may be cancelled by giving to such 72 mortgagee a ten days' written notice of can- 73 cellation. 74 If the insured fails to render proof of loss such mortgagee, upon 75 notice, shall render proof of loss in the form herein specified 76 within sixty (60) days thereafter and shall be subject to the pro- 77 visions hereof relating to appraisal and time of payment and of 78 bringing suit. If this Company shall claim that no liability ex- 79 isted as to the mortgagor or owner, it shall, to the extent of pay- 80 ment of loss to the mortgagee, be subrogated to all the mort- 81 gagee's rights of recovery, but without impairing mortgagee's 82 right to sue; or it may pay off the mortgage debt and require 83 an assignment thereof and of the mortgagee. Other provisions 84 relating to the interests and obligations of such mortgagee may 85 be added hereto by agreement in writing. 86 Pro rata liability. This Company shall not be liable for a greater 87 proportion of any loss than the amount 88 hereby insured shall bear to the whole insurance covering the 89 property against the peril involved, whether collectible or not. 90 Requirements in The insured shall give immediate written 91 case loss occurs. notice to this Company of any loss, protect 92 the property from further damage, forthwith 93 separate the damaged and undamaged personal property, put 94 it in the best possible order, furnish a complete inventory of 95 the destroyed, damaged, and undamaged property, showing in 96 detail quantities, costs, actual cash value and amount of loss 97 claimed; and within sixty days after the loss, unless such time 98 is extended in writing by this Company, the insured shall render 99 to this Company a proof of loss, signed and sworn to by the 100 insured, stating the knowledge and belief of the insured as to 101 the following: the time and origin of the loss, the interest of the 102 insured and of all others in the property, the actual cash value of 103 each item thereof and the amount of loss thereto, all encum- 104 brances thereon, all other contracts of insurance whether valid 105 or not, covering any of said property, any changes in the title, 106 use, occupation, location, possession or exposures of said prop- 107 erty since the issuing of this policy, by whom and for what Form SS 12 04 03 92 Printed in U.S.A. Copyright, Hartford Fire Insurance Company, 1 cF Risk Mwag me dDMsian 1'x REVIEWED & APPROVED BY.- v --� Risk janagement Analyst 108 purpose any building herein described and the several parts 109 thereof were occupied at the time of loss and whether or not it 110 then stood on leased ground, and shall furnish a copy of all the 111 descriptions and schedules in all policies and, if required, verified 112 plans and specifications of any building, fixtures or machinery 113 destroyed or damaged. The insured, as often as may be reason- 114 ably required, shall exhibit to any person designated by the 115 Company all that remains of any property herein described, and 116 submit to examinations under oath by any person named by this 117 Company, and subscribe the same; and, as often as may be 118 reasonably required, shall produce for examination all books of 119 account, bills, invoices and other vouchers, or certified copies 120 thereof if originals be lost, at such reasonable time and place as 121 may be designated by this Company or its representative, and 122 shall permit extracts and copies thereof to be made. 123 Appraisal. In case the insured and this Company shall 124 fail to agree as to the actual cash value or 125 the amount of loss, then, on the written demand of either, each 126 shall select a competent and disinterested appraiser and notify 127 the other of the appraiser selected within twenty days of such 128 demand. The appraisers shall first select a competent and dis- 129 interested umpire; and failing for fifteen days to agree upon 130 such umpire, then, on request of the insured or this Company, 131 such umpire shall be selected by a judge of a court of record in 132 the state in which the property covered is located. The ap- 133 praisers shall then appraise the loss, stating separately actual 134 cash value and loss to each item; and, failing to agree, shall 135 submit their differences, only to the umpire. An award in writ- 136 ing, so itemized, of any two when filed with this Company shall 137 determine the amount of actual cash value and loss. Each 138 appraiser shall be paid by the party selecting him and the ex- 139 penses of appraisal and umpire shall be paid by the parties 140 equally. 141 Company's It shall be optional with this Company to 142 options. take all, or any part, of the property at the 143 agreed or appraised value, and also to re- 144 pair, rebuild or replace the property destroyed or damaged with 145 other of like kind and quality within a reasonable time, on giv- 146 ing notice of its intention so to do within thirty days after the 147 receipt of the proof of loss herein required. 148 Abandonment. There can be no abandonment to this Com- 149 pany of any property. 150 When loss The amount of loss for which this Company 151 payable. may be liable shall be payable sixty days 152 after proof of loss, as herein provided, is 153 received by this Company and ascertainment of the loss is made 154 either by agreement between the insured and this Company ex- 155 pressed in writing or by the filing with this Company of an 156 award as herein provided. 157 Suit. No Suit or action on this policy for the recov- 158 ery of any claim shall be sustainable in any 159 court of law or equity unless all the requirements of this policy 160 shall have been complied with, and unless commenced within 161 three years next after inception of the loss. Form SS 12 04 03 92 Printed in U.S.A. Copyright, Hartford Fire Insurance Company, 1 cF Risk Mwag me dDMsian 1'x REVIEWED & APPROVED BY.- v --� Risk janagement Analyst 162 Subrogation. This Company may require from the insured 163 an assignment of all right of recovery against 164 any party for loss to the extent that payment therefor is made 165 by this Company. Form SS 12 04 03 92 Printed in U.S.A. Copyright, Hartford Fire Insurance Company, 1 cF Risk Mwag me dDMsian 1'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst Insurer: SENTINEL INSURANCE COMPANY, LIMITED ONE HARTFORD PLAZA, HARTFORD, CT 06155 This Declarations Page, with Common Policy Conditions, Data Breach Coverage Form and Endorsements, if any, issued to form a part thereof, shall together constitute this Data Breach Coverage Part, which in turn forms a part of the Policy Number shown below. The Common Policy Conditions and Nuclear Energy Liability Exclusion of the policy to which this Coverage Part is attached also apply to this Coverage Part. But if there is any conflict between the policy and this Coverage Part, then this Coverage Part will govern. "Coverage part" means this Declarations page and all Data Breach forms listed herein and attached hereto. POLICY NUMBER: 59 SBA RV9040 DATA BREACH COVERAGE DECLARATIONS PLEASE READ YOUR POLICY. IF YOU HAVE PURCHASED DATA BREACH - DEFENSE AND LIABILITY, NOTE THAT CLAIM EXPENSES ARE PAYABLE WITHIN THE LIMITS OF LIABILITY. Named Insured and Mailing Address: BAY SPROUTS LLC SEE FORM SS 12 35 6800 OWENSMOUTH AVE STE 350 CANOGA PARK CA 91303 Policy Period Effective Date: 11 / 13 / 2 0 Expiration Date: 11 / 13 / 21 12:01 A.M., Standard time at the address of the named insured as stated herein. Premium: Minimum Premium: Data Breach - Response Expenses Limit Of Insurance: Retroactive Date: If no date is entered, the Retroactive Date is the same as the effective date of this Coverage Part. Business Income And Extra Expense Sub -limit: Extortion Threats Sub -limit: Data Breach - Defense and Liability (THIS IS CLAIMS FIRST MADE AND REPORTED IN WRITING INSURANCE) Limit Of Insurance: Retroactive Date: If no date is entered, the Retroactive Date is the same as the effective date of this Coverage Part. Fines and Penalties Sub -limit: $207 NONE Data Breach - Response Expenses 10,000 Deductible: 1,000 11/13/18 Business Income And Extra Expense NOT INCLD Waiting Period Deductible: NA Hours NOT INCLD Data Breach - Response Expenses deductible shown above also applies to Extortion Threats coverage. 50,000 Data Breach - Defense and Liability Deductible: 11000 11/13/18 NOT INCLD PCI Loss Sub -limit: NOT INCLD Form Numbers Of Forms and Endorsements that apply: Common Policy Conditions: Form SS 00 05, Exclusion - Nuclear Energy Liability: SS 05 47 SS00470316 SS00480316 Countersigned by _;51' (where required by law) Form SS 00 46 09 19 Process Date: 0 8 / 18 / 2 0 Authorized Representative Policy cF RA ManWmad DMsian REVIEWED & APPROVED SY.- V"° --� Risk janagement Analyst DATA BREACH COVERAGE - RESPONSE EXPENSE Form SS 00 47 03 16 Risk MmWmentDMsian REVIEWED & APPROVED BY: v ©2016, The Hartford —_-- W.Wjanagementftalpt QUICK REFERENCE DATA BREACH COVERAGE - RESPONSE EXPENSE READ YOUR POLICY CAREFULLY Beginning on Page SECTION A: INSURING AGREEMENT 1 SECTION B: LIMIT OF INSURANCE 1 SECTION C: WHO IS AN INSURED 1 SECTION D: DEDUCTIBLES 1 SECTION E: DUTIES IN THE EVENT OF LOSS 2 SECTION F: EXCLUSIONS 2 SECTION G: CONDITIONS 2 SECTION H: DEFINITIONS 3 �40 1°x REVIEWED & APPROVED BY: Form SS 00 47 03 16 Rksk Pjanagement Analpt DATA BREACH COVERAGE - RESPONSE EXPENSE PLEASE READ ALL PROVISIONS CAREFULLY, AND CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS. YOUR COVERAGE APPLIES WHEN A "DATA BREACH" OCCURS ON OR AFTER THE 'RETROACTIVE DATE" AND BEFORE THE END OF THE "POLICY PERIOD", AND THE "DATA BREACH" IS FIRST DISCOVERED DURING THE "POLICY PERIOD". COVERED "DATA BREACH EXPENSES" WITHIN THE DEDUCTIBLE AMOUNT MUST BE PAID BY YOU AND DO NOT REDUCE THE LIMITS OF LIABILITY. COVERED "DATA BREACH EXPENSES" ABOVE THE DEDUCTIBLE ARE PAYABLE UNDER THIS COVERAGE PART AND REDUCE THE LIMITS OF LIABILITY. SOME PROVISIONS IN THIS COVERAGE PART RESTRICT COVERAGE. READ THE ENTIRE POLICY CAREFULLY TO DETERMINE RIGHTS, DUTIES AND WHAT IS AND WHAT IS NOT COVERED. Throughout this Coverage Part, the words "you" and "your" refer to the Named Insured shown in the Coverage Part Declarations. The words "we" "us" and 'bur" refer to the stock insurance company member of The Hartford providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section H. DEFINITIONS. A. INSURING AGREEMENT 2. Regardless of when expenses are incurred, We will pay for "data breach expenses" that you we will not pay "data breach expenses" in incur as a result of a "data breach" of "personally excess of the limit of insurance that is identifiable information", subject to the limit of applicable to the "policy period" when the insurance, if the following conditions are met: "data breach" was first discovered. 1. The "data breach" occurs on or after the C. WHO IS AN INSURED "retroactive date" and before the end of the "policy period". 2. The insured first becomes aware of the "data breach" during the "policy period". 3. At the time you applied for this insurance you had no knowledge of the "data breach". 4. The "data breach" is reported to us as soon as practicable, but in no event later than 30 days after it is first discovered by the insured. 5. The "data breach" must involve "personally identifiable information" that was held by you or on your behalf in the " coverage territory" . We will have no duty to pay for any damages for which this insurance does not apply. B. LIMIT OF INSURANCE 1. We will pay up to the applicable limit of insurance for "data breach expenses" stated in the Coverage Part Declarations. A sub -limit may apply for certain coverages as described in the Coverage Part Declarations. If you are designated in the Policy Declarations as: 1. An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. 2. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. 3. A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. 4. An organization, other than a partnership, joint venture or limited liability company, you are an insured. Your executive officers and directors are insureds, but only with respect to their duties as your executive officers or directors. 5. A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. We will not pay "data breach expenses" in D. DEDUCTIBLES excess of the applicable limit of insurance for We will not pay for "data breach expenses" until Data Breach - Response Expenses that is the amount of loss shown on the Coverage Part Declarations. deductible shown RA�DMsiun Jy/ w F\'x REVIEWED & APPROVED BY: Form SS 00 47 03 16 �� V © 2016, The Hartford -- Wsk Pjanagement Analpt DATA BREACH COVERAGE - RESPONSE EXPENSE Declarations. Subject to the terms and conditions of the Policy, we will pay the amount of loss in excess of the applicable deductible up to the applicable limit of insurance shown in the Coverage Part Declarations. E. DUTIES IN THE EVENT OF LOSS 1. You must report the "data breach" to us on or within 30 days of your discovery of the "data breach" and, you must: a. Immediately record the specifics of the "data breach", and the date discovered. b. Cooperate with us in the investigation of the "data breach". c. Assist us, upon our request in the enforcement of any right against any person or organization which may have accessed, lost, stolen or disclosed the information or data giving rise to a "data breach". d. You may not, except at your own cost, voluntarily make a payment, assume any obligation, or incur any expense without our prior written consent. 2. You have up to one year from the date of reporting a "data breach" to initiate the services provided to you. 3. As soon as possible, give us, and/or our agent, a description of how, when and where the "data breach" occurred, including but not limited to all of the following information as it becomes known to you: a. The method of "data breach"; b. The approximate date and time of the "data breach"; c. The approximate number of files compromised as a result of the "data breach"; d. A detailed description of the type and nature of the information that was compromised; e. Whether or not the information was encrypted, and, if so, the level of encryption; f. Whether or not law enforcement has been notified; g. If available, the place of domicile for all persons whose "personally identifiable information" was the subject of a "data breach"; h. If available, who received the information contained in the "data breach" and i. Any other access, information or documentation we reasonably require to investigate or adjust the loss Page 2 of 3 4. Take all reasonable steps to protect "personally identifiable information" remaining in your care, custody or control. 5. Preserve, and permit us to inspect, all evidence of the "data breach". 6. If requested, permit us to question you under oath, orally or in writing, at such times as may be reasonably required about any matter relating to this insurance or the loss, including copies of your books and records. In answering questions in writing, your answers must be signed. F. EXCLUSIONS This insurance does not cover: 1. "Data breach expenses" relating to any "data breach" arising out of a criminal, fraudulent or dishonest act, error or omission, or any intentional or knowing violation of the law by an insured. 2. "Data breach expenses" incurred in connection with any criminal investigations or proceedings, or any civil investigations or proceedings initiated by a governmental agency or authority. 3. Any costs to correct a deficiency in your systems, including but not limited to, data security, data storage or physical security and procedures. 4. "Data breach expenses" related to a "data breach" arising out of any failure to apply or improper application of necessary software patches. 5. Any fines, penalties, or surcharges. 6. Costs or losses incurred by a person whose "personally identifiable information" was the subject of a "data breach" except as provided under "data breach expenses". 7. "Data breach expenses" relating to any "data breach" that was known to an insured prior to the "policy period". 8. "Data breach expenses" arising from a failure to comply with any state, federal, foreign or self -regulatory requirement around minimum data security standards. G. CONDITIONS 1. The first named insured must pay all premiums when due. We will pay any return premium to the first named insured. 2. Our obligation to pay "data breach expenses" will only be in excess of the applicable deductible as stated in the Coverage Part Declarations. 3. To the extent " paid for service ew cF 4`°x RAMwagmedDMsiuR REVIEWED & APPROVED BY: provider, you ML .. . V --� Rusk Pjanagement Analpt DATA BREACH COVERAGE - RESPONSE EXPENSE 4. that we designate or approve prior to the start of any services. You will have a direct relationship with the provider and all services providers work for you. We are not liable for any act or omission by any third party provider of services. 5. All "data breach(es)" that occur at the same time, or are caused by the same act, error, omission, defect or deficiency, or series of related acts, errors, omissions, defects or deficiencies, shall be considered to be a single "data breach", regardless of the number of claimants, victims, or the number of entities that obtained access to the "personally identifiable information" involved in the breach. H. DEFINITIONS The following definitions only apply to this form and any supplemental coverages or amendatory endorsements added to it by endorsement. 1. " Coverage territory" means all parts of the world, provided that no trade or economic sanction, embargo, insurance or other laws or regulations prohibit us from paying " data breach expenses" in relation to the " data breach" . Payment of " data breach expenses" relating to notification expenses is only available in jurisdictions or countries that maintain data breach notice laws that requires notification of victims of a " data breach" . 2. "Data breach" means the loss, theft, accidental release or accidental publication of "personally identifiable information", or circumstances objectively giving rise to a substantial risk that such a loss, theft, release or publication has occurred. 3. "Data breach expenses" means reasonable: a. Notification expenses to notify a person whose "personally identifiable information" was the subject of a " data breach" in compliance with mandatory "data breach" notification statutes or regulations. Form SS 00 47 03 16 b. Crisis management expenses to perform services by any public relations firm, crisis management firm or law firm to minimize potential harm to the insured. Crisis management expenses also includes the fees and costs of a company hired to operate a call center to handle inquiries from the parties affected by a " data breach" . c. Monitoring service expenses to provide " data breach" victims with credit, fraud, public records or other monitoring alerts for up to one year, if determined to be warranted by us or the service provider. d."Good faith advertising services". e. "Legal and forensic services". 4. " Good faith advertising services" means services provided to assist in organizing the insured's media responses in relation to a " data breach" . 5. " Legal and forensic services" means reimbursement for the verification of compliance with data breach notification laws. " Legal and forensic services" also provides coverage for the investigation of computer hacking incidents, lost and stolen property, cyber extortion, database fraud and determinations as to whether or not data was accessed. 6. "Personally identifiable information" means an individual' s social security number, bank account number, credit and debit card account numbers, PIN numbers or transaction history, driver's license number, medical diagnosis, patient history and medications and any other applicable private information that may be defined by state, federal or applicable foreign law. 7. "Policy period" means the time beginning with the effective date shown in the Coverage Part Declarations and ending with the earlier of: a.The date of cancellation; or b.The expiration date shown in the Coverage Part Declarations. 8. "Retroactive date" means the date displayed on the Coverage Part Declarations. If no date is entered on the Coverage Part Declarations, the "retroactive date" is the same as the effective date. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst DATA BREACH COVERAGE - DEFENSE AND LIABILITY (CLAIMS MADE) Form SS 00 48 03 16 Risk MmWmentDMsian REVIEWED & APPROVEDSY: "° ©2016, The Hartford —_-- Risk PjanagementAnalyst QUICK REFERENCE DATA BREACH COVERAGE - DEFENSE AND LIABILITY (CLAIMS MADE) READ YOUR POLICY CAREFULLY SECTION A: INSURING AGREEMENT SECTION B: LIMIT OF INSURANCE AND DEDUCTIBLE SECTION C: NOTICE OF CLAIM SECTION D: YOUR DUTIES WITH RESPECT TO DATA BREACH CLAIMS SECTION E: EXCLUSIONS SECTION F: WHO IS AN INSURED SECTION G: CONDITIONS SECTION H: BASIC EXTENDED REPORTING PERIOD SECTION I: SUPPLEMENTAL EXTENDED REPORTING PERIOD SECTION J: DEFINITIONS Form SS 00 48 03 16 Beginning on Page 1 1 2 2 3 4 4 4 4 5 ew cF RAMwagementDMsian �40 1°x REVIEWED & APPROVED BY: --� Risk janagement Analyst DATA BREACH COVERAGE - DEFENSE AND LIABILITY NOW DATA BREACH COVERAGE - DEFENSE AND LIABILITY (CLAIMS MADE) THIS IS CLAIMS FIRST MADE AND REPORTED IN WRITING COVERAGE. PLEASE READ ALL PROVISIONS CAREFULLY, AND CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS. YOUR COVERAGE APPLIES ONLY TO "DATA BREACH CLAIMS" WHEN THE "DATA BREACH" OCCURS ON OR AFTER THE 'RETROACTIVE DATE" AND BEFORE THE END OF THE "POLICY PERIOD". ADDITIONALLY, YOUR COVERAGE APPLIES ONLY IF THE "DATA BREACH CLAIM" IS FIRST MADE DURING THE "POLICY PERIOD" AND REPORTED TO US WITHIN 30 DAYS OF YOUR FIRST NOTICE OF THE CLAIM, AND IN NO EVENT LATER THAN 30 DAYS AFTER THE END OF THE "POLICY PERIOD". PAYMENT OF DEFENSE COSTS REDUCES THE LIMIT OF LIABILITY. COVERED "LOSS" WITHIN THE DEDUCTIBLE AMOUNT MUST BE PAID BY YOU AND DOES NOT REDUCE THE LIMIT OF LIABILITY. COVERED "LOSS" ABOVE THE DEDUCTIBLE AMOUNT IS PAYABLE UNDER THIS COVERAGE PART AND REDUCES THE LIMIT OF LIABILITY. SOME PROVISIONS IN THIS COVERAGE PART RESTRICT COVERAGE. READ THE ENTIRE POLICY CAREFULLY TO DETERMINE RIGHTS, DUTIES AND WHAT IS AND WHAT IS NOT COVERED. Throughout this Coverage Part the words "you" and "your" refer to the Named Insured shown in the Coverage Part Declarations. The words "we" "us" and 'bur" refer to the stock insurance company member of The Hartford providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section J. DEFINITIONS. A. INSURING AGREEMENT We will pay for "loss" on behalf of the Insured(s) resulting from a "data breach claim" subject to the limit of insurance, if the following conditions are met: 1. The "data breach claim" is first made against you during the "policy period". A "data breach claim" will be deemed to have been made when notice of such "data breach claim" is received by you or by us, whichever comes first. 2. At the time you applied for this insurance you had no knowledge of the "data breach" out of which the "data breach claim" arises. 3. The "data breach claim" is reported to us within 30 days after you receive notice of the claim, but in no event later than 30 days after the end of the "policy period". 4. The "data breach claim" arises out of a "data breach" that occurs in the "coverage territory", and the "data breach" occurs on or after the "retroactive date" and before the end of the "policy period". 5. The "data breach" must involve "personally identifiable information" that was held by you or on your behalf in the "coverage territory". B. LIMIT OF INSURANCE AND DEDUCTIBLE 1. The DATA BREACH - DEFENSE AND LIABILITY limit of insurance that is stated in the Coverage Part Declarations is the most that we shall pay for all "loss" resulting from "data breach claims". 2. We will not pay for "loss" until the amount of "loss" exceeds the applicable deductible shown in the Coverage Part Declarations. Subject to the terms and conditions of the policy, we will pay the amount of "loss" in excess of the applicable deductible up to the DATA BREACH - DEFENSE AND LIABILITY limit of insurance that is stated in the Coverage Part Declarations. 3. The terms of this Coverage Part, including those with respect to our right and duty to defend "data breach claims" and your duties in the event of a "data breach claim", apply irrespective of the application of the deductible. 4. We may pay "loss" under this coverage part in the investigation or settlement of any "data breach claim" prior to your payment of any part or all of the deductible amount. Upon notification of the action we have taken, you Form SS 00 48 03 16 © 2016, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst DATA BREACH COVERAGE - DEFENSE AND LIABILITY shall reimburse us for that part of the 4. If, during the "policy period", you become deductible amount you owe within sixty (60) aware of any "data breach" that may lead to a days. We will be entitled to recover reasonable "data breach claim" and if written notice of attorney's fees and other costs incurred in such "data breach" is provided to us during the collecting the deductible amount you owe. "policy period", then any "data breach claims" 5. The limit of liability will not be reduced by the arising from that "data breach" shall be amount of any "loss" within the deductible deemed to be a "data breach claim" first made amount unless (but only to the extent that) during the "policy period", on the date when such "loss" has been paid by us and not we receive such notice, provided that the reimbursed by you. notice to us contains all of the following information: 6. If you agree with a request we make to submit a "data breach claim" made against you to a. The method of "data breach"; mediation or binding arbitration under the b. The approximate date and time of the terms and conditions we specify, and the "data "data breach"; breach claim" is resolved through such c. The approximate number of files mediation or binding arbitration, then we will compromised as a result of the "data reduce the deductible amount stated in the breach"; Coverage Part Declarations by fifty percent (50%). While the right to submit a "data breach d. A detailed description the type and claim" to mediation or binding arbitration shall nature of the information ion that was be ours, no "data breach claim" shall be compromised; submitted to mediation or binding arbitration e. Whether or not the information was under this paragraph without your prior written encrypted, and, if so, the level of consent. In the case of such resolution encryption; through mediation or binding arbitration, the f. Whether or not law enforcement has been maximum dollar amount by which the notified; deductible will be reduced under this paragraph is $10,000. g. If available, the place of domicile for all persons whose "personally identifiable C. NOTICE OF CLAIM information" was the subject of a "data 1. As a condition precedent to coverage, the breach"; Insured(s) shall provide us with notice of any h. If available, who received the information "data breach claim" within 30 days after you contained in the "data breach". receive notice of the claim, and in no event later than 30 days after the "policy period". D. YOUR DUTIES WITH RESPECT TO "DATA BREACH CLAIMS" 2. All "data breach claims" arising from the same "data breach" shall be considered as one "data 1. You must cooperate with us in the breach claim", first made on the earliest date investigation, settlement or defense of the that: "data breach claim", and assist us, upon our request in the enforcement of any right of a. any such "data breach claim" was first recovery regarding any payment of "loss" made, whether such date is before or under this Coverage Part. You shall execute during the "policy period"; any and all papers required, and do everything b. notice of the "data breach" was provided necessary to secure and preserve such rights, to us pursuant to section C. 4., below; or, including the execution of any documents c. notice of the "data breach" was provided needed to enable us to bring suit in your pursuant to any other insurance policy. name. You shall do nothing to prejudice our position or any potential or actual rights ofrecovery. 3. All "data breach(es)" that occur at the same time, or are caused by the same act, error, omission, defect or deficiency, or series of 2. You may not, except at your own cost, related acts, errors, omissions, defects or voluntarily make a payment, assume any deficiencies, shall be considered to be a single obligation, or incur any expense without our "data breach", regardless of the number of prior written consent. claimants, or the number of entities that 3. You must take all reasonable steps to protect obtained access to the "personally identifiable "personally identifiable information" remaining information" involved in the breach. in your care, custody or control. y e cF ILLi3RMwag'm2dDMsiOR Jy/ 1°x REVIEWED & APPROVED BY.- Pp Page 2 Of 5 Rusk janagement Analpt DATA BREACH COVERAGE - DEFENSE AND LIABILITY 4. You must preserve all evidence of the "data breach". E. EXCLUSIONS This insurance does not apply to "loss": 1. In connection with any "data breach claim" arising out of any criminal, fraudulent or dishonest act, error or omission, or any intentional or knowing violation of the law by any insured. 2. For "bodily injury" or "property damage". However, this exclusion will not apply to a claim for mental injury, mental tension, mental anguish, or emotional distress directly relating to a "data breach". 3. In connection with expenses arising out of any criminal investigations or proceedings or arising out of governmental action for the seizure or destruction of property by order of governmental authority, or war and military action including undeclared or civil war, insurrection rebellion, revolution or action taken by governmental authority in hindering or defending against any of these. 4. In connection with any "suit" seeking only non - monetary damages. 5. For any fines, penalties, or surcharges. 6. For any cost to correct a deficiency in your systems, including but not limited to, data security, data storage or physical security and procedures. 7. In connection with a "data breach claim" arising out of any shortcoming in a computer system that you knew about prior to the effective date of this Coverage Part. This includes any failure to take steps to use, design, maintain or upgrade a computer system and the inability to use, or lack of performance of software due to: a. expiration, cancellation, or withdrawal of such software; b. it not being released from its developmental state; or c. it not having passed all test runs or proven successful in applicable daily operations. Form SS 00 48 03 16 8. In connection with a "data breach" arising out of the failure to apply or improper application of necessary software patches. 9. In connection with a "data breach claim" arising out of any action or omission that violates or is alleged to violate: a. The Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law; b. The CAN-SPAM Act of 2003, including any amendment of, or addition to such law; or any statute, ordinance or regulation, other than the TCPA, or CAN- SPAM Act of 2003, that prohibits or limits the sending, transmitting, communicating or distribution of material or information. 10. In connection with a "data breach claim" arising out of any discrimination of any kind, including but not limited to race, creed, religion, age, handicap, sex, marital status or financial condition; refusal to employ, termination of employment, coercion, demotion, evaluation, reassignment, discipline, harassment, humiliation, discrimination or any employment related practices, policies, acts, errors or omissions. 11. In connection with a "data breach claim" arising out of any intentional or knowing violation of the Insured's privacy policy. 12. In connection with a "data breach claim" arising out of any actual or alleged infringement or patent, trade secret, copyright, service mark, trademark, trade name, or misappropriation of ideas or any other intellectual property right. 13. In connection with a "data breach claim" arising out of any rendering or failure to render any professional services for others, including without limitation, services performed by the Insured for or on behalf of a customer or client. 14. In connection with a "data breach claim" arising out of any breach of any express, implied, actual or constructive contract, warranty, guarantee, or promise, including liability of others assumed by you under any contract or agreement or breach of contract, unless such liability would have attached to you in the absence of such an agreement. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst DATA BREACH COVERAGE - DEFENSE AND LIABILITY 15. In connection with a "data breach claim" caused by the failure to comply with any state, federal or foreign regulation and/or self - regulatory requirements around minimum data security standards, including, but not limited to, the Fair and Accurate Credit Transaction Act (FACTA), and Song Beverly Act or similar statutes. However, this exclusion does not apply to reasonable and necessary legal fees and expenses incurred in the defense of a "regulatory proceeding". F. WHO IS AN INSURED If you are designated in the Policy Declarations as: 1. An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. 2. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. 3. A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. 4. An organization, other than a partnership, joint venture or limited liability company, you are an insured. Your executive officers and directors are insureds, but only with respect to their duties as your officers or directors. 5. A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. G. CONDITIONS 1. The first named insured must pay all premiums when due. We will pay any return premium to the first named insured. 2. If valid and collectible insurance is available for a "loss" we cover under this Coverage Part, we will share with that other insurance. If all the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes by equal amounts until it has paid its applicable limit of insurance or none of the "loss" remains, whichever comes first. If the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 3. If you refuse to consent to a settlement or compromise recommended by us and elect to contest the "data breach claim", our liability Page 4 of 5 shall not exceed the amount for which we would have been liable for "loss" if the "data breach claim" had been so settled when and as so recommended, (minus any applicable deductible) and we shall have the right to withdraw from the further defense of the "data breach claim" by tendering control of the defense thereof to you. 4. Immediately upon discovery of a "data breach", you must take all reasonable steps to mitigate potential damages to third parties by providing reasonable and necessary notification, monitoring and other services, as directed through our designated third party provider or by a third party provider that is approved by us. 5. Our obligation to pay "loss" will only be in excess of the applicable deductible as stated in the Coverage Part Declarations. H. BASIC EXTENDED REPORTING PERIOD We will automatically provide a Basic Extended Reporting Period if this Coverage Part is: 1. Cancelled; 2. Non -renewed; or 3. Renewed by us with insurance that does not apply on a claims made or claims made and reported basis. The Basic Extended Reporting Period begins with the end of the "policy period" and lasts for 30 days. The Basic Extended Reporting Period is provided at no charge. Under this provision, you have 30 days after the end of the "policy period" to report to us in writing "data breach claims" first made against any of you during the "policy period". The Basic Extended Reporting Period will not reinstate or increase the Limits of Insurance. SUPPLEMENTAL EXTENDED REPORTING PERIOD A Supplemental Extended Reporting Period is available, but only by an endorsement and for an extra charge. This supplemental period, if purchased, will run concurrently with the automatic Extended Reporting Period set forth in paragraph H. above. You must give us a written request for the endorsement within 30 days after the end of the "policy period". The Supplemental Extended Reporting Period will not go into effect unless you pay the additional premium promptly when due. The Supplemental Extended Reporting Period will not reinstate or increase the Limits of Insurance ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst DATA BREACH COVERAGE - DEFENSE AND LIABILITY We will determine the additional premium in accordance with our rules and rates. J. DEFINITIONS The following definitions only apply to this form and any applicable amendatory endorsements. 1. "Bodily injury" means physical injury, sickness or disease sustained by a person. 2. "Coverage territory" means all parts of the world provided that no trade or economic sanction, embargo, insurance or other laws or regulations prohibit us from paying "loss" in relation to the "data breach". The insured's liability for the "data breach claim" must be determined in the United States of America, Puerto Rico or Canada, in a civil suit or arbitration on the merits, according to the substantive law of United States of America, Puerto Rico or Canada, or in a settlement we agree to. 3. "Data breach" means the loss, theft, accidental release or accidental publication of "personally identifiable information", or circumstances objectively giving rise to a substantial risk that such loss, theft, release or publication has occurred. 4. "Data breach claim" means a written demand for relief based upon a "data breach" or a "suit" seeking monetary relief based upon a "data breach". 5. "Loss" means civil awards, settlements and judgments (including any award or prejudgment interest) that you are legally obligated to pay as a result of a "data breach claim", as well as reasonable and necessary legal fees and expenses incurred in the defense of a "suit" alleging a "data breach claim". With respect to "loss" applicable to a "regulatory proceeding", "loss" will only include reasonable and necessary legal fees and expenses incurred in the defense of a "regulatory proceeding". "Loss" does not include fines, penalties or punitive damages, or the cost of non -monetary relief. 6. "Personally identifiable information" means an individual's social security number, bank account number, credit or debit card transactions, driver's license numbers, medical diagnosis, patient history and medications and any other applicable private information that may be defined by state, federal or applicable foreign law. Form SS 00 48 03 16 7. "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property, or b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the physical injury that caused it. 8. "Policy period" means the time beginning with the effective date shown in the Coverage Part Declarations and ending with the earlier of: a. The date of cancellation; or b. The expiration date shown in the Coverage Part Declarations. 9. "Regulatory proceeding" means an investigation, demand or proceeding, including a request for information, brought by, or on behalf of, the Federal Trade Commission, Federal Communications Commission or other administrative or regulatory agency, or any federal, state, local or foreign governmental entity in such entity's regulatory or official capacity seeking relief based upon a "data breach". 10. "Retroactive date" means the date displayed on the Coverage Part Declarations. If no date is entered on the Coverage Part Declarations, the "retroactive date" is the same as the effective date. 11. "Suit" means a civil proceeding or "regulatory proceeding", in which monetary damages are sought for a "data breach claim" to which this insurance applies. "Suit" includes an arbitration proceeding in which monetary damages are sought, and to which the insured must submit, or does submit with our consent; or any other alternative dispute resolution proceeding in which such damages are sought and to which the insured submits with our consent. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THE HARTFORD U.S. DEPARTMENT OF THE TREASURY, 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 the United States. Please read this Notice carefully. The Office of Foreign Assets Control ("OFAC") of the U.S. Department of the Treasury administers and enforces economic and trade sanctions based on U.S. foreign policy and national security goals against targeted foreign countries and regimes, terrorists, international narcotics traffickers, those engaged in activities related to the proliferation of weapons of mass destruction, and other threats to the national security, foreign policy or economy of the United States. OFAC acts under Presidential national emergency powers, as well as authority granted by specific legislation, to impose controls on transactions and freeze assets under U.S. jurisdiction. OFAC publishes a list of individuals and companies owned or controlled by, or acting for or on behalf of, targeted countries. It also lists individuals, groups, and entities, such as terrorists and narcotics traffickers designated under programs that are not country -specific. Collectively, such individuals and companies are called "Specially Designated Nationals and Blocked Persons" or "SDNs". Their assets are blocked and U.S. persons are generally prohibited from dealing with them. This list can be located on OFAC's web site at — 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 an SDN, as identified by OFAC, the policy is a blocked contract and all dealings with it must involve 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. Form IH 99 40 04 09 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THE HARTFORD Named Insured: BAY SPROUTS LLC Policy Number: 59 SBA RV9040 Effective Date: 11 / 13 / 2 0 Expiration Date: 11 / 13 / 21 Company Name: SENTINEL INSURANCE COMPANY, LIMITED THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TRADE OR ECONOMIC SANCTIONS ENDORSEMENT This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including, but not limited to, the payment of claims. All other terms and conditions remain unchanged. Form IH 99 41 04 09 ew cF RAMwagementDMsian Jy/,'q REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst Insurer: SENTINEL INSURANCE COMPANY, LIMITED tL ay ONE HARTFORD PLAZA, HARTFORD, CT 06155 it This Declarations Page, with Umbrella Liability Provisions and Endorsements, if any, issued to form a part thereof, shall together constitute this Umbrella Liability Supplemental Contract, which in turn forms a part of Policy Number shown below. None of the provisions of the policy to which this Supplemental Contract is attached applies to the Umbrella Liability Insurance provided hereunder. Wherever the word "policy" appears in this form or in endorsements attached to or made a part of this Supplemental Contract, it means "Supplemental Contract". POLICY NUMBER: 59 SBA RV9040 DECLARATIONS Named Insured and Mailing Address: BAY SPROUTS LLC SEE FORM SS 12 35 6800 OWENSMOUTH AVE STE 350 CANOGA PARK CA 91303 Policy Period From: 11/13/20 To: 11/13/21 12:01 A.M., Standard time at the address of the named insured as stated herein. Premium $ INCLUDED ADVANCE PREMIUM Self Insured Retention $10, 000 each occurrence The Limits of Insurance subject to all the terms of this policy that apply are: Each Occurrence $ 6,000,000 Products -Completed Operations Aggregate Limit $ 6,000,000 General Aggregate Limit (Other $ 6,000,000 Bodily Injury By Disease Aggregate Limit $ 6,000,000 than Products - Completed Operations, Bodily Injury By Disease and Automobile) Schedule of Underlying Insurance Policies See Attached "Extension Schedule of Underlying Insurance Policies" Form Numbers of Forms and Endorsements that apply. SX80041008 SX02061008 SX21050697 SX21940317 SX24580901 SX80020405 SX02420317 SX21080405 SX23151215 SX01081008 SX02460120 SX21661008 SX24010401 SX02040118 SX21040697 SX21821008 SX24330610 Countersigned by`'"` �`�'�' 08/18/20 Authorized Representative Date Form SX 80 01 06 97 T Printed in U.S.A. (NS) Process Date: 0 8 / 18 / 2 0 ew cF RAMwagementDMsian Jy/,'q REVIEWED & APPROVED BY.- v Policy Expiration Date: WskPjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UMBRELLA LIABILITY PROVISIONS This supplemental contract modifies insurance provided under the policy to which it is attached In this policy the words "you" and "your" refer to the Named Insured first shown in the Declarations and any other person or organization qualifying as a Named Insured under this policy. "We", "us" and 'bur" refer to the stock insurance company member of The Hartford shown in the Declarations. Other words and phrases that appear in quotation marks also have special meanings. Refer to DEFINITIONS (Section VI I). IN RETURN FOR THE PAYMENT OF THE PREMIUM, in reliance upon the statements in the Declarations made a part hereof and subject to all of the terms of this policy, we agree with you as follows: SECTION I - COVERAGES INSURING AGREEMENTS A. Umbrella Liability Insurance 1. We will pay those sums that the "insured" becomes legally obligated to pay as "damages" in excess of the "underlying insurance" or of the "self -insured retention" when no "underlying insurance" applies, because of "bodily injury", "property damage" or "personal and advertising injury" to which this insurance applies caused by an 'occurrence". But, the amount we will pay as "damages" is limited as described in Section IV — LIMITS OF INSURANCE. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Section II - INVESTIGATION, DEFENSE, SETTLEMENT. 2. This insurance applies to "bodily injury", "property damage" or "personal and advertising injury" only if: a. The "bodily injury", "property damage" or "personal and advertising injury" occurs during the "policy period"; and b. Prior to the "policy period", no "insured" listed under Paragraph A. of Section III — Who Is An Insured and no "employee" authorized by you to give or receive notice of an 'occurrence" or claim, knew that the "bodily injury" or "property damage" had occurred, in whole or in part. If such a listed "insured" or authorized "employee" knew, prior to the "policy period", that the "bodily injury" or "property damage" occurred, then any continuation, change or resumption of such "bodily injury" or "property damage" during or after the "policy period" will be deemed to have been known prior to the "policy period". 3. "Bodily injury" or "property damage" will be deemed to have been known to have occurred at the earliest time when any "insured" listed under Paragraph A. of Section III — Who Is An Insured or any "employee" authorized by you to give or receive notice of an 'occurrence" or claim: a. Reports all, or any part, of the "bodily injury" or "property damage" to us or any other insurer; b. Receives a written or verbal demand or claim for "damages" because of the "bodily injury" or "property damage"; or c. Becomes aware by any other means that "bodily injury" or "property damage" has occurred or has begun to occur. B. Exclusions This policy does not apply to: 1. Pollution Any obligation: Form SX 80 02 04 05 © 2005, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: 11 ,v --� Risk janagement Analyst UMBRELLA LIABILITY PROVISIONS a. To pay for the cost of investigation, defense or settlement of any claim or suit against any "insured" alleging actual or threatened injury or damage of any nature or kind to persons or property which arises out of or would not have occurred but for the pollution hazard; or b. To pay any "damages", judgments, settlements, loss, costs or expenses that may be awarded or incurred: (1) By reason of any such claim or suit or any such injury or damage; or (2) In complying with any action authorized by law and relating to such injury or damage. As used in this exclusion, pollution hazard means an actual exposure or threat of exposure to the corrosive, toxic or other harmful properties of any solid, liquid, gaseous or thermal: a. Pollutants; b. Contaminants; c. Irritants; or d. Toxic substances; Including: Smoke; Vapors; Soot; Fumes; Acids; Alkalis; Chemicals, and Waste materials consisting of or containing any of the foregoing. Waste includes materials to be recycled, reconditioned or reclaimed. EXCEPTION This exclusion does not apply: a. To "bodily injury" to any of your "employees" arising out of and in the course of their employment by you; or b. To injury or damage as to which valid and collectible "underlying insurance" with at least the minimum limits shown in the Extension Schedule of Underlying Insurance Policies is in force and applicable to the 'occurrence". In such event, any coverage afforded by this policy for the 'occurrence" will be subject to the pollution exclusions of the "underlying insurance" and to the conditions, limits and other provisions of this policy. In the event that "underlying insurance" is not maintained with limits of liability as set forth in the Page 2 of 14 Extension Schedule of Underlying Insurance Policies, coverage under any of the provisions of this exception does not apply. Exception b. does not apply to: "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": (1) That are, or that are contained in any property that is: (a) Being transported or towed by, or handled for movement into, onto or from, any "auto"; (b) Otherwise in the course of transit by or on behalf of the "insured"; or (c) Being stored, disposed of, treated or processed in or upon any "auto"; (2) Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto any "auto"; or (3) After the "pollutants" or any property in which the "pollutants" are contained are moved from any "auto" to the place where they are finally delivered, disposed of or abandoned by the "insured". Paragraph (1) above does not apply to fuels, lubricants, fluids, exhaust gases or other similar "pollutants" that are needed for or result from the normal electrical, hydraulic or mechanical functioning of an "auto", covered by the "underlying insurance" or its parts, if: (a) The "pollutants" escape, seep, migrate, or are discharged or released directly from an "auto" part designed by its manufacturer to hold, store, receive or dispose of such "pollutants"; and (b) The "bodily injury", "property damage" or "covered pollution cost or expense" does not arise out of the operation of any equipment listed in Paragraphs f.(2) or f.(3). of the definition of "mobile equipment" in the Business Liability Coverage Form. Paragraphs (2) and (3) above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon an "auto" covered by the "underlying insurance" if: (a) The "pollutants" or any property in which the "pollutants" are contained are upset, overturned or d maintenance or ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst UMBRELLA LIABILITY PROVISIONS (b) The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. 2. Workers' Compensation and Similar Laws Any obligation of the "insured" under a workers' compensation, disability benefits or unemployment compensation law or any similar law. 3. Contractual Liability Liability assumed by the "insured" under any contract or agreement with respect to an "occurrence" taking place before the contract or agreement is executed. 4. Personal and Advertising Injury "Personal and advertising injury". EXCEPTION This exclusion does not apply if "underlying insurance" is applicable to "personal and advertising injury" and to claims arising out of that "personal and advertising injury". 5. Underlying Insurance Any injury or damage: a. Covered by "underlying insurance" but for any defense which any underlying insurer may assert because of the "insured's" failure to comply with any condition of its policy; or b. For which "damages" would have been payable by "underlying insurance" but for the actual or alleged insolvency or financial impairment of an underlying insurer. 6. Aircraft "Bodily injury" or "property damage" arising out of the ownership, operation, maintenance, use, entrustment to others, "loading or unloading" of any aircraft: a. Owned by any "insured"; or b. Chartered or loaned to any "insured". This exclusion applies even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an "insured", if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft that is owned or operated by or rented or loaned to any "insured". This exclusion does not apply to aircraft that is: Form SX 80 02 04 05 a. Hired, chartered or loaned with a paid crew; but b. Not owned by any "insured". This exclusion does not apply to "bodily injury" to any of your "employees" arising out of and in the course of their employment by you. 7. Watercraft "Bodily injury" or "property damage" arising out of the ownership, operation, maintenance, use, entrustment to others, "loading or unloading" of any watercraft. This exclusion applies even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an "insured", if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others, of any watercraft that is owned or operated by or rented or loaned to, any "insured". This exclusion does not apply to: a. Watercraft you do not own that is: (1) Less than 51 feet long; and (2) Not being used to carry persons for a charge; b. "Bodily injury" to any of your "employees" arising out of and in the course of their employment by you; or c. Any watercraft while ashore on premises owned by, rented to or controlled by you. 8. War Any injury or damage, however caused, arising, directly or indirectly, out of: a. War, including undeclared or civil war; b. Warlike action by a military force, including action in hindering or defending against an actual or expected attack by any government, sovereign or other authority using military personnel or other agents; or c. Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. 9. Damage to Property "Property damage" to property you own. 10. Damage to Your Product "Property damage" to "your product" arising out of it or any part of it. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst UMBRELLA LIABILITY PROVISIONS 11. Damage to Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products - completed operations hazard". This exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. 12. Damage to Impaired Property or Property Not Physically Injured "Property damage" to "impaired property" or property that has not been physically injured arising out of: 1. A defect, deficiency, inadequacy or dangerous condition in "your product" or "your work"; or 2. A delay or failure by you or anyone acting on your behalf to perform a contract or agreement in accordance with its terms. This exclusion does not apply to the loss of use of other property arising out of sudden and accidental physical injury to "your product" or "your work" after it has been put to its intended use. 13. Recall of Products, Work or Impaired Property "Damages" claimed for any loss, cost or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal or disposal of: a. "Your product"; b. "Your work"; or c. "Impaired property"; if such product, work or property is withdrawn or recalled from the market or from use by any person or organization because of a known or suspected defect, deficiency, inadequacy or dangerous condition in it. 14. Expected or Intended "Bodily injury" or "property damage" expected or intended from the standpoint of the "insured". This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 15. Employer Liability With respect to coverage afforded any of your "employees", to "bodily injury" or "personal and advertising injury": a. To other "employees" arising out of and in the course of their employment; Page 4 of 14 b. To the spouse, child, parent, brother or sister of that "employee" as a consequence of such "bodily injury" to that "employee"; c. To you, or any of your partners or members (if you are a partnership or joint venture), or your members (if you are a limited liability company); or d. Arising out of the providing or failing to provide professional health care services. Subparagraphs a. and b. of this exclusion apply: (1) Whether the "insured" may be liable as an employer or in any other capacity; and (2) To any obligation to share "damages" with or repay someone else who must pay "damages" because of the injury. EXCEPTION Subparagraphs a. and b. of this exclusion do not apply if "underlying insurance" is maintained providing coverage for such liability with minimum underlying limits, as described in the Extension Schedule of Underlying Insurance Polices. 16. Property Damage to Employee's Property With respect to coverage afforded any of your "employees", to "property damage" to property owned or occupied by or rented or loaned to: a. That "employee"; b. Any of your other "employees"; c. Any of your partners or members (if you are a partnership or joint venture); or d. Any of your members (if you are a limited liability company); 17. Uninsured or Underinsured Motorists Any claim for: a. Uninsured or Underinsured Motorists Coverage; b. Personal injury protection; c. Property protection; or d. Any similar no-fault coverage by whatever name called; unless this policy is endorsed to provide such coverage. 18. Employment Practices Liability Any injury or damage to: 1. A person arising out of any: (a) Refusal to employ that person; (b) Termination of that person's employment; or ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst UMBRELLA LIABILITY PROVISIONS (c) Any employment -related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation or discrimination directed at that person; or The spouse, child, parent, brother or sister of that person, as a consequence of "bodily injury" or "personal and advertising injury" to that person at whom any of the employment -related practices described in paragraphs (a), (b), or (c) above is directed. This exclusion applies: i. Whether the "insured" may be liable as an employer or in any other capacity; and ii. To any obligation to share "damages" with or repay someone else who must pay "damages" because of the injury. 19. Employee Retirement Income Security Act Any liability arising out of intentional or unintentional violation of any provision of the Employee Retirement Income Security Act of 1974, Public Law 93-406 (commonly referred to as the Revision Act of 1974), or any amendments to them. 20. Asbestos Any injury, "damages", loss, cost or expense, including but not limited to "bodily injury", "property damage" or "personal and advertising injury" arising out of, or relating to, in whole or in part, the "asbestos hazard" that: a. May be awarded or incurred by reason of any claim or suit alleging actual or threatened injury or damage of any nature or kind to persons or property which would not have occurred in whole or in part but for the "asbestos hazard"; or b. Arise out of any request, demand, order, or statutory or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, encapsulate, contain, treat, detoxify or neutralize or in any way respond to or assess the effects of any "asbestos hazard"; or c. Arise out of any claim or suit for "damages" because of testing for, monitoring, cleaning up, removing, encapsulating, containing, treating, detoxifying or neutralizing or in any way responding to or assessing the effects of an "asbestos hazard". Form SX 80 02 04 05 21. Racing And Stunting Activities "Bodily injury" or "property damage" arising out of the ownership, operation, maintenance, use, entrustment to others, "loading or unloading" of an "auto" or "mobile equipment" while being used in any: a. Prearranged or organized racing, speed or demolition contest; b. Stunting activity; or c. Preparation for any such contest or activity. 22. Electronic Data "Damages" arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data". 23. Limited Underlying Coverage Any injury, damage, loss, costs or expense, including but not limited to "bodily injury", "property damage" or "personal and advertising injury" for which: a. An "underlying insurance" policy or policies specifically provides coverage; but that b. Because of a provision within the "underlying insurance", such coverage is provided at a limit or limits of insurance that are less than the limit(s) for the "underlying insurance" policy or policies shown on the Extension Schedule of Underlying Insurance Policies. 24. Violation Of Statutes That Govern E-Mails, Fax, Phone Calls Or Other Methods Of Sending Material Or Information "Bodily injury", "property damage", or "personal and advertising injury" arising directly or indirectly out of any action or omission that violates or is alleged to violate: a. The Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law; b. The CAN-SPAM Act of 2003, including any amendment of or addition to such law; or c. Any statute, ordinance or regulation, other than the TCPA or CAN-SPAM Act of 2003, that prohibits or limits the sending, transmitting, communicating or distribution of material or information. SECTION II - INVESTIGATION, DEFENSE, SETTLEMENT A. With respect to "bodily injury", "property damage" or "personal and advertising injury" to which this insurance applies (whether or not the "self -insured retention" applies) and ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst UMBRELLA LIABILITY PROVISIONS 1. For which no coverage is provided under any "underlying insurance"; or 2. For which the underlying limits of any "underlying insurance" policy have been exhausted solely by payments of "damages" because of "occurrences" during the "policy period"; C. We: 1. Will have the right and the duty to defend any "suit" against the "insured" seeking "damages" on account thereof, even if such "suit" is groundless, false or fraudulent; but our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under coverages afforded by this policy; 2. May make such investigation and settlement of any claim or "suit" as we deem expedient; 3. Will pay all expenses incurred by us, all costs taxed against the "insured" in any "suit" defended by us and all interest on the entire amount of any judgment therein which accrues after the entry of the judgment and before we have paid or tendered or deposited in court that part of the judgment which does not exceed the applicable limit of insurance; 4. Will pay all premiums on appeal bonds required in any such "suit", premiums on bonds to release attachments in any such "suit" for an amount not in excess of the applicable limit of insurance, and the cost of bail bonds required of the "insured" because of an accident or traffic law violation arising out of the operation of any vehicle to which this policy applies, but we will have no obligation to apply for or furnish any such bonds; 5. Will pay all reasonable expenses incurred by the "insured" at our request in assisting us in the investigation or defense of any claim or "suit", including actual loss of earnings not to exceed $500 per day per "insured"; and the amounts so incurred, except settlement of claims and "suits", are not subject to the "self - insured retention" and are payable in addition to any applicable limit of insurance. The "insured" agrees to reimburse us promptly for amounts paid in settlement of claims or "suits" to the extent that such amounts are within the "self -insured retention". B. You agree to arrange for the investigation, defense or settlement of any claim or "suit" in any country where we may be prevented by law from carrying out this agreement. We will pay defense expenses incurred with our written consent in connection with any such claim or "suit" in addition Page 6 of 14 to any applicable limit of insurance. We will also promptly reimburse you for our proper share, but subject to the applicable limit of insurance, of any settlement above the "self -insured retention" made with our written consent. We will have the right to associate at our expense with the "insured" or any underlying insurer in the investigation, defense or settlement of any claim or "suit" which in our opinion may require payment hereunder. In no event, however, will we contribute to the cost and expenses incurred by any underlying insurer. SECTION III -WHO IS AN INSURED A. If you are doing business as: 1. An individual, you and your spouse are "insureds", but only with respect to the conduct of a business of which you are the sole owner. 2. A partnership or joint venture, you are an "insured". Your members, your partners, and their spouses are also "insureds", but only with respect to the conduct of your business. 3. A limited liability company, you are an "insured". Your members are also "insureds", but with only respect to the conduct of your business. Your managers are "insureds", but only with respect to their duties as your managers. 4. An organization other than a partnership, joint venture or limited liability company, you are an "insured". Your "executive officers" and directors are "insureds", but only with respect to their duties as your officers or directors. Your stockholders are also "insureds", but only with respect to their liability as stockholders. 5 A trust, you are an "insured". Your trustees are also "insureds", but only with respect to their duties as trustees. B. Each of the following is also an "insured": Your "volunteer workers" only while performing duties related to the conduct of your business or your "employees" other than your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts: a. Within the scope of their employment by you or while performing duties related to the conduct of your business; and b. Only if such "volunteer workers" or "employees" are "insureds" in the "underlying insurance" with limits of ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst UMBRELLA LIABILITY PROVISIONS liability at least as high as set forth in the Extension Schedule of Underlying Insurance Policies, subject to all the limitations upon coverage and all other policy terms and conditions of such "underlying insurance" and this policy. 2. Any person or organization with whom you agreed, because of a written contract, written agreement or because of a permit issued by a state or political subdivision, to provide insurance such as is afforded under this policy, but only with respect to your operations, "your work" or facilities owned or used by you. This provision does not apply: a. Unless the written contract or written agreement has been executed, or the permit has been issued, prior to the "bodily injury," "property damage," or "personal and advertising injury"; and b. Unless the limits of liability specified in such written contract, written agreement or permit are greater than the limits of liability provided by the "underlying insurance". c. Beyond the period of time required by the written contract, written agreement or permit. 3. Any person or organization having proper temporary custody of your property if you die, but only: a. With respect to liability arising out of the maintenance or use of that property; and b. Until your legal representative has been appointed 4. Your legal representative if you die, but only with respect to his or her duties as such. That representative will have all your rights and duties under this policy. C. With respect to any "auto", any "insured" in the "underlying insurance" is an "insured" under this insurance policy, subject to all the limitations of such "underlying insurance". D. With respect to "mobile equipment" registered in your name under any motor vehicle registration law, any person is an "insured" while driving such equipment along a public highway with your permission. Any other person or organization responsible for the conduct of such person is also an "insured", but only with respect to liability arising out of the operation of the equipment, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an "insured" with respect to: Form SX 80 02 04 05 1. "Bodily injury" to a co -"employee" of the person driving the equipment; or 2. "Property damage" to property owned by, rented to, in the charge of or occupied by you or the employer of any person who is an "insured" under this provision. E. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain financial interest of more than 50% of the voting stock, will qualify as an "insured" if there is no other similar insurance available to that organization. However: 1. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the "policy period", whichever is earlier; 2. This insurance does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and 3. This insurance does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. F. Each person or organization, not included as an "insured" in Paragraphs A., B., C., D., or E., who is an "insured" in the "underlying insurance" is an "insured" under this insurance subject to all the terms, conditions and limitations of such "underlying insurance". No person or organization is an "insured" with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. With respect to any person or organization who is not an "insured" under "underlying insurance", coverage under this policy shall apply only to loss in excess of the amount of the "underlying insurance" or "self -insured retention" applicable to you. However, coverage afforded by reason of the provisions set forth above applies only to the extent: (i) Of the scope of coverage provided by the "underlying insurance" but in no event shall coverage be broader than the scope of coverage provided by this policy and any endorsements attached hereto; and (ii) That such coverage provided by the "underlying insurance" is maintained having limits as set forth in the Extension Schedule of Underlying Insurance Policies. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst UMBRELLA LIABILITY PROVISIONS SECTION IV - LIMITS OF INSURANCE A. The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: 1. "Insureds"; 2. Claims made or "suits" brought; 3. Persons or organizations making claims or bringing "suits"; or 4. Coverages under which "damages" are covered under this policy. B. The Limit of Insurance stated as the General Aggregate Limit is the most we will pay for the sum of "damages", other than "damages": 1. Because of injury or damage included within the "products -completed operations hazard"; 2. Because of "bodily injury" by disease to your "employees" arising out of and in the course of their employment by you; and 3. Because of "bodily injury" or "property damage" arising out of the ownership, operation, maintenance, use, entrustment to others, "loading or unloading" of any "auto". C. The Limit of Insurance stated as the Products Completed Operations Aggregate Limit is the most we will pay for "damages" because of injury or damage included within the "products -completed operations hazard". D. The Limit of Insurance stated as the Bodily Injury By Disease Aggregate Limit is the most we will pay for "damages" because of "bodily injury" by disease to your "employees" arising out of and in the course of their employment by you. E. Subject to B., C., or D. above, whichever applies, the Each Occurrence Limit is the most we will pay for "damages" because of all "bodily injury", "property damage", and "personal and advertising injury" arising out of any one 'occurrence". F. Our obligations under this insurance, except for our obligations under the Cancellation and Nonrenewal Conditions, end when the applicable Limit of Insurance available is used up. If we pay any amounts for "damages" in excess of that Limit of Insurance, you agree to reimburse us for such amounts. G. The limits of this policy apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the "policy period" shown in the Declarations. However, if the "policy period" is extended after issuance for an additional period of less than 12 months, the additional period will be deemed part of the last preceding period for the purpose of determining the Limits of Insurance. Page 8 of 14 SECTION V - NUCLEAR ENERGY LIABILITY EXCLUSION (Broad Form) A. The insurance does not apply: 1. To "bodily injury" or "property damage": a. With respect to which an "insured" under the policy is also an "insured" under a nuclear energy liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters, Nuclear Insurance Association of Canada or any of their successors, or would be an "insured" under any such policy but for its termination upon exhaustion of its limit of liability; or b. Resulting from the "hazardous properties" of "nuclear material" and with respect to which (a) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (b) the "insured" is, or had this policy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization. 2. To "bodily injury" or "property damage" resulting from the "hazardous properties" of "nuclear material' if: a. The "nuclear material' (a) is at any "nuclear facility" owned by, or operated by or on behalf of, an "insured" or (b) has been discharged or dispersed therefrom; b. The "nuclear material' is contained in "spent fuel' or "waste" at any time possessed, handled, used, processed, stored, transported or disposed of by or on behalf of an "insured"; or c. The "bodily injury" or "property damage" arises out of the furnishing by an "insured" of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any "nuclear facility", but if such facility is located within the United States of America, its territories or possessions or Canada, this exclusion (c) applies only to "property damage" to such "nuclear facility" and any property thereat. B. As used in this exclusion: "Hazardous properties" include radioactive, toxic or explosive properties; ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst UMBRELLA LIABILITY PROVISIONS "Nuclear material" means "source material", "special nuclear material' or "by-product material'; "Source material", "special nuclear material" and "by-product material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof; "Spent fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a "nuclear reactor"; "Waste" means any waste material (a) containing "by-product material" other than the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its "source material' content, and (b) resulting from the operation by any person or organization of any "nuclear facility" included under the first two paragraphs of the definition of "nuclear facility". "Nuclear facility" means: (1) Any "nuclear reactor"; (2) Any equipment or device designed or used for (1) separating the isotopes of uranium or plutonium, (2) processing or utilizing "spent fuel', or (3) handling, processing or packaging "waste"; (3) Any equipment or device used for the processing, fabricating or alloying of "special nuclear material' if at any time the total amount of such material in the custody of the "insured" at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235; (4)Any structure, basin, excavation, premises or place prepared or used for the storage or disposal of "waste"; and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations; "Nuclear reactor" means any apparatus designed or used to sustain nuclear fission in a self-supporting chain reaction or to contain a critical mass of fissionable material; "Property damage" includes all forms of radioactive contamination of property. SECTION VI - CONDITIONS A. Premium All premiums for this policy shall be computed in accordance with the Premium Section of the Declarations. The premium stated as such in the Declarations is a deposit premium only which shall be credited to the amount of any earned premium. Form SX 80 02 04 05 At the close of each "policy period", the earned premium shall be computed for such period, and upon notice thereof to the Named Insured first shown in the Declarations, shall become due and payable by such Named Insured. If the total earned premium for the "policy period" is less than the premium previously paid and more than the minimum premium, we shall return to such Named Insured the unearned portion paid by such Named Insured. The Named Insured first shown in the Declarations shall maintain records of such information as is necessary for premium computation, and shall send copies of such records to us at the end of the "policy period" and at such times during the "policy period" as we may direct. B. Inspection and Audit We shall be permitted but not obligated to inspect your property and operations at any time. Neither our right to make inspections, nor the making thereof, nor any report thereon, shall constitute an undertaking on your behalf or for your benefit or that of others to determine or warrant that such property or operations are: 1. Safe; 2. Healthful; or 3. In compliance with any law, rule or regulation. We may examine and audit your books and records at any time during the "policy period" and extensions thereof and within three years after the final termination of this policy, insofar as they relate to the subject matter of this policy. C. Duties In The Event Of Occurrence, Claim or Suit 1. You must see to it that we are notified as soon as practicable of an 'occurrence" which may result in a claim under this policy. This requirement applies only when such "occurrence" is known to any of the following: (a) You, or any additional insured that is an individual; (b) Any partner, if you or an additional insured are a partnership; (c) Any manager, if you or an additional insured are a limited liability company; (d) Any "executive officer" or insurance manager, if you or an additional insured are a corporation. (e) Any trustee, if you or an additional insured is a trust; or (f) Any elected or appointed official, if you or an additional insured is a political subdivision or p ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst UMBRELLA LIABILITY PROVISIONS This duty applies separately to you and any additional insured. To the extent possible, notice should include: (a) How, when and where the "occurrence" took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence" or "offense". 2. If a claim is made or "suit" is brought against any "insured", you must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us in writing as soon as practicable if the claim is likely to exceed the amount of the "self -insured retention" or "underlying insurance", whichever applies. 3. You and any other involved "insured" must: (a) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit" involving or likely to involve a sum in excess of any "self -insured retention" or "underlying insurance", whichever applies"; (b) Authorize us to obtain records and other information; (c) Cooperate with us in the investigation or settlement of the claim or defense against the "suit"; and (d) Assist us, upon our request in the enforcement of any right against any person or organization which may be liable to the "insured" because of injury or damage to which this policy or any "underlying insurance" or "self -insured retention" may apply. 4. No "insured" will, except at that "insured's" own cost, make or agree to any settlement for a sum in excess of: (a) The total limits of "underlying insurance"; or (b) The "self -insured retention" if no "underlying insurance" applies without our consent. 5. No "insured" will, except at that "insured's" own cost, make a payment, assume any obligation, or incur any expenses, other than first aid, without our consent. D. Assistance and Cooperation of the Insured The "insured" shall: 1. Cooperate with us and comply with all the terms and conditions of this policy; and Page 10 of 14 2. Cooperate with any of the underlying insurers as required by the terms of the "underlying insurance" and comply with all the terms and conditions thereof. The "insured" shall enforce any right of contribution or indemnity against any person or organization who may be liable to the "insured" because of "bodily injury", "property damage" or "personal and advertising injury" with respect to this policy or any "underlying insurance". E. Legal Action Against Us No person or organization has a right under this policy: a. To join us as a party or otherwise bring us into a "suit" asking for "damages" from an "insured"; or b. To sue us on this policy unless all of its terms and those of the "underlying insurance" have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an "insured"; but, we will not be liable for "damages" that are not payable under the terms of this policy or that are in excess of the applicable Limits of Insurance. An agreed settlement means a settlement and release of liability signed by us, the "insured" and the claimant or the claimant's legal representative. F. Appeals In the event the "insured" or the "insured's" underlying insurer elects not to appeal a judgment in excess of the "underlying insurance" or the "self - insured retention", we may elect to make such appeal, at our cost and expense. If we so elect, we shall be liable in addition to the applicable Limit of Insurance, for the: 1. Taxable costs; 2. Disbursements; and 3. Additional interest incidental to such appeal; but in no event will we be liable for "damages" in excess of the applicable aggregate Limit of Insurance. If a judgment is rendered in excess of the limits of "underlying insurance" and we offer to pay our full share of such judgment, but you or your underlying insurers elect to appeal it, you, your underlying insurers or both will bear: a. The cost and duty of obtaining any appeal bond; b. The taxable costs, disbursements and additional interest incidental to such appeal; and ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst UMBRELLA LIABILITY PROVISIONS c. Any increase in "damages" over the amount the matter could have been settled for after the verdict was entered and before the appeal was filed. G. Other insurance This policy shall apply in excess of all "underlying insurance" whether or not valid and collectible. It shall also apply in excess of other valid and collectible insurance (except other insurance purchased specifically to apply in excess of this insurance) which also applies to any loss for which insurance is provided by this policy. These excess provisions apply, whether such other insurance is stated to be: 1. Primary; 2. Contributing; 3. Excess; or 4. Contingent; Provided that if such other insurance provides umbrella coverage in excess of "underlying insurance" or a "self - insured retention", this policy shall contribute therewith with respect to "damages". However, we shall not be liable for a greater proportion of such loss than the amount which would have been payable under this policy bears to the sum of: 1. Said amount; and c. Reasonable expenses incurred in the exercise of rights of recovery shall be apportioned among all interests in the ratio of their respective losses for which recovery is sought. I. Changes This policy contains all the agreements between you and us concerning the insurance afforded. Notice to any agent, or knowledge possessed by any agent or any other person shall not effect a waiver or a change in any part of this policy, or stop us from asserting any rights under the terms of this policy. The Named Insured first shown in the Declarations is authorized on behalf of all "insureds" to agree with us on changes in the terms of this policy. If the terms are changed, the changes will be shown in an endorsement issued by us and made a part of this policy. J. Separation Of Insureds Except with respect to the Limits of Liability, and any rights or duties specifically assigned in this policy to the Named Insured first shown in the Declarations, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each "insured" against whom claim is made or "suit" is brought. 2. The amounts which would have been payable K. under each other umbrella policy applicable to such loss, had each such policy been the only policy so applicable. H. Transfer Of Rights Of Recovery Against Others To Us a. If the "insured" has rights to recover all or a part of any payment we have made under this policy, those rights are transferred to us. The "insured" must do nothing after a loss to impair them. At our request, the "insured" will bring "suit" or transfer those rights to us and help us enforce them. b. Recoveries shall be applied to reimburse: (1) First, any interest (including the Named Insured) that paid any amount in excess of our limit of liability: (2) Second, us, along with any other insurers having a quota share interest at the same level; (3) Third, such interests (including the Named Insured) of whom this insurance is excess. However, a different apportionment may be made to effect settlement of a claim by agreement signed by all interests. Form SX 80 02 04 05 Maintenance of Underlying Insurance Policies affording in total the coverage and limits stated in the Extension Schedule of Underlying Insurance Policies shall be maintained in full effect during the currency of this policy. Your failure to comply with the foregoing shall not invalidate this policy, but in the event of such failure, we shall be liable only to the extent that we would have been liable had you complied herewith. The Named Insured first shown in the Declarations shall give us written notice as soon as practicable of any of the following: 1. Any change in the coverage or in the limits of any "underlying insurance", including but not limited to a change from occurrence coverage to claims made coverage; 2. Termination of part or all of one or more of the policies of "underlying insurance"; 3. Reduction or exhaustion of an aggregate limit of liability of any "underlying insurance". The "self -insured retention" shall not apply should the "underlying insurance" be exhausted by the payment of claims or "suits" which are also covered by this policy. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst UMBRELLA LIABILITY PROVISIONS L. Cancellation 1. The Named Insured first shown in the Declarations may cancel this policy by mailing or delivering to us or to any of our authorized agents advance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the Named Insured first shown in the Declarations at the address shown in this policy, written notice of cancellation at least: a. 10 days before the effective date of cancellation if such Named Insured fails to pay the premium or any installment when due; or b. 30 days before the effective date of cancellation if we cancel for any other reason. 3. If notice is mailed, proof of mailing will be sufficient proof of notice. Notice will state the effective date of cancellation. The "policy period" will end on that date. Delivery of such notice by the Named Insured first shown in the Declarations or by us will be equivalent to mailing. 4. If the Named Insured first shown in the Declarations cancels, the refund may be less than pro rata, but we will retain any minimum premium stated as such in the Declarations. If we cancel, the refund will be pro rata. The cancellation will be effective even if we have not made or offered a refund. M. Nonrenewal 1. If we decide not to renew, we will mail or deliver to the Named Insured first shown in the Declarations, at the address shown in this policy, written notice of nonrenewal at least 30 days before the end of the "policy period". 2. If notice is mailed, proof of mailing will be sufficient proof of notice. 3. If we offer to renew but such Named Insured does not accept, this policy will not be renewed at the end of the current "policy period". N. Workers' Compensation Agreement With respect to "bodily injury" to any officer or other "employee" arising out of and in the course of employment by you, you represent and agree that you have not abrogated and will not abrogate your common-law defenses under any Workers' Compensation Law by rejection of such law or otherwise. If at any time during the "policy period" you abrogate such defenses, the insurance for "bodily injury" to such officer or other "employee" automatically terminates at the same time. Page 12 of 14 O. Bankruptcy or Insolvency In the event of the bankruptcy or insolvency of the "insured" or any entity comprising the "insured", we shall not be relieved of any of our obligations under this policy. P. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. The statements in the Extension Schedule of Underlying Insurance Policies are accurate and complete; c. The statements in a. and b. are based upon representations you made to us; d. We have issued this policy in reliance upon your representations; and e. If unintentionally you should fail to disclose all hazards at the inception of this policy, we shall not deny coverage under this policy because of such failure. SECTION VII - DEFINITIONS Except as otherwise provided in this section or amended by endorsement, the words or phrases that appear in quotation marks within this policy shall follow the definitions of the applicable "underlying insurance" policy. A. "Accident" includes continuous or repeated exposure to the same conditions resulting in "bodily injury" or "property damage". B. "Auto" means a land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment. But "auto" does not include "mobile equipment". C. "Covered pollution cost or expense" means any cost or expense arising out of: 1. Any request, demand or order; or 2. Any claim or "suit" by or on behalf of a governmental authority demanding that the "insured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants". "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": 1. That are, or that are contained in any property that is: a. Being transported or towed by, handled, or handled for movement into, onto or from, any "auto"; ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst UMBRELLA LIABILITY PROVISIONS b. Otherwise in the course of transit by or on behalf of the "insured"; or c. Being stored, disposed of, treated or processed in or upon any "auto"; or 2. Before the "pollutants" or any property in which E the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto any "auto"; or 3. After the "pollutants" or any property in which the "pollutants" are contained are moved from any "auto" to the place where they are finally delivered, disposed of or abandoned by the F "insured". Paragraph a. above does not apply to fuels, lubricants, fluids, exhaust gases or other similar "pollutants" that are needed for or result from the normal electrical, hydraulic or mechanical functioning of an "auto", covered by the "underlying insurance" or its parts, if: 1. The "pollutants" escape, seep, migrate, or are discharged or released directly from an "auto" G. part designed by its manufacturer to hold, store, receive or dispose of such "pollutants"; and 2. The "bodily injury", "property damage" or "covered pollution cost or expense" does not arise out of the operation of any equipment listed in paragraphs f.(2) or f.(3) of the definition of "mobile equipment" in the Business Liability H. Coverage Form. Paragraphs b. and c. above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to I' "pollutants" not in or upon an "auto" covered by the "underlying insurance" if: 1. The "pollutants" or any property in which the "pollutants" are contained are upset, overturned or damaged as a result of the maintenance or use of the "auto"; and 2. The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. D. "Damages" means a monetary award, monetary settlement or monetary judgment. "Damages" include prejudgment interest awarded against the "insured" on that part of the judgment we pay. The following are not considered "damages" and are not covered by this policy: 1. Fines, penalties, sanctions or taxes; 2. Attorney's fees and costs associated with any non -monetary relief awarded against the "insured"; or Form SX 80 02 04 05 3. Any monetary award, monetary settlement or monetary judgment for which insurance is prohibited by the law(s) applicable to the construction of this policy. "Insured" means any person or organization qualifying as an "insured" in the applicable WHO IS AN INSURED provision of this policy. The insurance afforded applies separately to each "insured" against whom claim is made or "suit" is brought, except with respect to the limit of our liability under LIMITS OF INSURANCE (SECTION IV). "Occurrence" means: 1. With respect to "bodily injury" or "property damage", an "accident", including continuous or repeated exposure to substantially the same general harmful conditions; and 2. With respect to "personal and advertising injury", an offense described in one of the numbered subdivisions of that definition in the "underlying insurance". "Policy period" means the period beginning with the inception date stated as such in the Declarations and ending with the earlier of: 1. The date of cancellation of this policy; or 2. The expiration date stated as such in the Declarations. "Self -insured retention" means the amount stated as such in the Declarations which is retained and payable by the "insured" with respect to each "occurrence". "Underlying insurance" means the insurance policies listed in the Extension Schedule of Underlying Insurance Policies, including any renewals or replacements thereof, which provide the underlying coverages and limits stated in the Schedule of Underlying Insurance Policies. The limit of "underlying insurance" includes: 1. Any deductible amount; 2. Any participation of any "insured"; and 3. Any "self -insured retention" above or beneath any such policy; Less the amount, if any, by which the aggregate limit of such insurance has been reduced by any payment relating to any act, error, omission, injury, damage or offense for which insurance is provided by this policy, including Medical Payments Coverage as described in the "underlying insurance". The coverages and limits of such policies and any such deductible amount, participation or "self -in iirpri rptpntinn" czh�:Jl hp deemed to be applicable Aw RAMwagementDMsian F Jy/ \'x REVIEWED & APPROVED BY: i V"° --� RFsk janagement Analyst UMBRELLA LIABILITY PROVISIONS 1. Any defense which any underlying insurer may assert because of the "insured's" failure to comply with any condition of its policy; or 2. The actual or alleged insolvency or financial impairment of any underlying insurer or any "insured". The risk of insolvency or financial impairment of any underlying insurer or any "insured" is borne by you and not by us. Page 14 of 14 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst EXTENSION SCHEDULE OF UNDERLYING INSURANCE POLICIES This extension schedule forms a part of the policy designated in the Declarations. Carrier, Policy Number and Policy Period: A. SENTINEL INSURANCE COMPANY, LIMITED 59 SBA RV9040 11/13/20 TO 11/13/21 Type of Coverage Applicable Limits (X ) Business Liability - including: Bodily Injury and Property Damage Liability Combined $1, 000, 000 each occurrence $2, 000, 000 general aggregate Employees as Additional Insureds Contractual Liability Limited Non -Owned Watercraft Additional Insureds Damages To Premises Rented To You ( X ) Personal and Advertising Injury ( X ) Products/Completed Operations ( X ) Hired Auto and Non -Owned Auto B. ( ) Comprehensive Automobile Liability - Owned Automobiles ( ) Non -Owned Automobiles ( ) Hired Automobiles ( ) Uninsured Motorist C. HIG ( X ) Employer's Liability D. ( ) Liquor Liability Property Damage Liability $1, 000, 000 each occurrence $1,000,000 $2, 000, 000 Prod./Comp. Ops. aggregate $1, 000, 000 Limit of Liability Bodily Injury Liability each person each accident Property Damage Liability each accident Bodily Injury and Property Damage Liability Combined each accident each occurrence 59WECAC9055 07/03/20 TO 07/03/21 $1, 000, 000 each accident* $1, 000, 000 each employee by disease* $1, 000, 000 total policy by disease* An "V marked in the box indicates the coverage is provided in the Underlying Policies. (Note Maintenance of Underlying Insurance Condition SX 80 02 or SX 80 03) *Except that in any jurisdiction where the amount of Employers Liability Coverage afforded by the underlying insurer is by law unlimited, the limit stated does not apply and the policy of which this extension schedule forms a part shall afford no insurance with respect to Employers Liability in such jurisdiction. Form SX 80 04 10 08 Process Date: 0 8 / 18 / 2 0 J�N RiskMmRgk:merdDMsian REVIEWED & APPROVED BY. - Policy Expiration Date: VI --� Risk Pjanagement Analyst EXTENSION SCHEDULE OF UNDERLYING INSURANCE POLICIES (Continued) POLICY NUMBER: 59 SBA RV9040 Carrier, Policy Number and Policy Period: E. Type of Coverage Applicable Limits ( ) Foreign Commercial General Liability- including: each occurrence Personal and Advertising Injury Personal and Advertising Injury aggregate Products/Completed Operations Products/Completed Operations aggregate ( ) Foreign Contingent Auto Liability each accident ( ) Foreign Employer's Liability each accident * each employee by disease* total policy by disease* An "V marked in the box indicates the coverage is provided in the Underlying Policies. (Note Maintenance of Underlying Insurance Condition SX 80 02 or SX 80 03) *Except that in any jurisdiction where the amount of Employers Liability Coverage afforded by the underlying insurer is by law unlimited, the limit stated does not apply and the policy of which this extension schedule forms a part shall afford no insurance with respect to Employers Liability in such jurisdiction. Form SX 80 04 10 08 Process Date: 0 8 / 18 / 2 0 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: v Policy Expiration Date: R.Wjanagementftalpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CONDITIONS - NORTH CAROLINA This endorsement modifies insurance provided under the UMBRELLA LIABILITY PROVISIONS It is agreed that: 1. The Cancellation Condition is replaced by the following: Cancellation a. The Named Insured first shown in the Declarations may cancel this policy by: (1) Mailing or delivering to us advance written notice of cancellation; or (2) Surrendering the policy to us or to any of our authorized agents. b. We may cancel this policy by mailing or delivering to the Named Insured first shown in the Declarations written notice of cancellation at least: (1) 15 days before the effective date of cancellation, if we cancel for nonpayment of any premium when due; (2) 30 days before the effective date of cancellation, if we cancel for any other reason and the policy has been in effect for less than 60 days and is not a renewal with us; or (3) 30 days before the effective date of cancellation, if we cancel and the policy has been in effect for 60 days or more, or is a renewal with us, but only for one or more of the following reasons, or as permitted under applicable North Carolina law: (a) An act or omission by you or your representative that constitutes material misrepresentation or nondisclosure of a material fact in obtaining this policy, continuing this policy or presenting a claim under this policy; Form SX 01 08 10 08 (b) Increased hazard or material change in the risk assumed that could not have been reasonably contemplated by the parties at the time of assumption of the risk; (c) Substantial breach of contractual duties, conditions or warranties that materially affects the insurability of the risk; (d) A fraudulent act against us by you or your representative that materially affects the insurability of the risk; (e) Willful failure by you or your representative to institute reasonable loss control measures that materially affect the insurability of the risk after written notice by the insurer; (f) You conviction of a crime arising out of acts that materially affect the insurability of the risk; (g) A determination by the Commissioner of Insurance that the continuation of this policy would place us in violation of the laws of North Carolina. c. We will mail or deliver our notice to the last mailing address known to us of the Named Insured first shown in the Declarations. We will also mail or deliver a copy of the notice to any mortgagee or loss payee indicated in the policy and to the agent or broker of record. If notice is mailed, proof of mailing will be sufficient proof of notice. d. Notice of cancellation by us will state the effective date of cancellation. The "policy period" will end on that date. © 2008, The Hartford ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst e. If this policy is canceled, we will send the 3. The Changes condition is amended. The first Named Insured first shown in the Declarations paragraph is deleted and replaced by the following: any premium refund due. If we cancel, the This policy contains all the agreements between you refund will be pro rata. and us concerning the insurance afforded. The first f. If the Named Insured cancels, we shall compute Named Insured shown in the Declarations is the return premium at 90% of the pro rata authorized on behalf of all insureds to agree with us unearned premium. We shall in any event be on changes in the terms of this policy. If the terms entitled to retain any minimum retained premium are changed, the changes will be shown in an stated in the Declarations. endorsement issued by us and made a part of this g. Premium adjustment may be made either at the policy. time cancellation is affected or as soon as practicable after cancellation becomes effective, but payment of tender of unearned premium is not a condition of cancellation. 2. The Nonrenewal Condition is replaced by the following: Nonrenewal a. If we decide not to renew this policy, we will mail or deliver written notice of non -renewal to the Named Insured first shown in the Declarations at least 45 days before the end of the "policy period." The notice shall specify the precise reasons for non -renewal. b. We need not mail or deliver the notice of non - renewal if you have: (1) Insured property covered under this policy under any other insurance policy; (2) Accepted replacement coverage; or (3) Requested or agreed to non -renewal of this policy. c. We will also mail or deliver a copy of the notice to any mortgagee or loss payee indicated in the policy and to the agent or broker or record. If notice is mailed, proof of mailing will be sufficient proof of notice. Page 2 of 2 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ILLINOIS CHANGES This endorsement modifies insurance under the following: UMBRELLA LIABILITY PROVISIONS A. SECTION VI- CONDITIONS The Cancellation Condition is deleted and replaced by the following: 1. The first Named Insured shown in the Declarations may cancel this policy by mailing to us advance written notice of cancellation. 2. We may cancel this policy by mailing to you written notice stating the reason for cancellation. If we cancel: a. For nonpayment of premium, we will mail the notice at least 10 days prior to the effective date of cancellation. b. For a reason other than nonpayment of premium, we will mail the notice at least; (1) 30 days prior to the effective date of cancellation if the policy has been in effect for 60 days or less. (2) 60 days prior to the effective date of cancellation if the policy has been in effect for more than 60 days. 3. If this policy has been in effect for more than 60 days or is a renewal or continuation policy, we may cancel only for one or more of the following reasons, or as permitted by applicable Illinois law: a. Nonpayment of premium; b. The policy was obtained through a material misrepresentation; c. Any insured has violated any of the terms and conditions of the policy; d. The risk originally accepted has measurably increased; e. Certification to the Director of Insurance of the loss of reinsurance by the insurer that provided coverage to us for all or a substantial part of the underlying risk insured; or f. A determination by the Director of Insurance that the continuation of the policy could place us in violation of the insurance laws of this State. 4. We will mail our notice to you, at your last mailing address known to us. Proof of mailing will be sufficient proof of notice. 5. Notification of cancellation will also be sent to your broker, if known, or agent of record, if known. 6. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 7. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund will be less than pro rata. The cancellation will be effective even if we have not offered a refund. B. SECTION VI- CONDITIONS The Nonrenewal Condition is deleted and replaced by the following: a. If we decide not to renew or continue this policy, we will mail you written notice, stating the reason for nonrenewal at least: (1) 60 days before the end of the policy period for all policies other than that described in a.(2); or (2) 30 days before the end of the policy period for all commercial excess and umbrella liability policies as defined in 215 ILL. COMP. STAT. 143.13.(h). The nonrenewal shall not become effective until at least 30 days from the proof of mailing date of the notice to you. b. Proof of mailing will be sufficient proof of notice. c. Notification of nonrenewal will also be sent to your broker, if known, or agent of record, if known. d. If we offer to renew or continue 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 offer. Form SX 02 04 01 18 © 2018, The Hartford cF RAMmWmentDMsian REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst e. If we fail to mail proper written notice of nonrenewal and you obtain other insurance, this policy will end on the effective date of that insurance. For the purposes of Paragraph a.(2), commercial excess and umbrella liability policies are defined in 215 ILL. COMP. STAT. 143.13.(h) as follows: (h) "Commercial excess and umbrella liability policy" means a policy written over one or more underlying policies for an insured: (1) that has at least 25 full-time employees at the time the commercial excess and umbrella liability policy is written and procures the insurance of any risk or risks, other than life, accident and health, and annuity contracts, as described in clauses (a) and (b) of Class 1 of Section 4 and clause (a) of Class 2 of Section 4, by use of the services of a full-time employee acting as an insurance manager or buyer; or (2) whose aggregate annual premiums for all property and casualty insurance on all risks is at least $50,000. C. The following Conditions are added to SECTION VI: Premium Increase Or Coverage Change If we elect upon renewal to increase the premium by 30% or more or make a material change in coverage or deductible, we will mail or deliver notice of such change to the Named Insured first shown in the Declarations at least 60 days before expiration of this policy. A copy of such notice shall be mailed to your agent or broker. If notice is mailed, proof of mailing will be sufficient proof of notice Page 2 of 2 E. SECTION II - INVESTIGATION, DEFENSE, SETTLEMENT The following is added to SECTION II.A. 6. Will pay any prejudgment interest awarded against the insured on the part of the judgment we pay. If we make an offer to pay the applicable limit of insurance, we will not pay any prejudgment interest applicable to any period of time after the offer. F. SECTION VII- DEFINITIONS The definition of "damages" is replaced by the following: "Damages" means a monetary award, monetary settlement or monetary judgment. The following are not considered "damages" and are not covered by this policy: 1. Fines, penalties, sanctions or taxes; 2. Attorney's fees and costs associated with any non -monetary relief awarded against the "insured"; or 3. Any monetary award, monetary settlement or monetary judgment for which insurance is prohibited by the law(s) applicable to the construction of this policy. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CONDITIONS - COLORADO This endorsement modifies insurance provided under the UMBRELLA LIABILITY PROVISIONS It is agreed that: 1. The CANCELLATION Condition is replaced by the following: CANCELLATION a. The Named Insured first shown in the Declarations may cancel this policy by: (1) Mailing or delivering to us advance written notice of cancellation; or (2) Surrendering the policy to us or to any of our authorized agents. (3) A substantial change in the exposure or risk other than that indicated in the application and underwritten as of the effective date of the policy unless the first Named Insured has notified us of the change and we accept such change. e. We will mail or deliver our notice to the last mailing address known to us of the Named Insured first shown in the Declarations. b. If this policy has been in effect for less than 60 f. days, we may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: 9• (1) 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or (2) 30 days before the effective date of h. cancellation if we cancel for any other reason. c. If this policy has been in effect for 60 days or more, or is a renewal of a policy we issued, we may cancel this policy by mailing through first- class mail to the first Named Insured written notice of cancellation: (1) Including the actual reason, at least 10 days before the effective date of cancellation, if we cancel for nonpayment of premium; or 2 (2) At least 45 days before the effective date of cancellation if we cancel for any other reason. d. We may only cancel this policy based on one or more of the following reasons, or as permitted under applicable Colorado law: (1) Nonpayment of premium; (2) A false statement knowingly made by the insured on the application for insurance; or Form SX 02 06 10 08 If notice is mailed, proof of mailing will be sufficient proof of notice. Notice of cancellation by us will state the effective date of cancellation. The "policy period" will end on that date. If this policy is cancelled, we will send the Named Insured first shown in the Declarations any premium refund due. If we cancel, the refund will be pro-rata. If the Named Insured cancels, we shall compute the return premium at 90% of the pro-rata unearned premium. We shall in any event be entitled to retain any minimum retained premium stated in the Declarations. i. Premium adjustment may be made either at the time cancellation is effected or as soon as practicable after cancellation becomes effective, but payment or tender of unearned premium is not a condition of cancellation. The NONRENEWAL Condition is replaced by the following: NONRENEWAL a. If we decide not to renew this policy, we will mail or deliver written notice of non -renewal to the Named Insured first shown in the Declarations at least 45 days before the end of the "policy period." © 2008, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst b. If notice is mailed, we will mail it to the last mailing address known to us of the Named Insured first shown in the Declarations. Proof of mailing will be sufficient proof of notice. c. If we offer to renew but such Named Insured does not accept our offer during the current "policy period," this policy will not be renewed at the end of such "policy period." 3. The following Condition is added to the policy: PREMIUM INCREASE OR COVERAGE CHANGE If we elect to increase your premium or decrease your coverage on renewal, we will mail or deliver to the Named Insured first shown in the Declarations Page 2 of 2 45 days advance written notice of such premium increase or coverage change. If notice is mailed, proof of mailing will be sufficient proof of notice. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CONDITIONS - CALIFORNIA This endorsement modifies insurance provided under the following: UMBRELLA LIABILITY PROVISIONS It is agreed that: (c) Failure by you or your representative to 1. The CANCELLATION Condition is replaced by the implement reasonable loss control following: requirements which were agreed to by CANCELLATION you as a condition of policy issuance or which were conditions precedent to the a. The Named Insured first shown in the use by us of a particular rate or rating Declarations may cancel this policy by plan, if the failure materially increases (1) Mailing or delivering to us advance written any of the risk insured against; notice of cancellation; or (d) A determination by the Commissioner (2) Surrendering the policy to us or to any of our that the loss of, or changes in our authorized agents. reinsurance covering all or part of the b. We may cancel this policy by mailing or risk would threaten our financial integrity delivering to the Named Insured first shown in or solvency. the Declarations written notice of cancellation at (e) A determination by the Commissioner least: that a continuation of the policy (1) 10 days before the effective date of coverage would place us in violation of cancellation, if we cancel because of fraud, the Laws of the State of California or the misrepresentation or for nonpayment of any State of our domicile or that the premium when due; continuation of coverage would threaten (2) 30 days before the effective date of our solvency; cancellation, if we cancel for any other (f) A change by you or your representative reason and the policy has been in effect for in the activities or property of the less than 60 days and is not a renewal with commercial or industrial enterprise us; or which results in a materially added risk, (3) 30 days before the effective date of a materially increased risk or a cancellation, if we cancel and the policy has materially changed risk, unless the been in effect for 60 days or more, but only added, increased or changed risk is for one or more of the following reasons, or included in the policy; as permitted under applicable California law: (g) Discovery of material misrepresentation (a) A judgment by a court or an by you or your representative either in administrative tribunal that you have obtaining the insurance or in pursuing a violated any law of this state or of the claim under the policy; or United States, having as one of its (h) Nonpayment of premium, including necessary elements an act which payment due on a prior policy we issued materially increases any of the risks and due during the current policy term insured against; covering the same risks. (b) Discovery of willful or grossly negligent c. We will mail or deliver our notice to the last acts or omissions, or of any violations of mailing address known to us of the Named state laws or regulations establishing Insured first shown in the Declarations. safety standards, by you or your If notice is mailed, proof of mailing will be representative which materially sufficient proof of notice. increases any of the risks insured against; y e cF ILLi3RMwag'm2dDMsiOR \'x REVIEWED & APPROVED BY.- Form SX 02 42 03 17 Jy/ �� V ©2017, The Hartford Wsk Pjanagement Analpt R C. re e. f Notice of cancellation by us will state the 2. effective date of cancellation. The "policy period" will end on that date. We will mail or deliver our notice to the last mailing address known to us of the Named Insured first shown in the Declarations. If notice is mailed, proof of mailing will be sufficient proof of notice. Notice of cancellation by us will state the effective date of cancellation. The "policy period" will end on that date. If this policy is canceled, we will send the Named Insured first shown in the Declarations any premium refund due. If we cancel, the refund will be pro-rata. If the Named Insured cancels, we shall compute the return premium at 90% of the pro-rata unearned premium. We shall in any event be entitled to retain any minimum retained premium stated in the Declarations. g. Premium adjustment may be made either at the time cancellation is effected or as soon as practicable after cancellation becomes effective, but payment or tender of unearned premium is not a condition of cancellation. h. 10 days before the effective date of cancellation, if we cancel for a reason listed in 1.b.(1). L 30 days before the effective date of cancellation if we cancel for any other reason listed in 1.b.(2) or (3). Page 2 of 2 The NONRENEWAL Condition is replaced by the following: NONRENEWAL a. If we decide not to renew to this policy, we will mail or deliver written notice of non -renewal with reasons for the non -renewal to the Named Insured first shown in the Declarations at least 60 days but not more than 120 days before the end of the "policy period." b. If notice is mailed, we will mail it to the last mailing address known to us of the Named Insured first shown in the Declarations. Proof of mailing will be sufficient proof of notice. c. If we offer to renew but such Named Insured does not accept our offer during the current "policy period," this policy will not be renewed at the end of such "policy period". 3. The following Condition is added to the policy: NOTICE OF PREMIUM OR COVERAGE CHANGE If we elect to increase the policy premium by more than 25% or increase a deductible, reduce limits, or eliminate coverages, we will mail or deliver to the Named Insured first shown in the Declarations at the address shown in the policy or the last mailing address known to us, written notice of such change at least 60 days prior to the expiration date of the policy. If notice is mailed, proof of mailing will be sufficient proof of notice. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CONDITIONS - ARIZONA This endorsement modifies insurance provided under the following: UMBRELLA LIABILITY PROVISIONS A. The following is added to paragraph L of the Cancellation Condition: 5. Cancellation of Policies in effect For 60 Days Or More: If this policy has been in effect for 60 days or more, or if this policy is a renewal of a policy we issued, we may cancel this policy only for one or more of the following reasons, or as permitted under applicable Arizona law: a. Nonpayment of premium; b. Your conviction of a crime arising out of acts increasing the hazard insured against; c. Acts or omissions, by you or your representative, constituting fraud or material misrepresentation in the procurement of this policy, in continuing this policy or in presenting a claim under this policy; d. Substantial change in the risk assumed, except to the extent that we should have reasonably foreseen the change or contemplated the risk in writing the contract; e. Substantial breach of contractual duties or conditions; f. Loss of reinsurance applicable to the risk insured against resulting from termination of treaty or facultative reinsurance initiated by our reinsurer or reinsurers; g. Determination by the Director of Insurance that the continuation of the policy would place us in violation of the insurance laws of this state or would jeopardize our solvency; or h. Acts or omissions by you or your representative which materially increase the hazard insured against. If we cancel this policy based on one or more of the above reasons, we will mail by certified mail to the first Named Insured and mail to the agent, if any, written notice of cancellation stating the reasons for cancellation. We will mail this notice to the last mailing addresses known to us at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment of premium; b. 60 days before the effective date of cancellation if we cancel for any of the other reasons. B. The Nonrenewal Condition is replaced by the following: Nonrenewal 1. If we elect not to renew this policy, we will mail by certified mail to the first Named Insured, and mail to the agent, if any, written notice of nonrenewal. We will mail this notice, stating the reason(s) for nonrenewal, to the last mailing addresses known to us at least 60 days prior to the expiration date of this policy. 2. If notice is mailed, proof of mailing will be sufficient proof of notice. 3. We will not provide written notice of nonrenewal if: a. We or a company within the same insurance group has offered to issue a renewal policy; or b. You have obtained replacement coverage or agreed in writing to do so. E. The following Condition is added: Renewal 1. If we elect to renew this policy and the renewal is subject to any of the following: Form SX 02 46 01 20 woRAMwagmedDMsiun Jy/ F\'x REVIEWED & APPROVED BY.- © 2019, The Hartford I v (Includes copyrighted material of Insurance Service Office, Inc., with its �__ _� Wsk Pjanagement Analpt 2 a. Increase in premium; b. Change in deductible; c. Reduction in limits of insurance; or d. Substantial reduction in coverage; we will mail or deliver written notice of the change(s) to the first Named Insured, at the last mailing address known to us, at least 60 days before the anniversary or expiration date of the policy. If renewal is subject to any condition described in 1.a. through 1.d. above, and we fail to provide notice 60 days before the anniversary or expiration date of this policy, the following procedures apply: a. The present policy will remain in effect until the earlier of the following: (1) 60 days after the date of mailing or delivery of the notice; or (2) The effective date of replacement coverage obtained by the first Named Insured. Page 2 of 2 b. If the first Named Insured elects not to renew, any earned premium for the period of extension of the terminated policy will be calculated pro rata at the lower of the following rates: (1) The rates applicable to the terminated policy; or (2) The rates presently in effect. c. If the first Named Insured accepts the renewal, the premium increase, if any, and other changes are effective the day following this policy's anniversary or expiration date. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - CARE, CUSTODY OR CONTROL OF PERSONAL PROPERTY This endorsement modifies insurance provided under the SPECTRUM UMBRELLA LIABILITY SUPPLEMENTAL CONTRACT This policy does not apply to "property damage" to personal property: 1. Rented to; 2. Used by; or 3. In the care, custody or control; Of any "insured" or as to which any "insured" is for any purpose exercising physical control. Form SX 21 04 06 97 Printed in U.S.A. ew cF RAMwagemen DMsian Jy/, 1°x REVIEWED & APPROVED BY: © 1997, The Hartford �� .. v --� Wsk Pjanagement Analpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - CARE, CUSTODY OR CONTROL OF REAL PROPERTY This endorsement modifies insurance provided under the SPECTRUM UMBRELLA LIABILITY SUPPLEMENTAL CONTRACT This policy does not apply to "property damage" to real property: 1. Owned by; 2. Occupied by; 3. Rented to; or 4. In the care, custody or control; Of any "insured" or as to which any "insured" is for any purpose exercising physical control. Form SX 21 05 06 97 Printed in U.S.A. ew cF RAMwagemen DMsian Jy/, 1°x REVIEWED & APPROVED BY: © 1997, The Hartford �� .. v --� Wsk Pjanagement Analpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - LIQUOR LIABILITY This endorsement modifies insurance provided under the UMBRELLA LIABILITY PROVISIONS The following exclusion is added to B., Exclusions (SECTION 1- COVERAGES): This policy does not apply to "bodily injury" or "property damage" for which any "insured" may be held liable by reason of: 1. Causing or contributing to the intoxication of any person; 2. The furnishing of alcoholic beverages to: a. A person under the legal drinking age; or b. Under the influence of alcohol; or 3. Any statute, ordinance or regulation relating to the sale, gift, distribution or use of alcoholic beverages. Form SX 21 08 04 05 This exclusion applies only if such "insured" is in the business of manufacturing, distributing, selling, serving or furnishing alcoholic beverages. © 2005, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - UNMANNED AIRCRAFT This endorsement modifies insurance provided under the following: UMBRELLA LIABILITY PROVISIONS .1JIT, 1-]N=1IW_\II_1-]I111Vd:J:101TA6-1C07►RIST/l:tr]1►11_1 Except as otherwise stated in this endorsement, the ownership, maintenance, use or terms and conditions of the policy apply to the insurance entrustment to others of any aircraft (other stated below. than "unmanned aircraft") that is owned or A. The following changes Section I, Paragraph B. operated by or rented or loaned to any EXCLUSIONS: "insured". 1. The Aircraft exclusion in Section I, Paragraph B.6. of the Umbrella Liability Provisions, Form SX 80 02, or Section I, Paragraph B.5. of the Umbrella Liability Provisions - Virginia, Form SX 80 03, is deleted and replaced with the following: Aircraft a. Unmanned Aircraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". Use includes operation and "loading or unloading". This Paragraph a. applies even if the claims against any "insured" allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that "insured", if the "occurrence" which caused the "bodily injury' or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". b. Aircraft (Other Than Unmanned Aircraft) "Bodily injury" or "property damage" arising out of the ownership, operation, maintenance, use, entrustment to others, "loading or unloading" of any aircraft (other than "unmanned aircraft": (1) Owned by any "insured"; or (2) Chartered or loaned to any "insured". This exclusion applies even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an "insured", if the "occurrence" which caused the "bodily injury" or "property damage" involved the Form SX 21 94 03 17 This exclusion does not apply to aircraft (other than "unmanned aircraft) that is: (1) Hired, chartered or loaned with a paid crew; but (2) Not owned by any "insured". This exclusion does not apply to "bodily injury" to any of your "employees" arising out of and in the course of their employment by you. 2. The following exclusion is added: Personal and Advertising Injury - Unmanned Aircraft "Personal and advertising injury' arising out of the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". Use includes operation and "loading or unloading". This exclusion applies even if the claims against any "insured" allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that "insured", if the offense which caused the "personal and advertising injury" involved the ownership, maintenance, use or entrustment to others of any aircraft that is an "unmanned aircraft". However, this exclusion does not apply if the only allegation in the claim or "suit" involves an intellectual property right which is limited to: a. Infringement, in your "advertisement", of: (1) Copyright; (2) Slogan; or (3) Title of any literary or artistic work; or b. Copying, in your "advertisement", a person's or organization' of "advertiseme ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY. - I .° --� Rt janagement Analpt B. The following changes apply to Section VII. DEFINITIONS: 1. The following definition is added: "Unmanned aircraft" means an aircraft that is not: a. Designed; b. Manufactured; or c. Modified after manufacture to be controlled directly by a person from within or on the aircraft. Page 2 of 2 ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION AND DATA RELATED LIABILITY - WITH LIMITED BODILY INJURY EXCEPTION This endorsement modifies insurance provided under the following: UMBRELLA LIABILITY PROVISIONS (SX 80 02) A. The following is added to Exclusions, B.4 lists, financial information, credit card Personal and Advertising Injury of SECTION 1- information, health information or any other COVERAGES: type of nonpublic information; or This insurance does not apply to: (2) The loss of, loss of use of, damage to, Access Or Disclosure Of Confidential Or corruption of, inability to access, or inability Personal Information to manipulate electronic data. "Personal and advertising injury" arising out of any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of any access to or disclosure of any person's or organization's confidential or personal information. B. Exclusion B.22 Electronic Data of SECTION 1- COVERAGES is deleted and replaced with the following: 22. Access Or Disclosure Of Confidential Or Personal Information And Data -related Liability Damages arising out of: (1) Any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer Form SX 23 15 12 15 © 2015, The Hartford This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which is described in Paragraph (1) or (2) above. However, unless Paragraph (1) above applies, this exclusion does not apply to damages because of "bodily injury". As used in this exclusion, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - PLAYGROUND FACILITY This endorsement modifies insurance provided under the UMBRELLA LIABILITY PROVISIONS I. This policy does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of the: 1. ownership; 2. maintenance; 3. operation; or 4. use; of "playground facility." Form SX 21 66 10 08 II. Additional Definitions "Playground facility" means an area designated for recreational activities specifically set aside for children. Such an area is usually equipped with recreational equipment including, but not limited to: 1. swings; 2. slides; and 3. merry-go-rounds © 2008, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- v --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ABSOLUTE LEAD EXCLUSION This endorsement modifies insurance provided under the following: UMBRELLA LIABILITY PROVISIONS A. The following exclusion is added to B., Exclusions (SECTION 1-COVERAGES): This policy does not apply to: 1. Any injury, damage, loss, costs or expense, including, but not limited to, "bodily injury", "property damage" or "personal and advertising injury" arising out of, in whole or in part, the "lead hazard." 2. Any damages, judgments, settlements, loss costs or expenses that: a. May be awarded or incurred by reason of any claim or suit alleging actual or threatened injury or damage of any nature or kind to persons or property which arises out of, or would not have occurred, in whole or in part, but for the "lead hazard"; or b. Arise out of any request, demand, order or statutory or regulatory requirement that any "insured" or others: (1) Identify, abate, test for, sample, monitor, clean up, remove, cover, contain, treat, detoxify, decontaminate, neutralize or mitigate or in any way respond to or assess the effects of a "lead hazard"; or (2) As a result of such effects, repair, replace or improve any property; or c. Arise out of any claim or any suit for damages because of: (1) Identification of, abatement of, testing for, sampling, monitoring, cleaning up, removing, covering, containing, treating, detoxifying, decontaminating, neutralizing or mitigating or in any way responding to or assessing the effects of a "lead hazard"; or (2) As a result of such effects, the repair, replacement, or improvement of any property . B. The following definition is added to the Definitions section: "Lead hazard" means an exposure or threat of exposure to the actual or alleged properties of lead, and includes the mere presence or suspected presence of lead in any form or combination. Form SX 21 82 10 08 © 2008, The Hartford ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FOLLOWING FORM ENDORSEMENT AUTOMOBILE LIABILITY This endorsement modifies insurance provided under the SPECTRUM UMBRELLA LIABILITY SUPPLEMENTAL CONTRACT This policy does not apply to liability arising out of the 1. Ownership; 2. Operation; 3. Maintenance; 4. Use; 5. Entrustment to others; or 6. Loading or unloading; Of any "auto." This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused in the injury or damage involved the ownership, maintenance, use, entrustment to others, or loading or unloading of any "auto". Form SX 24 01 04 01 EXCEPTION This exclusion does not apply if "underlying insurance" is maintained providing coverage for such "auto" with minimum underlying limits as described for Commercial Automobile Liability in the Schedule of Underlying Insurance Policies. Condition K. - Maintenance of Underlying Insurance applies to this exception. © 2001, The Hartford ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FOLLOWING FORM ENDORSEMENT - PERSONAL AND ADVERTISING INJURY This endorsement modifies insurance provided under the following: UMBRELLA POLICY PROVISIONS Exclusion B.4 (Section I — Coverages), is replaced by the following: 4. Personal and Advertising Injury This policy does not apply to "personal and advertising injury". EXCEPTION This exclusion does not apply to the extent that coverage for such "personal and advertising injury" is provided by "underlying insurance", but in no event shall any "personal and advertising injury" coverage provided under this policy apply to any claim or "suit" to which "underlying insurance" does not apply. Any coverage restored by this EXCEPTION applies only to the extent that such coverage provided by the "underlying insurance" is maintained having limits as set forth in the Schedule of Underlying Insurance Policies. ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- Form SX 24 33 06 10 �� V © 2010 The Hartford Wsk Pjanagement Analpt THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FOLLOWING FORM ENDORSEMENT -FUNGI, BACTERIA AND VIRUSES This endorsement modifies insurance provided under the: SPECTRUM UMBRELLA LIABILITY SUPPLEMENTAL CONTRACT This policy does not apply to: 1. Injury or damage arising out of or related to the presence of, suspected presence of, or exposure to: a. fungi, including but not limited to mold, mildew, and yeast; b. bacteria; c. viruses; or 2. Any loss, cost or expense arising out of the testing for, monitoring of, cleaning up of, removal of, containment of, treatment of, detoxification of, neutralization of, remediation of, disposal of, or any other response to or assessment of, the effects of any of the items in 1.a., b., c. or d. above, from any source whatsoever. EXCEPTION d. dust, spores, odors, particulates or This exclusion does not apply if "underlying insurance" is byproducts, including but not limited to maintained providing coverage for such liability with mycotoxins and endotoxins, resulting from minimum underlying limits as described in the Schedule any of the organisms listed in a., b., or c. of Underlying Insurance Policies. above; from any source whatsoever. Form SX 24 58 09 01 Any coverage restored by this EXCEPTION applies only to the extent of the scope of coverage provided by the "underlying insurance" but in no event shall coverage be broader than the scope of coverage provided by the policy of which this endorsement forms a part. Condition K. - Maintenance Of Underlying Insurance applies to this exception. © 2001, The Hartford ew cF RAMwagementDMsian Jy/ \'x REVIEWED & APPROVED BY.- v --� Risk Pjanagement Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WINDSTORM OR HAIL PERCENTAGE DEDUCTIBLE This endorsement modifies insurance provided under the following: STANDARD PROPERTY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM The Windstorm or Hail Deductible, as shown in the Declarations, and as set forth in this endorsement, applies to physical loss or physical damage to Covered Property caused directly or indirectly by Windstorm or Hail. This Deductible applies to each occurrence of Windstorm or Hail, regardless of any other cause or event that contributes concurrently or in any sequence to the loss or damage. If loss or damage from a covered weather condition other than Windstorm or Hail occurs, and that loss or damage would not have occurred but for the Windstorm or Hail, such loss or damage shall be considered to be caused by Windstorm or Hail and therefore part of the Windstorm or Hail occurrence. With respect to Covered Property at a "scheduled premises" identified in the Declarations, no other deductible applies to Windstorm or Hail. Nothing in this endorsement implies or affords coverage for any loss or damage that is excluded under the terms of the Water Exclusion B.1.f of the Special Property Coverage Form or any other exclusion in this policy. A. "Specific Insurance" and 'Blanket Insurance" Definitions As used in this endorsement. "Specific Insurance" and "Blanket Insurance" have the following meaning: 1. "Specific Insurance" covers: a. Each individual Building; or b. Business Personal Property contained in or on each individual building or in the open (or within a vehicle) within 1000 feet of each individual building; at the described premises and for which a separate Limit of Insurance is shown in the Declarations. 2. 'Blanket Insurance" covers: a. Two or more Buildings; or b. Business Personal Property contained in or on those buildings or in the open (or within a vehicle) within 1000 feet of those Buildings at the described premises and for which a Form SS 82 23 09 15 single Limit of Insurance is shown in the Declarations. B. Windstorm or Hail Deductible Clause If physical loss or physical damage to covered property is caused by or results from Windstorm or Hail, paragraph D.1. Deductibles is deleted and replaced by the following: 1. We will not pay for physical loss or physical damage in any one occurrence until the amount of physical loss or physical damage exceeds the selected deductible, as shown in the Declarations. We will then pay the amount of physical loss or physical damage in excess of the deductible up to the applicable Limit of Insurance shown in the Declarations. The Windstorm or Hail Deductible Clause shown above applies separately to: a. Each building, if two or more buildings are covered; b. The building and business personal property, if the building and its business personal property are both covered; c. Business personal property at each building, if business personal property of two or more buildings is covered; d. Business personal property in the open. If there is damage to both a building and business personal property in that building, separate deductibles apply to the building and to the personal property. C. Application of Percentage Deductible In determining the amount, if any, that we will pay for physical loss or physical damage, we will deduct an amount equal to 1%, 2%, 3%, 4% or 5% (as shown in the Declarations) of the Limit(s) of Insurance applicable to the property that has sustained physical loss or physical damage. However, in any one occurrence of Windstorm or Hail, the total deductible for all covere Windstorm or Hail losses shall not be less than $51 RAMwagementDMsian Aw F �40 IL REVIEWED & APPROVED BY: v © 2015, The Hartford Is --� W. fjanagement Analyst With respect to Covered Property at the "scheduled premises" identified in the Declarations, no other deductible applies to Windstorm or Hail. D. Specific Insurance In determining the amount, if any, that we will pay for loss or damage, we will deduct an amount equal to Windstorm or Hail Percentage (%) deductible, as shown in the Declarations, multiplied by the Limit(s) of Insurance applicable to the property that has sustained physical loss or physical damage. E. Blanket Insurance In determining the amount, if any, that we will pay for physical loss or physical damage to Covered Property that is subject to 'Blanket Insurance", we will deduct an amount equal to the Windstorm or Hail Deductible as shown in the Declarations multiplied by the value of the property that has sustained physical loss or physical damage up to the Blanket Limit of Insurance as shown in the Declarations. The values to be used are those shown in the most recent statement of values on file with us. If the statement of values does not provide the value of each Building and the value of Business Personal at each building or "scheduled premises" we will determine individual values as a part of the total reported values prior to application of Windstorm or Hail Percentage Deductible. F. Newly Acquired or Constructed Property In determining the amount, if any, that we will pay for physical loss or physical damage to covered property under the Coverage Extension for Newly Acquired or Constructed Property, we will deduct an amount equal to the highest Windstorm or Hail percentage deductible shown in the Declarations for any described premises multiplied by the value of the newly acquired property up to the applicable limit(s) for Newly Acquired or Constructed Property. G. Examples- Application of Deductibles Example #1-Specific Insurance The amount of loss to the damaged building is $60,000. The actual Limit of Insurance on the damaged building is $90,OOO.The Deductible is 1 %. Step (1): $90,000 X 1 % _ $900 Step (2): $60,000 - $900 = $59,100 The most we will pay is $59,100. That portion of the total loss not covered due to application of the Deductible is $900. Page 2 of 2 Example #2-Specific Insurance The amounts of loss to the damaged property are $60,000 (building) and $40,000 (business personal property in building). The actual Limits of Insurance on the damaged property are $100,000 on the building and $64,000 on the business personal property. The Deductible is 2%. Building Step (1): $100,000 X 2% _ $2,000 Step (2): $60,000 - $2,000 = $58,000 Business Personal Property Step (1): $64,000 X 2% _ $1,280 Step (2): $40,000 - $1,280 = $38,720. The most we will pay is $96,720 ($58,000 + $38,720). The portion of the total loss that is not covered due to the application of the Deductible is $3,280 ($2,000 + $1,280). Example # 3- Blanket Insurance Percentage Deductible Buildings one, two and three are shown in the Declarations as included under the Blanket Insurance for Buildings with a Limit of Insurance of $2,000,000. The statements of values of buildings at the time of loss are: Building #1 is $500,000; Building #2 is $500,000; and, Building #3 is $1,000,000. Buildings #1 and #2 have sustained damage. The amounts of loss to these buildings are $40,000 for Building #1 and $20,000 for Building #2. The Deductible is 2%. Building #1 Step (1): $500,000 X 2% _ $10,000 Step (2): $40,000 - $10,000 = $30,000 Building #2 Step (1): $500,000 X 2% _ $10,000 Step (2): $20,000 - $10,000 = $10,000 The most we will pay is $40,000 ($30,000 + $10,000). That portion of the total loss not covered due to application of the Deductible is $20,000 ($10,000 + $10,000). ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst