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HomeMy WebLinkAboutLib Training Services; Edmond OtisAGREEMENT FOR PROFESSIONAL SERVICES
(Short Form for Agreements under $10,000)
This Agreement is made and entered into this 22 day of September, 2016, by and between
the CITY OF SAN RAFAEL (hereinafter "CITY"), and EDMOND OTIS & ASSOCIATES
(hereinafter "CONTRACTOR").
RECITALS
WHEREAS, CITY has aneed for the professional services specified hereafter, and
WHEREAS, CONTRACTOR has the expertise and experience to provide such services.-
AGREEMENT
ervices;
AGREEMENT
NOW, THEREFORE, the parties hereby agree as follows:
PROJECT COORDINATION.
A. CITY'S Project Manager. CITY hereby designates as its PROJECT MANAGER:
Sarah Houghton. Said PROJECT MANAGER shall supervise all aspects of the progress and
execution of this Agreement.
B. CONTRACTOR'S Project Director. CONTRACTOR shall assign a single
PROJECT DIRECTOR to have overall responsibility for the progress and execution of this
Agreement for CONTRACTOR. CONTRACTOR hereby designates as its PROJECT
DIRECTOR Edmond Otis. Should circumstances or conditions subsequent to the execution of this
Agreement require a substitute PROJECT DIRECTOR, for any reason, the CONTRACTOR shall
notifV the CITY within ten (10) business days of the substitution.
2. DUTIES OF CONTRACTOR.
CONTRACTOR shall provide the services described as follows: two full-day presentations
(Making Libraries Safe and Sane: Dealing -,with Difficult People & Resilence in the Face of Stress,
Change, and Conflict) on February 1 and 2. All printed seminar materials will provided by speaker
10 days prior to presentation.
3. DUTIES OF CITY.
CITY shall pay the compensation as provided in Paragraph 4. and perform the duties
described as follows: provide facilities and on-site support for the trainings.
4. COMPENSATION.
For the full performance of the services described herein by CONTRACTOR, CITY shall
pay CONTRACTOR as follows: $5,200.00, inclusive of cost of 2 full-day presentations as well as
all costs for accommodation, food, transport, parking, etc.
The total compensation paid to CONTRACTOR shall not exceed $5,200.00 Payment shall be
made monthly upon receipt by PROJECT MANAGER of itemized invoices submitted by
CONTRACTOR.
TERM OF AGREEMENT.
The term of this Agreement shall be nine months commencing on the date of this
Agreement.
Upon mutual agreement of the parties, and subject to the written approval of the City Manager, the
term of this Agreement may be extended, for an additional period of up to 30 days.
6. TERMINATION.
A. Discretionary. Either party may temninate this Agreement without cause upon
thirty (30) days written notice mailed or personally delivered to the other party.
B. Cause. Either party may terminate this Agreement for cause upon fifteen (15) days
written notice mailed or personally delivered to the other party, and the notified party's failure to
cure or correct the cause of the termination, to the reasonable satisfaction of the party giving such
notice, within such fifteen (15) day time period.
C. Effect of Termination. Upon receipt of notice of terrrrination, neither party shall
incur additional obligations under any provision of this Agreement without the prior written consent
of the other.
ASSIGNABILITY.
The parties agree that they shall not assign or transfer any interest in this Agreement nor the
performance of any of their respective obligations hereunder, without the prior written consent of
the other party, and any attempt to so assign this Agreement or any rights, duties or obligations
arising hereunder shall be void and of no effect.
INSURANCE.
A. Scope of Coverage. During the term of this Agreement, CONTRACTOR shall
maintain, at no expense to CITY, the following insurance policies:
1. A commercial general liability insurance policy in the minimum amount of
five hundred thousand dollars ($500,000) per occurrence, for death, bodily injury, personal injury,
or property damage.
2. An automobile liability (owned, non -owned, and hired vehicles) insurance
policy in the minimum amount of five hundred thousand dollars ($500,000) dollars per occurrence.
3. If CONTRACTOR employs any person, CONTRACTOR shall maintain
worker's compensation and employer's liability insurance, as required by the State Labor Code and
other applicable laws and regulations, and as necessary to protect both CONTRACTOR and CITY
against all liability for injuries to CONTRACTOR's officers and employees. CONTRACTOR'S
worker's compensation insurance shall be specifically endorsed to waive any right of subrogation
against CITY.
CONTRACTOR MUST COMPLETE: By initialing hereafter, CONTRACTOR
affirms that it: does ® does not ❑ employ any person.
[CONTRACTOR's initials]
B. Other Insurance Requirements. The insurance coverage required of the
CONTRACTOR in subparagraph A of this section above shall also meet the following
requirements:
1. The commercial general liability insurance policy shall be specifically
endorsed to include, the CITY, its officers, agents, employees, and volunteers, as additionally
named insureds under the policies.
2. The additional insured coverage under CONTRACTOR'S commercial
general liability insurance policy shall be primary with respect to any insurance or coverage
maintained by CITY and shall not call upon CITY'S insurance or self-insurance coverage for any
contribution. The "primary and noncontributory" coverage in CONTRACTOR'S policies shall be
at least as broad as ISO form CG20 0104 13.
3. It shall be a requirement under this Agreement that any available insurance
proceeds broader than or in excess of the specified minimum insurance coverage requirements
and/or limits shall be available to CITY or any other additional insured party. Furthermore, the
requirements for coverage and limits shall be: (1) the minimum coverage and limits specified in this
Agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy or
proceeds available to the named insured; whichever is greater.
C. Deductibles and SIR's. Anv deductibles or self-insured retentions in
CONTRACTOR's insurance policies must be declared to and approved by the PROJECT
MANAGER and City Attorney, and shall not reduce the limits of liability. Policies containing any
self-insured retention (SIR) provision shall provide or be endorsed to provide that the SIR may be
satisfied by either the named insured or CITY or other additional insured party. At CITY's option,
the deductibles or self-insured retentions with respect to CITY shall be reduced or eliminated to
CITY's satisfaction, or CONTRACTOR shall procure a bond guaranteeing payment of losses and
related investigations, claims administration, attorney's fees and defense expenses.
D. Proof of Insurance. CONTRACTOR shall provide to the PROJECT MANAGER
or CITY'S City Attorney all of the following: (1) Certificates of Insurance evidencing the insurance
coverage required in this Agreement; (2) a copy of the policy declaration page and/or endorsement
page listing all policy endorsements for the commercial general liability policy, and (3) excerpts of
policy language or specific endorsements evidencing the other insurance requirements set forth in
this Agreement. CITY reserves the right to obtain a full certified copy of any insurance policy and
endorsements from CONTRACTOR. Failure to exercise this right shall not constitute a waiver of
the right to exercise it later. The insurance shall be approved as to form and sufficiency by
PROJECT MANAGER and the City Attorney.
9. INDEMNIFICATION
CONTRACTOR shall, to the fullest extent permitted by law. indemnify, release. defend
and hold harmless CITY, its officers, agents, employees and volunteers, from any claim, demand
or liability that is related to, or results from the negligent acts or omissions or the willful
misconduct of CONTRACTOR or its officers, employees, or agents in connection with the
services prol.ided under this Agreement. The defense and indemnification obligations of this
Agreement are undertaken in addition to, and shall not in any way be limited by, the insurance
obligations contained in this Agreement, and shall survive the termination or completion of this
Agreement for the full period of time allowed by law.
10. NONDISCRIMINATION.
CONTRACTOR shall not discriminate, in any way, against any person on the basis of age,
sex, race, color, religion, ancestry, national origin or disability in connection with or related to the
performance of its duties and obligations under this Agreement.
11. COMPLIANCE WITH ALL LAWS.
CONTRACTOR shall observe and comply with all applicable federal, state and local laws,
ordinances, codes and regulations, in the performance of its duties and obligations under this
Agreement. CONTRACTOR shall release, defend, indemnify and hold harmless CITY, its
officers, agents and employees from any and all damages, liabilities, penalties, fines and all other
consequences from any noncompliance or violation of any laws, ordinances, codes or regulations.
12. NOTICES.
All notices and other communications required or permitted to be given under this
Agreement, shall be in writing and given by personal delivery, or deposited with the United States
Postal Service, postage prepaid, addressed to the parties intended to be notified. Notice shall be
deemed given as of the date of personal delivery, or if mailed, upon the date of deposit with the
United States Postal Service. Notice shall be given as follows:
TO CITY's PROJECT MANAGER:
TO CONTRACTOR's PROJECT
MANAGER--
13.
ANAGER
13. INDEPENDENT CONTRACTOR.
Sarah Houghton; Library Director
City of San Rafael
1400 Fifth Avenue
P.O. Box 151560
San Rafael. CA 94915-1560
Edmond Otis
Edmond Otis & Associates
1242 University Avenue Suite 6-570
Riverside, CA 92507
For the purposes, and for the duration, of this Agreement, CONTRACTOR, its officers,
agents and employees shall act in the capacity of an Independent Contractor, and not as employees
of the CITY. CONTRACTOR and CITY expressly intend and agree that the status of
CONTRACTOR, its officers, agents and employees be that of an Independent Contractor and not
that of an employee of CITY.
14. ENTIRE AGREEMENT -- AMENDMENTS.
The terms and conditions of this Agreement. all exhibits attached, and all documents
expressly incorporated by reference, represent die entire Agreement of the parties with respect to the
subject matter of this Agreement and shall not be altered or modified except by a written
amendment to this Agreement signed by the CONTRACTOR and the CITY. If any conflicts arise
between the terms and conditions of this Agreement, and the terms and conditions of the attached
exhibits or the documents expressly incorporated by reference, the terms and conditions of this
Agreement shall control_
15. WAIVERS.
The waiver by either party of any breach or violation of any term covenant or condition of
this Agreement, or of any ordinance, lave or regulation, shall not be deemed to be a waiver of any
other term. covenant, condition, ordinance, law or regulation, or of any subsequent breach or
violation of the same or other tenn, covenant, condition, ordinance, law or regulation. The
subsequent acceptance by either party of any fee, performance, or other consideration which may
become due or owing under this Agreement, shall not be deemed to be a waiver of any preceding
breach or violation by the other party of any term, condition, covenant of this Agreement or any
applicable law, ordinance or regulation.
16. COSTS AND ATTORNEY'S FEES.
The prevailing party in any action brought to enforce the terns and conditions of this
Agreement, or arising out of the performance of this Agreement, may recover its reasonable costs
(including claims administration) and attorney's fees expended in connection with such action.
17. CITY BUSINESS LICENSE / OTHER TAXES.
CONTRACTOR shall obtain and maintain during the duration of this Agreement, a CITY
business license as required by the San Rafael Municipal Code. CONTRACTOR shall pay any
and all applicable state, federal and local taxes. CITY shall not be required to pay for any work
performed under this Agreement, until CONTRACTOR has provided CITY with a completed
Internal Revenue Service Form W-9 (Request for Taxpayer Identification Number and
Certification).
18. APPLICABLE LAW.
The laws of the State of California shall govern this Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement as of the day, month
and year first above written.
CITY OF SAN RAFAEL
- C
Jllb SC `TZ, City Vl er
CONTRACTOR
By:
Printed Name: Edmond Otis
Title:
ATTEST:
ESTHER C. BEHU IE, City Clerk-
APPROVED
lerk
APPROVED AS TO FORM:
ROBERT R EPSTEIN_ Atto�
AC RO0 0® DATE(MMIDDIYYYY)
�� CERTIFICATE OF LIABILITY INSURANCE os/o8/zols
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
NAME:
Hiscox Inc d/b/a/ Hiscox insurance Agency in CA
faCNN . E■n: (888) 202-3007 ac No):
520 Madison Avenue
_
AODRIESS, contact@hiscox.COm
32nd Floor
INSURER(S) AFFORDING COVERAGE NAIC #
New York, NY 10022
INSURERA: Hiscox Insurance Company Inc 10200
INSURED
INSURER B
Edmond Otis
I INSURER C
1242 University Ave
I INSURER D
Suite 6-570
I INSURER E:
Riverside CA 92507
( INSURER F:
COVERAGES CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR I
TYPE OF INSURANCE
ADDL
SUBRI
POLICY EFF
POLICSY EXP
I LIMITS
LTR
X COMMERCIAL GENERAL LIABILITY
(ND
WVD
POLICYNUMBER
(MMIDDIYYYYI
(MMIODIYYYYI
I EACH OCCURRENCE s 1,000,000
T
CLAIMS -MADE LK OCCUR
i
DAMAGE TO RENTED
PREMISES (Ea occurrence, 5 100,000
i
MED EXP (Any one person) _ S 5,000
A Y Y UDC -1570729 -CGL -16 06/08/2016 06/08/2017
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY E P O LOC
OTHER:
AUTOMOBILE LIABILITY
ANY AUTO
I
WORKERS COMPENSATION
ALL OWNEDSCHEDULED
AND EMPLOYERS' LIABILITY Y I N
ANYP RO P RI ETORfPART N ERIE XEC U TI V E
AUTOS
NIA
AUTOS
If yes, describe under
NON -OWNED
HIRED AUTOS
AUTOS
UMBRELLA UAB OCCUR
EXCESS LIAB H
1
I—ilri en,ec_n
1 DED I I RETENTIONS
I
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANYP RO P RI ETORfPART N ERIE XEC U TI V E
OFFICERIMEMBEREXCLUE ❑
NIA
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
PERSONAL B ADV INJURY $ 1,000,000
GENERAL AGGREGATE IS 2,000,000
PRODUCTS - COMP/OP AGG 5 SIT Gen. Agg.
S
COMBINED SINGLE LIMIT S
Ea accident _
BODILY INJURY (Per person) t 5
BODILY INJURY (Per accident) 5
PROPERTY DAMAGE S
(Per accident)
5
EACH OCCURRENCE S
AGGREGATE 5
5
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT S
E.L. DISEASE - EA EMPLOYEEI S
E.L. DISEASE -POLICY LIMIT I 5
I I , I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
City of San Rafael Is Additional Insured. The Hiscox General Liability policy UDC -1570729 -CGL is endorsed with waiver of subrogation endorsement E5402 In
favor of City of San Rafael. The Hiscox General Liability policy UDC -1570729 -CGL is primary, subject to the policy terms and conditions.
CERTIFICATE HOLDER CANCELLATION
City of San Rafael
1400 Fifth Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
P O BOX 151560 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
I
©1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
40
HISCOX
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective
UDC -1570729 -CGL -16
Edmond Otis
20
September 06, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s)
City of San Rafael
1400 Fifth Ave
151560
San Rafael,CA 94915
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II — Who Is An Insured is amended to in-
clude as an additional insured the person(s) or organi-
zations) shown in the Schedule, 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 omis-
sions of those acting on your behalf:
A. In the performance of your ongoing operations; or
B. In connection with your premises owned by or
rented to you.
CG 20 26 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1
40
HISCOX
COMMERCIAL GENERAL LIABILITY
CG 00 01 12 07
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
Various provisions in this policy restrict coverage.
b. This insurance applies to "bodily injury" and
Read the entire policy carefully to determine rights,
"property damage" only if:
duties and what is and is not covered.
(1) The "bodily injury" or "property damage" is
Throughout this policy the words "you" and "your"
caused by an "occurrence" that takes place
refer to the Named Insured shown in the Declarations,
in the "coverage territory";
and any other person or organization qualifying as a
(2) The "bodily injury" or "property damage"
Named Insured under this policy. The words "we",
occurs during the policy period; and
"us" and "our" refer to the company providing this
insurance.
(3) Prior to the policy period, no insured listed
The word "insured" means any person or organization
under Paragraph 1. of Section II — Who IsAn Insured and no "employee" authorized
qualifying as such under Section II —Who Is An In-
by you to give or receive notice of an "oc-
sured.
currence" or claim, knew that the "bodily in -
Other words and phrases that appear in quotation
jury" or "property damage" had occurred, in
marks have special meaning. Refer to Section V —
whole or in part. If such a listed insured or
Definitions.
authorized "employee" knew, prior to the
SECTION I — COVERAGES
policy period, that the "bodily injury" or
"property damage" occurred, then any con -
COVERAGE A BODILY INJURY AND PROPERTY
tinuation, change or resumption of such
DAMAGE LIABILITY
"bodily injury" or "property damage" during
1. Insuring Agreement
or after the policy period will be deemed to
a. We will pay those sums that the insured be-
have been known prior to the policy period.
comes legally obligated to pay as damages
c. "Bodily injury" or "property damage" which
because of "bodily injury" or "property damage"
occurs during the policy period and was not,
to which this insurance applies. We will have
prior to the policy period, known to have oc-
the right and duty to defend the insured against
curred by any insured listed under Paragraph
any "suit" seeking those damages. However,
1. of Section II — Who Is An Insured or any
we will have no duty to defend the insured
"employee" authorized by you to give or re -
against any "suit" seeking damages for "bodily
ceive notice of an "occurrence" or claim, in -
injury" or "property damage" to which this in-
cludes any continuation, change or resumption
surance does not apply. We may, at our discre-
of that "bodily injury" or "property damage" af-
tion, investigate any "occurrence" and settle
ter the end of the policy period.
any claim or "suit" that may result. But:
d. "Bodily injury" or "property damage" will be
(1) The amount we will pay for damages is
deemed to have been known to have occurred
limited as described in Section III — Limits
at the earliest time when any insured listed un -
Of Insurance; and
der Paragraph 1. of Section II — Who Is An In -
(2) Our right and duty to defend ends when we
sured or any "employee" authorized by you to
"occurrence"
have used up the applicable limit of insur-
give or receive notice of an or
ance in the payment of judgments or set-
claim:
tlements under Coverages A or B or medi-
(1) Reports all, or any part, of the "bodily injury"
cal expenses under Coverage C.
or "property damage" to us or any other in -
No other obligation or liability to pay sums or
surer;
perform acts or services is covered unless ex-
(2) Receives a written or verbal demand or
plicitly provided for under Supplementary Pay-
claim for damages because of the "bodily
ments — Coverages A and B.
injury" or "property damage"; or
(3) Becomes aware by any other means that
"bodily injury" or "property damage" has oc-
curred or has begun to occur.
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 1 of 16 0
e. Damages because of "bodily injury" include
damages claimed by any person or organiza-
tion for care, loss of services or death resulting
at any time from the "bodily injury".
2. Exclusions
This insurance does not apply to:
a. Expected Or Intended Injury
"Bodily injury" or "property damage" expected
or intended from the standpoint of the insured.
This exclusion does not apply to "bodily injury"
resulting from the use of reasonable force to
protect persons or property.
b. Contractual Liability
"Bodily injury" or "property damage" for which
the insured is obligated to pay damages by
reason of the assumption of liability in a con-
tract or agreement. This exclusion does not
apply to liability for damages:
(1) That the insured would have in the absence
of the contract or agreement; or
(2) Assumed in a contract or agreement that is
an "insured contract", provided the "bodily
injury" or "property damage" occurs subse-
quent to the execution of the contract or
agreement. Solely for the purposes of liabil-
ity assumed in an "insured contract", rea-
sonable attorney fees and necessary litiga-
tion expenses incurred by or for a party
other than an insured are deemed to be
damages because of "bodily injury" or
"property damage", provided:
(a) Liability to such party for, or for the cost
of, that party's defense has also been
assumed in the same "insured contract";
and
(b) Such attorney fees and litigation ex-
penses are for defense of that party
against a civil or alternative dispute
resolution proceeding in which damages
to which this insurance applies are al-
leged.
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 un-
der the influence of alcohol; or
(3) Any statute, ordinance or regulation relating
to the sale, gift, distribution or use of alco-
holic 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 unem-
ployment 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
(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
Paragraph (1) above.
This exclusion applies whether the insured
may be liable as an employer or in any other
capacity and to any obligation to share dam-
ages with or repay someone else who must
pay damages because of the injury.
This exclusion does not apply to liability as-
sumed by the insured under an "insured con-
tract".
Page 2 of 16 0 ISO Properties, Inc., 2006 CG 00 01 12 07
f. Pollution
(d) At or from any premises, site or location
(1) "Bodily injury" or "property damage" arising
on which any insured or any contractors
out of the actual, alleged or threatened dis-
or subcontractors working directly or in -
charge, dispersal, seepage, migration, re-
directly on any insured's behalf are per -
lease or escape of "pollutants":
forming operations if the "pollutants" are
brought on or to the premises, site or lo-
(a) At or from any premises, site or location
cation in connection with such opera -
which is or was at any time owned or
tions by such insured, contractor or sub -
occupied by, or rented or loaned to, any
contractor. However, this subparagraph
insured. However, this subparagraph
does not apply to:
does not apply to:
(i) "Bodily injury" or "property damage"e"
(i) "Bodily injury" if sustained within a
arising out of the escape of fuels, lu-
building and caused by smoke,
bricants or other operating fluids
fumes, vapor or soot produced by or
which are needed to perform the
originating from equipment that is
normal electrical, hydraulic or me -
used to heat, cool or dehumidify the
chanical functions necessary for the
building, or equipment that is used to
operation of "mobile equipment" or
heat water for personal use, by the
its parts, if such fuels, lubricants or
building's occupants or their guests;
other operating fluids escape from a
(ii) "Bodily injury" or "property damage"
vehicle part designed to hold, store
for which you may be held liable, if
or receive them. This exception does
you are a contractor and the owner
not apply if the "bodily injury" or
or lessee of such premises, site or
"property damage" arises out of the
location has been added to your pol-
intentional discharge, dispersal or re -
icy as an additional insured with re-
lease of the fuels, lubricants or other
spect to your ongoing operations
operating fluids, or if such fuels, lu-
performed for that additional insured
bricants or other operating fluids are
at that premises, site or location and
brought on or to the premises, site or
such premises, site or location is not
location with the intent that they be
and never was owned or occupied
discharged, dispersed or released as
by, or rented or loaned to, any in-
part of the operations being per-
sured, other than that additional in-
formed by such insured, contractor
sured; or
or subcontractor;
(iii) "Bodily injury" or "property damage"
(ii) "Bodily injury" or "property damage"
arising out of heat, smoke or fumes
sustained within a building and
from a "hostile fire";
caused by the release of gases,
(b) At or from any premises, site or location
fumes or vapors from materials
which is or was at any time used by or
brought into that building in connec-
for any insured or others for the han-
tion with operations being performed
dling, storage, disposal, processing or
by you or on your behalf by a con -
treatment of waste;
tractor or subcontractor; or
(c) Which are or were at any time trans-
(iii) "Bodily injury" or "property damage"
ported, handled, stored, treated, dis-
arising out of heat, smoke or fumes
posed of, or processed as waste by or
from a "hostile fire".
for:
(e) At or from any premises, site or location
(i) Any insured; or
on which any insured or any contractors
or subcontractors working directly or in -
Any person or organization for whom
directly on any insured's behalf are per -
you may be legally responsible; or
forming 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 ef-
fects of, "pollutants".
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 3 of 16 0
(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, re-
move, contain, treat, detoxify or neutral-
ize, or in any way respond to, or assess
the effects of, "pollutants"; or
(b) Claim or "suit" by or on behalf of a gov-
ernmental authority for damages be-
cause of testing for, monitoring, cleaning
up, removing, containing, treating, de-
toxifying 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 govern-
mental authority.
g. Aircraft, Auto Or Watercraft
"Bodily injury" or "property damage" arising out
of the ownership, maintenance, use or en-
trustment to others of any aircraft, "auto" or wa-
tercraft 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, employ-
ment, 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 entrust-
ment to others of any aircraft, "auto" or water-
craft 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 26 feet long; and
(b) Not being used to carry persons or
property for a charge;
(3) Parking an "auto" on, or on the ways next
to, premises you own or rent, provided the
"auto" is not owned by or rented or loaned
to you or the insured;
(5) "Bodily injury" or "property damage" arising
out of:
(a) The operation of machinery or equip-
ment that is attached to, or part of, a
land vehicle that would qualify under the
definition of "mobile equipment" if it were
not subject to a compulsory or financial
responsibility law or other motor vehicle
insurance law in the state where it is li-
censed or principally garaged; or
(b) the operation of any of the machinery or
equipment listed in Paragraph f.(2) or
f.(3) of the definition of "mobile equip-
ment".
h. Mobile Equipment
"Bodily injury" or "property damage" arising out
of:
(1) The transportation of "mobile equipment" by
an "auto" owned or operated by or rented or
loaned to any insured; or
(2) The use of "mobile equipment" in, or while
in practice for, or while being prepared for,
any prearranged racing, speed, demolition,
or stunting activity.
i. War
"Bodily injury" or "property damage", 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 govern-
ment, sovereign or other authority using
military personnel or other agents; or
(3) Insurrection, rebellion, revolution, usurped
power, or action taken by governmental au-
thority in hindering or defending against any
of these.
j. Damage To Property
"Property damage" to:
(1) Property you own, rent, or occupy, including
any costs or expenses incurred by you, or
any other person, organization or entity, for
repair, replacement, enhancement, restora-
tion or maintenance of such property for
any reason, including prevention of injury to
a person or damage to another's property;
(2) Premises you sell, give away or abandon, if
the "property damage" arises out of any
part of those premises;
(4) Liability assumed under any "insured con- (3) Property loaned to you;
tract" for the ownership, maintenance or (4) Personal property in the care, custody or
use of aircraft or watercraft; or control of the insured;
Page 4 of 16 0 ISO Properties, Inc., 2006 CG 00 01 12 07
(5) That particular part of real property on
which you or any contractors or subcontrac-
tors working directly or indirectly on your
behalf are performing operations, if the
"property damage" arises out of those op-
erations; or
(6) That particular part of any property that
must be restored, repaired or replaced be-
cause "your work" was incorrectly per-
formed on it.
Paragraphs (1), (3) and (4) of this exclusion do
not apply to "property damage" (other than
damage by fire) to premises, including the con-
tents of such premises, rented to you for a pe-
riod of 7 or fewer consecutive days. A separate
limit of insurance applies to Damage To Prem-
ises Rented To You as described in Section III
— 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), (4), (5) and (6) of this exclu-
sion do not apply to liability assumed under a
sidetrack agreement.
Paragraph (6) of this exclusion does not apply
to "property damage" included in the "products -
completed operations hazard".
k. Damage To Your Product
"Property damage" to "your product' arising out
of it or any part of it.
I. 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 sub-
contractor.
m. 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 danger-
ous 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 ac-
cidental physical injury to "your product" or
"your work" after it has been put to its intended
use.
n. Recall Of Products, Work Or Impaired
Property
Damages claimed for any loss, cost or ex-
pense incurred by you or others for the loss of
use, withdrawal, recall, inspection, repair, re-
placement, 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.
o. Personal And Advertising Injury
"Bodily injury" arising out of "personal and ad-
vertising injury".
p. Electronic Data
Damages arising out of the loss of, loss of use
of, damage to, corruption of, inability to access,
or inability to manipulate electronic data.
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.
q. Distribution Of Material In Violation Of
Statutes
"Bodily injury" or "property damage" arising di-
rectly 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; or
(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, transmit-
ting, communicating or distribution of mate-
rial or information.
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 5 of 16
Exclusions c. through n. do not apply to damage
by fire to premises while rented to you or tempo-
rarily occupied by you with permission of the
owner. A separate limit of insurance applies to this
coverage as described in Section 111 — Limits Of
Insurance.
COVERAGE B PERSONAL AND ADVERTISING
INJURY LIABILITY
1. Insuring Agreement
a. We will pay those sums that the insured be-
comes legally obligated to pay as damages
because of "personal and advertising injury" to
which this insurance applies. We will have the
right and duty to defend the insured against
any "suit" seeking those damages. However,
we will have no duty to defend the insured
against any "suit" seeking damages for "per-
sonal and advertising injury" to which this in-
surance does not apply. We may, at our discre-
tion, investigate any offense and settle any
claim or "suit" that may result. But:
(1) The amount we will pay for damages is
limited as described in Section III — Limits
Of Insurance; and
(2) Our right and duty to defend end when we
have used up the applicable limit of insur-
ance in the payment of judgments or set-
tlements under Coverages A or B or medi-
cal expenses under Coverage C.
No other obligation or liability to pay sums or
perform acts or services is covered unless ex-
plicitly provided for under Supplementary Pay-
ments — Coverages A and B.
b. This insurance applies to "personal and adver-
tising injury" caused by an offense arising out
of your business but only if the offense was
committed in the "coverage territory" during the
policy period.
2. Exclusions
This insurance does not apply to:
a. Knowing Violation Of Rights Of Another
"Personal and advertising injury" caused by or
at the direction of the insured with the knowl-
edge that the act would violate the rights of an-
other and would inflict "personal and advertis-
ing injury".
b. Material Published With Knowledge Of
Falsity
c. Material Published Prior To Policy Period
"Personal and advertising injury" arising out of
oral or written publication of material whose
first publication took place before the beginning
of the policy period.
d. Criminal Acts
"Personal and advertising injury" arising out of
a criminal act committed by or at the direction
of the insured.
e. Contractual Liability
"Personal and advertising injury" for which the
insured has assumed liability in a contract or
agreement. This exclusion does not apply to li-
ability for damages that the insured would have
in the absence of the contract or agreement.
f. Breach Of Contract
"Personal and advertising injury" arising out of
a breach of contract, except an implied con-
tract to use another's advertising idea in your
"advertisement".
g. Quality Or Performance Of Goods — Failure
To Conform To Statements
"Personal and advertising injury" arising out of
the failure of goods, products or services to
conform with any statement of quality or per-
formance made in your "advertisement".
h. Wrong Description Of Prices
"Personal and advertising injury" arising out of
the wrong description of the price of goods,
products or services stated in your "advertise-
ment".
I. Infringement Of Copyright, Patent,
Trademark Or Trade Secret
"Personal and advertising injury" arising out of
the infringement of copyright, patent, trade-
mark, trade secret or other intellectual property
rights. Under this exclusion, such other intellec-
tual property rights do not include the use of
another's advertising idea in your "advertise-
ment".
However, this exclusion does not apply to in-
fringement, in your "advertisement", of copy-
right, trade dress or slogan.
j. Insureds In Media And Internet Type
Businesses
"Personal and advertising injury" committed by
an insured whose business is:
"Personal and advertising injury" arising out of (1) Advertising, broadcasting, publishing or
oral or written publication of material, if done by telecasting;
or at the direction of the insured with knowl-
edge of its falsity. (2) Designing or determining content of web-
sites for others; or
Page 6 of 16 © ISO Properties, Inc., 2006 CG 00 01 12 07
(3) An Internet search, access, content or
service provider.
However, this exclusion does not apply to
Paragraphs 14.a., b. and c. of "personal and
advertising injury" under the Definitions Sec-
tion.
(3) Insurrection, rebellion, revolution, usurped
power, or action taken by governmental au-
thority in hindering or defending against any
of these.
p. Distribution Of Material In Violation Of
Statutes
For the purposes of this exclusion, the placing "Personal and advertising injury" arising di -
of frames, borders or links, or advertising, for rectly or indirectly out of any action or omission
you or others anywhere on the Internet, is not that violates or is alleged to violate:
by itself, considered the business of advertis- (1) The Telephone Consumer Protection Act
ing, broadcasting, publishing or telecasting. (TCPA), including any amendment of or
k. Electronic Chatrooms Or Bulletin Boards addition to such law; or
"Personal and advertising injury" arising out of
an electronic chatroom or bulletin board the in-
sured hosts, owns, or over which the insured
exercises control.
I. Unauthorized Use Of Another's Name Or
Product
"Personal and advertising injury" arising out of
the unauthorized use of another's name or
product in your e-mail address, domain name
or metatag, or any other similar tactics to mis-
lead another's potential customers.
m. Pollution
"Personal and advertising injury" arising out of
the actual, alleged or threatened discharge,
dispersal, seepage, migration, release or es-
cape of "pollutants" at any time.
n. Pollution -Related
Any loss, cost or expense arising out of any:
(1) Request, demand, order or statutory or
regulatory requirement that any insured or
others test for, monitor, clean up, remove,
contain, treat, detoxify or neutralize, or in
any way respond to, or assess the effects
of, "pollutants"; or
(2) Claim or suit by or on behalf of a govern-
mental authority for damages because of
testing for, monitoring, cleaning up, remov-
ing, containing, treating, detoxifying or neu-
tralizing, or in any way responding to, or
assessing the effects of, "pollutants".
o. War
"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 govern-
ment, sovereign or other authority using
military personnel or other agents; or
(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, transmit-
ting, communicating or distribution of mate-
rial or information.
COVERAGE C MEDICAL PAYMENTS
1. 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:
(a) The accident takes place in the "cover-
age territory" and during the policy pe-
riod;
(b) The expenses are incurred and reported
to us within one year of the date of the
accident; and
(c) The injured person submits to examina-
tion, at our expense, by physicians of
our choice as often as we reasonably
require.
b. We will make these payments regardless of
fault. These payments will not exceed the ap-
plicable limit of insurance. We will pay reason-
able expenses for:
(1) First aid administered at the time of an
accident;
(2) Necessary medical, surgical, x-ray and
dental services, including prosthetic de-
vices; and
(3) Necessary ambulance, hospital, profes-
sional nursing and funeral services.
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 7 of 16 0
2. Exclusions
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 occu-
pies.
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 work-
ers' 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 within the "products -completed opera-
tions hazard".
g. Coverage A Exclusions
Excluded under Coverage A.
SUPPLEMENTARY PAYMENTS — COVERAGES A
AND B
1. We will pay, with respect to any claim we investi-
gate or settle, or any "suit" against an insured we
defend:
a. All expenses we incur.
b. Up to $250 for cost of bail bonds required
because of accidents or traffic law violations
arising out of the use of any vehicle to which
the Bodily Injury Liability Coverage applies. We
do not have to furnish these bonds.
c. The cost of bonds to release attachments, but
only for bond amounts within the applicable
limit of insurance. We do not have to furnish
these bonds.
d. All reasonable expenses incurred by the in-
sured at our request to assist us in the investi-
gation or defense of the claim or "suit", includ-
ing actual loss of earnings up to $250 a day
because of time off from work.
e. 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.
f. 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 in-
terest based on that period of time after the of-
fer.
g. 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 depos-
ited in court the part of the judgment that is
within the applicable limit of insurance.
These payments will not reduce the limits of insur-
ance.
2. If we defend an insured against a "suit" and an
indemnitee of the insured is also named as a party
to the "suit", we will defend that indemnitee if all of
the following conditions are met:
a. The "suit" against the indemnitee seeks dam-
ages for which the insured has assumed the li-
ability of the indemnitee in a contract or agree-
ment that is an "insured contract";
b. This insurance applies to such liability as-
sumed by the insured;
c. The obligation to defend, or the cost of the
defense of, that indemnitee, has also been as-
sumed by the insured in the same "insured
contract";
d. The allegations in the "suit" and the information
we know about the "occurrence" are such that
no conflict appears to exist between the inter-
ests of the insured and the interests of the in-
demnitee;
e. The indemnitee and the insured ask us to
conduct and control the defense of that indem-
nitee against such "suit" and agree that we can
assign the same counsel to defend the insured
and the indemnitee; and
f. The indemnitee:
(1) Agrees in writing to:
(a) Cooperate with us in the investigation,
settlement or defense of the "suit";
(b) Immediately send us copies of any
demands, notices, summonses or legal
papers received in connection with the
"suit";
(c) Notify any other insurer whose coverage
is available to the indemnitee; and
(d) Cooperate with us with respect to coor-
dinating other applicable insurance
available to the indemnitee; and
(2) Provides us with written authorization to:
(a) Obtain records and other information
related to the "suit"; and
Page 8 of 16 © ISO Properties, Inc., 2006 CG 00 01 12 07
(b) Conduct and control the defense of the
indemnitee in such "suit".
So long as the above conditions are met, attor-
neys' fees incurred by us in the defense of that in-
demnitee, 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 2.b.(2) of Section I — Cov-
erage A — Bodily Injury And Property Damage Li-
ability, 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 litiga-
tion expenses as Supplementary Payments ends
when we have used up the applicable limit of in-
surance in the payment of judgments or settle-
ments or the conditions set forth above, or the
terms of the agreement described in Paragraph f.
above, are no longer met.
SECTION II — WHO IS AN INSURED
1. If you are designated in the Declarations as:
a. An individual, you and your spouse are insur-
eds, 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 in-
sured. Your members, your partners, and their
spouses are also insureds, but only with re-
spect 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 du-
ties as your officers or directors. Your stock-
holders are also insureds, but only with respect
to their liability as stockholders.
e. A trust, you are an insured. Your trustees are
also insureds, but only with respect to their du-
ties as trustees.
2. Each of the following is also an insured:
a. Your "volunteer workers" only while performing
duties related to the conduct of your business,
or your "employees", other than either your
"executive officers" (if you are an organization
other than a partnership, joint venture or limited
liability company) or your managers (if you are
a limited liability company), but only for acts
within the scope of their employment by you or
while performing duties related to the conduct
of your business. However, none of these "em-
ployees" 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 li-
ability company), to a co -"employee"
while in the course of his or her em-
ployment or performing duties related to
the conduct of your business, or to your
other "volunteer workers" while perform-
ing duties related to the conduct of your
business;
(b) To the spouse, child, parent, brother or
sister of that co -"employee" or "volun-
teer worker" as a consequence of Para-
graph (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.
(2) "Property damage" to property:
(a) Owned, occupied or used by,
(b) Rented to, in the care, custody or con-
trol 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 mem-
ber (if you are a limited liability company).
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 9 of 16 ❑
b. Any person (other than your "employee" or
"volunteer worker"), or any organization while
acting as your real estate manager.
c. Any person or organization having proper
temporary custody of your property if you die,
but only:
(1) With respect to liability arising out of the
maintenance or use of that property; and
(2) Until your legal representative has been
appointed.
d. Your legal representative if you die, but only
with respect to duties as such. That represen-
tative will have all your rights and duties under
this Coverage Part.
3. Any organization you newly acquire or form, other
than a partnership, joint venture or limited liability
company, and over which you maintain ownership
or majority interest, will qualify as a Named In-
sured if there is no other similar insurance avail-
able to that organization. However:
a. Coverage under this provision is afforded only
until the 90th day after you acquire or form the
organization or the end of the policy period,
whichever is earlier;
b. Coverage A does not apply to "bodily injury" or
"property damage" that occurred before you
acquired or formed the organization; and
c. Coverage B does not apply to "personal and
advertising injury" arising out of an offense
committed before you acquired or formed the
organization.
No person or organization is an insured with respect
to the conduct of any current or past partnership, joint
venture or limited liability company that is not shown
as a Named Insured in the Declarations.
SECTION III — LIMITS OF INSURANCE
1. The Limits of Insurance shown in the Declarations
and the rules below fix the most we will pay re-
gardless of the number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or
bringing "suits".
2. The General Aggregate Limit is the most we will
pay for the sum of:
a. Medical expenses under Coverage C;
b. Damages under Coverage A, except damages
because of "bodily injury" or "property damage"
included in the "products -completed operations
hazard"; and
c. Damages under Coverage B.
3. The Products -Completed Operations Aggregate
Limit is the most we will pay under Coverage A for
damages because of "bodily injury" and "property
damage" included in the "products -completed op-
erations hazard".
4. Subject to Paragraph 2. above, the Personal and
Advertising Injury Limit is the most we will pay un-
der Coverage B for the sum of all damages be-
cause of all "personal and advertising injury" sus-
tained by any one person or organization.
5. Subject to Paragraph 2. or 3. above, whichever
applies, the Each Occurrence Limit is the most we
will pay for the sum of:
a. Damages under Coverage A; and
b. Medical expenses under Coverage C
because of all "bodily injury" and "property dam-
age" arising out of any one "occurrence".
6. Subject to Paragraph S. above, the Damage To
Premises Rented To You Limit is the most we will
pay under Coverage A for damages because of
"property damage" to any one premises, while
rented to you, or in the case of damage by fire,
while rented to you or temporarily occupied by you
with permission of the owner.
7. Subject to Paragraph 5. above, the Medical Ex-
pense Limit is the most we will pay under Cover-
age C for all medical expenses because of "bodily
injury" sustained by any one person.
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.
SECTION IV — COMMERCIAL GENERAL LIABILITY
CONDITIONS
1. Bankruptcy
Bankruptcy or insolvency of the insured or of the
insured's estate will not relieve us of our obliga-
tions under this Coverage Part.
2. Duties In The Event Of Occurrence, Offense,
Claim Or Suit
a. You must see to it that we are notified as soon
as practicable of an "occurrence" or an offense
which may result in a claim. To the extent pos-
sible, 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
Page 10 of 16 0 ISO Properties, Inc., 2006 CG 00 01 12 07
(3) The nature and location of any injury or
damage arising out of the "occurrence" or
offense.
b. If a claim is made or "suit" is brought against
any insured, you must:
(1) Immediately record the specifics of the
claim or "suit" and the date received; and
(2) Notify us as soon as practicable.
You must see to it that we receive written no-
tice of the claim or "suit" as soon as practica-
ble.
c. You and any other involved insured must:
(1) Immediately send us copies of any de-
mands, notices, summonses or legal pa-
pers received in connection with the claim
or "suit";
(2) Authorize us to obtain records and other
information;
(3) Cooperate with us in the investigation or
settlement of the claim or defense against
the "suit"; and
(4) Assist us, upon our request, in the en-
forcement of any right against any person
or organization which may be liable to the
insured because of injury or damage to
which this insurance may also apply.
d. No insured will, except at that insured's own
cost, voluntarily make a payment, assume any
obligation, or incur any expense, other than for
first aid, without our consent.
3. Legal Action Against Us
No person or organization has a right under this
Coverage Part:
a. To join us as a party or otherwise bring us into
a "suit" asking for damages from an insured; or
b. To sue us on this Coverage Part 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 Coverage Part or that are in excess of the ap-
plicable limit of insurance. An agreed settlement
means a settlement and release of liability signed
by us, the insured and the claimant or the claim-
ant's legal representative.
4. Other Insurance
If other valid and collectible insurance is available
to the insured for a loss we cover under Cover-
ages A or B of this Coverage Part, our obligations
are limited as follows:
a. Primary Insurance
This insurance is primary except when Para-
graph b. below applies. If this insurance is pri-
mary, our obligations are not affected unless
any of the other insurance is also primary.
Then, we will share with all that other insur-
ance by the method described in Paragraph c.
below.
b. Excess Insurance
(1) This insurance is excess over:
(a) Any of the other insurance, whether
primary, excess, contingent or on any
other basis:
(i) That is Fire, Extended Coverage,
Builder's Risk, Installation Risk or
similar coverage for "your work";
(ii) That is Fire insurance for premises
rented to you or temporarily occu-
pied by you with permission of the
owner;
(iii) That is insurance purchased by you
to cover your liability as a tenant for
"property damage" to premises
rented to you or temporarily occu-
pied by you with permission of the
owner; or
(iv) If the loss arises out of the mainte-
nance or use of aircraft, "autos" or
watercraft to the extent not subject to
Exclusion g. of Section I — Coverage
A — Bodily Injury And Property Dam-
age Liability.
(b) Any other primary insurance available to
you covering liability for damages aris-
ing out of the premises or operations, or
the products and completed operations,
for which you have been added as an
additional insured by attachment of an
endorsement.
(2) When this insurance is excess, we will have
no duty under Coverages A or B 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 de-
fends, we will undertake to do so, but we
will be entitled to the insured's rights
against all those other insurers.
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 11 of 16
(3) 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:
c. We have issued this policy in reliance upon
your representations.
7. Separation Of Insureds
(a) The total amount that all such other Except with respect to the Limits of Insurance, and
insurance would pay for the loss in the any rights or duties specifically assigned in this
Coverage Part to the first Named Insured, this in-
surance applies:
(b) The total of all deductible and self- a. As if each Named Insured were the only
insured amounts under all that other in- Named Insured; and
surance.
(4) We will share the remaining loss, if any,
with any other insurance that is not de-
scribed 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 of the other insurance permits contribution
by equal shares, we will follow this method
also. Under this approach each insurer con-
tributes equal amounts until it has paid its ap-
plicable 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.
5. Premium Audit
a. We will compute all premiums for this Cover-
age Part in accordance with our rules and
rates.
b. Premium shown in this Coverage Part as ad-
vance premium is a deposit premium only. At
the close of each audit period we will compute
the earned premium for that period and send
notice to the first Named Insured. The due date
for audit and retrospective premiums is the
date shown as the due date on the bill. If the
sum of the advance and audit premiums paid
for the policy period is greater than the earned
premium, we will return the excess to the first
Named Insured.
c. The first Named Insured must keep records of
the information we need for premium computa-
tion, and send us copies at such times as we
may request.
6. Representations
By accepting this policy, you agree:
a. The statements in the Declarations are accu-
rate and complete;
b. Those statements are based upon representa-
tions you made to us; and
b. Separately to each insured against whom claim
is made or "suit" is brought.
8. Transfer Of Rights Of Recovery Against Others
To Us
If the insured has rights to recover all or part of
any payment we have made under this Coverage
Part, those rights are transferred to us. The in-
sured 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.
9. When We Do Not Renew
If we decide not to renew this Coverage Part, we
will mail or deliver to the first Named Insured
shown in the Declarations written notice of the
nonrenewal not less than 30 days before the expi-
ration date.
If notice is mailed, proof of mailing will be sufficient
proof of notice.
SECTION V — DEFINITIONS
1. "Advertisement" means a notice that is broadcast
or published to the general public or specific mar-
ket segments about your goods, products or ser-
vices for the purpose of attracting customers or
supporters. For the purposes of this definition:
a. Notices that are published include material
placed on the Internet or on similar electronic
means of communication; and
b. Regarding web -sites, only that part of a web-
site that is about your goods, products or ser-
vices for the purposes of attracting customers
or supporters is considered an advertisement.
2. "Auto" means:
a. A land motor vehicle, trailer or semitrailer de-
signed for travel on public roads, including any
attached machinery or equipment; or
b. Any other land vehicle that is subject to a com-
pulsory or financial responsibility law or other
motor vehicle insurance law in the state where
it is licensed or principally garaged.
However, "auto" does not include "mobile equip-
ment".
Page 12 of 16 0 ISO Properties, Inc., 2006 CG 00 01 12 07 a
3. "Bodily injury" means bodily injury, sickness or
disease sustained by a person, including death re-
sulting from any of these at any time.
4. "Coverage territory" means:
a. The United States of America (including its
territories and possessions), Puerto Rico and
Canada;
b. International waters or airspace, but only if the
injury or damage occurs in the course of travel
or transportation between any places included
in Paragraph a. above; or
c. All other parts of the world if the injury or dam-
age arises out of:
(1) Goods or products made or sold by you in
the territory described in Paragraph a.
above;
(2) The activities of a person whose home is in
the territory described in Paragraph a.
above, but is away for a short time on your
business; or
(3) "Personal and advertising injury" offenses
that take place through the Internet or simi-
lar electronic means of communication
provided the insured's responsibility to pay dam-
ages is determined in a "suit" on the merits, in the
territory described in Paragraph a. above or in a
settlement we agree to.
5. "Employee" includes a "leased worker". "Em-
ployee" does not include a "temporary worker".
6. "Executive officer" means a person holding any of
the officer positions created by your charter, con-
stitution, by-laws or any other similar governing
document.
7. "Hostile fire" means one which becomes uncon-
trollable or breaks out from where it was intended
to be.
8. "Impaired property" means tangible property, other
than "your product" or "your work", that cannot be
used or is less useful because:
a. It incorporates "your product" or "your work"
that is known or thought to be defective, defi-
cient, inadequate or dangerous; or
b. You have failed to fulfill the terms of a contract
or agreement;
if such property can be restored to use by the re-
pair, replacement, adjustment or removal of "your
product" or "your work" or your fulfilling the terms
of the contract or agreement.
9. "Insured contract" means:
a. A contract for a lease of premises. However,
that portion of the contract for a lease of prem-
ises that indemnifies any person or organiza-
tion for damage by fire to premises while
rented to you or temporarily occupied by you
with permission of the owner is not an "insured
contract";
b. A sidetrack agreement;
c. Any easement or license agreement, except in
connection with construction or demolition op-
erations on or within 50 feet of a railroad;
d. An obligation, as required by ordinance, to
indemnify a municipality, except in connection
with work for a municipality;
e. An elevator maintenance agreement;
f. That part of any other contract or agreement
pertaining to your business (including an in-
demnification 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 dam-
age" to a third person or organization. Tort li-
ability means a liability that would be imposed
by law in the absence of any contract or
agreement.
Paragraph f. does not include that part of any
contract or agreement:
(1) That indemnifies a railroad for "bodily injury"
or "property damage" arising out of con-
struction or demolition operations, within 50
feet of any railroad property and affecting
any railroad bridge or trestle, tracks, road-
beds, tunnel, underpass or crossing;
(2) That indemnifies an architect, engineer or
surveyor for injury or damage arising out of:
(a) Preparing, approving, or failing to pre-
pare or approve, maps, shop drawings,
opinions, reports, surveys, field orders,
change orders or drawings and specifi-
cations; or
(b) Giving directions or instructions, or
failing to give them, if that is the primary
cause of the injury or damage; or
(3) Under which the insured, if an architect,
engineer or surveyor, assumes liability for
an injury or damage arising out of the in-
sured's rendering or failure to render pro-
fessional services, including those listed in
(2) above and supervisory, inspection, ar-
chitectural or engineering activities.
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 13 of 16 ❑
10."Leased worker" means a person leased to you by
a labor leasing firm under an agreement between
you and the labor leasing firm, to perform duties
related to the conduct of your business. "Leased
worker" does not include a "temporary worker".
11."Loading or unloading" means the handling of
property:
a. After it is moved from the place where it is
accepted for movement into or onto an aircraft,
watercraft or "auto";
b. While it is in or on an aircraft, watercraft or
"auto"; or
c. While it is being moved from an aircraft, water-
craft or "auto" to the place where it is finally de-
livered;
but "loading or unloading" does not include the
movement of property by means of a mechanical
device, other than a hand truck, that is not at-
tached to the aircraft, watercraft or "auto".
12."Mobile equipment" means any of the following
types of land vehicles, including any attached. ma-
chinery or equipment:
a. Bulldozers, farm machinery, forklifts and other
vehicles designed for use principally off public
roads;
b. Vehicles maintained for use solely on or next to
premises you own or rent;
c. Vehicles that travel on crawler treads;
d. Vehicles, whether self-propelled or not, main-
tained primarily to provide mobility to perma-
nently mounted:
(1) Power cranes, shovels, loaders, diggers or
drills; or
(2) Road construction or resurfacing equipment
such as graders, scrapers or rollers;
e. Vehicles not described in Paragraph a., b., c.
or d. above that are not self-propelled and are
maintained primarily to provide mobility to per-
manently attached equipment of the following
types:
(1) Air compressors, pumps and generators,
including spraying, welding, building clean-
ing, geophysical exploration, lighting and
well servicing equipment; or
(2) Cherry pickers and similar devices used to
raise or lower workers;
However, self-propelled vehicles with the fol-
lowing types of permanently attached equip-
ment are not "mobile equipment" but will be
considered "autos":
(1) Equipment designed primarily for:
(a) Snow removal;
(b) Road maintenance, but not construction
or resurfacing; or
(c) Street cleaning;
(2) Cherry pickers and similar devices mounted
on automobile or truck chassis and used to
raise or lower workers; and
(3) Air compressors, pumps and generators,
including spraying, welding, building clean-
ing, geophysical exploration, lighting and
well servicing equipment.
However, "mobile equipment" does not include
any land vehicles that are subject to a compulsory
or financial responsibility law or other motor vehi-
cle insurance law in the state where it is licensed
or principally garaged. Land vehicles subject to a
compulsory or financial responsibility law or other
motor vehicle insurance law are considered
"autos".
13."Occurrence" means an accident, including con-
tinuous or repeated exposure to substantially the
same general harmful conditions.
14."Personal and advertising injury" means injury,
including consequential "bodily injury", arising out
of one or more of the following offenses:
a. False arrest, detention or imprisonment;
b. Malicious prosecution;
c. The wrongful eviction from, wrongful entry into,
or invasion of the right of private occupancy of
a room, dwelling or premises that a person oc-
cupies, committed by or on behalf of its owner,
landlord or lessor;
d. Oral or written publication, in any manner, of
material that slanders or libels a person or or-
ganization or disparages a person's or organi-
zation's goods, products or services;
e. Oral or written publication, in any manner, of
material that violates a person's right of pri-
vacy;
f. The use of another's advertising idea in your
"advertisement"; or
f. Vehicles not described in Paragraph a., b., c. g. Infringing upon another's copyright, trade dress
or d. above maintained primarily for purposes or slogan in your "advertisement".
other than the transportation of persons or
cargo.
Page 14 of 16 0 ISO Properties, Inc., 2006 CG 00 01 12 07
15. "Pollutants" mean any solid, liquid, gaseous or
thermal irritant or contaminant, including smoke,
vapor, soot, fumes, acids, alkalis, chemicals and
waste. Waste includes materials to be recycled,
reconditioned or reclaimed.
16."Products-completed operations hazard":
a. Includes all "bodily injury" and "property dam-
age" 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 pos-
session; or
(2) Work that has not yet been completed or
abandoned. However, "your work" will be
deemed completed at the earliest of the fol-
lowing 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 con-
tract 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.
Work that may need service, maintenance,
correction, repair or replacement, but which
is otherwise complete, will be treated as
completed.
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;
(2) The existence of tools, uninstalled equip-
ment or abandoned or unused materials; or
(3) Products or operations for which the classi-
fication, listed in the Declarations or in a
policy schedule, states that products -
completed operations are subject to the
General Aggregate Limit.
17."Property damage" means:
a. Physical injury to tangible property, including
all resulting loss of use of that property. All
such loss of use shall be deemed to occur at
the time of the physical injury that caused it; or
b. Loss of use of tangible property that is not
physically injured. All such loss of use shall be
deemed to occur at the time of the "occur-
rence" that caused it.
For the purposes of this insurance, electronic data
is not tangible property.
As used in this definition, electronic data means
information, facts or programs stored as or on,
created or used on, or transmitted to or from com-
puter software, including systems and applications
software, hard or floppy disks, CD-ROMS, tapes,
drives, cells, data processing devices or any other
media which are used with electronically controlled
equipment.
18."Suit" means a civil proceeding in which damages
because of 'bodily injury", "property damage" or
"personal and advertising injury" to which this in-
surance applies are alleged. "Suit' includes:
a. An arbitration proceeding in which such dam-
ages are claimed and to which the insured
must submit or does submit with our consent;
or
b. Any other alternative dispute resolution pro-
ceeding in which such damages are claimed
and to which the insured submits with our con-
sent.
19."Temporary worker" means a person who is fur-
nished to you to substitute for a permanent "em-
ployee" on leave or to meet seasonal or short-term
workload conditions.
20. "Volunteer worker" means a person who is not
your "employee", and who donates his or her work
and acts at the direction of and within the scope of
duties determined by you, and is not paid a fee,
salary or other compensation by you or anyone
else for their work performed for you.
21."Your product':
a. Means:
(1) Any goods or products, other than real
property, manufactured, sold, handled, dis-
tributed or disposed of by:
(a) You;
(b) Others trading under your name; or
(c) A person or organization whose busi-
ness 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, du-
rability, performance or use of "your prod-
uct'; and
CG 00 01 12 07 © ISO Properties, Inc., 2006 Page 15 of 16
(2) The providing of or failure to provide warn-
ings or instructions.
c. Does not include vending machines or other
property rented to or located for the use of oth-
ers but not sold.
22. "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, du-
rability, performance or use of "your work",
and
(2) The providing of or failure to provide warn-
ings or instructions.
Page 16 of 16 © ISO Properties, Inc., 2006 CG 00 01 12 07
HISCOX
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective
UDC -1570729 -CGL -16
Edmond Otis
1
June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DEFINITION OF EMPLOYEE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
In Section V — DEFINITIONS, Definition 5.
"Employee" is deleted and replaced with the
following:
5. "Employee" includes a "leased worker" and a
"temporary worker".
CGL E5401 CW (03/10)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Page 1 of 1
�3
Yv^
HISCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 2
Endorsement Effective: June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE INFORMATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Where To Send Notice
Phone: 866-424-8508
Email: reportaclaim@hiscox.com
Mail: Hiscox
520 Madison Avenue -32nd Floor
Attn: Direct Claims
New York, NY, 10022
Subparagraph 2. Duties In The Event Of Occur-
rence, Offense, Claim Or Suit in Section IV —
COMMERCIAL GENERAL LIABILITY CONDI-
TIONS is amended to include the following:
Any notification required by this policy shall be pr o-
vided t o us at t he addr ess I isted in the above
SCHEDULE.
CGL E5403 CW (03/10)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Page 1 of 1
HISCOX
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective
UDC -1570729 -CGL -16
Edmond Otis
3
June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EXCLUSION - PERSONAL INFORMATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Paragraph 2. Exclusions under Section 1 — COV-
ERAGE A — BODILY INJURY AND PROPERTY
DAMAGE LIABILITY, COVERAGE B — PERSONAL
AND ADVERTISING INJURY LIABILITY, and
COVERAGE C — MEDICAL PAYMENTS is
amended to include the following exclusion:
Personal Information
"Bodily injury", "property damage" or "personal and
advertising injury" caused by the insured's failure to
protect any non-public, personally identifiable infor-
mation in the insured's care, custody or control.
CGL E5404 CW (03/10)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Page 1 of 1
f$ev
HISCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 4
Endorsement Effective: June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EXCLUSION - DAMAGE TO PRIMARY RESIDENCE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
With respect to a premises that is an insured's primary residence:
A.
B.
The last paragraph ("Exclusions c. through n. do
not apply ... ") of Paragraph 2., Exclusions un-
der Section 1— Coverage A — Bodily Injury And
Property Damage Liability is deleted.
The first exception ("Paragraphs (1), (3) and (4)
of this exclusion do not apply ... ") to Exclusion
j., Damage To Property of Paragraph 2., Exclu-
sions of Section I — Coverage A — Bodily Injury
And Property Damage Liability is deleted.
CGL E5405 CW (03/10)
C. Paragraph 6. of Section III — Limits Of Insur-
ance is deleted.
D. Any reference in the Declarations to "Damage To
Premises Rented To You" is deleted.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Page 1 of 1
Am
HISCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 5
Endorsement Effective: June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EXCLUSION - PROFESSIONAL SERVICES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Paragraph 2. Exclusions under Section I —
COVERAGE A — BODILY INJURY AND PROPER-
TY DAMAGE LIABILITY, and COVERAGE B —
PERSONAL AND ADVERTISING INJURY
LIABILITY, is amended to include the following
exclusion:
Professional Services
"Bodily injury", "property damage" or "personal and
advertising injury" caused by the rendering or failure
to render any professional service.
CGL E5407 CW (03/10)
This exclusion applies even if the claims allege neg-
ligence or other wrongdoing in the supervision, hir-
ing, employment, training or monitoring of others by
an insured, if the 'occurrence" which caused the
"bodily injury" or "property damage", or the offense
which caused the "personal and advertising injury",
involved the rendering or failure to render any pro-
fessional service.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Page 1 of 1
HISCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 6
Endorsement Effective: June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CANCELLATION PROVISION
(14 DAY FULL REFUND)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
All Coverage Parts included in this policy are subject to the following condition:
Notwithstanding anything in the "COMMON POLICY
CONDITIONS" or any other cancellation provision to
the contrary, if the first Named Insured cancels
within 14 days of the inception of the policy period
shown in the Declarations without there having
been: (i) an 'occurrence" that caused "bodily in-
jury" or "property damage"; (ii) an offense arising
out of your business that caused a "personal and
advertising injury"; or (iii) an accident that caused
"bodily injury"; then we shall return in full any pre-
mium amount actually paid to us. In such event,
the effective date of cancellation shall be deemed
to be the inception date of the policy period shown
in the Declarations.
CGL E5408 CW (03/10)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Page 1 of 1
F �S
H I SCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 7
Endorsement Effective: June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RIGHT AND DUTY TO SELECT DEFENSE COUNSEL
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
In regard to any covered "suit' seeking damages
under Section I — COVERAGE A — BODILY IN-
JURY AND PROPERTY DAMAGE LIABILITY or
COVERAGE B — PERSONAL AND ADVERTISING
INJURY LIABILITY, our right and duty to defend
shall include the right to select defense counsel.
CGL E5409 CW (03/10) Page 1 of 1
HISCOX
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
UDC -1570729 -CGL -16
Edmond Otis
8
June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - AUTOMATIC STATUS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II — Who Is An Insured is amended
to include as an additional insured any per-
sons) or organization(s) for whom you are
performing operations or leasing a premises
when you and such person(s) or organiza-
tion(s) have agreed in writing in a contract or
agreement that such person(s) or organiza-
tion(s) be added as an additional insured on
your policy. Such person or organization is
an additional insured only with respect to lia-
bility 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:
1. In the performance of your ongoing opera-
tions; or
2. In connection with your premises owned by or
rented to you.
A person's or organization's status as an addi-
tional insured under this endorsement ends
when your operations or lease agreement for
that additional insured are completed.
CGL E5421 CW (02/14) Includes copyrighted material of Insurance Services Office, Inc., with its Page 1 of 1
permission.
1
HISCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 9
Endorsement Effective: June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ELECTRONIC DATA LIABILITY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Loss Of Electronic Data Limit:
Schedule
1$25,000
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Exclusion 2.p. of Coverage A— Bodily Injury And D. For the purposes of the coverage provided by this
Property Damage Liability in Section I — Cove- endorsement, the definition of "Property Damage"
rages is replaced by the following: in the Definitions Section is replaced by the fol -
2. Exclusions lowing:
This insurance does not apply to:
p. Electronic Data
Damages arising out of the loss of, loss of
use of, damage to, corruption of, inability to
access, or inability to manipulate "electronic
data" that does not result from physical in-
jury to tangible property.
B. The following paragraph is added to Section III —
Limits Of Insurance:
Subject to 5. above, the Loss of Electronic Data
Limit shown in the Schedule above is the most we
will pay under Coverage A for "property damage"
because of all loss of "electronic data" arising out
of any one 'occurrence".
C. The following definition is added to the Definitions
Section:
"Electronic data" means information, facts or pro-
grams stored as or on, created or used on, or
transmitted to or from computer software (includ-
ing 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.
17. "Property damage" means:
a. Physical injury to tangible property, includ-
ing all resulting loss of use of that property.
All such loss of use shall be deemed to oc-
cur at the time of the physical injury that
caused it;
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 "oc-
currence" that caused it; or
c. Loss of, loss of use of, damage to, corrup-
tion of, inability to access, or inability to
properly manipulate "electronic data", result-
ing from physical injury to tangible property.
All such loss of "electronic data" shall be
deemed to occur at the time of the "occur-
rence" that caused it.
For the purposes of this insurance, "electronic
data" is not tangible property.
CG 04 37 12 04 © ISO Properties, Inc., 2003 Page 1 of 1
144,
HISCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 10
Endorsement Effective: June 08, 2016
Hiscox Insurance Company Inc.
COMMON POLICY CONDITIONS
All Coverage Parts included in this policy are subject to the following conditions.
A. Cancellation
1. The first Named Insured shown in the Declara-
tions may cancel this policy by mailing or deli-
vering to us advance written notice of cancella-
tion.
2. We may cancel this policy by mailing or deliver-
ing to the first Named Insured written notice of
cancellation at least:
a. 10 days before the effective date of cancel-
lation if we cancel for nonpayment of pre-
mium; or
b. 30 days before the effective date of cancel-
lation if we cancel for any other reason.
3. We will mail or deliver our notice to the first
Named Insured's last mailing address known to
us.
4. Notice of cancellation will state the effective
date of cancellation. The policy period will end
on that date.
5. If this policy is cancelled, we will send the first
Named Insured any premium refund due. If we
cancel, the refund will be pro rata. If the first
Named Insured cancels, the refund may be
less than pro rata. The cancellation will be ef-
fective even if we have not made or offered a
refund.
6. If notice is mailed, proof of mailing will be suffi-
cient proof of notice.
B. Changes
This policy contains all the agreements between
you and us concerning the insurance afforded.
The first Named Insured shown in the Declarations
is authorized to make changes in the terms of this
policy with our consent. This policy's terms can be
amended or waived only by endorsement issued
by us and made a part of this policy.
C. Examination Of Your Books And Records
We may examine and audit your books and
records as they relate to this policy at any time dur-
ing the policy period and up to three years after-
ward.
D. Inspections And Surveys
1. We have the right to:
a. Make inspections and surveys at any time;
b. Give you reports on the conditions we find;
and
c. Recommend changes.
2. We are not obligated to make any inspections,
surveys, reports or recommendations and any
such actions we do undertake relate only to in-
surability and the premiums to be charged. We
do not make safety inspections. We do not un-
dertake to perform the duty of any person or
organization to provide for the health or safety
of workers or the public. And we do not warrant
that conditions:
a. Are safe or healthful; or
b. Comply with laws, regulations, codes or
standards.
3. Paragraphs 1. and 2. of this condition apply not
only to us, but also to any rating, advisory, rate
service or similar organization which makes in-
surance inspections, surveys, reports or rec-
ommendations.
4. Paragraph 2. of this condition does not apply to
any inspections, surveys, reports or recom-
mendations we may make relative to certifica-
tion, under state or municipal statutes, ordin-
ances or regulations, of boilers, pressure ves-
sels or elevators.
E. Premiums
The first Named Insured shown in the Declara-
tions:
1. Is responsible for the payment of all premiums;
and
2. Will be the payee for any return premiums we
pay.
IL 00 1711 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 2
F. 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 representa-
tive. 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.
Page 2 of 2 Copyright, Insurance Services Office, Inc., 1982, 1983 IL 00 17 11 98
lm
H I SCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 11
Endorsement Effective: June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NUCLEAR ENERGY LIABILITY EXCLUSION
ENDORSEMENT
(Broad Form)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. The insurance does not apply:
A. Under any Liability Coverage, to "bodily injury"
or "property damage":
(1) With respect to which an "insured" under
the policy is also an insured under a nuc-
lear energy liability policy issued by Nuclear
Energy Liability Insurance Association, Mu-
tual Atomic Energy Liability Underwriters,
Nuclear Insurance Association of Canada
or any of their successors, or would be an
insured under any such policy but for its
termination upon exhaustion of its limit of
liability; or
(2) Resulting from the "hazardous properties"
of "nuclear material' and with respect to
which (a) any person or organization is re-
quired to maintain financial protection pur-
suant to the Atomic Energy Act of 1954, or
any law amendatory thereof, or (b) the "in-
sured" 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 organi-
zation.
B. Under any Medical Payments coverage, to
expenses incurred with respect to "bodily in-
jury" resulting from the "hazardous properties"
of "nuclear material' and arising out of the op-
eration of a "nuclear facility" by any person or
organization.
C. Under any Liability Coverage, to "bodily injury"
or "property damage" resulting from "hazard-
ous properties" of "nuclear material', if:
(1) The "nuclear material' (a) is at any "nuclear
facility" owned by, or operated by or on be-
half of, an "insured" or (b) has been dis-
charged or dispersed therefrom;
(2) The "nuclear material' is contained in
"spent fuel" or "waste" at any time pos-
sessed, handled, used, processed, stored,
transported or disposed of, by or on behalf
of an "insured"; or
(3) 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 "nuc-
lear facility", but if such facility is located
within the United States of America, its terri-
tories or possessions or Canada, this ex-
clusion (3) applies only to "property dam-
age" to such "nuclear facility" and any
property thereat.
2. As used in this endorsement:
IL 00 21 09 08 © ISO Properties, Inc., 2007 Page 1 of 2
"Hazardous properties" includes radioactive, toxic
or explosive properties.
"Nuclear material" means "source material', "spe-
cial 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 com-
ponent, solid or liquid, which has been used or ex-
posed 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 concentra-
tion of uranium or thorium from any ore processed
primarily for its "source material' content, and (b)
resulting from the operation by any person or or-
ganization of any "nuclear facility" included under
the first two paragraphs of the definition of "nuc-
lear facility".
"Nuclear facility" means:
(a) Any "nuclear reactor";
(b) Any equipment or device designed or used
for (1) separating the isotopes of uranium or
plutonium, (2) processing or utilizing "spent
fuel', or (3) handling, processing or packag-
ing "waste";
(c) Any equipment or device used for the
processing, fabricating or alloying of "spe-
cial 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 pluto-
nium or uranium 233 or any combination
thereof, or more than 250 grams of uranium
235;
(d) 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 radioac-
tive contamination of property.
Page 2 of 2 © ISO Properties, Inc., 2007 IL 00 21 09 08
AM
H I SCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 12
Endorsement Effective: June 08, 2016
Hiscox Insurance Company Inc.
RECORDING AND DISTRIBUTION OF MATERIAL OR
INFORMATION IN VIOLATION OF LAW EXCLUSION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Exclusion q. of Paragraph 2. Exclusions of Sec-
tion I — Coverage A — Bodily Injury And Proper-
ty Damage Liability is replaced by the following:
2. Exclusions
This insurance does not apply to:
q. Recording And Distribution Of Material
Or Information In Violation Of Law
"Bodily injury" or "property damage" arising
directly or indirectly out of any action or
omission that violates or is alleged to vi-
olate:
(1) The Telephone Consumer Protection
Act (TCPA), including any amendment
of or addition to such law;
(2) The CAN -SPAM Act of 2003, including
any amendment of or addition to such
law;
(3) The Fair Credit Reporting Act (FCRA),
and any amendment of or addition to
such law, including the Fair and Accu-
rate Credit Transaction Act (FACTA); or
(4) Any federal, state or local statute, ordin-
ance or regulation, other than the TCPA,
CAN -SPAM Act of 2003 or FCRA and
their amendments and additions, that
addresses, prohibits, or limits the print-
ing, dissemination, disposal, collecting,
recording, sending, transmitting, com-
municating or distribution of material or
information.
B. Exclusion p. of Paragraph 2. Exclusions of Sec-
tion I — Coverage B — Personal And Advertising
Injury Liability is replaced by the following:
2. Exclusions
This insurance does not apply to:
p. Recording And Distribution Of Material
Or Information In Violation Of Law
"Personal and advertising injury" arising di-
rectly or indirectly out of any action or omis-
sion that violates or is alleged to violate:
(1) The Telephone Consumer Protection
Act (TCPA), including any amendment
of or addition to such law;
(2) The CAN -SPAM Act of 2003, including
any amendment of or addition to such
law;
(3) The Fair Credit Reporting Act (FCRA),
and any amendment of or addition to
such law, including the Fair and Accu-
rate Credit Transaction Act (FACTA); or
(4) Any federal, state or local statute, ordin-
ance or regulation, other than the TCPA,
CAN -SPAM Act of 2003 or FCRA and
their amendments and additions, that
addresses, prohibits, or limits the print-
ing, dissemination, disposal, collecting,
recording, sending, transmitting, com-
municating or distribution of material or
information.
CG 00 68 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1
Ao
H I SCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 13
Endorsement Effective: June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EXCLUSION - INTERCOMPANY PRODUCTS SUITS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
This insurance does not apply to any claim for dam-
ages by any Named Insured against another Named
Insured because of "bodily injury" or "property dam-
age" arising out of "your products" and included
within the "products -completed operations hazard."
CG 21 41 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1
HISCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 14
Endorsement Effective: June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CALIFORNIA CHANGES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The term "spouse" is replaced by the following:
Spouse or registered domestic partner under Califor-
nia law.
CG 32 34 01 05 © ISO Properties, Inc., 2004 Page 1 of 1
40
HISCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 15
Endorsement Effective: June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CALIFORNIA CHANGES - CANCELLATION
AND NONRENEWAL
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Paragraphs 2. and 3, of the Cancellation Com-
mon Policy Condition are replaced by the follow-
ing:
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 no-
tice of cancellation, stating the reason for can-
cellation, at least:
a. 10 days before the effective date of cancel-
lation if we cancel for:
(1) Nonpayment of premium; or
(2) Discovery of fraud by:
(a) Any insured or his or her representa-
tive in obtaining this insurance; or
(b) You or your representative in pur-
suing a claim under this policy.
b. 30 days before the effective date of cancel-
lation 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:
(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 misrepre-
sentation by:
(a) Any insured or his or her representa-
tive in obtaining this insurance; or
(b) You or your representative in pur-
suing a claim under this policy.
(3) A judgment by a court or an administra-
tive 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 in-
sured against.
IL 02 70 09 08 © ISO Properties, Inc., 2007 Page 1 of 4
(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 repre-
sentative, which materially increase any
of the risks insured against.
(5) Failure by you or your representative to
implement reasonable loss control re-
quirements, agreed to by you as a con-
dition of policy issuance, or which were
conditions precedent to our use of a par-
ticular rate or rating plan, if that failure
materially increases any of the risks in-
sured against.
(6) A determination by the Commissioner of
Insurance that the:
(a) Loss of, or changes in, our reinsur-
ance 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 com-
mercial or industrial enterprise, which
results in a materially added, increased
or changed risk, unless the added, in-
creased or changed risk is included in
the policy.
b. We will mail or deliver advance written
notice of cancellation, stating the reason for
cancellation, to the first Named Insured, at
the mailing address shown in the policy,
and to the producer of record, at least:
(1) 10 days before the effective date of
cancellation if we cancel for nonpay-
ment 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 Cancella-
tion Common Policy Condition:
7. Residential Property
This provision applies to coverage on real
property which is used predominantly for resi-
dential purposes and consisting of not more
than four dwelling units, and to coverage on
tenants' household personal property in a resi-
dential unit, if such coverage is written under
one of the following:
Commercial Property Coverage Part
Farm Coverage Part — Farm Property — Farm
Dwellings, Appurtenant Structures And House-
hold Personal Property Coverage Form
a. If such coverage has been in effect for 60
days or less, and is not a renewal of cover-
age we previously issued, we may cancel
this coverage for any reason, except as
provided in b. and c. below.
b. We may not cancel this policy solely be-
cause the first Named Insured has:
(1) Accepted an offer of earthquake cover-
age; or
(2) Cancelled or did not renew a policy
issued by the California Earthquake Au-
thority (CEA) that included an earth-
quake 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 in-
cludes an earthquake policy premium sur-
charge but fails to pay the earthquake poli-
cy premium surcharge authorized by the
CEA.
c. We may not cancel such coverage solely
because corrosive soil conditions exist on
the premises. This Restriction (c.) applies
only if coverage is subject to one of the fol-
lowing, which exclude loss or damage
caused by or resulting from corrosive soil
conditions:
(1) Capital Assets Program Coverage Form
(Output Policy);
(2) Commercial Property Coverage Part —
Causes Of Loss — Special Form; or
(3) Farm Coverage Part — Causes Of Loss
Form — Farm Property, Paragraph D.
Covered Causes Of Loss — Special.
Page 2 of 4 0 ISO Properties, Inc., 2007 IL 02 70 09 08
C. The following is added and supersedes any provi-
(2) The Commissioner of Insurance finds
sions to the contrary:
that the exposure to potential losses will
NONRENEWAL
threaten our solvency or place us in a
hazardous condition. A hazardous con -
1. Subject to the provisions of Paragraphs C.2.
dition includes, but is not limited to, a
and C.3. below, if we elect not to renew this
condition in which we make claims
policy, we will mail or deliver written notice stat-
payments for losses resulting from an
ing the reason for nonrenewal to the first
earthquake that occurred within the pre -
Named Insured shown in the Declarations and
ceding two years and that required a re -
to the producer of record, at least 60 days, but
duction in policyholder surplus of at
not more than 120 days, before the expiration
least 25% for payment of those claims;
or anniversary date.
or
We will mail or deliver our notice to the first
(3) We have:
Named Insured, and to the producer of record,
(a) Lost or experienced a substantial
at the mailing address shown in the policy.
reduction in the availability or scope
2. Residential Property
of reinsurance coverage; or
This provision applies to coverage on real
(b) Experienced a substantial increase
property used predominantly for residential
in the premium charged for reinsur-
purposes and consisting of not more than four
ance coverage of our residential
dwelling units, and to coverage on tenants'
property insurance policies; and
household property contained in a residential
the Commissioner has approved a plan
unit, if such coverage is written under one of
for the nonrenewals that is fair and
the following:
equitable, and that is responsive to the
Capital Assets Program (Output Policy) Cover-
changes in our reinsurance position.
age Part
c. We will not refuse to renew such coverage
Commercial Property Coverage Part
solely because the first Named Insured has
Farm Coverage Part — Farm Property — Farm
cancelled or did not renew a policy, issued
Dwellings, Appurtenant Structures And House-
by the California Earthquake Authority that
hold Personal Property Coverage Form
included an earthquake policy premium
a. We may elect not to renew such coverage
surcharge.
for any reason, except as provided in b., c.
d. We will not refuse to renew such coverage
and d. below:
solely because corrosive soil conditions ex -
b. We will not refuse to renew such coverage
ist on the premises. This Restriction (d.)
solely because the first Named Insured has
applies only if coverage is subject to one of
accepted an offer of earthquake coverage.
the following, which exclude loss or dam -
However, the following applies only to in-
age caused by or resulting from corrosive
surers who are associate participating in-
soil conditions:
surers as established by Cal. Ins. Code
(1) Capital Assets Program Coverage Form
Section 10089.16. We may elect not to re-
(Output Policy);
new such coverage after the first Named
(2) Commercial Property Coverage Part —
Insured has accepted an offer of earth-
Causes Of Loss — Special Form; or
quake coverage, if one or more of the fol-
(3) Farm Coverage Part —Causes Of Loss
lowing reasons applies:
Form — Farm Property, Paragraph D.
(1) The nonrenewal is based on sound
Covered Causes Of Loss — Special.
underwriting principles that relate to the
coverages provided by this policy and
3. We are not required to send notice of nonre-
that are consistent with the approved
newal in the following situations:
rating plan and related documents filed
a. If the transfer or renewal of a policy, without
with the Department of Insurance as re-
any changes in terms, conditions, or rates,
quired by existing law;
is between us and a member of our insur-
ance group.
IL 02 70 09 08 © ISO Properties, Inc., 2007 Page 3 of 4
b. If the policy has been extended for 90 days e. If the first Named Insured requests a
or less, provided that notice has been given change in the terms or conditions or risks
in accordance with Paragraph C.1. covered by the policy within 60 days of the
c. If you have obtained replacement coverage, end of the policy period.
or if the first Named Insured has agreed, in f. If we have made a written offer to the first
writing, within 60 days of the termination of Named Insured, in accordance with the
the policy, to obtain that coverage. timeframes shown in Paragraph C.1., to re-
d. If the policy is for a period of no more than new the policy under changed terms or
60 days and you are notified at the time of conditions or at an increased premium rate,
issuance that it will not be renewed. when the increase exceeds 25%.
Page 4 of 4 0 ISO Properties, Inc., 2007 IL 02 70 09 08
AM
HISCOX
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective:
UDC -1570729 -CGL -16
Edmond Otis
17
June 08, 2016
Hiscox Insurance Company Inc.
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:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. If aggregate insured losses attributable to terrorist
acts certified under the federal Terrorism Risk In-
surance Act exceed $100 billion in a calendar year
and we have met our insurer deductible under the
Terrorism Risk Insurance Act, we shall not be lia-
ble for the payment of any portion of the amount of
such losses that exceeds $100 billion, and in such
case insured losses up to that amount are subject
to pro rata allocation in accordance with proce-
dures established by the Secretary of the Trea-
sury.
"Certified act of terrorism" means an act that is
certified by the Secretary of the Treasury, in ac-
cordance with the provisions of the federal Terror-
ism Risk Insurance Act, to be an act of terrorism
pursuant to such Act. The criteria contained in the
Terrorism Risk Insurance Act for a "certified act of
terrorism" include the following:
1. The act resulted in insured losses in excess of
$5 million in the aggregate, attributable to all
types of insurance subject to the Terrorism
Risk Insurance Act; and
2. The act is a violent act or an act that is dan-
gerous to human life, property or infrastructure
and is committed by an individual or individuals
as part of an effort to coerce the civilian popu-
lation of the United States or to influence the
policy or affect the conduct of the United States
Government by coercion.
B. The terms and limitations of any terrorism exclu-
sion, or the inapplicability or omission of a terror-
ism exclusion, do not serve to create coverage for
injury or damage that is otherwise excluded under
this Coverage Part.
CG 21 70 01 15 © Insurance Services Office, Inc., 2015 Page 1 of 1
N4A
HISCOX
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective
UDC -1570729 -CGL -16
Edmond Otis
18
June 08, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN
RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK
INSURANCE ACT. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR
CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY.
DISCLOSURE PURSUANT TO TERRORISM RISK
INSURANCE ACT
SCHEDULE
SCHEDULE —PART I
Terrorism Premium (Certified Acts) $ 4.00
This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Cover-
age Form(s) and/or Policy(ies):
Additional information, if any, concerning the terrorism premium:
SCHEDULE — PART II
Federal share of terrorism losses 85% year 2015; 84% year 2016; 83% year 2017; 82% year 2018; 81%
year 2019 and 80% year 2020.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Disclosure Of Premium
In accordance with the federal Terrorism Risk In-
surance Act, we are required to provide you with a
notice disclosing the portion of your premium, if
any, attributable to coverage for terrorist acts certi-
fied under the Terrorism Risk Insurance Act. The
portion of your premium attributable to such cov-
erage is shown in the Schedule of this endorse-
ment or in the policy Declarations.
IL 09 85 01 15 0 Insurance Services Office, Inc., 2015 Page 1 of 2
B. Disclosure Of Federal Participation In Payment
Of Terrorism Losses
The United States Government, Department of the
Treasury, will pay a share of terrorism losses in-
sured under the federal program. The federal
share equals a percentage (as shown in Part II of
the Schedule of this endorsement or in the policy
Declarations) of that portion of the amount of such
insured losses that exceeds the applicable insurer
retention. However, if aggregate insured losses at-
tributable to terrorist acts certified under the Ter-
rorism Risk Insurance Act 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.
C. Cap On Insurer Participation In Payment Of
Terrorism Losses
If aggregate insured losses attributable to terrorist
acts certified under the Terrorism Risk Insurance
Act exceed $100 billion in a calendar year and we
have met our insurer deductible under the Terror-
ism Risk Insurance Act, we shall not be liable for
the payment of any portion of the amount of such
losses that exceeds $100 billion, and in such case
insured losses up to that amount are subject to pro
rata allocation in accordance with procedures es-
tablished by the Secretary of the Treasury.
Page 2 of 2 © Insurance Services Office, Inc., 2015 IL 09 85 01 15
140
HISCOX
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective
UDC -1570729 -CGL -16
Edmond Otis
19
August 31, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
MODIFIED WAIVER OF TRANSFER OF RIGHTS OF
RECOVERY AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV — Conditions:
You may waive your rights against another party so
long as you do so in writing prior to: (i) an offense
arising out of your business that caused a "personal
and advertising injury"; or (ii) an 'occurrence" that
caused 'bodily injury" or "property damage".
CGL E5402 CW (03/10)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Page 1 of 1
}
C)Xf%
H I SCOX
Policy Number:
Named Insured:
Endorsement Number:
Endorsement Effective
UDC -1570729 -CGL -16
Edmond Otis
20
September 06, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s)
City of San Rafael
1400 Fifth Ave
151560
San Rafael,CA 94915
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II — Who Is An Insured is amended to in-
clude as an additional insured the person(s) or organi-
zation(s) shown in the Schedule, 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 omis-
sions of those acting on your behalf:
A. In the performance of your ongoing operations; or
B. In connection with your premises owned by or
rented to you.
CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1
4L.
HISCOX
Policy Number: UDC -1570729 -CGL -16
Named Insured: Edmond Otis
Endorsement Number: 21
Endorsement Effective: September 06, 2016
Hiscox Insurance Company Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY CHANGES
This endorsement will not be used to decrease coverage, increase rates or deductibles or alter any terms or
conditions of coverage unless at the sole request of the insured.
The following item(s):
insured's Name
Policy Number
Effective/Expiration Date
Payment Plan
❑ Additional Interested Parties
Limits/Exposures
Covered Property/Located Description
Rates
is (are) changed to read (See Additional Page(s)):
insured's Mailing Address
Company
insured's Legal Status/Business of Insured
Premium Determination
❑X Coverage Forms and Endorsements
❑ Deductibles
❑ Classification/Class Codes
❑ Underlying Insurance
The above amendments result in a change in the premium as follows:
NO CHANGES TO BE ADJUSTED ADDITIONAL PREMIUM RETURN PREMIUM
AT AUDIT
$ $ 37.70
CGL E5410 CW (03/10) Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2
with its permission.
POLICY CHANGES ENDORSEMENT DESCRIPTION
It is understood and agreed that effective September 6, 2016, Endorsement # 16 entitled Additional
Insured - Designated Person or Organization is deleted in its entirety.
All other terms and conditions remain unchanged.
CGL E6410 CW (03/10) Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2
with its permission.
CONTRACT ROUTING FORM
INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below.
TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER:
Contracting Department: Library
Project Manager: Sarah Houghton
Extension: 3325
Contractor Name: Edmond Otis & Associates
Contractor's Contact: Amy Hung
Contact's Email: admin@edmondotis.co.nz
❑ FPPC: Check if Contractor/Consultant must file Form 700
Step RESPONSIBLE DESCRIPTION COMPLETED REVIEWER
DEPARTMENT DATE Check/Initial
1 Project Manager a. Email PINS Introductory Notice to Contractor W/r;4�b EK
7/22/2016
b. Email contract (in Word) & attachments to City
Atty c/o Laraine.Gittens@cityofsanrafael.org
2 City Attorney a. Review, revise, and comment on draft agreement 7/25/2016 ® LAG
and return to Project Manager',' -R ^-4� ® LAG
b. Confirm insurance requirements, create Job on W -k
PINS, send PINS insurance notice to contractor
3 Project Manager Forward three (3) originals of final agreement to Click here to ❑
contractor for their signature enter a date.
4 Project Manager When necessary, * contractor -signed agreement ® N/A
agendized for Council approval
*PSA > $20,000; or Purchase > $35,000; or Or ❑
Public Works Contract > $125,000
Date of Council approval Click here to
enter a date
PRINT CONTINUE ROUTING PROCESS WITH HARD COPY
5 Project Manager Forward signed original agreements to City 9/26/16
Attorney with printed copy of this routing form/
6 City Attorney Review and approve hard copy of signed
agreement
7 City Attorney Review and approve insurance in;41gT,_andto
Q
(for Public Works Contracts) V� r�!
7/a7//,(7
A-
8 City Manager/ Mayor Agreement executed by Council authorized official I
9 City Clerk Attest signatures, retains original agreement and I l
forwards copies to Project Manager