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17-001 Mark Wright NO.2017-557 FY 17-18 AGREEMENT BETWEEN THE CITY OF CUPERTINO AND MARK WRIGHT FOR KARATE CLASSES THIS AGREEMENT, for reference dated THURSDAY,JUNE 1,2017, is by and between CITY OF CUPERTINO, a municipal corporation (hereinafter referred to as"City"),and MARK WRIGHT, a CALIFORNIA SOLE PROPRIETORSHIP, whose address is (hereinafter referred to as"Consultant"), and is made with reference to the following: RECITALS: A. City is a municipal corporation duly organized and validly existing under the laws of the State of California with the power to carry on its business as it is now being conducted under the Constitution and the statutes of the State of California and the Cupertino Municipal Code. B. Consultant is specially trained,experienced and competent to perform the special services which will be required by this Agreement;and C. Consultant possesses the skill,experience, ability,background, certification and knowledge to provide the services described in this Agreement on the terms and conditions described herein. D. City and Consultant desire to enter into an agreement for KARATE CLASSES upon the terms and conditions herein. NOW,THEREFORE, it is mutually agreed by and between the undersigned parties as follows: 1. TERM: The term of this Agreement shall commence on SATURDAY,JULY 1,2017, and shall terminate on SATURDAY,JUNE 30,2018, unless terminated earlier as set forth herein. 2. SERVICES TO BE PERFORMED: Consultant shall perform each and every service set forth in Exhibit"A"which is attached hereto and incorporated herein by this reference. 3. COMPENSATION TO CONSULTANT: Consultant shall be compensated for services performed pursuant to this Agreement in the amount set forth below and as described in Exhibit"A"which is attached hereto and incorporated herein by this reference.Compensation shall consist of the following:67%OF THE RESIDENT REGISTRATION FEE. In the event that less than the required minimum number of participants shall request and pay for services prior to the agreed upon time for the commencement of services to be performed by Consultant,City may cancel and withdraw from this Agreement. The total compensation to the Consultant shall not exceed TWENTY THOUSAND DOLLARS($20,000). 4. ACKNOWLEDGEMENT OF MANDATED REPORTING REO_UIREMENTS AND CONCUSSION PROTOCOL AND TRAINING: A. Mandatory Reporting and Fingerprinting, and Consultant shall comply with the requirements of California Penal Code 11164-11174.3 and as set forth in Exhibit"B" which is attached hereto and incorporated herein by this reference. B. Concussion Protocol: Consultant shall comply with all requirements of AB2007, including those outlined in Health and Safety Code Section 124235, et seq. including concussion FY 2017/2018 Standard Consultant Agreement 1 evaluation,removal from play,and return to play protocols. (Resources are available at the Center for Disease Control &Prevention.httt)s://www.cdc.gov/headsup/index.htmi) 1. Consultant shall provide each participant with a concussion information sheet, which may be in the form as attached as Exhibit C-1. Consultant shall ensure each participant signs and returns the form as required by Health and Safety Code Section 124235;and 2. Consultant shall require all coaches and administrators`to successfully complete the concussion and head injury education at least once either online or in person, before supervising a participant. Consultant shall offer training, educational materials,or both to each consultant administrator on a yearly basis.(Training resources are available at the Center for Disease Control&Prevention. httns://www.cdc,gov/headsup/index.html) 5. FINGERPRINT&TUBERCULOSIS (TB) CONSULTANT DECLARATION: Consultant agrees that all individuals covered under this Agreement shall provide fingerprints for criminal background test purposes and results of TB screening,pursuant to the requirements as set forth in Exhibit"C" which is attached hereto and incorporated herein by this reference. 6. TIME IS OF THE ESSENCE: Consultant and City agree that time is of the essence regarding the performance of this Agreement. 7. STANDARD OF CARE: Consultant agrees to perform all services hereunder in a manner commensurate with the prevailing standards of specially trained professionals in the San Francisco Bay Area and agrees that all services shall be performed by qualified and experienced personnel who are not employed by the City nor have any contractual relationship with City. 8. INDEPENDENT PARTIES: City and Consultant intend that the relationship between them created by this Agreement is that of an independent Consultant. The manner and means of conducting the work are under the control of Consultant, except to the extent they are limited by statute,rule or regulation and the express terms of this Agreement. No civil service status or other right of employment will be acquired by virtue of Consultant's services. None of the benefits provided by City to its employees, including but not limited to, unemployment insurance,workers' compensation plans, vacation and sick leave are available from City to Consultant,its employees or agents. Deductions shall not be made for any state or federal taxes, FICA payments,PERS payments,or other purposes normally associated with an employer-employee relationship from any fees due Consultant. Payments of the above items, if required, are the responsibility of Consultant. 9. IMMIGRATION REFORM AND CONTROL ACT(IBCA): Consultant assumes any and all responsibility for verifying the identity and employment authorization of all of his/her employees performing work hereunder, pursuant to all applicable IRCA or other federal,or state rules and regulations. Consultant shall indemnify and hold City harmless from and against any loss, damage, liability, costs or expenses arising from any noncompliance of this provision by Consultant. FY 2017/2018 Standard Consultant Agreement 2 I I r - 10. NON-DISCRIMINATION: Consistent with City's policy that harassment and discrimination are unacceptable employer/employee conduct, Consultant agrees that harassment or discrimination directed toward a job applicant,a City employee, or a citizen by Consultant or Consultant's employee or subcontractor on the basis of race,religious creed, color, national origin, ancestry,handicap, disability,marital status, pregnancy,sex, age,or sexual orientation will not be tolerated. Consultant agrees that any and all violations of this provision shall constitute a material breach of this Agreement. 11. HOLD HARMLESS: Consultant shall, to the fullest extent allowed by law, with respect to all services performed in connection with the Agreement, indemnify, defend, and hold harmless the City and its officers, officials, agents,employees and volunteers from and against any and all liability,claims,actions,causes of action or demands whatsoever against any of them, including any injury to or death of any person or damage to property or other liability of any nature, whether physical, emotional, consequential or otherwise, arising out, pertaining to, or related to the performance of this Agreement by Consultant or Consultant's employees, officers, officials, agents or independent contractors. Such costs and expenses shall include reasonable attorneys' fees of counsel of City's choice,expert fees and all other costs and fees of litigation. In addition to the obligations set forth above, Consultant shall indemnify, defend, and hold the City, its elected and appointed officers, employees, and volunteers, harmless from and against any Claim in which a violation of intellectual property rights, including but not limited to copyright or patent rights, is alleged that arises out of, pertains to, or relates to Consultant's negligence, recklessness or willful misconduct under this Agreement. Such costs and expenses shall include reasonable attorneys' fees of counsel of City's choice,expert fees and all other costs and fees of litigation. 12. INSURANCE: On or before the commencement of the term of this Agreement, Consultant shall furnish City with certificates showing the type, amount,class of operations covered,effective dates and dates of expiration of insurance coverage in compliance with the paragraphs below. Such certificates,which do not limit Consultant's indemnification,shall also contain substantially the following statement: "Should any of the above insurance covered by this certificate be canceled or coverage reduced before the expiration date thereof, the insurer affording coverage shall provide thirty(30) days'advance written notice to the City of Cupertino by certified mail,Attention:City Manager." It is agreed that Consultant shall maintain in force at all times during the performance of this Agreement all appropriate coverage of insurance required by this Agreement with an insurance company that is acceptable to City and licensed to do insurance business in the State of California. Endorsements naming the City as additional insured shall be submitted with the insurance certificates. A. COVERAGE: Consultant shall maintain the following insurance coverage: 1. Workers'Compensation:Statutory coverage as required by the State of California. 2. Liabilitv:Commercial general liability coverage, including sexual abuse and molestation coverage, in the following minimum limits: 1. Bodily Injury: $500,000 each occurrence $1,000,000 aggregate-all other 2. Property Damage: $100,000 each occurrence $250,000 aggregate FY 2017/2018 Standard Consultant Agreement 3 If submitted,combined single limit policy with aggregate limits in the amounts of$1,000,000 will be considered equivalent to the required minimum limits shown above. 3. 'Automotive:Proof of automobile insurance required at the California statutory minimums. B. SUBROGATION WAIVER: Consultant agrees that in the event of loss due to any of the perils for which he/she has agreed to provide comprehensive general and automotive liability insurance,Consultant shall look solely to his/her insurance for recovery. Consultant hereby grants to City,on behalf of any insurer providing comprehensive general and automotive liability insurance to either Consultant or City with respect to the services of Consultant herein,a waiver of any right to subrogation which any such insurer of said Consultant may acquire against City by virtue of the payment of any loss under such insurance. C. FAILURE TO SECURE: If Consultant at any time during the term hereof should fail to secure or maintain the foregoing insurance,City shall be permitted to obtain such insurance in the Consultant's name or as an agent of the Consultant and shall be compensated by the Consultant for the costs of the insurance premiums at the maximum rate permitted by law and computed from the date written notice is received that the premiums have not been paid. D. ADDITIONAL INSURED: City, its City Council,boards and commissions,officers,employees and volunteers shall be named as an additional insured under all insurance coverages, except any professional liability insurance, required by this Agreement. The naming of an additional insured shall not affect any recovery to which such additional insured would be entitled under this policy if not named as such additional insured. An additional insured named herein shall not be held liable for any premium, deductible portion of any loss, or expense of any nature on this policy or any extension thereof. Any other insurance held by an additional insured shall not be required to contribute anything toward any loss or expense covered by the insurance provided by this policy. E. SUFFICIENCY OF INSURANCE: The insurance limits required by City are not represented as being sufficient to protect Consultant. Consultant is advised to confer with Consultant's insurance broker to determine adequate coverage for Consultant. 13. CONFLICT OF INTEREST: Consultant warrants that it is not a conflict of interest for Consultant to perform the services required by this Agreement. Consultant may be required to fill out a conflict of interest form if the services provided under this Agreement require Consultant to make certain governmental decisions or serve in a staff capacity as defined in Title 2,Division 6,Section 18700 of the California Code of Regulations. 14. PROHIBITION AGAINST TRANSFERS: Consultant shall not assign, sublease, hypothecate, or transfer this Agreement,or any interest therein, directly or indirectly, by operation of law or otherwise, without prior written consent of City. Any attempt to do so without said consent shall be null and void,and any assignee, sublessee, hypothecate or transferee shall acquire no right or interest by reason of such attempted assignment, FY 2017/2018 Standard Consultant Agreement 4 hypothecation or transfer. However,claims for money by Consultant from City under this Agreement may be assigned to a bank, trust company or other financial institution without prior written consent. Written notice of such assignment shall be promptly furnished to City by Consultant. The sale, assignment, transfer or other disposition of any of the issued and outstanding capital stock of Consultant, or of the interest of any general partner or joint venturer or syndicate member or cotenant, if Consultant is a partnership or joint venture or syndicate or cotenancy,which shall result in changing the control of Consultant,shall be construed as an assignment of this Agreement. Control means fifty percent(50%)or more of the voting power of the corporation. 15. SUBCONTRACTOR APPROVAL: Unless prior written consent from City is obtained,only those people and subcontractors whose names and resumes are attached to this Agreement shall be used in the performance of this Agreement. In the event that Consultant employs subcontractors,such subcontractors shall be required to furnish proof of workers'compensation insurance and shall also be required to carry general,and professional liability insurance in reasonable conformity to the insurance carried by Consultant. In addition,any work or services subcontracted hereunder shall be subject to each provision of this Agreement. 16. PERMITS AND LICENSES: Consultant,at his/her sole expense, shall obtain and maintain during the term of this Agreement, all appropriate permits,certificates and licenses including, but not limited to,a City Business License,that may be required in connection with the performance of services hereunder. 17. REPORTS: A. Each and every report, draft,work product,map,record and other document,hereinafter collectively referred to as"Report",reproduced,prepared or caused to be prepared by Consultant pursuant to or in connection with this Agreement,shall be the exclusive property of City. Consultant shall not copyright any Report required by this Agreement and shall execute appropriate documents to assign to City the copyright to Reports created pursuant to this Agreement. Any Report,information and data acquired or required by this Agreement shall become the property of City,and all publication rights are reserved to City. Consultant may retain a copy of any report furnished to the City pursuant to this Agreement. B. All Reports prepared by Consultant may be used by City in execution or implementation of: 1. The original Project for which Consultant was hired; 2. Completion of the original Project by others; 3. Subsequent additions to the original project;and/or 4. Other City projects as appropriate. C. Consultant shall,at such time and in such form as City may require, furnish reports concerning the status of services required under this Agreement. D. All Reports required to be provided by this Agreement shall be printed on recycled paper. All Reports shall be copied on both sides of the paper except for one original,which shall be single sided. E. No Report, information or other data given to or prepared or assembled by Consultant pursuant to this Agreement shall be made available to any individual or organization by Consultant without prior approval by City. FY 2017/2018 Standard Consultant Agreement 5 i i I 18. RECORDS: Consultant shall maintain complete and accurate records with respect to sales, costs,expenses, receipts and other such information required by City that relate to the performance of services under this Agreement. Consultant shall maintain adequate records of services provided in sufficient detail to permit an evaluation of services. All such records shall be maintained in accordance with generally accepted accounting principles and shall be clearly identified and readily accessible. Consultant shall provide free access to such books and records to the representatives of City or its designees at all proper times, and gives City the right to examine and audit same,and to make transcripts therefrom as necessary,and to allow inspection of all work, data,documents, proceedings and activities related to this Agreement. Such records,together with supporting documents,shall be kept separate from other documents and records and shall be maintained for a period of three(3)years after receipt of final payment. If supplemental examination or audit of the records is necessary due to concerns raised by City's preliminary examination or audit of records,and the City's supplemental examination or audit of the records discloses a failure to adhere to appropriate internal financial controls,or other breach of contract or failure to act in good faith, then Consultant shall reimburse City for all reasonable costs and expenses associated with the supplemental examination or audit. 19. NOTICES: All notices, demands,requests or approvals to be given under this Agreement shall be given in writing and conclusively shall be deemed served when delivered personally or on the second business day after the deposit thereof in the United States Mail,postage prepaid,registered or certified,addressed as hereinafter provided. All notices, demands,requests, or approvals from the Consultant to the City shall be addressed to the City at: 10300 Torre Ave., Cupertino,CA,95014,Attention: Director of Recreation and Community Services. All 95123, Attention:MARK WRIGHT. 20. TERMINATION: In the event Consultant fails or refuses to perform any of the provisions hereof at the time and in the manner required hereunder,Consultant shall be deemed in default in the performance of this Agreement. If such default is not cured within the time specified after receipt by Consultant from City of written notice of default,specifying the nature of such default and the steps necessary to cure such default, City may terminate the Agreement forthwith by giving to the Consultant written notice thereof. City shall have the option,at its sole discretion and without cause, of terminating this Agreement by giving thirty (30) days'prior written notice to Consultant as provided herein. Upon termination of this Agreement, each party shall pay to the other party that portion of compensation specified in this Agreement that is earned and unpaid prior to the effective date of termination. City has no obligation to offer any of Consultant's services to participants, and,unless minimum enrollment for a particular class identified in the Scope of Services is met,City may cancel that class without further notice to Consultant or payment under this Agreement. The City in its sole discretion may determine the type of classes, the number of classes and the assigned instructor. FY 2017/2018 Standard Consultant Agreement 6 21. COMPLIANCES: Consultant shall comply with all state or federal laws and all ordinances, rules and regulations enacted or issued by City. Consultant shall obtain a Cupertino Business License and further comply with the City's Minimum Wage Ordinance as set forth in Cupertino Municipal Code Chapter 3.37. 22. CONFLICT OF LAW: This Agreement shall be interpreted under,and enforced by the laws of the State of California excepting any choice of law rules which may direct the application of laws of another jurisdiction. The Agreement and obligations of the parties are subject to all valid laws,orders, rules,and regulations of the authorities having jurisdiction over this Agreement(or the successors of those authorities.) Any suits brought pursuant to this Agreement shall be filed with the courts of the County of Santa Clara,State of California. 23. ADVERTISEMENT: Consultant shall not post,exhibit,display or allow to be posted, exhibited, displayed any signs, advertising,show bills,lithographs, posters or cards of any kind pertaining to the services performed under this Agreement unless prior written approval has been secured from City to do otherwise. 24. WAIVER: A waiver by City of any breach of any term,covenant, or condition contained herein shall not be deemed to be a waiver of any subsequent breach of the same or any other term,covenant, or condition contained herein, whether of the same or a different character. 25. INTEGRATED CONTRACT: This Agreement represents the full and complete understanding of every kind or nature whatsoever between the parties hereto,and all preliminary negotiations and agreements of whatsoever kind or nature are merged herein. No verbal agreement or implied covenant shall be held to vary the provisions hereof. Any modification of this Agreement will be effective only by written execution signed by both City and Consultant. 26. INSERTED PROVISIONS: Each provision and clause required by law to be inserted into the Agreement shall be deemed to be enacted herein,and the Agreement shall be read and enforced as though each were included herein. If through mistake or otherwise,any such provision is not inserted or is not correctly inserted, the Agreement shall be amended to make such insertion on application by either party. 27. CAPTIONS: The captions in this Agreement are for convenience only, are not a part of the Agreement and in no way affect, limit or amplify the terms or provisions of this Agreement. 28. AGREEMENT COORDINATOR: The Agreement Coordinator and representative for CITY shall be:JEFF ORDWAY, RECREATION COORDINATOR, Recreation&Community Service Department FY 2017/2018 Standard Consultant Agreement 7 I IN WITNESS, WHEREOF, the parties have caused the Agreement to be executed. MARK WRIGHT CITY OF CUPERTINO A Municipal Corporation By: MARK WRIGHT By: JEFF ORD Title: OWNER Title: RECREATION COORDI OR Date: (s -l S - 6 Date: RECOMMENDED FOR APPROVAL: n;kkIRNRUTION -/X, jv— IV\ By OVERMAN tie: SUPERVISOR APPROVED AS TO FORM: RANDOLPH STEVENSON HOM CITY ATTORNEY ATTEST: GRACE SCHMIDT CITY CLERK —� EXPENDITURE DISTRIBUTION: Account No: 580-63-620-700-702 Amount: $20,000 FY 2017/2018 Standard Consultant Agreement 8 I, EXHIBIT A CONSULTANT SERVICES TO BE PERFORMED The CONSULTANT will provide KARATE CLASSES in,but not limited to,the following programs: KARATE TOTS, KIDZ KARATE: BEGINNING&KIDZ KARATE: ADVANCED Location and Time of CONSULTANT Services: Refer to the Recreation Schedule dated 2017 SUMMER(JULY/AUGUST CAMPS),2017 FALL,2018 WINTER,2018 SPRING(JUNE CAMPS) for agreed upon dates, times,and class locations. By the mutual agreement of both parties,class schedule may change. Eligible Participant Minimum and Maximums for CONSULTANT Services: Minimum: 5 Maximum: 30 If less than the required minimum number of participants enroll in and pay for a particular class as identified in the schedule before the class is scheduled to start, the City may cancel the particular class and/or terminate this Agreement without additional notice or payment to Consultant. Performance of CONSULTANT Services: City shall have no right of control as to the manner Consultant performs the services to be performed. Nevertheless, City may, at any time, observe the manner in which such services are being performed by the consultant. The Consultant shall follow all guidelines pertaining to registration procedures as listed in the quarterly recreation schedule. Participants may not take part in the program unless they are listed on the class roster or can show proof of enrollment. All participants and volunteers need to complete the City's Waiver of Liability form prior to taking part in the program. Consultants are responsible for supervising minors after class until a parent of legal guardian has arrived. In the event of an injury occurring to a participant, the Consultant will notify the City within 1 hour and complete an Incident Report in the form approved by the City. The Incident Report must be submitted to the City within 24 hours of the injury occurring. FY 2017/2018 Standard Consultant Agreement 9 i EXHIBIT B ACKNOWLEDGEMENT OF MANDATED REPORTING REQUIREMENTS,RECEIPT OF TRAINING,AND RECEIPT OF PENAL CODES STATUTES A mandated reporter is an individual who is obligated by law to report suspected cases of child abuse and neglect. In general, any individual who, in the ordinary course of their employment,has contact with children is a mandated reporter. Mandated reporters include child care workers, teachers and coaches. (California Penal.Code 11165.7). If your job duties as an employee or an independent contractor of MARK WRIGHT include contact with children, you are a Mandated Reporter. Prior to commencing employment and as a prerequisite of that employment,California law requires that you sign a statement to the effect that you have knowledge of the provisions of the Mandated Reporter Law,and will comply with those provisions. (California Penal Code 11166.5). The following are the Mandated Reporter responsibilities under California law. You are also being provided with a separate informational document which includes the text of the California Mandated Reporter Law and contact information for Child Abuse and Neglect Reporting for the County of Santa Clara.Please review this information carefully and acknowledge your receipt and understanding where indicated. If you have questions or concerns about this form or your Mandated Reporter responsibilities, please contact the Recreation Supervisor at 408-777-3120. 1 understand that: • By virtue of my employment or independent contractor status with MARK WRIGHT, and because my employment requires me to have contact with children,I am a Mandated Reporter as defined by California Penal Code 11165.7. • The following situations trigger mandatory reports: a)Physical Abuse(willful harming of a child);b)Sexual abuse including sexual assault,child exploitation, pornography, and trafficking;c)Severe or General Neglect;and d) Extreme Corporal Punishment(resulting in injury). (Cal.Pen.Code 11165 et.seq.) I further understand that I may,but am not required to, report suspected Emotional Abuse. • If I reasonably suspect that a child is being abused, I must immediately make a telephone report. I must follow up with a written report within 36 hours. This report may be made to local law enforcement, or County Sheriff's Department,Probation Department or Child Welfare Agency. (Cal Pen. Code 11166(a)). • I am not required to, but I may,share information about suspected abuse with my supervisor or management or the parents of the alleged victim. • When I make a mandated report, I will be required to give my name. However, my identity will be kept confidential unless I either consent to disclosure or if the disclosure is made pursuant to a court order.Further, agencies investigating the mandated report may disclose my identity to one another. (Cal Pen. Code 11167(d)). FY 2017/2018 Standard Consultant Agreement 10 t • The following agencies and individuals receiving or investigating mandated reports may disclose my identity to one another: o Prosecutors in a criminal prosecuting or in an action initiated under section 602 of the Welfare and Institutions Code arising from alleged child abuse; o Counsel appointed pursuant to subdivision (c)of Section 317 of the Welfare and Institutions Code; o A licensing agency when abuse or neglect in out-of-home care is reasonably suspected. (Cal Pen.Code 11167.5) • I may not be disciplined,dismissed,retaliated against, discriminated against or harassed for making a mandated report of reasonably suspected child abuse. • As a Mandated Reporter,I have civil and criminal immunity when making a report(Cal Pen. Code 11172). • As a Mandated Reporter,it is a misdemeanor to fail to comply with Mandated Reporting laws and I can be held criminally liable for failing to report suspected abuse. The penalty for this is up to six months in County jail,a fine of not more than $1000, or both. I further understand I could be civilly liable for failure to report.(Cal. Pen. Code 11166(c)). I have been provided with a copy of California Penal Code sections 11164-11174.3 (Mandated Reporter Law). I understand that I am a legally Mandated Reporter. I am aware of and understand my responsibilities under the Mandated Reporter laws of this state and am willing and able to comply. I understand that a copy of this Acknowledgement will be kept in my personnel file. MARK WRIGHT By. MARK RIGHT Title: OWNER Date: 2 a / 7 FY 2017/2018 Standard Consultant Agreement I 1 I EXHIBIT C CITY OF CUPERTINO CONSULTANT DECLARATION The undersigned does hereby certify that: 1. I am a representative of MARK WRIGHT; that I am familiar with the facts herein and am authorized and qualified to execute this declaration. 2. 1 declare that MARK WRIGHT has complied with fingerprinting and criminal background investigation requirements with respect to all Consultant's employees who may have contact with minors in the course of providing services pursuant to the Agreement, and the California Department of Justice has determined that none of those employees has been convicted of a felony, as that term is defined in California Penal Code Section 11105.3. 3. I declare that each coach and administrator shall be required to successfully complete concussion and head injury education at least once, either online or in person, before supervising a participant,as required by California Health and Safety Code Section 124235,et seq. 4. On a yearly basis,all participants shall be required to sign and return a concussion and head injury information sheet in compliance with California Health and Safety Code Section 124235, which may be in the form attached as C-1. 5. That a complete and accurate list of Consultant's employees,who may come in contact with minors during the course and scope of the Agreement,are included below. 6. All of the below mentioned employees have tested negative for TB,or X-ray results for TB, and have current documentation on file with Consultant. 7. All of the below mentioned employees have received training and understand their responsibilities under the Mandated Reporter laws of this state and are willing and able to comply. List of all Consultant Employees working for the City of Cupertino(if no Employees,identify"self"): FY 2017/2018 Standard Consultant Agreement 12 8. The Consultant will notify the City of Cupertino in writing of any new employees and will be added to the above list prior to beginning work at the City of Cupertino. I declare under penalty of perjury that the foregoing is true and correct. MARK WRIGHT �By: MARK WRIGHT Title: OWNER Date: FY 2017/2018 Standard Consultant Agreement 13 DATE(MM/DD/YYYY) .a►`o CERTIFICATE OF LIABILITY INSURANCE 06/14/201' PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Maguire Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 27101 Puerta Real Suite 200 HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR Mission Viejo,CA 92691- ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 877.438.7459 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Philadelphia Indemnity Insurance Company 18058 I INSURER C: San Jose,CA 95123- I INSURER D: INSURER E: _ COVERAGES 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 CERIFICATION 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE I POLICY NUMBER DATE(MM/DD/YYYY) DATE(MM /DD/YYYY) LIMITS A X GENERAL LIABILITY PHPK1511906- 06/23/2017 06/23/2018 EACH OCCURENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY 001 I DAMAGt IRENIEU PREMISES 10PREMISES $100,000 CLAIMS MADE I--] OCCUR I MED EXP(Any one person) $2,500 X PROFESSIONAL LIABILITY I PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GENT AGGREGATE LIMIT APPLIES PER: I PRODUCTS—COMP/OP AGG $3,000,000 XIPOLICY n PROJECT n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO - (EA accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY ( NON-OWNED AUTOS Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY—EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURENCE 7 OCCUR El CLAIMS MADE I AGGREGATE DEDUCTIBLE I RETENTION I WURKEHSL MPLNSAFION AND I I WLSIA1U I I ERH EMPLOYERS'LIABILITY Y N TORY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT (Mandatory In NH) I E.L DISEASE—EA AMPLOYEE If yes,dcribe under SPECIAesL PROVISIONS below E.L.DISEASE—POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS It is understood and agreed that the following entity is added as an additional insured but only with respect(s)to the operations of the named insured except that liability resulting from the additional insured's sole negligence. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABGVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE city or cupertino its city council bards and commission,officers,employees and volunterrs shall be named THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE as an additional insured under alll insurance required by this agreement CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR 21111 Stevens Creek Blvd LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Cupertino,CA 95014- AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) © 1988-2009 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD ^ ® C TI R LATE OF UABI UW I NSURANCE I �� p'r'y A�>D PRODUCER THIS aPTT R CATT ON IS ISSUED ASA MATTER OF I N FORM ATI ON Maguire Insurance Agency,lnc ONLY AND OONFERS NO RIGHTS UPON THE CEPTIFICATE 27101 Fluerta Peal Suite 200 HOLDER THI S CERTI R CATE DOES NOT AM M END, BM31D OR MissonMejo,CA92691- ALTERTHEC OVERAGEAFFORDED BYTHEPOUO6BELOW. 877.438.7456 INSJRIERSAFFORDING COVERAGE NAIC# INSURED INE UFSRA Philadelphia Indemnity Insurance Company 18058 mark wright I INSUPER H I INSUFE RD. INSURE RE COVERAGES THE POJ060FINS,JRANCEUSfIDBB-OJVRAVE BEEN ISSIJ®TOTHE IN9JRED NAM®ABOVE FOR THEFOUCG PERODINDICAIID. NOTWITHSTANDING ANY RBDUIPEM ENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUM ENT WITH FST TO WHICH THIS CERFICATION MAYBE IS3J®OR MAYPBRTAIN,THE INSURANCEAF-ORDBD BY THE POLJOESDESCIBED HERRN ISSJB,QTTOALL THE TERMS DCQ.USONSAND OONDIIICXNSOFSJCH PCXJOES ApGTEUMITSS-JaMMAYHAVEBBJRIDUCEDBY'AIDCLAMS INSR ADDL POUCYFFEGWE POLY- EXARAiION LTR INS TYPE OFINSURANC= PCUCYNUMBER DATE(MM/DD(YYYY) DAIS YM DLYYYYY) LIMITS A X C$NERALUABUTY R-PK1511806i 06/23/2017 08/23/2018 EACH OC R3,ICE $1,000,000 X ODMMBa7ALCENERALUABUTY 001 AdlU (B3Nrreuce) $100,000 I CIAIMSMADE ❑X COCUR MBE7P(Anyone person) $2,500 X RmFIESEICNALLIABLITY I PEBSUAL&ADJINWF;Y $1,000,000 GREWLAGGRMATE $3,000,000 GENLA(3RB34TEUMITAPPUESFER PRODUCTS–COMPYCPAGG $3,000,000 X1POLIC( nFFnE7nLCC AUTOMOBLELIABILITY ODMDNBDSNGEUMIT _ ANYAUiO (EAaoddent) ALLCN\MEDAUTOS BODLYIN,UR( (Ferperson) _ S3-EDU _ HR3)AUTCS BODLYIN JRY _ NCN-OANDAUrOS (Peraoddent) PRD ERfYCAMACE (Per accident) C4RACEUABIUTY AUEOCA&Y–FAACODBJT ANYAUTO OTI-IERTHM FA AM AUTO CNLY A03 E)(CESS/UMBRELtALIABILITY I EAG-I0MJR3,KE OOZTUR F] CLAIMSMADE ABATE CEDLcnBI E RETENTION vKa� F�IIUNANU ftUbiAIU- U1 t+ BNFLOYBb UAEFUTY Y/N I TURR(LIMITS I ER ANY FR)FREFOR'PARFNEt'EXB.LIf1VE ❑ EL EACHAODDENT OFA C&7/M Evl BER BCODU= (Mandatory in N" EL DI�Sg-EAAMFLO)EF If Vyes,describe under EL DISC-PCUGYUMIT STi]AL FIbM S(XJS bel ow OTHER Dsa bTRoN oFopmwnc NS/LOCATIONS VEiia-S/DCQUSONSADDED w E NDOR11M ENT/S�_IALPRDVIS(xJS It is understood aid agreed that the folloNing entity is added as an additional insured but only with respect(s)to the operations of the named insured except that liability resulting from the additional insured's sole neJigence. CEFf l R LATE HOLDER CANCHIATT ON EFM D ANY OF THE ABOVE DE]33d—D POLICES BE CAN®..L®BBUFE TFE EXARATION DATE TF E ,, THE 193JING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRTTEJ NOTICE TO THE CERA ACATE HaDE R NAM ED TO THE LEFT,R f FAI W FE TO CO S7 S-LALL I M FOSENO OBUGATICN OR UABIUTY OFANY K ND UPON THE INSURE ITSAW4TSORFETESMATI VES AUTHORZEJ FOiRERNTATVE AC OM 25(2009/01) © 1988-2009 AICORD COFPORATION.All rights reserved. The AC OM name and logo are registered marks of AC OM ACS DATE(MM/DO/YYYY) CERTIFICATE OF LIABILILITY INSURANCE 6/20/201.7 THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Important if the certificate holder is an additional insured the policy(ies) must be endorsed. Insured 80 STONE PINE ROAD, SUITE 210 _ HALF MOON BAY CA_ 94019 _ COVERAGES CERTIFIFICATE NUMBER Revision Number 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 CERIFICATION 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADO-L POLICY EFFECTIVE POLICY INSRD DATE EXPIRATION DATE TYPE OF INSURANCE POLICY NUMBER (MM/DO/YYYY) (MM/DD/YYYY) LIMITS -_ GENERAL LIABILITY EACH OCCURENCE COMMERCIAL GENERAL LIABILWY ______ DAMAGE TO RENTED CLAIMS MADEOCCUR I �ll PREMISES(Fa occurrence) PROFESSIONAL LIABILITY MED EXP(Any one person) ------- --- -- PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE. PRODUCTS-COMP/OP AGG s ' POLICY --� PROJECT LOC ----------- _ AUTOMOBILE LIABILITY COMBINED ANY AUTO SINGLE LIMIT IEA accident) ALL OWNED AUTOS BODILY INJURY --------------------- SCHEDULED AUTOS (Per person) -_ HIRED AUTOS — ----------- BODILYINJURY NON-OWNED AUTOS (Per accident) _ PROPERTY DAMAGE---------------_--- --- -- (Per accident) EXCESS/UMBRELLA LIABILITY EACH OCCURENCE OCCUR D CLAIMSMADE AGGREGATE 1 DEDUCTIBLE ----—--- --- -- RETENTION WORKERS COMPENSATION AND WC OTHER EMPOYERS LIABILITY STATU- Y/N Y X TORY ANY prop..-or/partner/ LIMITS Officer/member excluded 800673729 06/19/2017 06/19/2018 E.L.EACH ACCIDENT 1,000,000 (mandatory in NH) --- l/ ---- C.L.DISEASE-EA AMPLOYEE 1,000,000 If yes describe under _ Description of operations below E.L.DISEASE-POLICY LIMIT 1,000,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE.ABOVE DESCRIBED POLICIE S BE CANCELLED BEFORE THE EXPIRATION DA IE Certificate is provide as proof of insurance THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO TH CERTIFICATE HOLDER NAMED TO THE:LEFT,BUT FAILURE TO DO SO SHALE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE PHILADELPHIA INSURANCE COMPANIES A Member of the Tokio lvlarine Group One Bala Plaza,Suite 100,Bala Cynwyd,Pennsylvania 19004 610.617.7900•Fax 610.617.7940-PHLY.com 05/25/2017 ys 4 mark wright Re: Account#: 82698159 Policy#: t Dear Valued Customer: Thank you very much for choosing Philadelphia Insurance Companies(PHLY)for your insurance needs. Our first class customer service, national presence and A++(Superior)A.M. Best financial strength rating have made us the selection by over 150,000 policyholders nationwide. I realize you have a choice in insurance companies and truly appreciate your business. I wish you much success this year and look forward to building a mutually beneficial business partnership which will prosper for years to come. Welcome to PHLY and please visit PHLY.com to learn more about our Company! Sincerely, Robert D.O'Leary Jr. President&CEO Philadelphia Insurance Companies Philadelphia Consolidated Holding Corp.•Philadelphia Indemnity Insurance Company•Tokio Marine Specialty Insurance Company•Maguire Insurance Agency,Inc. Fitness and Wellness Insurance A Member of Philadelphia Insurance Companies Tel: 877-438-7459 Fax: 866-847-4046 CA License#0377645 Name: Renewal Date: 06/23/2017 Policy Type: General and Professional Liability Policy Limits: $1,000,000/$3,000,000 Total Balance Due*: $172.00 Total charge includes insurance premium, applicable taxes, and a $50 Risk Purchasing Group administration fee that is fully earned and non-refundable. If you have made changes to your operations, such as producing videos, leasing or purchasing a facility, or hiring employees, please call customer service for a revised premium. This payment notice is being sent thirty (30) days prior to the expiration of your current policy. Your policy has been automatically renewed and issued and is enclosed. If payment is not received by your policy expiration date, your renewal will be automatically canceled. Available payment options are below. Questions? Please call customer service 877-438-7459 If payment has already been made, please disregard this notice. If you do not wish to renew your current coverage, please send an email to service(L�Qhlv.com specifying the insured name and address, policy number, policy term, effective date of cancellation and reason for cancellation. If this is brokered business please contact your agent to cancel. Please note the following payment options for renewal of your insurance coverage: 1. You can renew via Visa or MasterCard on-line at www.fitnessandweliness.com or by contacting our customer service department at 877-438-7459. 2. You can renew via check made payable to Fitness and Wellness Insurance by mailing your payment notice and check to: Fitness and Wellness Insurance P.O. Box 70251 Philadelphia, PA 19176-0251 Note: If you have a landlord, facility owner, or other party to be listed as an additional insured, please attach a list including name and mailing address. All correspondence should be sent to: Philadelphia Insurance Companies Attention: Customer Service One Bala Plaza, Suite 100 Bala Cynwyd, PA 19004 Please detach here ---------------------------------------------------------------------------------------------------------------- Fitness and Wellness Insurance If you are an IDEA member and your membership has lapsed, please go to www.ideafit.com to activate your membership prior to making payment. Membership#: Membership Expiration Date: Phone: Email: Name: mark wright Account#: 82698159 Expiring Policy#: PHPK1511806-000 Expiration Date: 06/23/2017 Total Balance Due: $172.00 1TINSURANCE COMPANIES Risk Mana ement Services 9 4� -sr,� CT .PM PHLY RISK MANAGEMENT SERVICES Welcome to PHLY Risk Management Services Services, PHLY is familiar with the unique Risk Management Services programming needs of you or- gonization and has achieved superior results in this area.We are committed to delivering quality and timely loss prevention services and risk control products to your organization. Customer satisfaction through the delivery of these professional products to achieve measurable risk improvement results is our goal.We know the fulfillment of our Risk Management Services commitment is not complete until we deliver upon our promises. OUR MISSION:We welcome the opportunity to demonstrate how we can tailor a risk management program suitable to our customer's needs. We are committed to providing our customers with improved communications, quicker implementation of loss control servicing initiatives,and specific benchmarking goals that help us quantify the true value of our services. OUR MOTTO: 'Innovative Services Producing Optimum Results:"This mantra reflects our commitment to utilize innovative products and solutions to help our customers achieve measurable results. Customer satisfaction through the delivery of these quality professional products is our goal. We know the fulfillment of our Risk Management Services commitment is not complete until we deliver upon our promises. In order to gain full access to these resources and others, please take a moment to register on our website. If you already have an id to PHLY.com, please lo_g_in to access Risk Management Services resources. Risk Management Resources • IntelliCorp Records, Inc. • Accountants Resources • WEMED Loss Assistance Hotline • in2vate: Web-enabled EPLI (employment practices liability insurance) Risk Management Services Proprietary Risk Management Services • PHLY Risk Management Services E-flyers • Responding to Risk Management Services Recommendations Contact • For more information please contact: Customer Service 800. 873 .4552 IMPORTANT NOTICE is rn•., .ata 3 - L,P- a 'r l., F;ayc_ r3x_or�ter ! _ rr fr clh� rj;�s�. iscr: gran # I�' c. i `t r-xr•_4h i;e-:c> ns_-'ds - -- "ycu pan.:ons r_ ; of poa Ga s C —A-v a r- a.. �, > } _ t- rr. :Ek y.a.,,:d•_, _ u:ry ;rrr r _ r:, �-_� _�.�- r a, Al =,- n ait, •,S - x:- r i r r r -- ..... .[I-.r .,_ '`I7-.i_ -..:r«.D•— rr_• _ .r-raif s.. t,. :.,c .-�-r- t ,t: '--t c! .- it.{' _.i{:_ .,.. l.• 7 . 1• J ' - •t- M BEST Philadelphia Indemnity Insurance Company One Bala Plaza, Suite 100, Bala Cynwyd, Pennsylvania 19004 1-800-759-4961 C o d low&,M d wLftL e cm i a Lines Policy ............ THIS POLICY CONSISTS OF: - DECLARATIONS - COMMON POLICY CONDITIONS - ONE OR MORE COVERAGE PARTS. A COVERAGE PART CONSISTS OF: - ONE OR MORE COVERAGE FORMS - APPLICABLE FORMS AND ENDORSEMENTS BJP-190-1 (12/98) IN WITNESS WHEREOF,we have caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless signed by our authorized representative. v President&CEO Secretary BJP-190-1 (12198) PP 20 15 (06/15) PHILADELPHIA INSURANCE COMPANIES PRIVACY POLICY NOTICE Philadelphia Indemnity Insurance Company The Philadelphia Insurance Companies value your privacy and we are committed to protecting personal information that we collect during the course of our business relationship with you. The collection, use and disclosure of certain nonpublic personal information are regulated by law. This notice is for your information only and requires no action on your part. It will inform you about the types of information that we collect and how it may be used or disclosed. This does not reflect a change in the way we do business or handle your information. Information We Collect: We collect personal information about you from the following sources: • Applications or other forms such as claims forms or underwriting questionnaires completed by you; • Information about your transactions with us, our affiliates or others; and • Depending on the type of transaction you are conducting with us, information may be collected from consumer reporting agencies, health care providers, employers and other third parties. Information We Disclose: We will only disclose the information described above to our affiliates and non-affiliated third parties, as permitted by law, and when necessary to conduct our normal business activities. For example, we may make disclosures to the following types of third parties: • Your agent or broker(producer); • Parties who perform a business, professional or insurance functions for our company, including our reinsurance companies; • Independent claims adjusters, investigators, attorneys, other insurers or medical care providers who need information to investigate, defend or settle a claim involving you; • Regulatory agencies in connection with the regulation of our business; and • Lienholders, mortgagees, lessors or other persons shown on our records as having a legal or beneficial interest in your policy. We do not sell your information to others for marketing purposes. We do not disclose the personal information of persons who have ceased to be our customers. Protection of Information: The Philadelphia Insurance Companies maintain physical, electronic and procedural safeguards that comply with state and federal regulations to protect the confidentiality of your personal information. We also limit employee access to personally identifiable information to those with a business reason for knowing such information. Use of Cookies and Opt-Out: We may place electronic"cookies" in the browser files of your computer when you access our website. Cookies are text files placed on your computer to enable our systems to recognize your browser and so that we may tailor information on our website to your interests. We or our third party service providers or business partners may place cookies on your computer's hard drive to enable us to match personal information that we maintain about you so that we are able to pre- populate on-line forms with your information. We also use cookies to help us analyze traffic on our website to better understand your interests. Although we do not use your non-public personal information for this purpose, you may opt- out of cookies and advertising features through one of the available options including but not limited to Ads Settings in Google.com or the Network Advertising Initiative (NAI) Consumer Opt-out. Opting out does not mean you will no longer receive online advertising. It does mean that companies from which you opted out will no longer customize ads based on your interests and web usage patterns using cookies. How to Contact Us: Philadelphia Indemnity Insurance Company, One Bala Plaza, Suite 100, Bala Cynwyd, PA 19004 Attention: Chief Privacy Officer CPD-PITC (01/07) Philadelphia Indemnity Insurance Company V1 One Bala Plaza, Suite 100, Bala Cynwyd, Pennsylvania 19004 COMMON POLICY DECLARATIONS Policy Number: PHPK1511806-001 Named Insured and Mailing Address: Producer: 6039 mark wright Maguire Insurance Agency, Inc. Mission Viejo, CA 92691- Policy Period From: 06/23/2017 To: 06/23/2018 at 12:01 AM.Standard Time at your mailing address shown above Business Description: Fitness Trainer Style/Art: Martial Arts IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM Commercial Property Coverage Part Commercial General Liability Coverage Part $122.00 Commercial Crime Coverage Part Commercial Inland Marine Coverage Part Commercial Auto Coverage Part Commercial Stop Gap Part Businessowners Workers Compensation Taxes/Fees/Surcharges $50.00 Total $172.00 FORM (S)AND ENDORSEMENT(S) MADE A PART OF THIS POLICY AT THE TIME OF ISSUE Refer To Forms Schedule *Omits applicable Forms and Endorsements if shown in specific Coverage Part/Coverage Form Declarations Countersignature Date Authorized Representative Forms Schedule— Policy Policy Number: PHPK1511806-001 Forms and Endorsements applying to this Coverage Part and made a part of this policy at time of issue: Form/Edition Description CPD-PIIC (01/07) Common Policy Declarations -PHLY Indemnity Insurance Fees And Surcharge Schedule Fees and Surcharge Schedule Page 1 of 1 Fees and Surcharge Schedule Policy Number: PHPK1511806-001 RPGFEE $50.00 Page 1 of 1 Philadelphia Indemnity Insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS Policy Number:PHPK1511806-001 Agent#:6039 W See Supplemental Schedule LIMITS OF INSURANCE G $3,000,000 General Aggregate Limit(Other Than Products—Completed Operation) $3,000,000 Products/Completed Operations Aggregate Limit(Any One Person Or Organization) $1,000,000 Personal and Advertising Injury Limit $1,000,000 Each Occurrence Limit $100,000 Rented To You Limit $2,500 Medical Expense Limit(Any One Person) FORM OF BUSINESS:Individual Business Description:Fitness Trainer Location of All Premises You Own, Rent or Occupy: SEE SCHEDULE ATTACHED AUDIT PERIOD,ANNUAL, UNLESS OTHERWISE STATED: Rates Advance Premiums Premium Prod./ Prod./ Classifications Basis Prem./Ops. Comp.Ops. Prem./Ops. Comp. Ops. SEE SCHEDULE ATTACHED TOTAL PREMIUM FOR THIS COVERAGE PART: $122.00 Included Retroactive Date(CG 00 02.Only) This insurance does not apply to "Bodily Injury", "Property Damage", or"Personal and Advertising Injury"which occurs before the retroactive date, if any, shown below. Retroactive Date: FORM(S)AND ENDORSEMENT(S)APPLICABLE TO THIS COVERAGE PART: Refer To Forms Schedule Countersignature Date Authorized Representative Page 1 of 1 Forms Schedule — General Liability Policy Number: PHPK1511806-001 Forms and Endorsements applying to this Coverage Part and made a part of this policy at time of issue: Form/Edition Description CG 00 01 04 13 Commercial General Liability Coverage Form Commercial General Liability GL Coverage Part Declarations Page Coverage Part Declarations Commercial GL Supplemental Commercial GL Coverage Supplemental Schedule Schedule PI-APG-004 (01/07) Additional Conditions PI-APG-CA-1 (01/07) California Changes-Cancel, Nonrenewal and Cond. Renewal PI-BELL-1 11-09 Bell Endorsement PI-FW-001 (01/07) Coverage C-Athletic Activities Exclusion Deletion PI-FW-002 (03/09) Fitness and Wellness Liability Insurance Exclusions PI-FW-003 (01/07) Fitness and Wellness Liability Insurance Extension PI-FW-005 (01/07) Punitive Damages Exclusion PI-FW-006 (01/07) Sexual Abuse Endorsement PI-FW-007 (01/07) Specific Claimant Exclusion PI-FW-008 (01/07) Violation of Communication or Information Law Exclusion PI-FW-009 (06/11) Blanket Additional Insured Page 1 of 1 COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK1511806-001 Agent#: 6039 Rates Advance Premiums Premium Prod/Comp Prod/Comp Classifications& Code No. Basis Prem/Ops Ops Prem/Ops Ops 44311 - Certified Fitness Each Included Included $122.00 Included Instructor TOTAL PREMIUM FOR THIS COVERAGE PART: $122.00 Included Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 00 01 04 13 COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. (2) The "bodily injury" or "property damage" Read the entire policy carefully to determine rights, occurs during the policy period; and duties and what is and is not covered. (3) Prior to the policy period, no insured listed Throughout this policy the words "you" and "your" under Paragraph 1. of Section II — Who Is refer to the Named Insured shown in the Declarations, An Insured and no "employee" authorized and any other person or organization qualifying as a by you to give or receive notice of an Named Insured under this policy. The words "we", "occurrence" or claim, knew that the "bodily "us" and "our" refer to the company providing this injury" or "property damage" had occurred, insurance. in whole or in part. If such a listed insured The word "insured" means any person or organization or authorized "employee" knew, prior to the qualifying as such under Section II — Who Is An policy period, that the "bodily injury" or Insured. "property damage" occurred, then any continuation, change or resumption of such Other words and phrases that appear in quotation "bodily injury" or "property damage" during marks have special meaning. Refer to Section V or after the policy period will be deemed to —Definitions. have been known prior to the policy period. SECTION I—COVERAGES c. "Bodilyinjury" or "property damage' which COVERAGE A—BODILY INJURY AND PROPERTY occurs during the policy period and was not, DAMAGE LIABILITY prior to the policy period, known to have 1. Insuring Agreement occurred by any insured listed under Paragraph 1. of Section II—Who Is An Insured a. We will pay those sums that the insured or any "employee" authorized by you to give or becomes legally obligated to pay as damages receive notice of an "occurrence" or claim, because of"bodily injury"or"property damage" includes any continuation, change or to which this insurance applies. We will have resumption of that "bodily injury" or "property the right and duty to defend the insured against damage"after the end of the policy period. any "suit" seeking those damages. However, d. "Bodily injury" or "property damage" will be we will have no duty to defend the insured deemed to have been known to have occurred against any "suit" seeking damages for "bodily at the earliest time when any insured listed injuryor 'property damage to which this under Paragraph 1. of Section II — Who Is An insurance does not apply. We may, at our �, Insured or any"employee"authorized by you to discretion, investigate any "occurrence and give or receive notice of an "occurrence" or settle any claim or suit"that may result. But: claim: (1) The amount we will pay for damages is (1) Reports all, or any part, of the "bodily injury" limited as described in Section III — Limits or "property damage" to us or any other Of Insurance; and insurer; (2) Our right and duty to defend ends when we have used up the applicable limit of (2) Receives a written or verbal demand or insurance in the payment of judgments or claim for damages because of the "bodily settlements under Coverages A or B or injury"or"property damage"; or medical expenses under Coverage C. (3) Becomes aware by any other means that No other obligation or liability to pay sums or "bodily injury" or "property damage" has perform acts or services is covered unless occurred or has begun to occur. explicitly provided for under Supplementary e. Damages because of "bodily injury" include Payments—Coverages A and B. damages claimed by any person or b. This insurance applies to "bodily injury" and organization for care, loss of services or death "property damage"only if: resulting at any time from the "bodily injury". (1) The "bodily injury" or "property damage" is caused by an "occurrence" that takes place in the"coverage territory"; CG 00 01 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 16 2. Exclusions This exclusion applies even if the claims This insurance does not apply to: against any insured allege negligence or other wrongdoing in: a. Expected Or Intended Injury (a) The supervision, hiring, employment, "Bodily injury" or "property damage" expected training or monitoring of others by that or intended from the standpoint of the insured. insured; or This exclusion does not apply to "bodily injury" resulting from the use of reasonable force to (b) Providing or failing to provide protect persons or property. transportation with respect to any person that may be under the influence b. Contractual Liability of alcohol; "Bodily injury" or "property damage" for which if the "occurrence" which caused the "bodily the insured is obligated to pay damages by injury" or "property damage", involved that reason of the assumption of liability in a which is described in Paragraph (1), (2) or (3) contract or agreement. This exclusion does not above. apply to liability for damages: However, this exclusion applies only if you are (1) That the insured would have in the absence in the business of manufacturing, distributing, of the contract or agreement; or selling, serving or furnishing alcoholic (2) Assumed in a contract or agreement that is beverages. For the purposes of this exclusion, an "insured contract", provided the "bodily permitting a person to bring alcoholic injury" or "property damage" occurs beverages on your premises, for consumption subsequent to the execution of the contract on your premises, whether or not a fee is or agreement. Solely for the purposes of charged or a license is required for such liability assumed in an "insured contract", activity, is not by itself considered the business reasonable attorneys' fees and necessary of selling, serving or furnishing alcoholic litigation expenses incurred by or for a party beverages. other than an insured are deemed to be d. Workers' Compensation And Similar Laws damages because of "bodily injury" or "property damage", provided: Any obligation of the insured under a workers' compensation, disability benefits or (a) Liability to such party for, or for the cost unemployment compensation law or any of, that party's defense has also been similar law. assumed in the same "insured contract"; e. Employer's Liability and (b) Such attorneys' fees and litigation "Bodily injury"to: expenses are for defense of that party (1) An "employee" of the insured arising out of against a civil or alternative dispute and in the course of: resolution proceeding in which damages (a) Employment by the insured; or to which this insurance applies are alleged. (b) Performing duties related to the conduct of the insured's business; or c. Liquor Liability (2) The spouse, child, parent, brother or sister "Bodily injury" or "property damage" for which of that "employee" as a consequence of any insured may be held liable by reason of: Paragraph (1) above. (1) Causing or contributing to the intoxication of This exclusion applies whether the insured any person; may be liable as an employer or in any other (2) The furnishing of alcoholic beverages to a capacity and to any obligation to share person under the legal drinking age or damages with or repay someone else who under the influence of alcohol; or must pay damages because of the injury. (3) Any statute, ordinance or regulation relating This exclusion does not apply to liability to the sale, gift, distribution or use of assumed by the insured under an "insured alcoholic beverages. contract". Page 2 of 16 ©Insurance Services Office, Inc., 2012 CG 00 01 04 13 If. 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 or subcontractors working directly or discharge, dispersal, seepage, migration, indirectly on any insured's behalf are release or escape of"pollutants": performing operations if the "pollutants" (a) At or from any premises, site or location are brought on or to the premises, siteor location in connection with such which is or was at any time owned or operations by such insured, contractor occupied by, or rented or loaned to, any or subcontractor. However, this insured. However, this subparagraph subparagraph does not apply to: does not apply to: (i) "Bodily injury" if sustained within a (i) "Bodily injury" or "property damage" arising out of the escape of fuels, building and caused by smoke, lubricants 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 used to heat, cool or dehumidify the mechanical functions necessary for building, or equipment that is used to the operation of "mobile equipment" heat water for personal use, by the or its parts, if such fuels, lubricants building's occupants or their guests; or other operating fluids escape from (ii) "Bodily injury" or "property damage" a 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 intentional discharge, dispersal or policy as an additional insured with release of the fuels, lubricants or respect to your ongoing operations other operating fluids, or if such performed for that additional insured fuels, lubricants or other operating at that premises, site or location and fluids are brought on or to the such premises, site or location is not premises, site or location with the and never was owned or occupied intent that they be discharged, by, or rented or loaned to, any dispersed or released as part of the insured, other than that additional operations being performed by such insured; or insured, contractor 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 for any insured or others for the connection with operations being handling, storage, disposal, processing performed by you or on your behalf or treatment of waste; by a contractor or subcontractor;or (c) Which are or were at any time (iii) "Bodily injury" or "property damage" transported, handled, stored, treated, arising out of heat, smoke or fumes disposed of, or processed as waste by from a"hostile fire". or 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 (ii) Any person or organization for whom indirectly on any insured's behalf are you may be legally responsible; or performing operations if the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants". CG 00 01 04 13 ©Insurance Services Office, Inc., 2012 Page 3 of 16 (2) Any loss, cost or expense arising out of (5) "Bodily injury" or "property damage" arising any: out of: (a) Request, demand, order or statutory or (a) The operation of machinery or regulatory requirement that any insured equipment that is attached to, or part of, or others test for, monitor, clean up, a land vehicle that would qualify under remove, contain, treat, detoxify or the definition of "mobile equipment" if it neutralize, or in any way respond to, or were not subject to a compulsory or assess the effects of, "pollutants"; or financial responsibility law or other (b) Claim or suit by or on behalf of a motor vehicle insurance law where it is governmental authority for damages licensed or principally garaged; or because of testing for, monitoring, (b) The operation of any of the machinery cleaning up, removing, containing, or equipment listed in Paragraph f.(2) or treating, detoxifying or neutralizing, or in f.(3) of the definition of "mobile any way responding to, or assessing the equipment". effects of, "pollutants". h. Mobile Equipment However, this paragraph does not apply to "Bodily injury" or "property damage" arising out liability for damages because of "property of: damage" that the insured would have in the absence of such request, demand, order or (1) The transportation of"mobile equipment" by statutory or regulatory requirement, or such an "auto" owned or operated by or rented or claim or "suit" by or on behalf of a loaned to any insured; or governmental authority. (2) The use of "mobile equipment" in, or while g. Aircraft, Auto Or Watercraft in practice for, or while being prepared for, "Bodily injury" or"property damage" arising out any prearranged racing, speed, demolition, or stunting activity. of the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or i. War watercraft owned or operated by or rented or "Bodily injury" or "property damage", however loaned to any insured. Use includes operation caused, arising, directly or indirectly,out of: and "loading or unloading". (1) War, including undeclared or civil war; This exclusion applies even if the claims (2) Warlike action by a military force, including against any insured allege negligence or other action in hindering or defending against an wrongdoing in the supervision, hiring, actual or expected attack, by any employment, training or monitoring of others by government, sovereign or other authority that insured, if the "occurrence" which caused using military personnel or other agents;or the "bodily injury" or "property damage" involved the ownership, maintenance, use or (3) Insurrection, rebellion, revolution, usurped entrustment to others of any aircraft, "auto" or power, or action taken by governmental watercraft that is owned or operated by or authority in hindering or defending against rented or loaned to any insured. any of these. This exclusion does not apply to: j. Damage To Property (1) A watercraft while ashore on premises you "Property damage"to: own or rent; (1) Property you own, rent, or occupy, including (2) A watercraft you do not own that is: any costs or expenses incurred by you, or (a) Less than 26 feet long; and any other person, organization or entity, for repair, replacement, enhancement, (b) Not being used to carry persons or restoration or maintenance of such property property for a charge; for any reason, including prevention of (3) Parking an "auto" on, or on the ways next injury to a person or damage to another's to, premises you own or rent, provided the property; "auto" is not owned by or rented or loaned (2) Premises you sell, give away or abandon, if to you or the insured; the "property damage" arises out of any (4) Liability assumed under any "insured part of those premises; contract" for the ownership, maintenance or (3) Property loaned to you; use of aircraft or watercraft;or Page 4 of 16 ©Insurance Services Office, Inc., 2012 CG 00 01 04 13 (4) Personal property in the care, custody or This exclusion does not apply to the loss of use control of the insured; of other property arising out of sudden and (5) That particular part of real property on accidental physical injury to "your product" or which you or any contractors or "your work"after it has been put to its intended subcontractors working directly or indirectly use. on your behalf are performing operations, if n. Recall Of Products, Work Or Impaired the "property damage" arises out of those Property operations; or Damages claimed for any loss, cost or (6) That particular part of any property that expense incurred by you or others for the loss must be restored, repaired or replaced of use, withdrawal, recall, inspection, repair, because "your work" was incorrectly replacement, adjustment, removal or disposal performed on it. of: Paragraphs (1), (3) and (4) of this exclusion do (1) "Your product"; not apply to "property damage" (other than (2) "Your work'; or damage by fire) to premises, including the contents of such premises, rented to you for a (3) "Impaired property"; period of seven or fewer consecutive days. A if such product, work, or property is withdrawn separate limit of insurance applies to Damage or recalled from the market or from use by any To Premises Rented To You as described in person or organization because of a known or Section III—Limits Of Insurance. suspected defect, deficiency, inadequacy or Paragraph (2) of this exclusion does not apply dangerous condition in it. if the premises are "your work" and were never o. Personal And Advertising Injury occupied, rented or held for rental by you. Paragraphs (3), 4 , 5 and 6 of this "Bodily injury" arising out of "personal and ( ) ( ) ( ) advertising injury". exclusion do not apply to liability assumed p. Electronic Data under a sidetrack agreement. Paragraph (6) of this exclusion does not apply Damages arising out of the loss of, loss of use to "property damage" included in the "products- of, damage to, corruption of, inability to access, completed operations hazard". or inability to manipulate electronic data. k. Damage To Your Product However, this exclusion does not apply to liability for damages because of"bodily injury". "Property damage"to "your product"arising out As used in this exclusion, electronic data of it or any part of it. means information, facts or programs stored as I. Damage To Your Work or on, created or used on, or transmitted to or "Property damage" to "your work" arising out of from computer software, including systems and it or any part of it and included in the "products- applications software, hard or floppy disks, CD- completed operations hazard". ROMs, tapes, drives, cells, data processing This exclusion does not apply if the damaged devices or any other media which are usedwith electronically controlled equipment. work or the work out of which the damage arises was performed on your behalf by a q• Recording And Distribution Of Material Or subcontractor. Information In Violation Of Law m. Damage To Impaired Property Or Property "Bodily injury" or "property damage" arising Not Physically Injured directly or indirectly out of any action or "Property damage" to "impaired property" or omission that violates or is alleged to violate: property that has not been physically injured, (1) The Telephone Consumer Protection Act arising out of: (TCPA), including any amendment of or (1) A defect, deficiency, inadequacy or addition to such law; dangerous condition in "your product" or (2) The CAN-SPAM Act of 2003, including any "your work"; or amendment of or addition to such law; (2) A delay or failure by you or anyone acting (3) The Fair Credit Reporting Act (FCRA), and on your behalf to perform a contract or any amendment of or addition to such law, agreement in accordance with its terms. including the Fair and Accurate Credit Transactions Act(FACTA); or CG 00 01 04 13 ©Insurance Services Office, Inc., 2012 Page 5 of 16 (4) Any federal, state or local statute, 2. Exclusions ordinance or regulation, other than the This insurance does not apply to: TCPA, CAN-SPAM Act of 2003 or FCRA and their amendments and additions, that a. Knowing Violation Of Rights Of Another addresses, prohibits, or limits the printing, "Personal and advertising injury" caused by or dissemination, disposal, collecting, at the direction of the insured with the recording, sending, transmitting, knowledge that the act would violate the rights communicating or distribution of material or of another and would inflict "personal and information. advertising injury". Exclusions c. through n. do not apply to damage b. Material Published With Knowledge Of by fire to premises while rented to you or Falsity temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this "Personal and advertising injury' arising out of coverage as described in Section III — Limits Of oral or written publication, in any manner, of Insurance. material, if done by or at the direction of the insured with knowledge of its falsity. COVERAGE B— PERSONAL AND ADVERTISING c. Material Published Prior To Policy Period INJURY LIABILITY "Personal and advertising injury" arising out of 1. Insuring Agreement oral or written publication, in any manner, of a. We will pay those sums that the insured material whose first publication took place becomes legally obligated to pay as damages before the beginning of the policy period. because of "personal and advertising injury" to d. Criminal Acts which this insurance applies. We will have the right and duty to defend the insured against "Personal and advertising injury" arising out of any "suit" seeking those damages. However, a criminal act committed by or at the direction we will have no duty to defend the insured of the insured. against any "suit" seeking damages for e. Contractual Liability "personal and advertising injury" to which this "Personal and advertising injury" for which the insurance does not apply. We may, at our insured has assumed liability in a contract or discretion, investigate any offense and settle agreement. This exclusion does not apply to any claim or suit'that may result. But: liability for damages that the insured would (1) The amount we will pay for damages is have in the absence of the contract or limited as described in Section III — Limits agreement. Of Insurance; and f. Breach Of Contract (2) Our right and duty to defend end when we "Personal and advertising injury" arising out of have used up the applicable limit of a breach of contract, except an implied insurance in the payment of judgments or contract to use another's advertising idea in settlements under Coverages A or B or your"advertisement". medical expenses under Coverage C. No other obligation or liability to pay sums or g• Quality Or Performance Of Goods—Failure perform acts or services is covered unless To Conform To Statements explicitly provided for under Supplementary "Personal and advertising injury" arising out of Payments—Coverages A and B. the failure of goods, products or services to b. This insurance applies to "personal and conform with any statement of quality or advertising injurycaused by an offense arising performance made in your"advertisement". out of your business but only if the offense was h. Wrong Description Of Prices committed in the "coverage territory" during the "Personal and advertising injury" arising out of policy period. the wrong descrip`:on of the price of goods, products or services stated in your "advertisement". Page 6 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 i. Infringement Of Copyright, Patent, n. Pollution-related Trademark Or Trade Secret Any loss, cost or expense arising out of any: "Personal and advertising injury" arising out of (1) Request, demand, order or statutory or the infringement of copyright, patent, trademark, trade secret or other intellectual regulatory requirement that any insured or others test for, monitor, clean up, remove, property rights. Under this exclusion, such contain, treat, detoxify or neutralize, or in other intellectual property rights do not include any way respond to, or assess the effects the use of another's advertising idea in your "advertisement". of, "pollutants"; or However, this exclusion does not apply to (2) Claim or suit by or on behalf of agovernmental authority for damages infringement, in your "advertisement", of because of testing for, monitoring, cleaning copyright,trade dress or slogan. up, removing, containing, treating, j. Insureds In Media And Internet Type detoxifying or neutralizing, or in any way Businesses responding to, or assessing the effects of, "Personal and advertising injury" committed by "pollutants". an insured whose business is: o. War (1) Advertising, broadcasting, publishing or "Personal and advertising injury", however telecasting; caused, arising, directly or indirectly, out of: (2) Designing or determining content of web (1) War, including undeclared or civil war; sites for others; or (2) Warlike action by a military force, including (3) An Internet search, access, content or action in hindering or defending against an service provider. actual or expected attack, by any However, this exclusion does not apply to government, sovereign or other authority Paragraphs 14.a., b. and c. of "personal and using military personnel or other agents; or advertising injury" under the Definitions (3) Insurrection, rebellion, revolution, usurped section. power, or action taken by governmental For the purposes of this exclusion, the placing authority in hindering or defending against of frames, borders or links, or advertising, for any of these. you or others anywhere on the Internet, is not p. Recording And Distribution Of Material Or by itself, considered the business of Information In Violation Of Law advertising, broadcasting, publishing or "Personal and advertising injury" arising telecasting. directly or indirectly out of any action or k. Electronic Chatrooms Or Bulletin Boards omission that violates or is alleged to violate: "Personal and advertising injury" arising out of (1) The Telephone Consumer Protection Act an electronic chatroom or bulletin board the (TCPA), including any amendment of or insured hosts, owns, or over which the insured addition to such law; exercises control. (2) The CAN-SPAM Act of 2003, including any I. Unauthorized Use Of Another's Name Or amendment of or addition to such law; Product (3) The Fair Credit Reporting Act (FCRA), and "Personal and advertising injury" arising out of any amendment of or addition to such law, the unauthorized use of another's name or including the Fair and Accurate Credit product in your e-mail address, domain name Transactions Act(FACTA); or or metatag, or any other similar tactics to (4) Any federal, state or local statute, mislead another's potential customers. ordinance or regulation, other than the m. Pollution TCPA, CAN-SPAM Act of 2003 or FCRA "Personal and advertising injury" arising out of and their amendments and additions, that the actual, alleged or threatened discharge, addresses, prohibits, or limits the printing, dispersal, seepage, migration, release or dissemination, disposal, collecting, escape of"pollutants" at any time. recording, sending, transmitting, communicating or distribution of material or information. CG 00 01 04 13 ©Insurance Services Office, Inc., 2012 Page 7 of 16 COVERAGE C—MEDICAL PAYMENTS d. Workers' Compensation And Similar Laws 1. Insuring Agreement To a person, whether or not an "employee" of a. We will pay medical expenses as described any insured, if benefits for the "bodily injury" below for"bodily injury"caused by an accident: are payable or must be provided under a workers' compensation or disability benefits (1) On premises you own or rent; law or a similar law. (2) On ways next to premises you own or rent; e. Athletics Activities or To a person injured while practicing, instructing (3) Because of your operations; or participating in any physical exercises or provided that: games, sports, or athletic contests. (a) The accident takes place in the f. Products-Completed Operations Hazard "coverage territory" and during the policy Included within the "products-completed period; operations hazard". (b) The expenses are incurred and reported g. Coverage A Exclusions to us within one year of the date of the Excluded under Coverage A. accident; and (c) The injured person submits to SUPPLEMENTARY PAYMENTS— COVERAGES A examination, at our expense, by AND B physicians of our choice as often as we 1. We will pay, with respect to any claim we reasonably require. investigate or settle, or any "suit" against an b. We will make these payments regardless of insured we defend: fault. These payments will not exceed the a. All expenses we incur. applicable limit of insurance. We will pay b. Up to $250 for cost of bail bonds required reasonable expenses for: because of accidents or traffic law violations (1) First aid administered at the time of an arising out of the use of any vehicle to which accident; the Bodily Injury Liability Coverage applies. We (2) Necessary medical, surgical, X-ray and do not have to furnish these bonds. dental services, including prosthetic c. The cost of bonds to release attachments, but devices; and only for bond amounts within the applicable (3) Necessary ambulance, hospital, limit of insurance. We do not have to furnish professional nursing and funeral services. these bonds. 2. Exclusions d. All reasonable expenses incurred by the insured at our request to assist us in the We will not pay expenses for"bodily injury": investigation or defense of the claim or "suit", a. Any Insured including actual loss of earnings up to $250 a To any insured, except"volunteer workers". day because of time off from work. b. Hired Person e. All court costs taxed against the insured in the "suit". However, these payments do not include To a person hired to do work for or on behalf of attorneys' fees or attorneys' expenses taxed any insured or a tenant of any insured. against the insured. c. Injury On Normally Occupied Premises f. Prejudgment interest awarded against the To a person injured on that part of premises insured on that part of the judgment we pay. If you own or rent that the person normally we make an offer to pay the applicable limit of occupies. insurance, we will not pay any prejudgment interest based on that period of time after the offer. Page 8 of 16 ©Insurance Services Office, Inc., 2012 CG 00 01 04 13 g. All interest on the full amount of any judgment So long as the above conditions are met, that accrues after entry of the judgment and attorneys' fees incurred by us in the defense of before we have paid, offered to pay, or that indemnitee, necessary litigation expenses deposited in court the part of the judgment that incurred by us and necessary litigation expenses is within the applicable limit of insurance. incurred by the indemnitee at our request will be These payments will not reduce the limits of paid as Supplementary Payments. insurance. Notwithstanding the provisions of Paragraph 2.b.(2) of Section I — Coverage A — Bodily Injury 2. If we defend an insured against a "suit" and an And Property Damage Liability, such payments will indemnitee of the insured is also named as a party not be deemed to be damages for "bodily injury" to the "suit", we will defend that indemnitee if all of and "property damage" and will not reduce the the following conditions are met: limits of insurance. a. The "suit" against the indemnitee seeks Our obligation to defend an insured's indemnitee damages for which the insured has assumed and to pay for attorneys' fees and necessary the liability of the indemnitee in a contract or litigation expenses as Supplementary Payments agreement that is an 'insured contract"; ends when we have used up the applicable limit of b. This insurance applies to such liability insurance in the payment of judgments or assumed by the insured; settlements or the conditions set forth above, or c. The obligation to defend, or the cost of the the terms of the agreement described in defense of, that indemnitee, has also been Paragraph f. above, are no longer met. assumed by the insured in the same "insured SECTION II—WHO IS AN INSURED contract"; 1. If you are designated in the Declarations as: d. The allegations in the "suit" and the information a. An individual, you and your spouse are we know about the "occurrence" are such that insureds, but only with respect to the conduct no conflict appears to exist between the of a business of which you are the sole owner. interests of the insured and the interests of the indemnitee; b. A partnership or joint venture, you are an insured. Your members, your partners, and e. The indemnitee and the insured ask us to their spouses are also insureds, but only with conduct and control the defense of that respect to the conduct of your business. indemnitee against such "suit" and agree that we can assign the same counsel to defend the c. A limited liability company, you are an insured. insured and the indemnitee; and Your members are also insureds, but only with respect to the conduct of your business. Your f. The indemnitee: managers are insureds, but only with respect (1) Agrees in writing to: to their duties as your managers. (a) Cooperate with us in the investigation, d. An organization other than a partnership, joint settlement or defense of the "suit"; venture or limited liability company, you are an (b) Immediately send us copies of any insured. Your "executive officers" and directors demands, notices, summonses or legal are insureds, but only with respect to their papers received in connection with the duties as your officers or directors. Your "suit"; stockholders are also insureds, but only with respect to their liability as stockholders. (c) Notify any other insurer whose coverage e. A trust, you are an insured. Your trustees are is available to the indemnitee; and also insureds, but only with respect to their (d) Cooperate with us with respect to duties as trustees. coordinating 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 (b) Conduct and control the defense of the indemnitee in such "suit". CG 00 01 04 13 ©Insurance Services Office, Inc., 2012 Page 9 of 16 2. Each of the following is also an insured: c. Any person or organization having proper a. Your "volunteer workers" only while performing temporary custody of your property if you die, duties related to the conduct of your business, but only: or your "employees", other than either your (1) With respect to liability arising out of the "executive officers" (if you are an organization maintenance or use of that property; and other than a partnership,joint venture or limited (2) Until your legal representative has been liability company) or your managers (if you are appointed. a limited liability company), but only for acts within the scope of their employment by you or d. Your legal representative if you die, but only while performing duties related to the conduct with respect to duties as such. That of your business. However, none of these representative will have all your rights and "employees" or "volunteer workers" are duties under this Coverage Part. insureds for: 3. Any organization you newly acquire or form, other (1) "Bodily injury" or "personal and advertising than a partnership, joint venture or limited liability injury": company, and over which you maintain ownership or majority interest, will qualify as a Named (a) To you, to your partners or members (if Insured if there is no other similar insurance you are a partnership or joint venture), to your members (if you are a limited available to that organization. However: liability company), to a co-"employee" a. Coverage under this provision is afforded only while in the course of his or her until the 90th day after you acquire or form the employment or performing duties related organization or the end of the policy period, to the conduct of your business, or to whichever is earlier; your other "volunteer workers" while b. Coverage A does not apply to "bodily injury" or performing duties related to the conduct "property damage" that occurred before you of your business; acquired or formed the organization; and (b) To the spouse, child, parent, brother or c. Coverage B does not apply to "personal and sister of that co-"employee" or advertising injury" arising out of an offense "volunteer worker" as a consequence of committed before you acquired or formed the Paragraph (1)(a) above; organization. (c) For which there is any obligation to No person or organization is an insured with respect share damages with or repay someone to the conduct of any current or past partnership,joint else who must pay damages because of venture or limited liability company that is not shown the injury described in Paragraph (1)(a) as a Named Insured in the Declarations. or(b) above;or SECTION III—LIMITS OF INSURANCE (d) Arising out of his or her providing or 1. The Limits of Insurance shown in the Declarations failing to provide professional health and the rules below fix the most we will pay care services. regardless of the number of: (2) "Property damage"to property: a. Insureds; (a) Owned, occupied or used by; b. Claims made or"suits" brought; or (b) Rented to, in the care, custody or c. Persons or organizations making claims or control of, or over which physical control bringing "suits". is being exercised for any purpose by; you, any of your "employees", "volunteer 2. The General Aggregate Limit is the most we will pay for the sum of: workers", any partner or member(if you are a partnership or joint venture), or any a. Medical expenses under Coverage C; member (if you are a limited liability b. Damages under Coverage A, except damages company). because of"bodily injury" or"property damage" b. Any person (other than your "employee" or included in the "products-completed operations "volunteer worker"), or any organization while hazard"; and acting as your real estate manager. c. Damages under Coverage B. Page 10 of 16 ©Insurance Services Office, Inc., 2012 CG 00 01 04 13 3. The Products-Completed Operations Aggregate (3) The nature and location of any injury or Limit is the most we will pay under Coverage A for damage arising out of the "occurrence" or damages because of "bodily injury" and "property offense. damage" included in the "products-completed b. If a claim is made or "suit" is brought against operations hazard". any insured, you must: 4. Subject to Paragraph 2. above, the Personal And (1) Immediately record the specifics of the Advertising Injury Limit is the most we will pay claim or"suit"and the date received; and under Coverage B for the sum of all damages because of all "personal and advertising injury" (2) Notify us as soon as practicable. sustained by any one person or organization. You must see to it that we receive written 5. Subject to Paragraph 2. or 3. above, whichever notice of the claim or "suit" as soon as applies, the Each Occurrence Limit is the most we practicable. will pay for the sum of: c. You and any other involved insured must: a. Damages under Coverage A; and (1) Immediately send us copies of any b. Medical expenses under Coverage C demands, notices, summonses or legal because of all "bodily injury" and "property papers received in connection with theclaim or"suit"; damage"arising out of any one"occurrence". 6. Subject to Paragraph 5. above, the Damage To (2) Authorize us to obtain records and other information; Premises Rented To You Limit is the most we will pay under Coverage A for damages because of (3) Cooperate with us in the investigation or "property damage" to any one premises, while settlement of the claim or defense against rented to you, or in the case of damage by fire, the"suit"; and while rented to you or temporarily occupied by you (4) Assist us, upon our request, in the with permission of the owner. enforcement of any right against any 7. Subject to Paragraph 5. above, the Medical person or organization which may be liable Expense Limit is the most we will pay under to the insured because of injury or damage Coverage C for all medical expenses because of to which this insurance may also apply. "bodily injury" sustained by any one person. d. No insured will, except at that insured's own The Limits of Insurance of this Coverage Part apply cost, voluntarily make a payment, assume any separately to each consecutive annual period and to obligation, or incur any expense, other than for any remaining period of less than 12 months, starting first aid,without our consent. with the beginning of the policy period shown in the 3. Legal Action Against Us Declarations, unless the policy period is extended No person or organization has a right under this after issuance for an additional period of less than 12 Coverage Part: months. In that case, the additional period will be deemed part of the last preceding period for purposes a. To join us as a party or otherwise bring us into of determining the Limits of Insurance. a"suit"asking for damages from an insured; or SECTION IV—COMMERCIAL GENERAL LIABILITY b. To sue us on this Coverage Part unless all of CONDITIONS its terms have been fully complied with. 1. Bankruptcy A person or organization may sue us to recover on Bankruptcy or insolvency of the insured or of the an agreed settlement or on a final judgment insured's estate will not relieve us of our against an insured; but we will not be liable for obligations under this Coverage Part. damages that are not payable under the terms of this Coverage Part or that are in excess of the 2. Duties In The Event Of Occurrence, Offense, applicable limit of insurance. An agreed settlement Claim Or Suit means a settlement and release of liability signed a. You must see to it that we are notified as soon by us, the insured and the claimant or the as practicable of an "occurrence" or an offense claimant's legal representative. which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 11 of 16 4. Other Insurance (3) When this insurance is excess over other If other valid and collectible insurance is available insurance, we will pay only our share of the to the insured for a loss we cover under amount of the loss, if any, that exceeds the Coverages A or B of this Coverage Part, our sum of: obligations are limited as follows: (a) The total amount that all such other a. Primary Insurance insurance would pay for the loss in the This insurance is primary except when absence of this insurance; and Paragraph b. below applies. If this insurance is (b) The total of all deductible and self- primary, our obligations are not affected unless insured amounts under all that other any of the other insurance is also primary. insurance. Then, we will share with all that other (4) We will share the remaining loss, if any, insurance by the method described in with any other insurance that is not Paragraph c. below. described in this Excess Insurance b. Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance (1) This insurance is excess over: shown in the Declarations of this Coverage (a) Any of the other insurance, whether Part. primary, excess, contingent or on any c. Method Of Sharing other basis: If all of the other insurance permits contribution (i) That is Fire, Extended Coverage, by equal shares, we will follow this method Builder's Risk, Installation Risk or also. Under this approach each insurer similar coverage for"your work"; contributes equal amounts until it has paid its (ii) That is Fire insurance for premises applicable limit of insurance or none of the loss rented to you or temporarily remains, whichever comes first. occupied by you with permission of If any of the other insurance does not permit the owner; contribution by equal shares, we will contribute (iii) That is insurance purchased by you by limits. Under this method, each insurer's to cover your liability as a tenant for share is based on the ratio of its applicable "property damage" to premises limit of insurance to the total applicable limits of rented to you or temporarily insurance of all insurers. occupied by you with permission of 5. Premium Audit the owner; or a. We will compute all premiums for this (iv) If the loss arises out of the Coverage Part in accordance with our rules maintenance or use of aircraft, and rates. "autos"or watercraft to the extent not subject to Exclusion g. of Section I — b. Premium shown in this Coverage Part as Coverage A — Bodily Injury And advance premium is a deposit premium only. Property Damage Liability. At the close of each audit period we will compute the earned premium for that period (b) Any other primary insurance available to and send notice to the first Named Insured. you covering liability for damages The due date for audit and retrospective arising out of the premises or premiums is the date shown as the due date operations, or the products and on the bill. If the sum of the advance and audit completed operations, for which you premiums paid for the policy period is greater have been added as an additional than the earned premium, we will return the insured. excess to the first Named Insured. (2) When this insurance is excess, we will have c. The first Named Insured must keep records of no duty under Coverages A or B to defend the informat -.n we need for premium the insured against any "suit" if any other computation, and send us copies at such times insurer has a duty to defend the insured as we may request. against that "suit". If no other insurer defends, we will undertake to do so, but we 6. Representations will be entitled to the insured's rights By accepting this policy, you agree: against all those other insurers. a. The statements in the Declarations are accurate and complete; Page 12 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 b. Those statements are based upon However, "auto" does not include "mobile representations you made to us; and equipment". c. We have issued this policy in reliance upon 3. "Bodily injury" means bodily injury, sickness or your representations. disease sustained by a person, including death 7. Separation Of Insureds resulting from any of these at any time. Except with respect to the Limits of Insurance, and 4. "Coverage territory" means: any rights or duties specifically assigned in this a. The United States of America (including its Coverage Part to the first Named Insured, this territories and possessions), Puerto Rico and insurance applies: Canada; a. As if each Named Insured were the only b. International waters or airspace, but only if the Named Insured; and injury or damage occurs in the course of travel b. Separately to each insured against whom claim or transportation between any places included is made or"suit" is brought. in Paragraph a. above; or 8. Transfer Of Rights Of Recovery Against Others c. All other parts of the world if the injury or To Us damage arises out of: If the insured has rights to recover all or part of (1) Goods or products made or sold by you in any payment we have made under this Coverage the territory described in Paragraph a. Part, those rights are transferred to us. The above; insured must do nothing after loss to impair them. (2) The activities of a person whose home is in At our request, the insured will bring "suit" or the territory described in Paragraph a. transfer those rights to us and help us enforce above, but is away for a short time on your them. business; or 9. When We Do Not Renew (3) "Personal and advertising injury" offenses If we decide not to renew this Coverage Part, we that take place through the Internet or will mail or deliver to the first Named Insured similar electronic means of communication; shown in the Declarations written notice of the provided the insured's responsibility to pay nonrenewal not less than 30 days before the damages is determined in a "suit" on the merits, in expiration date. the territory described in Paragraph a. above or in If notice is mailed, proof of mailing will be sufficient a settlement we agree to. proof of notice. 5. "Employee" includes a "leased worker". SECTION V— DEFINITIONS "Employee" does not include a "temporary 1. "Advertisement" means a notice that is broadcast worker". or published to the general public or specific 6. "Executive officer" means a person holding any of market segments about your goods, products or the officer positions created by your charter, services for the purpose of attracting customers or constitution, bylaws or any other similar governing supporters. For the purposes of this definition: document. a. Notices that are published include material 7• "Hostile fire" means one which becomes placed on the Internet or on similar electronic uncontrollable or breaks out from where it was means of communication; and intended to be. b. Regarding web sites, only that part of a web 8. "Impaired property" means tangible property, other site that is about your goods, products or than "your product" or "your work", that cannot be services for the purposes of attracting used or is less useful because: customers or supporters is considered an a. It incorporates "your product" or "your work" advertisement. that is known or thought to be defective, 2. "Auto" means: deficient, inadequate or dangerous; or a. A land motor vehicle, trailer or semitrailer b. You have failed to fulfill the terms of a contract designed for travel on public roads, including or agreement; any attached machinery or equipment; or if such property can be restored to use by the b. Any other land vehicle that is subject to a repair, replacement, adjustment or removal of compulsory or financial responsibility law or "your product" or "your work" or your fulfilling the other motor vehicle insurance law where it is terms of the contract or agreement. licensed or principally garaged. CG 00 01 04 13 ©Insurance Services Office, Inc., 2012 Page 13 of 16 9. "Insured contract" means: 10."Leased worker" means a person leased to you by a. A contract for a lease of premises. However, a labor leasing firm under an agreement between that portion of the contract for a lease of you and the labor leasing firm, to perform duties premises that indemnifies any person or related to the conduct of your business. "Leased organization for damage by fire to premises worker" does not include a "temporary worker". while rented to you or temporarily occupied by 11."Loading or unloading" means the handling of you with permission of the owner is not an property: "insured contract"; a. After it is moved from the place where it is b. A sidetrack agreement; accepted for movement into or onto an aircraft, c. Any easement or license agreement, except in watercraft or"auto"; connection with construction or demolition b. While it is in or on an aircraft, watercraft or operations on or within 50 feet of a railroad; "auto"; or d. An obligation, as required by ordinance, to c. While it is being moved from an aircraft, indemnify a municipality, except in connection watercraft or "auto" to the place where it is with work for a municipality; finally delivered; e. An elevator maintenance agreement; but "loading or unloading" does not include the f. That part of any other contract or agreement movement of property by means of a mechanical pertaining to your business (including an device, other than a hand truck, that is not indemnification of a municipality in connection attached to the aircraft, watercraft or"auto". with work performed for a municipality) under 12."Mobile equipment" means any of the following which you assume the tort liability of another types of land vehicles, including any attached party to pay for "bodily injury" or "property machinery or equipment: damage" to a third person or organization. Tort a. Bulldozers, farm machinery, forklifts and other liability means a liability that would be imposed vehicles designed for use principally off public by law in the absence of any contract or roads; agreement. b. Vehicles maintained for use solely on or next to Paragraph f. does not include that part of any premises you own or rent; contract or agreement: c. Vehicles that travel on crawler treads; (1) That indemnifies a railroad for"bodily injury" or "property damage" arising out of d. Vehicles, whether self-propelled or not, construction or demolition operations, within maintained primarily to provide mobility to 50 feet of any railroad property and permanently mounted: affecting any railroad bridge or trestle, (1) Power cranes, shovels, loaders, diggers or tracks, road-beds, tunnel, underpass or drills; or crossing; (2) Road construction or resurfacing equipment (2) That indemnifies an architect, engineer or such as graders, scrapers or rollers; surveyor for injury or damage arising out of: e. Vehicles not described in Paragraph a., b., c. (a) Preparing, approving, or failing to or d. above that are not self-propelled and are prepare or approve, maps, shop maintained primarily to provide mobility to drawings, opinions, reports, surveys, permanently attached equipment of the field orders, change orders or drawings following types: and specifications; or (1) Air compressors, pumps and generators, (b) Giving directions or instructions, or including spraying, welding, building failing to give them, if that is the primary cleaning, geophysical exploration, lighting cause of the injury or damage; or and well servicing equipment; or (3) Under which the insured, if an architect, (2) Cherry pickers and similar devices used to engineer or surveyor, assumes liability for raise or lower workers; an injury or damage arising out of the f. Vehicles not described in Paragraph a., b., c. insured's rendering or failure to render or d. above maintained primarily for purposes professional services, including those listed other than the transportation of persons or in (2) above and supervisory, inspection, architectural or engineering activities. cargo. Page 14 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 0413 However, self-propelled vehicles with the 16."Prod ucts-completed operations hazard": following types of permanently attached a. Includes all "bodilyin and "property equipment are not "mobile equipment" but will damageinjury" be considered "autos": " occurring away from premises you own or rent and arising out of"your product or (1) Equipment designed primarily for: "your work" except: (a) Snow removal; (1) Products that are still in your physical (b) Road maintenance, but not construction possession; or or resurfacing; or (2) Work that has not yet been completed or (c) Street cleaning; abandoned. However, "your work" will be deemed completed at the earliest of the (2) Cherry pickers and similar devices mounted following times: on automobile or truck chassis and used to (a) When all of the work called for in your raise or lower workers; and 3 Air compressors, contract has been completed. ( ) p pumps and generators, including spraying, welding, building (b) When all of the work to be done at the job site has been completed if cleaning, geophysical exploration, lighting your and well servicing equipment. contract calls for work at more than one job site. However, "mobile equipment" does not include (c) When that part of the work done at a job any land vehicles that are subject to a compulsory site has been put to its intended use by or financial responsibility law or other motor any person or organization other than vehicle insurance law where it is licensed or another contractor or subcontractor principally garaged. Land vehicles subject to a compulsory or financial responsibility law or other working on the same project. motor vehicle insurance law are considered Work that may need service, maintenance, "autos". correction, repair or replacement, but which 13."Occurrence" means an accident, including is otherwise complete, will be treated as continuous or repeated exposure to substantially completed, the same general harmful conditions. b. Does not include "bodily injury" or "property 14."Personal and advertising injury" means injury, damage"arising out of: including consequential "bodily injury", arising out (1) The transportation of property, unless the of one or more of the following offenses: injury or damage arises out of a condition in a. False arrest, detention or imprisonment; or on a vehicle not owned or operated by b. Malicious prosecution; you, and that condition was created by the p loading or unloading of that vehicle by any c. The wrongful eviction from, wrongful entry into, insured; or invasion of the right of private occupancy of (2) The existence of tools, uninstalled a room, dwelling or premises that a person equipment or abandoned or unused occupies, committed by or on behalf of its materials; or owner, landlord or lessor; (3) Products or operations for which the d. Oral or written publication, in any manner, of classification, listed in the Declarations or in material that slanders or libels a person or a policy Schedule, states that products- organization or disparages a person's or completed operations are subject to the organization's goods, products or services; General Aggregate Limit. e. Oral or written publication, in any manner, of 17."Property damage"means: material that violates a person's right of privacy; a. Physical injury to tangible property, including all resulting loss of use of that property. All f. The use of another's advertising idea in your such loss of use shall be deemed to occur at "advertisement"; or the time of the physical injury that caused it; or g. Infringing upon another's copyright, trade dress b. Loss of use of tangible property that is not or slogan in your"advertisement". physically injured. All such loss of use shall be 15."Pollutants" mean any solid, liquid, gaseous or deemed to occur at the time of the thermal irritant or contaminant, including smoke, "occurrence"that caused it. vapor, soot, fumes, acids, alkalis, chemicals and For the purposes of this insurance, electronic data waste. Waste includes materials to be recycled, is not tangible property. reconditioned or reclaimed. CG 00 01 04 13 ©Insurance Services Office, Inc., 2012 Page 15 of 16 As used in this definition, electronic data means b. Includes: information, facts or programs stored as or on, (1) Warranties or representations made at any created or used on, or transmitted to or from computer software, including systems and time with respect to the fitness, quality, durability, performance or use of "your applications software, hard or floppy disks, CD- ROMs, tapes, drives, cells, data processing product"; and devices or any other media which are used with (2) The providing of or failure to provide electronically controlled equipment. warnings or instructions. 18."Suit" means a civil proceeding in which damages c. Does not include vending machines or other because of "bodily injury", "property damage" or property rented to or located for the use of "personal and advertising injury" to which this others but not sold. insurance applies are alleged. "Suit" includes: 22."Your work": a. An arbitration proceeding in which such a. Means: damages are claimed and to which the insured (1) Work or operations performed by you or on must submit or does submit with our consent; your behalf; and or b. Any other alternative dispute resolution (2) Materials, parts or equipment furnished in proceeding in which such damages are connection with such work or operations. claimed and to which the insured submits with b. Includes: our consent. (1) Warranties or representations made at any 19."Temporary worker" means a person who is time with respect to the fitness, quality, furnished to you to substitute for a permanent durability, performance or use of "your "employee" on leave or to meet seasonal or short- work"; and term workload conditions. (2) The providing of or failure to provide 20."Volunteer worker" means a person who is not warnings or instructions. 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, distributed or disposed of by: (a) You; (b) Others trading under your name; or (c) A person or organization whose business or assets you have acquired; and (2) Containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products. Page 16 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 PI-APG-004 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL CONDITIONS This endorsement modifies insurance provided under the: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Section IV—Commercial General Liability Conditions: 1. Changes The Certificate of Insurance contains all the agreements between you and us concerning the insurance afforded. The first Named Certificate Holder shown in the Certificate of Insurance is authorized to make changes in the terms of the Certificate of Insurance with our consent. The Certificate of Insurance terms can be amended or waived only by endorsement issued by us and made a part of the Certificate of Insurance. 2. Transfer of Your Rights and Duties Under The Certificate of Insurance: Your rights and duties under the Certificate of Insurance may not be transferred without our written consent except in the case of death of an individual Named Certificate Holder. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. Page 1 of 1 PI-APG-CA-1 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES—CANCELLATION, NONRENEWAL AND CONDITIONAL RENEWAL This endorsement modifies insurance provided under the following: COMMERICAL GENERAL LIABILITY COVERAGE PART SECTION IV- COMMERICAL GENERAL LIABILITY CONDITIONS, Paragraph 9. When We Do Not Renew is deleted and replaced with the following.: 1. Cancellation of Master Policy a. The Master Policy may be canceled by the Members of the Fitness and Wellness Purchasing Group by surrender of the policy to us or by mailing written notice to us stating when such cancellation shall take effect. If canceled by the Members of the Fitness and Wellness Purchasing Group, we shall retain the customary short-rate proportion of the premium. In no event may the requested date of cancellation be greater than 10 days prior to the date the request is received by US. b. The Master Policy may be canceled by us by written notice mailed by certified mail to the Members of the Fitness and Wellness Purchasing Group at the address shown in the Master Policy Declarations. Such cancellation shall be no fewer than 30 days from the date the notice is mailed. 2. Cancellation of the Certificate of Insurance a. The Certificate of Insurance may be canceled by the first Named Certificate Holder shown in Item 1. of the Certificate of Insurance by surrender of the Certificate of Insurance to us or by mailing written notice to us stating when such cancellation shall take effect. If canceled by the first Named Certificate Holder shown in Item 1. of the Certificate of Insurance, we shall retain the customary short-rate proportion of the premium. In no event may the requested date of cancellation be greater than 10 days prior to the date the request is received by us. b. If this Certificate of Insurance has been in effect 60 days or less, the Certificate of Insurance may be canceled by us by written notice mailed by certified mail to the first Named Certificate Holder at the address shown in the Certificate of Insurance. Such cancellation shall be no fewer than 30 days from the date the notice is mailed unless the Certificate of Insurance is canceled because the first Named Certificate Holder has failed to pay a premium when due or has committed fraud. In that event, such cancellation shall take effect no fewer than 10 days from the date the notice is mailed. c. If this Certificate of Insurance has been in effect for more than 60 days, the Certificate of Insurance may be canceled by us only for the following reasons: (1) Nonpayment of premium; (2) Discovery of fraud or material misrepresentation by either of the following: (a)The Named Certificate Holder or his or her representative in obtaining the insurance; (b) The Named Certificate Holder or his or her representative in pursuing a claim under the Certificate of Insurance; (3) A judgment by a court or an administrative tribunal that the Named Certificate holder has violated any law of the state of California or of the United States, having as one of its necessary elements, an act which materially increases any of the risk insured against; (4) Discovery of willful or grossly negligent acts or omissions, or of any violations of state Page 1 of 4 PI-APG-CA-1 (01/07) laws or regulations establishing safety standards, by the Named Certificate Holder or his or her representative,which materially increase any of the risks insured against; (5) Failure by the Named Certificate Holder or his or her representative to implement reasonable loss control requirements which were agreed by the insured as a condition of policy issuance or which were conditions precedent to the use by us of a particular rate or rating plan, if the failure materially increases any of the risks insured against; (6) A determination by the commissioner that the loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency. A certification made under penalty of perjury to the commissioner by one of our officers of the loss of, or change in, reinsurance and that the loss or change will threaten our financial integrity or solvency if the cancellation of the Certificate of Insurance is not permitted shall constitute such a determination unless disapproved by the commissioner within 30 days of the filing. There shall be no extension to this 30 day period; (7) A determination by the commissioner that the continuation of the Certificate of Insurance would place us in violation of the laws of this state or the state of its domicile or that the continuation of coverage would threaten our solvency; or (8) A change by the Named Certificate Holder or his or her representative.in the activities or property of the commercial or industrial enterprise which results in a material added risk, a materially increased risk or a materially changed risk, unless the added, increased, or changed risk is included in the Certificate of Insurance. If we cancel subjects to Paragraphs c.(1) through c.(8) above, we shall mail by certified mail to the first Named Certificate Holder at the address shown in the Certificate of Insurance, and mail to the producer of record, if any. Written notice of cancellation shall take effect: (i) 10 days from the date of mailing for the reasons set forth in Paragraph c.(1) and c.(2); and (ii) 30 days from the date of mailing for the reasons set forth in Paragraph c.(3) through c.(8). d. If the Certificate of Insurance is canceled by us, the earned premium shall be computed pro-rata. Premium adjustment may be made at the time cancellation is effected or as soon as practicable thereafter. Failure to pay any premium adjustment at, on, or around the time of the effective date of cancellation shall not alter the effectiveness of cancellation. 3. Nonrenewal of the Master Policy a. If we elect not to renew this Master Policy, we will mail or deliver written notice stating the reason for nonrenewal to the Members of the Fitness and Wellness Group at the mailing address shown in the Master Policy Declarations, and to the producer of record, at least 60 days, but not more than 120 days, before the expiration date. If we fail to provide timely written notice required by the paragraph above, the coverage provided to the Members of the Fitness and Wellness Group shall remain in effect with no change in its terms and conditions, for a period of 60 days. b.We are not required to send notice of nonrenewal in the following situations: (1)If the transfer or renewal of a Master Policy, without any changes in terms, conditions or rates, is between us and a member of our insurance group. (2)If the Master Policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph 3.a.above Page 2 of 4 PI-APG-CA-1 (01/07) (3)If the Members of the Fitness and Wellness Group have obtained replacement coverage, or have agreed, in writing, within 60 days of the termination of the Master Policy, to obtain that coverage. (4)If the Master Policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. (5)If the Members of the Fitness and Wellness Group request a change in the terms or conditions or risks covered by the Master Policy within 60 days of the end of the policy period. (6)If we have made a written offer to the Members of the Fitness and Wellness Group in accordance with the timeframes shown in Paragraph 3.a above, to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25% c. The transfer of a Master Policy between companies with the same insurance group or changes in Deductible, premium, Limit of Insurance or coverage are not refusal to renew. 4. Nonrenewal of the Certificate of Insurance a. If we elect not to renew this Certificate of Insurance, we will mail or deliver written notice stating the reason for nonrenewal to the first Named Certificate Holder at the mailing address shown in the Certificate of Insurance and to the producer of record, if any, at least 60 days, but not more than 120 days, before the expiration date. If we fail to provide timely written notice required by the paragraph above, the coverage provided to the first Named Certificate Holder shall remain in effect with no change in its terms and conditions, for a period of 60 days. b. We are not required to send notice of nonrenewal in the following situations: (1) If the transfer or renewal of a Certificate of Insurance, without any changes in terms, conditions or rates, is between us and a member of our insurance group. (2) If the Certificate of Insurance has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph 4.a. above. (3) If you have obtained replacement coverage, or have agreed, in writing, within 60 days of the termination of the Certificate of Insurance, to obtain that coverage. (4) If the Certificate of Insurance is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. (5) If you request a change in the terms or conditions or risks covered by the Certificate of Insurance within 60 days of the end of the policy period. Page 3 of 4 PI-APG-CA-1 (01/07) (6) If we have made a written offer to you, in accordance with the timeframes shown in Paragraph 4.a. above, to renew the Certificate of Insurance under changed terms or conditions or at an increased premium rate, when the increase exceeds 25%. c. The transfer of a Certificate of Insurance between companies with the same insurance group or changes in Deductible, premium, Limit of Insurance or coverage are not refusal to renew. 5. Conditional Renewal If we elect to renew this Master Policy or Certificate of Insurance, and the renewal is subject to any of the following: a.Increase in Deductible; b.Reduction in Limit of Insurance; c. Elimination of coverages; or d. 25%or more rate increase. We shall mail or deliver written notice of the change(s) to the Members of the Fitness and Wellness Group at the mailing address shown in the Master Policy Declarations or the first Named Certificate Holder at the mailing address shown in the Certificate of Insurance and to the producer of record, if any, at least 60 days, but not more than 120 days, before the expiration date. 6. Mailing time must be added to the notice periods as follows: a. Add 5 days if the place of address and place of mailing is in California; b. Add 10 days if the place of address or place of mailing is outside of California; or C. Add 20 days if the place of address or place of mailing is outside the United States. Page 4 of 4 PI-BELL-1 (11/09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BELL ENDORSEMENT iA Unless otherwise stated herein, the terms, conditions, exclusions and other limitations set forth in this endorsement are solely applicable to coverage afforded by this endorsement, and the policy is amended as follows: I. SCHEDULE OF ADDITIONAL COVERAGES AND LIMITS The following is a summary of Limits of Liability or Limits of Insurance and/or additional coverages provided by this endorsement. This endorsement is subject to the provisions of the policy to which it is attached. COVERAGE LIMITS OF INSURANCE Business Travel Accident Benefit $50,000 Conference Cancellation $25,000 Donation Assurance $50,000 Emergency Real Estate Consulting Fee $50,000 Fundraising Event Blackout $25,000 Identity Theft Expense $50,000 Image Restoration and Counseling $50,000 Key Individual Replacement Expenses $50,000 Kidnap Expense $50,000 Political Unrest $5,000 per employee: $25,000 policy limit Temporary Meeting Space Reimbursement $25,000 Terrorism Travel Reimbursement $50,000 Travel Delay Reimbursement $1,500 Workplace Violence Counseling $50,000 Page 1 of 8 ©2009 Philadelphia Indemnity Insurance Company PI-BELL-1 (11/09) II. CONDITIONS A. Applicability of Coverage Coverage provided by your policy and any endorsements attached thereto is amended by this endorsement where applicable. B. Limits of Liability or Limits of Insurance 1. When coverage is provided by this endorsement and another coverage form or endorsement attached to this policy,the greater limits of liability or limits of insurance will apply. In no instance will multiple limits apply to coverages which may be duplicated within this policy. Additionally, if this policy and any other coverage part or policy issued to you by us, or any company affiliated with us, apply to the same occurrence, offense, wrongful act, accident or loss, the maximum limits of liability or limits of insurance under all such coverage parts or policies combined shall not exceed the highest applicable limits of liability or limits of insurance under any one coverage part or policy. 2. Limits of liability or limits of insurance identified in Section I. SCHEDULE OF ADDITIONAL COVERAGES AND LIMITS above are not excess of, but are in addition to the applicable Limits of Liability or Limits of Insurance stated in the Declarations. C. Claim Expenses Coverages provided herein are not applicable to the generation of claim adjustment costs by you; such as fees you may incur by retaining a public adjuster or appraiser. III. ADDITIONAL COVERAGES A. Business Travel Accident Benefit We will pay a Business Travel Accident Benefit to the insured if a director or officer suffers injury or death while traveling on a common carrier for your business during the policy period. For the purpose of Business Travel Accident Benefit coverage, injury means: 1. Physical damage to the body caused by violence, fracture, or an accident that results in loss of life not later than one hundred eighty(180)days after the policy expiration, the date of cancellation or the date of non-renewal; 2. Accidental loss of limbs or multiple fingers; 3. Total loss of sight, speech or hearing. The limit of insurance for this coverage is$50,000 per policy period for all insureds combined. No deductible applies to this coverage. The Business Travel Accident Benefit shall not be payable if the cause of the injury was: 1. An intentional act by the insured; 2. An act of suicide or attempted suicide; 3. An act of war; or 4. A disease process. Page 2 of 8 ©2009 Philadelphia Indemnity Insurance Company PI-BELL-1 (11/09) B. Conference Cancellation We will reimburse the insured for any business-related conference expenses, paid by the insured and not otherwise reimbursed, for a canceled conference that an employee was scheduled to attend. The cancellation must be due directly to a "natural catastrophe"or a "communicable disease" outbreak that forces the cancellation of the conference. With respect to a conference cancellation claim, it is further agreed as follows: 1. The insured employee must have registered for the conference at least thirty(30)days prior to the cancellation; and 2. The cancellation must be ordered by a local, state or federal Board of Health or other governmental authority having jurisdiction over the location of the conference. The limit of insurance for this coverage is$25,000 per policy period for all insureds combined. No deductible applies to this coverage. C. Donation Assurance If the insured is a 501(c)(3)status non-profit organization as defined in the United States Internal Revenue Code,we will reimburse the insured for"failed donation claim(s)." With respect to any"failed donation claim," it is further agreed as follows: 1. The donor must not have been in bankruptcy, nor have filed for bankruptcy or reorganization in the past seven (7)years prior to the time said pledge was made to the insured; 2. For non-cash donations, our payment of a"failed donation claim"shall be based on the fair market value of said non-cash donation at the time of the"failed donation claim"; 3. In the case of unemployment or incapacitation of a natural person donor and as a condition of payment of the"failed donation claim": a. Neither the natural person donor nor the insured shall have had reason to believe the donor would become unemployed or incapacitated subsequent to the donation date; and b. The donor shall be unemployed for at least sixty(60)days prior to a claim being submitted by the insured; 4. No coverage shall be afforded for a written pledge of funds or other measurable, tangible property to the insured dated prior to the policy period; and 5. A donation amount which is to be collected by the insured over more than a twelve(12) month period shall be deemed a single donation. The limit of insurance for this coverage is $50,000 per policy period for all insureds combined. No deductible applies to this coverage. D. Emergency Real Estate Consulting Fee We will reimburse the insured any realtor's fee or real estate consultant's fee necessitated by the insured's need to relocate due to the "unforeseeable destruction"of the insured's"principal location" listed in the Declarations during the policy period. The limit of insurance for this Page 3 of 8 ©2009 Philadelphia Indemnity Insurance Company PI-BELL-1 (11/09) coverage is$50,000 per policy period for all insureds combined. No deductible applies to this coverage. E. Fundraising Event Blackout We will reimburse the insured for"fundraising expenses"that are incurred due to the cancellation of a fundraising event caused by the lack of electric supply resulting in a power outage, provided the fundraising event is not re-scheduled. The fundraising event must have been planned at least thirty(30)days prior to the power outage. The limit of insurance for this coverage is$25,000 per policy period for all insureds combined. No deductible applies to this coverage. F. Identity Theft Expense We will reimburse any present director or officer of the named insured for"identity theft expenses" incurred as the direct result of any"identity theft"first discovered and reported during the policy period; provided that it began to occur subsequent to the effective date of the insured's first policy with us. The limit of insurance for this coverage is $50,000 per policy period for all insureds combined. No deductible applies to this coverage. G. Image Restoration and Counseling We will reimburse the insured for expenses incurred for image restoration and counseling arising out of"improper acts" by any natural person. Covered expenses are limited to: 1. The costs of rehabilitation and counseling for the accused natural person insured, provided the natural person insured is not ultimately found guilty of criminal conduct;this reimbursement to occur after acquittal of the natural person insured; 2. The costs charged by a recruiter or expended on advertising, for replacing an officer as a result of"improper acts'; and 3. The costs of restoring the named insured's reputation and consumer confidence through image consulting. The limit of insurance for this coverage is$50,000 per policy period for all insureds combined. No deductible applies to this coverage. H. Key Individual Replacement Expenses We will pay"key individual replacement expenses" if the Chief Executive Officer or Executive Director suffers an"injury"during the policy period which results in the loss of life during the policy period. The limit of insurance for this coverage is the lesser of$50,000 or ten (10)times the annual premium paid for this policy. No deductible applies to this coverage. I. Kidnap Expense We will pay on behalf of any director or officer of the insured, reasonable fees incurred as a result of the kidnapping of them or their spouse, "domestic partner," parent or child during the policy period. Coverage will not apply to any kidnapping by or at the direction of any present or former family member of the victim. Reasonable fees will include: Page 4 of 8 ©2009 Philadelphia Indemnity Insurance Company PI-BELL-1 (11/09) 1. Fees and costs of independent negotiators; 2. Interest costs for any loan from a financial institution taken by you to pay a ransom demand or extortion threat; 3. Travel costs and accommodations incurred by the named insured; 4. Reward money paid to an informant which leads to the arrest and conviction of parties responsible for loss covered under this insurance; and 5. Salary, commissions and other financial benefits paid by you to a director or officer. Such compensation applies at the level in effect on the date of the kidnap and ends upon the earliest of: a. Up to thirty(30)days after their release, if the director or officer has not yet returned to work; b. Discovery of their death; c. One hundred twenty (120)days after the last credible evidence following abduction that they are still alive; or d. Twelve (12)months after the date of the kidnapping. The limit of insurance for this coverage is $50,000 each policy period for all insureds combined. No deductible applies to this coverage. J. Political Unrest Coverage We will reimburse any present director, officer, employee or volunteer of the named insured while traveling outside the United States of America for"emergency evacuation expenses"that are incurred as a result of an incident of"political unrest." This "political unrest" must occur during the policy period. No coverage is granted for travel to countries in a state of"political unrest" at the time of departure of the travel. The limit of insurance for this coverage is$5,000 per covered person, subject to a maximum of$25,000 per policy period for all insureds combined. No deductible applies to this coverage. K. Temporary Meeting Space Reimbursement We will reimburse the insured for rental of meeting space which is necessitated by the temporary unavailability of the insured's primary office space due to the failure of a climate control system, or leakage of a hot water heater during the policy period. Coverage will exist only for the renting of temporary meeting space required for meeting with parties who are not insured under this policy. The limit of insurance for this coverage is $25,000 per policy period for all insureds combined. No deductible applies to this coverage. L. Terrorism Travel Reimbursement We will reimburse any present director or officer of the named insured in the event of a .'certified act of terrorism" during the policy period which necessitates that he/she incurs "emergency travel expenses." The limit of insurance for this coverage is $50,000 per policy period for all insureds combined. No deductible applies to this coverage. Page 5 of 8 ©2009 Philadelphia Indemnity Insurance Company PI-BELL-1 (11/09) M. Travel Delay Reimbursement We will reimburse any present director or officer of the named insured for any"non- reimbursable expenses"they incur as a result of the cancellation of any regularly scheduled business travel on a common carrier. The limit of insurance for this coverage is $1,500 per policy period for all insureds combined. A seventy-two (72) hour waiting period deductible applies to this coverage. N. Workplace Violence Counseling We will reimburse the insured for emotional counseling expenses incurred directly as a result of a"workplace violence" incident at any of the insured's premises during the policy period. The emotional counseling expenses incurred must have been for: 1. Your employees who were victims of, or witnesses to the"workplace violence'; 2. The spouse, "domestic partner," parents or children of your employees who were victims of, or witnesses to the "workplace violence"; and 3. Any other person or persons who directly witnessed the"workplace violence" incident. The limit of insurance for this coverage is $50,000 per policy period for all insureds combined. No deductible applies to this coverage. IV. DEFINITIONS For the purpose of this endorsement, the following definitions apply: A. "Certified act of terrorism"means any act so defined under the Terrorism Risk Insurance Act, and its amendments or extensions. B. "Communicable disease" means an illness, sickness, condition or an interruption or disorder of body functions, systems or organs that is transmissible by an infection or a contagion directly or indirectly through human contact, or contact with human fluids, waste, or similar agent, such as, but not limited to Meningitis, Measles or Legionnaire's Disease. C. "Domestic partner"means any person who qualifies as a domestic partner under the provisions of any federal, state or local statute or regulation, or under the terms and provisions of any employee benefit or other program established by the named insured. D. "Emergency evacuation expenses" mean: 1. Additional lodging expenses; 2. Additional transportation costs; 3. The cost of obtaining replacements of lost or stolen travel documents necessary for evacuation from the area of"political unrest"; and 4. Translation services, message transmittals and other communication expenses. provided that these expenses are not otherwise reimbursable. E. "Emergency travel expenses" mean: Page 6 of 8 ©2009 Philadelphia Indemnity Insurance Company PI-BELL-1 (11/09) 1. Hotel expenses incurred which directly result from the cancellation of a scheduled transport by a commercial transportation carrier, resulting directly from and within forty-eight(48) hours of a "certified act of terrorism"; and 2. The increased amount incurred which may result from re-scheduling comparable transport, to replace a similarly scheduled transport canceled by a commercial transportation carrier in direct response to a "certified act of terrorism"; provided that these expenses are not otherwise reimbursable. F. "Failed donation claim" means written notice to the insured during the policy period of: 1. The bankruptcy or reorganization of any donor whereby such bankruptcy or reorganization prevents the donor from honoring a prior written pledge of funds or other measurable, tangible property to the insured; or 2. The unemployment or incapacitation of a natural person donor preventing him/her from honoring a prior written pledge of funds or other measurable, tangible property to the insured. G. "Fundraising expenses"mean deposits forfeited and other charges paid by you for catering services, property and equipment rentals and related transport, venue rentals, accommodations (including travel), and entertainment expenses less any deposits or other fees refunded or refundable to you. H. "Identity theft' means the act of knowingly transferring or using,without lawful authority, a means of identification of any director or officer(or spouse or"domestic partner"thereof) of the named insured with the intent to commit, or to aid or abet another to commit, any unlawful activity that constitutes a violation of federal law or a felony under any applicable state or local law. I. "Identity theft expenses" mean: 1. Costs for notarizing affidavits or similar documents attesting to fraud required by financial institutions or similar credit grantors or credit agencies; 2. Costs for certified mail to law enforcement agencies, credit agencies, financial institutions or similar credit grantors; and 3. Loan application fees for re-applying for a loan or loans when the original application is rejected solely because the lender received incorrect credit information. J. "Improper acts" means any actual or alleged act of: 1. Sexual abuse; 2. Sexual intimacy; 3. Sexual molestation; or 4. Sexual assault; committed by an insured against any natural person who is not an insured. Such "improper acts" must have been committed by the insured while in his or her capacity as an insured. K. "Injury" whenever used in this endorsement, other than in Section III.A. Business Travel, Page 7 of 8 ©2009 Philadelphia Indemnity Insurance Company PI-BELL-1 (11/09) means any physical damage to the body caused by violence,fracture or an accident. L. "Key individual replacement expenses" mean the following necessary expenses: 1. Costs of advertising the employment position opening; 2. Travel, lodging, meal and entertainment expenses incurred in interviewing job applicants for the employment position opening; and 3. Miscellaneous extra expenses incurred in finding, interviewing and negotiating with the job applicants, including, but not limited to, overtime pay, costs to verify the background and references of the applicants and legal expenses incurred to draw up an employment contract. M. "Natural catastrophe" means hurricane, tornado, earthquake or flood. N. "Non-reimbursable expenses" means the following travel-related expenses incurred after a seventy-two (72) hour waiting period, beginning from the time documented on the proof of cancellation, and for which your director or officer produces a receipt: 1. Meals and lodging; 2. Alternative transportation; 3. Clothing and necessary toiletries; and 4. Emergency prescription and non-prescription drug expenses. O. "Political unrest" means: 1. A short-term condition of disturbance, turmoil or agitation within a foreign country that poses imminent risks to the security of citizens of the United States; 2. A long-term condition of disturbance,turmoil or agitation that makes a foreign country dangerous or unstable for citizens of the United States; or 3. A condition of disturbance,turmoil or agitation in a foreign country that constrains the United States Government's ability to assist citizens of the United States, due to the closure or inaccessibility of an embassy or consulate or because of a reduction of its staff for which either an alert or travel warning has been issued by the United States Department of State. P. "Principal location" means the headquarters, home office or main location where most business is substantially conducted. Q. "Unforeseeable destruction" means damage resulting from a "certified act of terrorism,"fire, collision or collapse which renders all of the insured's "principal locations"completely unusable. R. "Workplace violence" means any intentional use of or threat to use deadly force by any person with intent to cause harm and that results in bodily"injury"or death of any person while on the insured's premises. Page 8 of 8 ©2009 Philadelphia Indemnity Insurance Company PI-FW-001 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE C—ATHLETIC ACTIVITIES EXCLUSION DELETION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION I - COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2. Exclusions, Paragraph e. Athletic Activities, is deleted in its entirety. Page 1 of 1 PI-FW-002 (03/09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FITNESS AND WELLNESS LIABILITY INSURANCE EXCLUSIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusions are added to Paragraph 2. Exclusions of SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY; and Paragraph 2. Exclusions of SECTION I — COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY: 2. Exclusions This insurance does not apply to: a. Services Furnished by Health Care Providers (1) "Bodily injury," "property damage" or "personal and advertising injury" based upon or arising out of, in whole or in part, the rendering of or failure to render: (a) Medical, surgical, dental, x-ray, or nursing service, treatment, advice or instruction, or the related furnishing of food or beverages; (b) Any health or therapeutic service, treatment, advice or instruction; or (c) Any service, treatment, advice or instruction in chemical skin enhancement, laser hair removal or replacement. (2) The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances; or (3) The handling or treatment of dead bodies, including autopsies, organ donation or other procedures. This exclusion does not apply to the rendering of first aid. Page 1 of 3 PI-FW-002 (03/09) Paragraph 2.a. (1)(b) above does not apply to a licensed physical therapist providing any health or therapeutic service, treatment, advice or instruction on behalf of a Named Certificate Holder. b. Vitamins, Supplements and Steroids (1) "Bodily injury," "property damage"or"personal and advertising injury"based upon or arising out of, in whole orin part, the production, testing or manufacture of vitamins, minerals, herbal supplements, medicinal supplements or nutritional supplements. (2) "Bodily injury," "property damage" or "personal and advertising injury" based upon or arising out of, in whole or in part, the production, recommendation, selling, testing, promotion, solicitation, or manufacture of steroids. c. Improper Fees, Dues and Expenses "Bodily injury," "property damage" and "personal and advertising injury" based upon or arising out of, in whole or in part, improper fees, dues, and expenses incurred or charged by an insured. d. Communicable Disease (1) "Bodily injury," "property damage"or"personal and advertising injury" arising out of any "communicable disease," including but not limited to the following: (a) Acquired Immune Deficiency Syndrome (AIDS); (b) Human Immunodeficiency Virus(HIV); or (c) Hepatitis. (2) This exclusion applies even if such damages arise or are alleged to arise as a result of the insureds' negligent hiring, placement, training, supervision, act, error or omission or alleged sexual and/or physical abuse. (3) For purposes of this exclusion, "communicable disease" means an infectious disease transmittable from person to person by direct contact with an affected person or that person's discharges or body fluids. e. Fungi or Bacteria Page 2 of 3 PI-FW-002 (03/09) (1) `Bodily injury," "property damage" or "personal and advertising injury" caused directly or indirectly by the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of any: (a) "Fungi,""spores,"or bacteria; or (b) Substance, vapor or gas produced by or Substance, vapor or gas produced by oror arising out of any"fungi,""spores"or bacteria. (2) Loss, costs or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, "fungi," "spores" or bacteria, by any insured or by any other person or entity. (3) For the purposes of this exclusion, the following definitions are added: (a) "Fungi" means any type or form of fungus, including mold or mildew and any mycotoxins, "spores,"scents or byproducts produced or released by"fungi." (b) "Spores" means reproductive bodies produced by or arising out of"fungi." This exclusion does not apply to any"fungi,""spores" or bacteria that are on, or are contained in, an edible good or edible product intended for human or animal consumption. Page 3 of 3 PI-FW-003(01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FITNESS AND WELLNESS LIABILITY INSURANCE EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to Paragraph 1. Insuring Agreement of SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: "Bodily injury"or"property damage"arising out of the rendering of or failure to render "professional training services"shall be deemed to be caused by an "occurrence." B. For the purpose of determining the Limits of Insurance for the coverage provided by this endorsement, any act or omission together with all related acts or omissions in the furnishing of these "professional training services"to any one person will be considered one "occurrence." C. For purposes of this endorsement, "professional training services" means any service, advice, or instruction relating to physical fitness. Page 1 of 1 PI-FW-005 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, PUNITIVE DAMAGES EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2. Exclusions of SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY; and Paragraph 2. Exclusions of SECTION I - COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY: 2. Exclusions This insurance does not apply to: Punitive Damages Any punitive, treble or exemplary damages, whether or not such punitive, treble or exemplary damages arise out of any obligation to share damages with or repay someone else who must pay damages. Page 1 of 1 PI-FW-006 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY SEXUAL ABUSE ENDORSEMENT This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part SCHEDULE Sexual Abuse Limits of Insurance Sexual Abuse Each Occurrence Limit: $100,000 Sexual Abuse Aggregate Limit $300,000 A. Except as otherwise provided by this endorsement, this policy does not apply to "bodily injury," "property damage"or"personal and advertising injury"caused by, based upon or arising, in whole or in part, out of any: 1. Actual, threatened or alleged "sexual abuse" or"sexual harassment"; or 2. "Negligent employment"of any person who caused or commits or is alleged to have caused or committed "sexual abuse"or"sexual harassment." As respects coverage afforded by this endorsement, the following changes apply to the COMMERCIAL GENERAL LIABILITY COVERAGE FORM: B. Paragraph 1. of Section I — Coverages — Coverage A — Bodily Injury And Property Damage Liability is deleted and replaced by the following: 1. Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as damages because of"bodily injury"to which this insurance applies. We will have the right and duty to defend the insured against any"suit' seeking those damages, including any"suit' alleging that the"bodily injury"arose out of"sexual abuse" caused or committed by the insured. However, we will have no duty to defend or continue to defend any insured against: (1) any"suit' seeking damages for"bodily injury"to which this insurance does not apply; (2) any"suit'for which the insured is found to have in fact caused or committed an act of "sexual abuse"; or (3) any"suit'for which the insured has admitted to have in fact caused or committed an act of"sexual abuse." We may, at our discretion, investigate any"occurrence" and settle any claim or"suit' that may result. But: Page 1 of 4 PI-FW-006 (01/07) (a) The amount we will pay for damages is limited as described in Section F—Limits Of Insurance of this endorsement; and (b) Our right and duty to defend ends when we have used up the applicable limit of insurance in the payment of judgments, settlements or"defense expenses" under Coverages A or B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided under Section D of this endorsement — Supplementary Payments — Coverage A and B. b. This insurance applies to"bodily injury"only if: (1) the"bodily injury" is caused by an "occurrence"that first commences in the"coverage territory" at a specific date and time on or after the effective date of this endorsement and during the policy period; (2) the"bodily injury" arises out of "sexual abuse"caused or committed by your "employee"; and (3) the"sexual abuse"arises out of your"negligent employment"of that"employee." C. The insurance provided by this endorsement is subject to the following additional exclusions: 2. Exclusions This insurance does not apply to: a. Any person who: (1) Has admitted to or been found guilty of, or pled guilty or nolo contendere to any act involving "sexual abuse"; (2) Participated in,directed or knowingly allowed "sexual abuse"; or (3) Has failed to comply with any applicable law, ordinance or regulation which requires the reporting of"sexual abuse"after having knowledge of the"sexual abuse." b. Any expense associated with a criminal trial, proceeding or investigation, or to any expense for appeals for any"suit"against you or any person insured. c. Any claim for damages arising out of"sexual abuse"which is part of a series of related acts of"sexual abuse" if the first of such series of acts took place before the effective date of this endorsement. d. Any claim for damages arising out of"sexual abuse"alleged to have been caused or committed by any"employee"who had previously committed such an act of which any insured had knowledge. e. Any liability of others assumed by you under any contract or agreement, either oral or written. f. Any claim made against an insured by another insured. g. Any"sexual abuse" caused or committed by or which is alleged to have been caused or committed by any independent contractor or employee or ager`of such independent contractor. h. "Sexual harassment." i. "Bodily injury"arising from any violation or alleged violation of the civil rights of any person. Page 2 of 4 PI-FW-006 (01/07) D. SUPPLEMENTARY PAYMENTS -COVERAGES A AND B With respect to the insurance provided by this endorsement, Paragraph 1.a. and Paragraph 2. of Section I—Supplementary Payments—Coverages A and B are deleted. E. WHO IS AN INSURED With respect to the insurance provided by this endorsement, Paragraph 2. of Section 11 —Who Is An Insured is deleted. F. LIMITS OF INSURANCE For purposes of the coverage provided by this endorsement, the following is added to Section III — Limits Of Insurance of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM and applies solely to this coverage: 1. The Sexual Abuse Limits of Insurance shown in the SCHEDULE of this endorsement and the rules below fix the most we will pay for damages and"defense expenses", regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits." 2. The Sexual Abuse Aggregate Limit shown in the SCHEDULE of this endorsement is the most we will pay for the sum of all damages and"defense expenses" because of all "bodily injury"arising out of"sexual abuse." 3. Subject to 2. above, the Sexual Abuse Each Occurrence Limit shown in the SCHEDULE of this endorsement is the most we will pay for the sum of all damages and "defense expenses" because of all "bodily injury"arising out of"sexual abuse"from any one"occurrence." 4. Subject to 1., 2., and 3. above, covered damages for which insurance is afforded by this endorsement will apply against and reduce the General Aggregate Limit of this policy, as described in Paragraph 2. of Section III—Limits Of Insurance of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM. The Limits of Insurance of this endorsement 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 to be part of the last preceding period for purposes of determining the Limits of Insurance. G. For purposes of the coverage provided by this endorsement, the following definitions are added to Section V—Definitions of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM: 1. "Defense expenses" means: a. Fees, costs and expenses charged by attorneys retained by us; and b. Reasonable and necessary fees, costs and expenses resulting from the investigation, adjustment, defense or appeal of a claim. "Defense expenses"do not include: a. Salaries, loss of earnings, reimbursement for the insured's time or attendance required at any investigation, defense or appearance; or b. Other remuneration by or to any insured. Page 3 of 4 PI-FW-006 (01/07) 2. "Negligent employment' means negligent selection, investigation, supervision, training or retention of an "employee." 3. "Sexual abuse" means actual or alleged physical abuse arising out of a single, continuous or repeated exposure of one or more persons to acts of a sexual nature involving inappropriate physical contact caused by or committed by: a. One person; or b. Two or more persons acting together or in related acts or series of acts. All related, interrelated, repeated or continuous episodes of "sexual abuse" involving the same claimant or perpetrator shall be deemed to be a single 'occurrence." 4. "Sexual harassment' means inappropriate non-physical actions or verbal comments or suggestions of a sexual nature. H. For purposes of the coverage provided by this endorsement, Paragraph 13. of Section V — Definitions of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to include: 13. "Occurrence" means any act of"sexual abuse." Page 4 of 4 PI-FW-007 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY., SPECIFIC CLAIMANT EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusions are added to Paragraph 2. Of SECTION I — COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY. 2. Exclusions This insurance does not apply to: Any actual or alleged "personal and advertising injury" asserted by or on behalf of Bikram Choudhury, Rajashree Choudhury, their corporations, subsidiaries, affiliates or other related business enterprises or successors in interest. Page 1 of 1 PI-FW-008 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VIOLATION OF COMMUNICATION OR INFORMATION LAW EXCLUSION This endorsement modifies insurance provided under the: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Exclusions of Section I — Coverage A — Bodily Injury and Property Damage Liability and Coverage B — Personal and Advertising Injury Liability, Paragraph 2.: 2. Exclusions: This insurance does not apply to: Violation of Communication or Information Law "Bodily injury", "property damage or"personal and advertising injury" resulting from or arising out of any actual or alleged violation of: A. The federal Telephone Consumer Protection Act(47 U.S.C. § 227), Drivers Privacy Protection Act(18 U.S.C.§2721-2725)or Controlling the Assault of Non-Solicited Pornography and Marketing Act(15 U.S.C. § 7701, et seq.); or B. Any other federal, state, or local statute, regulation or ordinance that imposes liability for the: (1) unlawful use of telephone, electronic mail, internet, computer, facsimile machine or other communication or transmission device; or (2) unlawful use, collection, dissemination, disclosure or re-disclosure of personal information in any manner by any insured or on behalf of any insured. Page 1 of 1 PI-FW-009 (06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Blanket Additional Insured Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION II—WHO IS AN INSURED is amended to include the following as an additional insured, but only with respect to liability arising out of your operations, and in accordance with a required Certificate of Insurance: 1. Managers, Owners or Lessors of the Premises Leased, Rented, or Loaned to You, but only with respect to that part of the premises leased, rented or loaned to you subject to the following additional exclusions: This insurance does not apply to: a. Any 'occurrence"which takes place after you cease to be a tenant in that premises; b. Structural alterations, new construction or demolition operations performed by or on behalf of the manager, owner or lessor of the premises; c. Any design defect or structural maintenance of the premises or loss caused by a premises defect. 2. Lessor of Leased Equipment, but only with respect to liability for"bodily injury", "property damage" or"personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s)or organization(s)subject to the following additional exclusions: This insurance does not apply to: Any"occurrence"which takes place after the equipment lease expires. 3. Sponsors, but only with respect to their liability as a sponsor to you. 4. Co-Promoters, but only with respect to their liability as a co—promoter to you 5. Subcontractors 6. Grantor of Franchise, but only with respect to their liability as grantor of franchise to you. With respect to any additional insured covered under this policy, this insurance does not apply to the sole negligence of such additional insured. Page 1 of 1 I M PORTANT If the certificate holder is an ADDITIONAL_IN9JFR®,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If 9J13ROCATION ISWAIV®, 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). DIMAI M ER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AOORD 25(2009/01) POLICY CHANGE DOCUMENT POLICY NO: CHANGE # 1 CHANGE EFFECTIVE: 06/23/2017 PHPK1511806-001 Philadelphia Indemnity Insurance Company I PRODUCER: Maguire Insurance Agency, Inc. NAMED INSURED: mark wright MAILING ADDRESS POLICY PERIOD: FROM 06/23/2017 TO 06/23/2018 at 12:01 A.M. Standard Time at your mailing address shown above. DESCRIPTION: In consideration of the premium reflected,the policy is amended as indicated below: Added 1 Additional Insured. Total Annual Total Prorate Additional/Return Premium $0.00 Additional/Return Premium $0.00 Total Annual Total Prorate Additional/Return Additional/Return Tax/Surcharge/Fee $0.00 Tax/Surcharge/Fee $0.00 Page 1 of 1 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) Prepared on February 6,2017 Page 3 of 4 Nationwide' Your Policy Declarations is on your side Personal Auto Policy Policy Period:Mar 6,2017-Mar 6,2018 Policy Number: PPA 0018765501-0 Account Number: 7255551749 Premium Summary 2001 Gmc Sierra1500 $501.68 2008 Toyo Camry Le/ $1,025.26 2014 Lexu Gs 350 $1,292.84 State Fraud Surcharge*No Refund $5.28 Total For Policy Coverages $0.00 Total Policy Premium $2,825.06 0 Policy Form and Endorsements C) IN1254(0816) N AA0001 (0986) Personal Auto Policy V" AA0001A(1111) Signature Page C) AA0007(1192) Changes Provision Co AA0008A(1109) Allied Extra Coverages C) AA0073(0697) Waiver of Collision Deductible M AAO 169(1014) Amendment of Policy Provisions-California AA0487(1109) Uninsured Motorists Coverage-California ErLM For Office Use Only: 03/06/07 Terr:998 $0.00 Issued By:Amco Insurance Company,Des Moines,IA Countersigned at:Des Moines,IA By:Tera Insurance Services Inc Horn to Contact Us Your Allied Agent TERA INSURANCE SERVICES INC 408.457.3030 Customer Service 1.800.282.1446 Internet www.alliedinsurance.com 24-Hour Claims Reporting 1.800.282.1446 16243(12-08) Prepared on February 6,2017 Page 3 of 4 Nationwide® Your Policy Declarations is on your side Personal Auto Policy Policy Period:Mar 6,2017-Mar 6,2018 Policy Number: PPA 0018765501-0 Account Number: 7255551749 Premium Summary 2001 Gmc Sierra1500 $501.68 2008 Toyo Camry Le/ $1,025.26 2014 Lexu Gs 350 $1,292.84 State Fraud Surcharge*No Refund $5,28 Total For Policy Coverages $0.00 Total Policy Premium $2,825.06 0 Policy Form and Endorsements Ln IN 1254(0816) 0 N AA0001 (0986) Personal Auto Policy AA0001A(1111) Signature Page 0 AA0007(1192) Changes Provision co AA0008A(1109) Allied Extra Coverages C) AA0073(0697) Waiver of Collision Deductible M AAO 169(1014) Amendment of Policy Provisions-California AA0487(1109) Uninsured Motorists Coverage-California For Office Use Only: 03/06/07 Terr:998 $0.00 Issued By:Amco Insurance Company,Des Moines,IA Countersigned at:Des Moines,IA By:Tera Insurance Services Inc How to Contact Us Your Allied Agent TERA INSURANCE SERVICES INC 408.457.3030 Customer Service 1.800.282.1446 Internet www.alliedinsurance.com 24-Hour Claims Reporting 1.800.282.1446 16243(12-08) Prepared onFebruary 6.2017 Page 1 of 4 Nationwide® Your Policy Declarations is on your side Personal Auto Policy Policy Period:Mar 6,2017-Mar 6,2018 Policy Number: PPA 0018765501-0 Policyholder(Named Insured): Account Number: 7255551749 Mark A.Wright Aiqiu Xie Keep these Declarations for your records. General Policy Information Issued:February 6,2017 These Declarations are a part of the policy named above and identified by the policy number above.They supersede any ►� Declarations issued earlier.Your policy provides the coverages and limits shown in the schedule of coverages.They apply C) to each insured vehicle as indicated.Your policy complies with the motorist's financial responsibility laws of your state N only for vehicles for which Property Damage and Bodily Injury Liability coverages are provided. o Policy Period:March 6,2017-March 6,2018 but only if the required premium for this period has been paid and only for twelve month renewal periods if renewal premiums have been paid as required.This policy is initially effective at(1) Co the time the application for insurance is completed,or(2)12:01 a.m.on the first day of the policy period,whichever is o later.Each renewal period begins and ends at 12:01 a.m.Standard time at the address of the named insured stated '^ herein.This policy term expires at 12:01 a.m.at the address of the named insured stated herein. Your carrier is Amco Insurance Company, NAIC#19100. How You Saved on this Policy with Allied + Multi-Policy + Persistency Discount + Multi-Car Discount + Air Bag Discount + Anti-Theft Device + Good Driver Discount + Elite Driver Discount Insured Drivers Name Date of Birth Marital Status License Number Mark Wright 15243(12-08) I.Ont hued on ' e rxzxcrt;Paggs Prepared on February 6,2017 Page 2 of 4 Nationwide® Your Policy Declarations is on your side Personal Auto Policy Policy Period:Mar 6,2017-Mar 6,2018 Policy Number: PPA 0018765501-0 For coverage definitions and descriptions, Account Number: 7255551749 visit www.alliedinsurance.com Insured Vehicles and Schedule of Coverages 2001 Gmc Sierra1500 VIN 1GTEC14W11Z322158 Coverages Limits of Liability Premium Bodily Injury Liability $500,000 Per Person $227.96 $500,000 Per Occurrence Property Damage Liability $100,000 Per Occurrence $175.04 Medical Payments $5,000 Per Person $18.60 Uninsured Motorist Bodily Injury $100,000 Per Person $73.88 $300,000 Per Accident Uninsured Motorist Property Damage $3,500 Per Occurrence $6.20 Liability Total for this Vehicle $501.68 2008 Toyo Camry Lel VIN 4T1 BE46K28U733595 Coverages Limits of Liability Premium Bodily Injury Liability $500,000 Per Person $314.96 $500,000 Per Occurrence Property Damage Liability $100,000 Per Occurrence $237.78 Medical Payments $5,000 Per Person $36.46 Uninsured Motorist Bodily Injury $100,000 Per Person $99.56 $300,000 Per Accident Comprehensive Actual Cash Value Less A$500 Deductible $39.82 Collision Actual Cash Value Less A$500 Deductible $290.56 Waiver Of Collision Deductible $6.12 Total for this Vehicle $1,025.26 2014 Lexu Gs 350 VINJTHBEIBL4ESO41229 Coverages Limits of Liability Premium Bodily Injury Liability $500,000 Per Person $304.96 $500,000 Per Occurrence Property Damage Liability $100,000 Per Occurrence $170.22 Medical Payments $5,000 Per Person $27.06 Uninsured Motorist Bodily Injury $100,000 Per Person $100.30 $300,000 Per Accident Comprehensive Actual Cash Value Less A$500 Deductible $81.74 Collision Actual Cash Value Less A$500 Deductible $602.44 Waiver Of Collision Deductible $6.12 Total for this Vehicle $1,292.84 Policy Level Schedule of Coverages Allied Extra Coverages See Endorsement Tota!for Polity Coverages $0.00 Continued on the next page 162.93 i12-081