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Action Research-Certificate of Insurance-2018CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) INSURER(S) AFFORDING COVERAGE NAIC # PRODUCER INSURED INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : COVERAGES TYPE OF INSURANCE POLICY NUMBER LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: LOCPOLICY OTHER: EACH OCCURRENCE MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ $ $ $ $ $ AUTOMOBILE LIABILITY ANY AUTO $ $ $ $ OCCUR CLAIMS-MADE DED RETENTION $ EACH OCCURRENCE AGGREGATE E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION $ $ $ $ $ Y/N CONTACT NAME: PHONE (A/C, No, Ext): E-MAIL ADDRESS: FAX (A/C, No): CERTIFICATE NUMBER:REVISION NUMBER: $ UMBRELLA LIAB EXCESS LIAB AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD $ INSURER F : $ N/A SCHEDULED AUTOS NON-OWNED AUTOS ONLY OWNED AUTOS ONLY HIRED AUTOS ONLY THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADDL INSD POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) PRO- JECT DAMAGE TO RENTED PREMISES (Ea occurrence) COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below PER STATUTE OTH- ER SUBR WVD THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 07/28/2018 PAYCHEX INSURANCE AGENCY INC 150 SAWGRASS DR ROCHESTER, NY 14620 (877) 362-6785 (877) 362-6785 (877) 677-0447 paychex@travelers.com ACTION RESEARCH INC 3630 OCEAN RANCH BLVD OCEANSIDE, CA 92056 TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 928329757412802 A X UB-8K900398-18 04/16/2018 04/16/2019 X 1,000,000 1,000,000 1,000,000 AS RESPECTS TO WORKERS COMPENSATION COVERAGE, WC 99 03 76 ( A) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA HAS BEEN ATTACHED TO THE POLICY. CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO, CA 95014 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 5/15/2018 Lovitt &Touche'Inc -Phoenix P.O.Box 64985 Phoenix AZ 85082 Karen Charlton 602-385-0541 602-956-2258 kcharlton@lovitt-touche.com Massachusetts Bay Insurance Co 22306 ACTIRES-C1 Darwin Select Insurance CompanyActionResearch,Inc. 3630 Ocean Ranch Blvd. Oceanside CA 92056 1198415117 A X 2,000,000 X 300,000 10,000 2,000,000 4,000,000 X Y Y OD4A636297 6/15/2018 6/15/2019 4,000,000 Deductible 0 A X X Y OD4A636297 6/15/2018 6/15/2019 Deductible 0 B Professional Liability 03036101 6/15/2018 6/15/2019 Occurrence Limit Aggregate Limit Deductible $1,000,000 $1,000,000 $2,500 Regarding the Liability coverage shown,if required by written contract: 1)This insurance is Primary and Non-Contributory with respect to any other insurance maintained by the Additional Insured(s),and 2)Certificate Holder(s)and others as required in said contract are Additional Insured(s)(except Workers Compensation), 3)the company Waives its Right of Subrogation against the Additional Insured(s). Coverage is subject to all policy terms,conditions,definitions,exclusions,forms &endorsements. City of Cupertino 10300 Torre Ave Cupertino CA 95014 ~&\\Hanover ~ Jnsurance Group- OD4A636297 2301022 BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE EAD IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SUMMARY OF COVERAGES 1. Additional Insured by Contract, Agreement or Permit 2. Additional Insured -Broad Form Vendors 3. Alienated Premises 4. Bodily Injury Redefined 5. Broad Form Property Damage-Borrowed Equipment, Customers 6. Incidental Malpractice (Employed Nurses, EMT's and Paramedics) 7. Personal and Advertising Injury-Broad Form Limits Goods and Use of Elevators l 8. Product Recall Expense $, 5,000 Occurrence $50,000 Aggregate 9. Unintentional Failure to Disclose Hazards 10. Unintentional Failure to Notify Page 2 2 2 2 3 3 3 5 5 This endorsement amends coverages provided under the Businessowners Coverage Form through new coverages and broader coverage grants. This coverage is subjectlto the provisions applicable to the Businessowners Coverage Form, except as provided below. 1. Additional Insured by Contract, Agreement or This in urance applies on a primary basis if Permit that is required by the written contract, agreen1ent or permit. Under SECTION II -LIABILITY, C. Who Is An 1 Insured, Paragraph 4. is added as follows: b. This prfvision does not apply: a. Any person or organization for whom you (1) Unl 1 ess the written contract or written are performing operations when you and ag~eement has been executed or permit such person or organization have agreed in has been issued prior to the "bodily writing in a contract, agreement or permit injYry", "property damage" or "personal that such person or organization be added anl advertising injury"; as an additional insured on your policy. Such (2) To any person or organization included person or organization is an additional as an insured by an endorsement insured only with respect to liability for iss ed by us and made part of this "bodily injury", "property dam age" or Pol 'icy; "personal and advertising injury" caused, in I whole or in part, by: (3) To any person or organization included as an insured under Item 1.a.2. of this (1) Your acts or omissions; or enqorsement; (2) The acts or omissions of those acting (4) To lany lessor of equipment: on your behalf, but only with respect to: (3) "Your work" for the additional insured(s) at the location designated in the contract, agreement or permit; or (4) Premises you own, rent, lease, control or occupy. (a) After the equipment lease expires; or (b) If the "bodily injury", "property damage" or "personal and advertising injury" arises out of the sole negligence of the lessor: 391-1006 06 09 25,077 Includes copyrighted material of Insurance Services Office, Inc. I Page 1 of 5 (5) To any: (a) Owners or other interests from whom land has been leased which takes place after the lease for that land expires; or (b) Managers or lessors of premises if: (i) The occurrence takes place after you cease to be a tenant in that premises; or (ii) The "bodily injury", "property damage" or "personal and advertising injury" arises out of structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor; or (6) To "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services. c. Additional insured coverage provided by this provision will not be broader than coverage provided to any other insured. d. All other insuring agreements, exclusions, and conditions of the policy apply. 2. Additional Insured -Broad Form Vendors Under SECTION II · LIABILITY, C. Who Is An Insured, paragraph 5. is added as follows: 5. Any person or organization with whom you agreed, because of a written contract or written agreement to provide insurance, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instruction from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspection, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the distribution or sale of the product; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any thing or substance by or for the vendor; or h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in paragraphs 5.d. or 5.f.; or (2) Such inspections, adjustments, test or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 3. Alienated Premises Under SECTION II -LIABILITY, B. Exclusions, paragraph 1.k.(2) is replaced in its entirety with the following: (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises and occurred from hazards that were known by you, or should have reasonably been known by you, at the time the property was transferred or abandoned. 4. Bodily Injury Redefined Under SECTION II -LIABILITY, F. Liability and Medical Expenses Definitions, definition 4. is replaced in its entirety by the following: 391·1006 06 09 25,078 Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 5 4. "Bodily injury" means bodily injury, disability. sickness or disease sustained by a person, including death resulting from any of these at any time. "Bodily Injury" includes mental anguish or other mental injury resulting from "bodily injury". 5. Broad Form Property Damage -Borrowed Equipment, Customers Goods, Use of Elevators a. Under SECTION II LIABILITY, B. Exclusions, paragraph 1.k., the following is added: Paragraph (4) does not apply to "property damage" to borrowed equipment while at a jobsite and not being used to perform operations. Paragraph (3), (4) and (6) do not apply to "property damage" to "customers goods" while on your premises nor to the use of elevators. b. Under SECTION II -LIABILITY, F. Liability and Medical Expenses Definitions, the following additional definition is added: "Customers goods" means property of your customer on your premises for the purpose of being: a. Worked on; or b. Used in your manufacturing process. c. The insurance afforded under this provision is excess over any other valid and collectible property insurance (including deductible) available to the insured whether primary, excess, contingent or on any other basis. 6. Incidental Malpractice -Employed Nurses, EMf's and Paramedics Under SECTION II -LIABILITY, C. Who Is An Insured, paragraph 2.a.(1)(d) does not apply to a nurse, emergency medical technician or paramedic employed by you if you are not engaged in the business or occupation of providing medical, paramedical, surgical, dental, x-ray or nursing services. 7. Personal and Advertising Injury -Broad Form Under SECTION II -LIABILITY, F. Liability and Medical Expenses Definitions, definition 15, "Personal and Advertising Injury", paragraph h. is added as follows: h. Discrimination or humiliation (unless insurance thereof is prohibited by law) that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) Not done intention ally by or at the direction of: ;&\\Hanover ~ lnsurance Group- 004 A636297 2301022 (a) he insured; or (b) ~ny officer of the corporation, rector, stockholder, partner or ember of the insured; and (2) Not irectly or indirectly related to an "employee", nor to the employment, prosp clive employment or termination of any p rson or persons by an insured. B. Product Re all Expense a. Under SECTION II LIABILITY, B. Exclusi ns, Paragraph 1. o. is replaced in its entire! by the following: o. Re all of Products, Work or Impaired Property Da~ages claimed for any loss, cost or ex ense incurred by you or others for the loss of use, withdrawal, recall, ins ection, repair, replacement, adj stment, removal or disposal of: (1) "Your product"; (2) "Your work"; or (3) "Impaired property"; If uch product, work or property is wit drawn or recalled from the market or from use by any person or organization because of a known or su~pected defect, deficiency, inadequacy or dangerous condition in it, but this ex I us ion does not apply to "product recall expenses" that you incur for the "co~~ered recall" of "your product". The ex eption to the exclusion does not ap ly to "product recall expenses" res lting from: (1) Failure of any products to accomplish their intended purpose; (2) Breach of warranties of fitness, quality, durability or performance; (3) Loss of customer approval, or any cost incurred to regain customer approval; (4) Redistribution or replacement of "your product" which has been recalled by like products or substitutes; (5) Caprice or whim of the insured; (6) A condition likely to cause loss of which any insured knew or had reason to know at the inception of this insurance; <n Asbestos, including loss, damage or clean up resulting from asbestos or asbestos containing materials; or 391-1006 06 09 25,079 Includes copyrighted material of Insurance Servic s Office, Inc. Page 3 of 5 (B) Recall of "your products" that have no known or suspected defect solely because a known or suspected defect in another of "your products" has been found. b. Under SECTION II -LIABILITY, C. Who Is An Insured, paragraph 4.c. is added as follows: c. "Bodily injury" or "property damage" do not apply to "product recall expense" ansmg out of any withdrawal or recall that occurred before you acquired or formed the organization. c. Under SECTION II -LIABILITY, E. Liability and Medical Expense General Conditions, 2. Duties in the Event of Occurrence, Offense, Claim or Suit, paragraph e. is added as follows: e. You must see to it that the following are done in the event of an actual or anticipated "covered recall" that may result in "product recall expense": (1) Give us prompt notice of any discovery or notification that "your product" m us! be withdrawn or recalled. Include a description of "your product" and the reason for the withdrawal or recall; (2) Cease any further release, shipment. consignment or any other method of distribution of like or similar products until it has been determined that all such products are free from defects that could be a cause of loss under this insurance. d. Under SECTION II -LIABILITY, F. Liability and Medical Expenses Definitions, the following additional definitions are added: "Covered recall" means a recall made necessary because you or a govern men! body has determined that a known or suspected defect. deficiency, inadequacy, or dangerous condition in "your product" has resulted or will result in "bodily injury" or "property damage". "Product recall expense(s)" means: a. Necessary and reasonable expenses for: (1) Communications. including radio or television announcements or printed advertisements including stationary, envelopes and . postage; (2) Shipping the recalled products from any purchaser. distributor or user to the place or pi aces designated by you; (3) Remuneration paid to your regular "employees" for necessary overtime; (4) Hiring additional persons. other than your regular "employees"; (5) Expenses incurred by "employees" including iransportation and accommodations; (6) Expenses to rent add ilion al \"arehouse or storage space; <n Disposal of "your product". but only· to the extent that specific methods of destruction other than those employed for trash discarding or disposal are required to avoid "bodily injury" or "property damage" as a result of such disposal, you ,incur exclusively for the purpose of re;calling "your product"; and b. Your lost profit resulting from such "covered recall". e. Under SECTION II -LIABILITY, D. Liability: and Medical Expenses Limits of Insurance, the following is added: 5. The Limits of Insurance and rules stated below fix the most that we will•pay under this Product Recall Exp~nse Coverage. (1) The Aggregate Limit is the most that we will reimburse you for the sum of all "product recall expenses" incurred for all ·:product recall expenses" initiated during the policy period. (2) The Occurrence Limit shown on the Summary of Coverages is the most we will pay in connection with any one defect or deficiency. (a) All "product recall expenses" in connection with substantially the same general harmful condition will be deemed to arise out of the same defect or deficiency and considered one "occurrence'/. 351-1006 06 OS 25,080 Includes copyrighted material of Insurance Services Office, Inc. Page 4 of 5 (b) Any amount reimbursed for "product recall expenses" in connection with any one "occurrence" ·will reduce the amount of the Aggregate Limit available for reimbursement of "product recall expenses" in connection with any other defect or deficiency. (c) If the Aggregate Limit has been reduced by reimbursement of "product recall expenses" to an amount that is less than the Occurrence Lim it, the remaining Aggregate Limit is the most that will be available for reimbursement of "product recall expenses" in connection with any other defect or deficiency. 6. A deductible of $500 applies per each "Occurrence". 9. Unintentional Failure to Disclose Hazards Under SECTION II · LIABILITY, E. Liability and Medical Expenses General Conditions, paragraph 6. is added as follows: 6. Representations We will not disclaim coverage under this Coverage Form if you fail to disclose all hazards existing as of the inception date of the policy provided such failure is not intentional. 10. Unintentional Failure to Notify Under SECTION II · LIABILITY, E. Liability and Medical Expenses General Conditions, 2. Duties in the Event of Occurrence, Offense, Claim or Suit, paragraph f. is added as follows: f. Your rights afforded under this Coverage Form shall not be prejudiced if you fail to give us notice of an "occurrence", offense, claim or "suit", solely due to your reasonable and documented belief that the "bodily injury" or "property damage" is not covered under this Policy. 391-1006 06 09 25,081 Includes copyrighted material of Insurance Ser·vicoos Office, Inc. ~\\Hanover ~ Jnsurance Group- OD4A636297 2301022 Page 5 of 5 Includes copyrighted material of Insurance Services Office, Inc., 1997,2001 391-1006 (7/02) Page 1 of 5 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SUMMARY OF COVERAGES Limits Page 1. Additional Insured by Contract, Agreement or Permit 1 2. Additional Insured – Broad Form Vendors 2 3. Alienated Premises 2 4. Bodily Injury Redefined 2 5. Broad Form Property Damage – Borrowed Equipment, Customers 2 Goods and Use of Elevators 6. Incidental Malpractice (Employed Nurses, EMT’s and Paramedics) 3 7. Personal and Advertising Injury – Broad Form 3 8. Product Recall Expense $25,000 Occurrence $50,000 Aggregate 3 9. Unintentional Failure to Disclose Hazards 5 10. Unintentional Failure to Notify 5 This endorsement amends coverages provided under the Businessowners Coverage Form through new coverages and broader coverage grants. This coverage is subject to the provisions applicable to the Businessowners Coverage Form, except as provided below. 1. Additional Insured by Contract, Agreement or Permit Under Section II – Liability C. Who Is An Insured, Paragraph 5. is added as follows: 5. Any person or organization with whom you agreed, because of a written contract, written agreement or permit to provide insurance, is an insured, but only with respect to: a. “Your work” for the additional insured(s) at the location designated in the contract, agreement or permit; or b. Facilities owned or used by you. This insurance applies on a primary basis if that is required by the written contract, written agreement or permit. This provision does not apply: a. Unless the written contract or written agreement has been executed or permit has been issued prior to the “bodily injury” , “property damage” or “personal and advertising injury”; b. To any person or organization included as an insured by an endorsement issued by us and made part of this Policy; c. To any person or organization included as an insured under Item 2 of this endorsement; d. To any lessor of equipment: (1) After the equipment lease expires; or (2) If the “bodily injury”, “property damage” or “personal and advertising injury” arises out of the sole negligence of the lessor; or e. To any: (1) Owners or other interests from whom land has been leased which takes place after the lease for that land expires; or Includes copyrighted material of Insurance Services Office, Inc., 1997,2001 391-1006 (7/02) Page 2 of 5 (2) Managers or lessors of premises if: (a) The occurrence takes place after you cease to be a tenant in that premises; or (b) The “bodily injury”, “property damage” or “personal and advertising injury” arises out of structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor. 2. Additional Insured - Broad Form Vendors Under Section II – Liability C. Who Is An Insured, paragraph 6. is added as follows: 6. Any person or organization with whom you agreed, because of a written contract or written agreement to provide insurance, but only with respect to “bodily injury” or “property damage” arising out of “your products” which are distributed or sold in the regular course of the vendor’s business. This provision does not apply to: a. “Bodily injury” or “property damage” for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instruction from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspection, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the sale of the product; f. Demonstration, installation, servicing or repair operations performed at the vendor’s premises in connection with the sale of the product; or g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any thing or substance by or for the vendor. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 3. Alienated Premises Under Section II – Liability B. Exclusions, paragraph 1.k.(2) is replaced in its entirety with the following: (2) Premises you sell, give away or abandon, if the “property damage” arises out of any part of those premises and occurred from hazards that were known by you, or should have reasonably been known by you, at the time the property was transferred or abandoned. 4. Bodily Injury Redefined Under Section II – Liability F. Liability and Medical Expenses Definitions, definition 4. is replaced in its entirety by the following: 4. “Bodily injury” means bodily injury, sickness or disease sustained by a person, this includes mental anguish, mental injury shock, fright or death resulting from such bodily injury, sickness or disease. 5. Broad Form Property Damage – Borrowed Equipment, Customers Goods, Use of Elevators a. Under Section II – Liability B. Exclusions, paragraph 1.k. the following is added: Paragraph (4) does not apply to “property damage” to borrowed equipment while at a jobsite and not being used to perform operations. Paragraph (3), (4) and (6) do not apply to “property damage” to “customers goods” while on your premises nor to the use of elevators. Includes copyrighted material of Insurance Services Office, Inc., 1997,2001 391-1006 (7/02) Page 3 of 5 b. Under Section II – Liability F. Liability and Medical Expenses Definitions, definition 25. is added as follows: 25. “customers goods” means property of your customer on your premises for the purpose of being: a. worked on; or b. used in your manufacturing process. c. The insurance afforded under this provision is excess over any other valid and collectible property insurance (including deductible) available to the insured whether primary, excess, contingent or on any other basis. 6. Incidental Malpractice – Employed Nurses, EMT’s and Paramedics Under Section II – Liability C. Who Is An Insured, paragraph 2.a.(1)(d) does not apply to a nurse, emergency medical technician or paramedic employed by you if you are not engaged in the business or occupation of providing medical, paramedical, surgical, dental, x-ray or nursing services. 7. Personal and Advertising Injury – Broad Form Under Section II – Liability F. Liability and Medical Expenses Definitions, definition 16, paragraph h. is added as follows: h. Discrimination or humiliation (unless insurance thereof is prohibited by law) that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1) Not done intentionally by or at the direction of: (a) The insured; or (b) Any officer of the corporation, director, stockholder, partner or member of the insured; and (2) Not directly or indirectly related to an “employee”, nor to the employment, prospective employment or termination of any person or persons by an insured. 8. Product Recall Expense a. Under Section II – Liability B. Exclusions, Paragraph 1. o. is replaced in its entirety by the following: o. Recall of Products, Work or Impaired Property Damages claimed for any loss, cost or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal or disposal of: (1) “Your product”; (2) “Your work”; or (3) “Impaired property”; If such product, work or property is withdrawn or recalled from the market or from use by any person or organization because of a known or suspected defect, deficiency, inadequacy or dangerous condition in it, but this exclusion does not apply to “product recall expenses” that you incur for the “covered recall” of “your product”. The exception to the exclusion does not apply to “product recall expenses” resulting from: (1) Failure of any products to accomplish their intended purpose; (2) Breach of warranties of fitness, quality, durability or performance; (3) Loss of customer approval, or any cost incurred to regain customer approval; (4) Redistribution or replacement of “your product” which has been recalled by like products or substitutes; (5) Caprice or whim of the insured; (6) A condition likely to cause loss of which any insured knew or had reason to know at the inception of this insurance; (7) Asbestos, including loss, damage or clean up resulting from asbestos or asbestos containing materials; or (8) Recall of “your products” that have no known or suspected defect solely because a known or suspected defect in another of “your products” has been found. Includes copyrighted material of Insurance Services Office, Inc., 1997,2001 391-1006 (7/02) Page 4 of 5 b. Under Section II – Liability C. Who Is An Insured, paragraph 4.c. is added as follows: c. “Bodily injury” or “property damage” do not apply to “product recall expense” arising out of any withdrawal or recall that occurred before you acquired or formed the organization. c. Under Section II – Liability E. Liability and Medical Expense General Conditions, 2. Duties in the Event of Occurrence, Offense, Claim or Suit, paragraph e. is added as follows: e. You must see to it that the following are done in the event of an actual or anticipated “covered recall” that may result in “product recall expense”: (1) Give us prompt notice of any discovery or notification that “your product” must be withdrawn or recalled. Include a description of “your product” and the reason for the withdrawal or recall; (2) Cease any further release, shipment, consignment or any other method of distribution of like or similar products until it has been determined that all such products are free from defects that could be a cause of loss under this insurance. d. Under Section II – Liability F. Liability and Medical Expenses Definitions, definition 26 and 27 are added as follows: 26. “Covered recall” means a recall made necessary because you or a government body has determined that a known or suspected defect, deficiency, inadequacy, or dangerous condition in “your product” has resulted or will result in “bodily injury” or “property damage”. 27. “Product recall expense (s)” means: a. Necessary and reasonable expenses for: (1) Communications, including radio or television announcements or printed advertisements including stationary, envelopes and postage; (2) Shipping the recalled products from any purchaser, distributor or user to the place or places designated by you; (3) Remuneration paid to your regular “employees” for necessary overtime; (4) Hiring additional persons, other than your regular “employees”; (5) Expenses incurred by “employees” including transportation and accommodations; (6) Expenses to rent additional warehouse or storage space; (7) Disposal of “your product”, but only to the extent that specific methods of destruction other than those employed for trash discarding or disposal are required to avoid “bodily injury” or “property damage” as a result of such disposal; You incur exclusively for the purpose of recalling “your product”’ and b. Your lost profit resulting from such “covered recall”. e. Under Section II – Liability D. Liability and Medical Expenses Limits of Insurance the following is added: 5. The Limits of Insurance and rules stated below fix the most that we will pay under this Includes copyrighted material of Insurance Services Office, Inc., 1997,2001 391-1006 (7/02) Page 5 of 5 Product Recall Expense Coverage. (1) The Aggregate Limit is the most that we will reimburse you for the sum of all “product recall expenses” incurred for all “product recall expenses” initiated during the policy period. (2) The Occurrence Limit shown on the Summary of Coverages is the most we will pay in connection with any one defect or deficiency. (a) All “product recall expenses” in connection with substantially the same general harmful condition will be deemed to arise out of the same defect or deficiency and considered one “occurrence”. (b) Any amount reimbursed for “product recall expenses” in connection with any one “occurrence” will reduce the amount of the Aggregate Limit available for reimbursement of “product recall expenses” in connection with any other defect or deficiency. (c) If the Aggregate Limit has been reduced by reimbursement of “product recall expenses” to an amount that is less than the Occurrence Limit, the remaining Aggregate Limit is the most that will be available for reimbursement of “product recall expenses” in connection with any other defect or deficiency. 6. A deductible of $500 applies per each “Occurrence”. 9. Unintentional Failure to Disclose Hazards Under Section II – Liability E. Liability and Medical Expenses General Conditions, paragraph 6. Is added: 6. Representations We will not disclaim coverage under this Coverage Form if you fail to disclose all hazards existing as of the inception date of the policy provided such failure is not intentional. 10. Unintentional Failure to Notify Under Section II - E. Liability and Medical Expenses General Conditions, 2. Duties in the Event of Occurrence, Offense, Claim or Suit, paragraph f. is added as follows: f. Your rights afforded under this Coverage Form shall not be prejudiced if you fail to give us notice of an “occurrence”, offense, claim or “suit”, solely due to your reasonable and documented belief that the “bodily injury” or “property damage” is not covered under this Policy.