General Liability $1, Commercial Fire $1, NJ PLIGA $ TOTAL DEPOSIT PREMIUM (Includes taxes and surcharges)

Transcription

1 Wesco Insurance Company Policy Number: 800 Superior Avenue East, 21st Floor WPP Cleveland, OH Named Insured: JUAN DE DIOS COMMERCIAL PACKAGE POLICY SUMMARY PAGE Policy Number WPP Policy Period: From 5/10/2015 To 5/10/ :01 a.m. Standard Time at the Named Insured s Address Transaction New Business Named Insured and Address JUAN DE DIOS DBA: D&R DELI MEAT MARKET 7101 PARK AVE WEST NEW YORK NJ Agent J. J. FARBER LOTTMAN & CO., INC. 200 ROUTE 5 BOX 613 PALISADES PARK NJ Telephone: (201) Business Description Type of Business Audit Period Grocery with Cooking Individual Annual 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. COVERAGE PART DESCRIPTION PREMIUM General Liability $1, Commercial Fire $1, NJ PLIGA $28.00 POLICY PREMIUM $ 3, DEPOSIT PREMIUM $ 3, TAXES AND SURCHARGES $ TOTAL DEPOSIT PREMIUM (Includes taxes and surcharges) $ 3, Forms applicable to all Coverage Parts: See Forms and Endorsements schedule These Declarations together with the common policy conditions, coverage declarations, coverage form(s), and form(s) and endorsements, if any, issued, complete the above number policy. Countersigned this By Authorized Representative Issued Date: 3/27/2015 CPPDEC 0408 Page 1 of 12 INSURED COPY

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3 Wesco Insurance Company Policy Number: 800 Superior Avenue East, 21st Floor WPP Cleveland, OH Named Insured: JUAN DE DIOS Prem # Park Ave West New York NJ COMMERCIAL PACKAGE POLICY LOCATION SUMMARY Issued Date: 3/27/2015 Page 2 of 12 DECLOCSCH 0408

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5 Wesco Insurance Company Policy Number: 800 Superior Avenue East, 21st Floor WPP Cleveland, OH Named Insured: JUAN DE DIOS GENERAL LIABILITY COVERAGE PART Policy Number WPP Policy Period: From 5/10/2015 To 5/10/ :01 a.m. Standard Time at the Named Insured s Address Transaction New Business Named Insured and Address JUAN DE DIOS DBA:D&R DELI MEAT MARKET 7101 PARK AVE WEST NEW YORK NJ Agent J. J. FARBER LOTTMAN & CO., INC. 200 ROUTE 5 BOX 613 PALISADES PARK NJ Telephone: (201) Business Description Type of Business Audit Period Grocery with Cooking Individual Annual 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. LIMITS OF INSURANCE General Aggregate Limit (Other than Products-Completed Operations) $ 2,000,000 Products Completed Operations Aggregate Limit $ 1,000,000 Each Occurrence Limit $ 1,000,000 Medical Expense Limit, any one person $ 5,000 Damage to Premises Rented to You Limit, any one premises $ 100,000 Personal and Advertising Injury Limit $ 1,000,000 AMENDED LIMITS OF LIABILITY Refer to attached schedule, if any. LOCATIONS OF ALL PREMISES YOU OWN, RENT OR OCCUPY Refer to attached schedule. CLASSIFICATIONS Refer to attached schedule, if any. Forms and Endorsements Applicable TOTAL PREMIUM FOR THIS COVERAGE PART $ 1, See Forms and Endorsements Schedule These Declarations together w it h t he common policy conditions, coverage declarations, coverage form(s), and form(s) and endorsement s, if any, issued, complete t he above numbered policy. Issued Date: 3/27/2015 Page 3 of 12 GLDEC 0410 INSURED COPY

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7 IN WITNESS WHEREOF, the company has caused this policy to be executed and attested by its President and Secretary at Rocky Hill, Connecticut, and this policy shall not be valid unless countersigned by an authorized representative of the company. President Secretary Issued Date: 3/27/2015 GLDEC 0106 Page 4 of 12 INSURED COPY

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9 Wesco Insurance Company Policy Number: 800 Superior Avenue East, 21st Floor WPP Cleveland, OH Named Insured: JUAN DE DIOS COMMERCIAL GENERAL LIABILITY EXTENSION OF DECLARATIONS LOCATION OF PREMISES Location of All Premises You Own, Rent or Occupy: Park Ave West New York NJ PREMIUM Rate Advance Premium Location Classification Code No. Exposure Basis Prem. Ops. Prod/Comp Prem. Ops. Prod/Comp Ops. Ops. $94.00 Minimum Products ,000 s $ $16.00 Grocery Stores (excluding Supermarkets with receipts in excess of $500,000 and area in excess of 3,000 sq. feet) u $ $0.00 Apartment Buildings Extension of Declarations Total Advance Annual Premium $1, Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., Issued Date: 3/27/2015 Page 5 of 12 GLDEC 0408 INSURED COPY

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11 Wesco Insurance Company Policy Number: 800 Superior Avenue East, 21st Floor WPP Cleveland, OH Named Insured: JUAN DE DIOS COMMERCIAL PROPERTY DECLARATIONS Policy Number WPP Policy Period: From 5/10/2015 To 5/10/ :01 a.m. Standard Time at the Named Insured s Address Transaction New Business Named Insured and Address Agent JUAN DE DIOS J. J. FARBER LOTTMAN & CO., INC. D&R DELI MEAT MARKET 7101 PARK AVE WEST NEW YORK NJ ROUTE 5 BOX 613 Telephone: (201) Business Description Type of Business Audit Period Grocery with Cooking Individual Annual <StateSpecific1> 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. DESCRIPTION OF PREMISES Refer to attached schedule. COVERAGES PROVIDED Refer to attached schedule, if any. OPTIONAL COVERAGES Refer to attached schedule, if any. MORTGAGEES AND ADDITIONAL INTERESTS Refer to attached schedule, if any. TOTAL PREMIUM FOR THIS COVERAGE PART $1, Forms and Endorsement s A pplicable t o t his Policy See Forms and Endorsements Schedule These Declarations together w it h t he common policy conditions, coverage part declarations, coverage part, coverage form(s) and form(s) and endorsements, if any, issued to form a part thereof, complete the above numbered policy. <StateSpecific2> Issued Date: 03/27/2015 DEC CF 0408 Page 6 of 12 INSURED COPY

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13 Wesco Insurance Company Policy Number: 800 Superior Avenue East, 21st Floor WPP Cleveland, OH Named Insured: JUAN DE DIOS COMMERCIAL PROPERTY DESCRIPTION OF PREMISES Prem. No. Bldg. No. Occupancy Construction Class Prot. Terr. EQ Class EQ Terr. 1 1 RESTAURANTS-W/NO SALE OF ALCO.BEV-W/TABLE SERVICE Joisted Masonry (Code 2) DEC CF B 0408 ISO Properties, Inc., 2005 Page 7 of 12

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15 Wesco Insurance Company Policy Number: 800 Superior Avenue East, 21st Floor WPP Cleveland, OH Named Insured: JUAN DE DIOS COMMERCIAL PROPERTY DESCRIPTION OF COVERAGES PROVIDED Prem No Bldg No. Coverage Limit Of Insurance Blanket Coverage Covered Causes Of Loss Coinsurance Ded. 1 1 Building $346,458 Basic 80% $1, Personal Property Of The Insured $112,486 Basic 80% $1,000 IF EXTRA EXPENSE COVERAGE, LIMITS ON LOSS PAYMENT Issued Date: 03/27/2015 DEC CF C 0408 Page 8 of 12 INSURED COPY

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17 Wesco Insurance Company Policy Number: 800 Superior Avenue East, 21st Floor WPP Cleveland, OH Named Insured: JUAN DE DIOS COMMERCIAL PROPERTY DESCRIPTION OF OPTIONAL COVERAGES PROVIDED Prem No Bldg No Coverage Effective Date Expiration Date Agreed Value Bldg Valuation Pers Prop Incl Stock Inflation Guard Bldg Pers Prop Monthly Limit of Indemnity Maximum Limit of Indemnity Extended Period of Indemnity 1 1 Bldg RC RC 4% 1 1 Pers Prop RC RC RC = Replacement Cost FRC = Functional Replacement Cost ACV = Actual Cash Value Issued Date: 03/27/2015 DEC CF D 0408 Page 9 of 12 INSURED COPY

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19 Wesco Insurance Company Policy Number: 800 Superior Avenue East, 21st Floor WPP Cleveland, OH Named Insured: JUAN DE DIOS COMMERCIAL PROPERTY SUPPLEMENTAL DECLARATIONS LOCATION SCHEDULE PREMIUM CHARGES: Premises Building Number Number Coverage Covered Causes Of Loss Premium 1 1 Building Basic $ Personal Property Of The Insured Basic $ Equipment Breakdown $61.00 Location 1 Total $1, OTHER PROPERTY COVERAGE PREMIUM CHARGES: Terrorism $25 Total Other Property: Total Blanket Property: $0.00 Total Property Premium Charges: $1, (Excluding Taxes and Surcharges) Issued Date: 3/27/2015 DEC CF F 0408 Page 10 of 12 Insured Copy

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21 Wesco Insurance Company Policy Number: 800 Superior Avenue East, 21st Floor WPP Cleveland, OH Named Insured: JUAN DE DIOS COMMERCIAL PACKAGE POLICY FORMS AND ENDORSEMENTS SCHEDULE Coverage Form _ Ed. Date Description CG CG0001 (12/07) COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG CG0068 (05/09) RECORDING AND DISTRIBUTION OF MATERIAL OR INFORMATION IN VIOLATION OF LAW EXCLUSION CG CG2132 (05/09) COMMUNICABLE DISEASE EXCLUSION CG CG2136 (03/05) EXCLUSION - NEW ENTITIES CG CG2139 (10/93) CONTRACTUAL LIABILITY LIMITATION (FOR USE WITH CGL AND PRODUCTS POLICIES) CG CG2144 (07/98) LIMITATION OF COVERAGE TO DESIGNATED PREMISES OR PROJECT CG CG2147 (12/07) EMPLOYMENT-RELATED PRACTICES EXCLUSION CG CG2149 (09/99) TOTAL POLLUTION EXCLUSION ENDORSEMENT CG CG2151 (09/89) AMENDMENT OF LIQUOR LIABILITY EXCLUSION - EXCEPTION FOR SCHEDULED ACTIVITIES CG CG2160 (09/98) EXCLUSION - YEAR 2000 COMPUTER-RELATED AND OTHER ELECTRONIC PROBLEMS CG CG2167 (12/04) FUNGI OR BACTERIA EXCLUSION CG CG2173 (01/08) EXCLUSION OF CERTIFIED ACTS OF TERRORISM CG CG2196 (03/05) SILICA OR SILICA-RELATED DUST EXCLUSION CG CG2401 (12/04) NON-BINDING ARBITRATION CG CG2620 (10/93) NEW JERSEY CHANGES - LOSS INFORMATION CG CG2651 (01/99) NEW JERSEY CHANGES EXCLUSION LIABILITY FOR HAZARDS OF LEAD CG CG92101 (05/06) ASBESTOS EXCLUSION CG CG92103 (05/06) DISCRIMINATION EXCLUSION CG CG92105 (05/06) ASSAULT & BATTERY EXCLUSION CG CG92158 (01/10) EXCLUSION - IMPORTED (CHINESE) DRYWALL AND SIMILAR PRODUCTS CF CP0010 (06/07) BUILDING AND PERSONAL PROPERTY COVERAGE FORM CF CP0090 (07/88) COMMERCIAL PROPERTY CONDITIONS CF CP0140 (07/06) EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA CF CP1010 (06/07) CAUSES OF LOSS BASIC FORM CF CP1032 (08/08) WATER EXCLUSION ENDORSEMENT Issued Date: 3/27/2015 Page 11 of 12 CPPSCHEDFORM 0408

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23 Wesco Insurance Company Policy Number: 800 Superior Avenue East, 21st Floor WPP Cleveland, OH Named Insured: JUAN DE DIOS COMMERCIAL PACKAGE POLICY FORMS AND ENDORSEMENTS SCHEDULE Coverage Form _ Ed. Date Description CF CP90405 (07/06) EQUIPMENT BREAKDOWN COVERAGE CF CP90421 (10/09) PROTECTIVE SAFEGUARDS CF CP91014 (12/12) EARTH MOVEMENT EXCLUSION CG IL0017 (11/98) COMMON POLICY CONDITIONS CF IL0017 (11/98) COMMON POLICY CONDITIONS CG IL0021 (09/08) NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) CF IL0111 (11/03) NEW JERSEY CHANGES CG IL0141 (09/08) NEW JERSEY CHANGES CIVIL UNION CG IL0208 (09/07) NEW JERSEY CHANGES CANCELLATION AND NONRENEWAL CF IL0208 (09/07) NEW JERSEY CHANGES CANCELLATION AND NONRENEWAL CF IL0935 (07/02) EXCLUSION OF CERTAIN COMPUTER-RELATED LOSSES CF IL0953 (01/08) EXCLUSION OF CERTIFIED ACTS OF TERRORISM CG IL1201 (11/85) POLICY CHANGES CF IL1201 (11/85) POLICY CHANGES CG IL90402 (12/07) IDENTITY RECOVERY COVERAGE CF IL90402 (12/07) IDENTITY RECOVERY COVERAGE Issued Date: 3/27/2015 Page 12 of 12 CPPSCHEDFORM 0408

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25 COMMERCIAL PROPERTY CPP EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA ADVISORY NOTICE TO POLICYHOLDERS This Notice does not form a part of your insurance contract. No coverage is provided by this Notice, nor can it be construed to replace any provisions of your policy (including its endorsements). If there is any conflict between this Notice and the policy (including its endorsements), the provisions of the policy (including its endorsements) shall prevail. Carefully read your policy, including the endorsements attached to your policy. This Notice provides information concerning the following new endorsement, which applies to your new or renewal policy being issued by us: Exclusion Of Loss Due To Virus Or Bacteria Endorsement CP This endorsement makes an explicit statement regarding a risk that is not covered under your Commercial Property insurance. It points out that there is no coverage under such insurance for loss or damage caused by or resulting from any virus, bacterium or other microorganism that induces or is capable of inducing physical distress, illness or disease. The exclusion in this endorsement applies to all coverages provided by your Commercial Property insurance, including (if any) property damage and business income coverages. CP P ISO Properties, Inc., 2006 Page 1 of 1

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27 NOTICE TO POLICYHOLDERS FOR USE WHEN POLICY INCLUDES: IL (IL in Alaska and IL in Idaho), IL (IL in Alaska and IL in Idaho), or IL (IL in Idaho) COMMERCIAL PROPERTY COMMERCIAL INLAND MARINE PN POTENTIAL RESTRICTIONS OF TERRORISM COVERAGE This Notice has been prepared in conjunction with the POTENTIAL implementation of changes related to coverage of terrorism under your policy. The Terrorism Risk Insurance Act established a program (Terrorism Risk Insurance Program) within the Department of the Treasury, under which the federal government shares, with the insurance industry, the risk of loss from future terrorist attacks. That Program is subject to a termination date of December 31, 2014 unless extended by the federal government. If the federal Program terminates, or is extended with certain changes prior to or during the term of your policy, then the treatment of terrorism under your policy will change. This Notice is being provided to you for the purpose of summarizing potential impact on your coverage. The summary is a brief synopsis of significant exclusionary provisions and limitations. This Notice does not form a part of your insurance contract. The Notice is designed to alert you to coverage restrictions and to other provisions in certain terrorism endorsement(s) in this policy. If there is any conflict between this Notice and the policy (including its endorsements), the provisions of the policy (including its endorsements) apply. Carefully read your policy, including the endorsements attached to your policy. THIS POLICYHOLDER NOTICE ADDRESSES ONLY THE POTENTIAL CHANGES IN COVERAGE RELATED TO THE TERMINATION OF THE FEDERAL TERRORISM RISK INSURANCE PROGRAM (TRIP), OR CERTAIN CHANGES TO THE PROGRAM. THEREFORE THE COMPARISON IN COVERAGE IS BETWEEN THE COVERAGE AT THE START OF THE NEW POLICY TERM (NEW OR RENEWAL POLICY) AND THE POSTTRIP COVERAGE. THESE NOTICES DO NOT DESCRIBE OR REFER TO A CHANGE IN COVERAGE BETWEEN THE PREVIOUS POLICY AND THE RENEWAL POLICY AT ITS INCEPTION. IF YOUR POLICY AT THE START OF THE NEW POLICY TERM: CONTAINS NO TERRORISM EXCLUSION AND NO CAP ON CERTIFIED LOSSES: In the absence of terrorism exclusion, terrorism coverage applies in accordance with the terms of the policy. That is, the absence of a terrorism exclusion does not create coverage for any loss that would otherwise be excluded under the policy, such as losses excluded by the nuclear hazard or war exclusions. PN Page 1 of 6

28 COMMERCIAL PROPERTY COMMERCIAL INLAND MARINE PN CONTAINS NO TERRORISM EXCLUSION AND CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM APPLY (IL 09 52): Then the policy contains an endorsement under which coverage for "certified acts of terrorism" (which is more fully defined in the endorsement but involves an act of terrorism certified by the federal government to be an act of terrorism pursuant to the federal Terrorism Risk Insurance Act) is subject to a limit on our liability pursuant to the federal Terrorism Risk Insurance Act. Further, the absence of terrorism exclusion does not create coverage for any loss that would otherwise be excluded under the policy, such as losses excluded by the nuclear hazard or war exclusions. CONTAINS EXCLUSION OF CERTIFIED ACTS OF TERRORISM (IL 09 53): Then this policy contains an endorsement excluding coverage for "certified acts of terrorism", which is more fully defined in the endorsement but involves an act of terrorism certified by the federal government to be an act of terrorism pursuant to the federal Terrorism Risk Insurance Act. The Exception Covering Certain Fire Losses applies only in certain states. If the exception applies in any states under your policy, the Schedule of the terrorism endorsement indicates the affected types of insurance in affected states. When the Exception applies, the exclusion of terrorism does not apply to direct loss or damage by fire to Covered Property, with respect to affected types of insurance in affected states. CONTAINS AN EXCLUSION OF CERTIFIED ACTS OF TERRORISM INVOLVING NUCLEAR, BIOLOGICAL, CHEMICAL OR RADIOLOGICAL TERRORISM; CAP ON COVERED CERTIFIED ACTS LOSSES (IL 09 86): The terrorism endorsement in this policy excludes coverage for "certified acts of terrorism" (which is more fully defined in the endorsement, but involves an act of terrorism certified by the federal government to be an act of terrorism pursuant to the federal Terrorism Risk Insurance Act), but such exclusion applies only if the event involves radioactive material or pathogenic or poisonous biological or chemical material under certain circumstances. The certified-acts coverage that remains is subject to a limit on our liability pursuant to the federal Terrorism Risk Insurance Act and is subject to all policy exclusions (for example, the war exclusion) and other policy provisions. The Exception Covering Certain Fire Losses applies only in certain states. If the exception applies in any states under your policy, the Schedule of the terrorism endorsement indicates the affected types of insurance in affected states. When the Exception applies, the exclusion of terrorism does not apply to direct loss or damage by fire to Covered Property, with respect to affected types of insurance in affected states. CONTAINS A LIMITATION OF COVERAGE FOR CERTIFIED ACTS OF TERRORISM (SUB-LIMIT ON ANNUAL AGGREGATE BASIS) (IL 09 87): The terrorism endorsement in this policy limits the amount of coverage for loss or damage caused by "certified acts of terrorism" (which is more fully defined in the endorsement, but involves an act of terrorism certified by the federal government to be an act of PN Page 2 of 6

29 COMMERCIAL PROPERTY COMMERCIAL INLAND MARINE PN terrorism pursuant to the federal Terrorism Risk Insurance Act). The Certified Acts Sub- Limit is a lower amount than the Limit that applies to your covered property and coverages in the event of a loss event other than a "certified act of terrorism". The Certified Acts Sub-Limit applies on an annual policy period basis: once the sub-limit is exhausted in one or more events, no further coverage for certified acts of terrorism is provided for the remainder of the annual policy period. Further, certified-acts coverage is subject to a limit on our liability pursuant to the federal Terrorism Risk Insurance Act. With respect to all acts of terrorism, policy exclusions (for example, the nuclear hazard and war exclusions) and other policy provisions continue to apply. The terrorism sub-limit does not restrict fire coverage under certain types of insurance in some states due to a statutory requirement in those states. The affected states and types of insurance, if relevant to your policy, are shown in the Schedule of this endorsement. With respect to affected types of insurance in affected states, losses to Covered Property attributable to fire following an act of terrorism, if otherwise covered, remain subject to the otherwise applicable Limit of Insurance for the involved property. POTENTIAL CHANGE TO YOUR POLICY: If Endorsement IL (IL in Alaska and IL in Idaho), IL (IL in Alaska and IL in Idaho), or IL (IL in Idaho) is attached to your policy. Its provisions become applicable to your policy only if certain events (one or more of them) occur. Those events include the following: If the federal Terrorism Risk Insurance Program (TRIP) terminates with respect to the type of insurance provided under this policy (TRIP is/was scheduled to terminate at the end of December 31, 2014 unless extended by the federal government.); or If TRIP is extended with changes that redefine terrorism, and we are not required to make such revised coverage available to you; or If TRIP is extended with changes that make insurance coverage for terrorism subject to provisions or requirements that differ from those that apply to other events or occurrences under this policy, and we are not required to make such revised coverage available to you; or If TRIP is extended with changes that increase insurers' statutory percentage deductible under TRIP for terrorism losses, or decrease the federal government's statutory percentage share in potential terrorism losses, and we are not required to make terrorism coverage available to you. Our deductible is 20% of the total of our previous year s direct earned premiums. The government s share is 85% of the terrorism losses paid by us above the deductible. Endorsement IL (IL in Alaska and IL in Idaho) (Conditional Exclusion of Terrorism) treats terrorism as follows: Coverage for loss or damage arising out of a terrorism incident is excluded only if: PN Page 3 of 6

30 COMMERCIAL PROPERTY COMMERCIAL INLAND MARINE PN The total of all insured damage to all types of property (including business interruption losses sustained by owners or occupants of damaged property), from the incident, exceeds $25 million. The $25 million property damage threshold is based on losses sustained by all persons and entities who are affected by an incident of terrorism, and who are insured for the damage, or who would be insured but for a terrorism exclusion; or (To determine whether the threshold for property damage ($25 million) is exceeded, multiple incidents of terrorism which occur within a seventy-two hour period and appear to be linked together or have a related purpose or common leadership behind them shall be considered to be one incident of terrorism.) The terrorism event involves nuclear materials or results in nuclear reaction or radiation or radioactive contamination; or The terrorism event involves the release of radioactive material, and it appears that one purpose of the terrorism was to release such material; or The terrorism event is carried out by means of the dispersal or application of pathogenic or poisonous biological or chemical materials; or The terrorism event involves the release of pathogenic or poisonous biological or chemical materials, and it appears that one purpose of the terrorism was to release such materials. The Exception Covering Certain Fire Losses applies only in certain states. If the exception applies in any states under your policy, the Schedule of the terrorism endorsement indicates the affected types of insurance in affected states. When the Exception applies, the exclusion of terrorism does not apply to direct loss or damage by fire to Covered Property, with respect to affected types of insurance in affected states. Endorsement IL (IL in Alaska and IL in Idaho) (Conditional Exclusion of Terrorism Involving Nuclear, Biological Or Chemical Terrorism) treats terrorism as follows: Coverage for loss or damage arising out of a terrorism incident is excluded only if: The terrorism event involves nuclear materials or results in nuclear reaction or radiation or radioactive contamination; or The terrorism event involves the release of radioactive material, and it appears that one purpose of the terrorism was to release such material; or The terrorism event is carried out by means of the dispersal or application of pathogenic or poisonous biological or chemical materials; or The terrorism event involves the release of pathogenic or poisonous biological or chemical materials, and it appears that one purpose of the terrorism was to release such materials. The Exception Covering Certain Fire Losses applies only in certain states. If the exception applies in any states under your policy, the Schedule of the terrorism endorsement indicates the PN Page 4 of 6

31 COMMERCIAL PROPERTY COMMERCIAL INLAND MARINE PN affected types of insurance in affected states. When the Exception applies, the exclusion of terrorism does not apply to direct loss or damage by fire to Covered Property, with respect to affected types of insurance in affected states. Endorsement IL (IL in Idaho) (Conditional Limitation Of Coverage For Terrorism - Sub-Limit On Annual Aggregate Basis) treats terrorism as follows: This form does not exclude terrorism. In the absence of terrorism exclusion, terrorism coverage would apply in accordance with the terms of the applicable Coverage Form, Coverage Part or Policy. That is, the absence of a terrorism exclusion does not create coverage for any loss or damage that would otherwise be excluded under the Coverage Form, Coverage Part or Policy, such as losses excluded by the Nuclear Hazard Exclusion or the War And Military Action Exclusion. The amount of your coverage for loss or damage arising out of terrorism is limited to the indicated sub-limit. The sub-limit applies on an annual aggregate basis: once the sublimit is exhausted in one or more events, no further coverage for terrorism is provided for the remainder of the annual policy period. But the sub-limit only applies to covered events of terrorism that exceed a threshold. That threshold operates so that the sub-limit applies only to an incident if the total of all insured damage to all types of property (including business interruption losses sustained by owners or occupants of damaged property), from the terrorism incident, exceeds $25 million. The $25 million property damage threshold is based on losses sustained by all persons and entities who are affected by an incident of terrorism, and who are insured for the damage, or who would be insured but for a terrorism exclusion. (To determine whether the threshold for property damage ($25 million) is exceeded, multiple incidents of terrorism that occur within a seventy-two hour period and appear to be linked together or have a related purpose or common leadership behind them shall be considered to be one incident of terrorism.) When the sub-limit does not apply to a covered incident of terrorism, the Limit Of Insurance on the affected property or coverage (as stated in the policy Declarations) would apply instead. Read the endorsement carefully for an explanation of the application of the sublimit and exhaustion of the sub-limit. An Exception (Non-Applicability Of The Terrorism Sub-Limit To Certain Fire Losses) applies only in certain states. If that exception applies in any states under your policy, that is indicated in the Schedule of the terrorism endorsement. If the exception applies in any states under your policy, the Schedule of the terrorism endorsement indicates the affected types of insurance in affected states. When the Exception applies, the sub-limit on terrorism coverage does not apply to direct loss or damage by fire to Covered PN Page 5 of 6

32 COMMERCIAL PROPERTY COMMERCIAL INLAND MARINE PN Property, with respect to affected types of insurance in affected states. In such case, the Limit of Insurance on that Covered Property (as stated in the policy Declarations) would apply instead. See the definition of terrorism for purposes of the terrorism exclusion. PN Page 6 of 6

33 AGENCY INSURANCE SUPPLEMENT - STANDARD FIRE POLICY ONLY APPLICANT/NAMED INSURED J. J. FARBER LOTTMAN & CO., INC. JUAN DE DIOS POLICY NUMBER CARRIER NAIC CODE WPP AGENCY CUSTOMER ID: Wesco Insurance Company POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE You are hereby notified that under the Terrorism Risk Insurance Act, as amended, that you have a right to purchase insurance coverage for losses resulting from acts of terrorism, as defined in Section 102(1) of the Act: The term act of terrorism means any act that is certified by the Secretary of the Treasury - in concurrence with the Secretary of State, and the Attorney General of the United States - to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM, SUCH LOSSES MAY BE PARTIALLY REIMBURSED BY THE UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THE FORMULA, THE UNITED STATES GOVERNMENT GENERALLY REIMBURSES 85% OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS THAT MAY BE COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT. YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A $100 BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS LIABILITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANY ONE CALENDAR YEAR EXCEEDS $100 BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED $100 BILLION, YOUR COVERAGE MAY BE REDUCED. In this state, a terrorism exclusion makes an exception for (and thereby provides coverage for) fire losses resulting from an act of terrorism. Therefore, if you reject this offer of terrorism coverage, that rejection does not apply to fire losses resulting from an act of terrorism. Coverage for such fire losses will be provided in your policy. The additional premium just for such fire coverage is stated below. If you reject the offer described above for terrorism coverage, this premium is due. Acceptance or Rejection of Terrorism Insurance Coverage I hereby elect to purchase terrorism coverage for a prospective premium of $ 60 I hereby decline to purchase terrorism coverage for certified acts of terrorism. I understand that an exclusion of certain terrorism losses will be made part of the policy. If you decline this offer, the premium for terrorism (fire only) coverage is $ 25.. Policyholder/Applicant s Signature Print Name Date Policyholder/Applicant s Signature Print Name Date Policyholder/Applicant s Signature Print Name Date ACORD 62 US (2008/02) Effective Date Includes copyrighted material of the National Association of Insurance Commissioners, with its permission ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD

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35 IL P U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY NOTICE TO POLICYHOLDERS No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your policy. You should read your policy and review your Declarations page for complete information on the coverages you are provided. This Notice provides information concerning possible impact on your insurance coverage due to directives issued by OFAC. Please read this Notice carefully. The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presidential declarations of "national emergency". OFAC has identified and listed numerous: Foreign agents; Front organizations; Terrorists; Terrorist organizations; and Narcotics traffickers; as "Specially Designated Nationals and Blocked Persons". This list can be located on the United States Treasury's web site http// In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entity claiming the benefits of this insurance has violated U.S. sanctions law or is a Specially Designated National and Blocked Person, as identified by OFAC, this insurance will be considered a blocked or frozen contract and all provisions of this insurance are immediately subject to OFAC. When an insurance policy is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments also apply. IL P ISO Properties, Inc., 2004 Page 1 of 1

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37 POLICY NUMBER: WPP IL THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE Terrorism Premium (Certified Acts) $ See Declarations This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Coverage Form(s) and/or Policy(s): Additional information, if any, concerning the terrorism premium: Certified Acts of Terrorism is not covered, exception covering certain fire losses. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act, we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for terrorist acts certified under the Terrorism Risk Insurance Act. The portion of your premium attributable to such coverage is shown in the Schedule of this endorsement or in the policy Declarations. B. Disclosure Of Federal Participation In Payment Of Terrorism Losses The United States Government, Department of the Treasury, will pay a share of terrorism losses insured under the federal program. The federal share equals 85% of that portion of the amount of such insured losses that exceeds the applicable insurer retention. However, if aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a Program Year (January 1 through December 31), the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. C. Cap On Insurer Participation In Payment Of Terrorism Losses If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a Program Year (January 1 through December 31) and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. IL ISO Properties, Inc., 2007 Page 1 of 1

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39 COMMERCIAL GENERAL LIABILITY CG THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations, and any other person or organization qualifying as a Named Insured under this policy. The words "we", "us" and "our" refer to the company providing this insurance. The word "insured" means any person or organization qualifying as such under Section II Who Is An Insured. Other words and phrases that appear in quotation marks have special meaning. Refer to Section V Definitions. SECTION I COVERAGES COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY 1. Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking damages for "bodily injury" or "property damage" to which this insurance does not apply. We may, at our discretion, investigate any "occurrence" and settle any claim or "suit" that may result. But: (1) The amount we will pay for damages is limited as described in Section III Limits Of Insurance; and (2) Our right and duty to defend ends when we have used up the applicable limit of insurance in the payment of judgments or settlements 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 for under Supplementary Payments Coverages A and B. b. This insurance applies to "bodily injury" and "property damage" only if: (1) The "bodily injury" or "property damage" is caused by an "occurrence" that takes place in the "coverage territory"; (2) The "bodily injury" or "property damage" occurs during the policy period; and (3) Prior to the policy period, no insured listed under Paragraph 1. of Section II Who Is An Insured and no "employee" authorized by you to give or receive notice of an "occurrence" or claim, knew that the "bodily injury" or "property damage" had occurred, in whole or in part. If such a listed insured or authorized "employee" knew, prior to the policy period, that the "bodily injury" or "property damage" occurred, then any continuation, change or resumption of such "bodily injury" or "property damage" during or after the policy period will be deemed to have been known prior to the policy period. c. "Bodily injury" or "property damage" which occurs during the policy period and was not, prior to the policy period, known to have occurred by any insured listed under Paragraph 1. of Section II Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim, includes any continuation, change or resumption of that "bodily injury" or "property damage" after the end of the policy period. d. "Bodily injury" or "property damage" will be deemed to have been known to have occurred at the earliest time when any insured listed under Paragraph 1. of Section II Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim: (1) Reports all, or any part, of the "bodily injury" or "property damage" to us or any other insurer; (2) Receives a written or verbal demand or claim for damages because of the "bodily injury" or "property damage"; or (3) Becomes aware by any other means that "bodily injury" or "property damage" has occurred or has begun to occur. e. Damages because of "bodily injury" include damages claimed by any person or organization for care, loss of services or death resulting at any time from the "bodily injury". CG ISO Properties, Inc., 2006 Page 1 of 15

40 2. Exclusions This insurance does not apply to: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" resulting from the use of reasonable force to protect persons or property. b. Contractual Liability "Bodily injury" or "property damage" for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages: (1) That the insured would have in the absence of the contract or agreement; or (2) Assumed in a contract or agreement that is an "insured contract", provided the "bodily injury" or "property damage" occurs subsequent to the execution of the contract or agreement. Solely for the purposes of liability assumed in an "insured contract", reasonable attorney fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of "bodily injury" or "property damage", provided: (a) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same "insured contract"; and (b) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. c. Liquor Liability "Bodily injury" or "property damage" for which any insured may be held liable by reason of: (1) Causing or contributing to the intoxication of any person; (2) The furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol; or (3) Any statute, ordinance or regulation relating to the sale, gift, distribution or use of alcoholic beverages. This exclusion applies only if you are in the business of manufacturing, distributing, selling, serving or furnishing alcoholic beverages. d. Workers' Compensation And Similar Laws Any obligation of the insured under a workers' compensation, disability benefits or unemployment compensation law or any similar law. e. Employer's Liability "Bodily injury" to: (1) An "employee" of the insured arising out of and in the course of: (a) Employment by the insured; or (b) Performing duties related to the conduct of the insured's business; or (2) The spouse, child, parent, brother or sister of that "employee" as a consequence of Paragraph (1) above. This exclusion applies whether the insured may be liable as an employer or in any other capacity and to any obligation to share damages with or repay someone else who must pay damages because of the injury. This exclusion does not apply to liability assumed by the insured under an "insured contract". f. Pollution (1) "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": (a) At or from any premises, site or location which is or was at any time owned or occupied by, or rented or loaned to, any insured. However, this subparagraph does not apply to: (i) "Bodily injury" if sustained within a building and caused by smoke, fumes, vapor or soot produced by or originating from equipment that is used to heat, cool or dehumidify the building, or equipment that is used to heat water for personal use, by the building's occupants or their guests; (ii) "Bodily injury" or "property damage" for which you may be held liable, if you are a contractor and the owner or lessee of such premises, site or location has been added to your policy as an additional insured with respect to your ongoing operations performed for that additional insured at that premises, site or location and such premises, site or location is not and never was owned or occupied by, or rented or loaned to, any insured, other than that additional insured; or Page 2 of 15 ISO Properties, Inc., 2006 CG

41 (iii) "Bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire"; (b) At or from any premises, site or location which is or was at any time used by or for any insured or others for the handling, storage, disposal, processing or treatment of waste; (c) Which are or were at any time transported, handled, stored, treated, disposed of, or processed as waste by or for: (i) Any insured; or (ii) Any person or organization for whom you may be legally responsible; or (d) At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the "pollutants" are brought on or to the premises, site or location in connection with such operations by such insured, contractor or subcontractor. However, this subparagraph does not apply to: (i) "Bodily injury" or "property damage" arising out of the escape of fuels, lubricants or other operating fluids which are needed to perform the normal electrical, hydraulic or mechanical functions necessary for the operation of "mobile equipment" or its parts, if such fuels, lubricants or other operating fluids escape from a vehicle part designed to hold, store or receive them. This exception does not apply if the "bodily injury" or "property damage" arises out of the intentional discharge, dispersal or release of the fuels, lubricants or other operating fluids, or if such fuels, lubricants or other operating fluids are brought on or to the premises, site or location with the intent that they be discharged, dispersed or released as part of the operations being performed by such insured, contractor or subcontractor; (ii) "Bodily injury" or "property damage" sustained within a building and caused by the release of gases, fumes or vapors from materials brought into that building in connection with operations being performed by you or on your behalf by a contractor or subcontractor; or (iii) "Bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire". (e) At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations if the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants". (2) Any loss, cost or expense arising out of any: (a) Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (b) Claim or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". However, this paragraph does not apply to liability for damages because of "property damage" that the insured would have in the absence of such request, demand, order or statutory or regulatory requirement, or such claim or "suit" by or on behalf of a governmental authority. g. Aircraft, Auto Or Watercraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft owned or operated by or rented or loaned to any insured. Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft that is owned or operated by or rented or loaned to any insured. This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: CG ISO Properties, Inc., 2006 Page 3 of 15

42 (a) Less than 26 feet long; and (b) Not being used to carry persons or property for a charge; (3) Parking an "auto" on, or on the ways next to, premises you own or rent, provided the "auto" is not owned by or rented or loaned to you or the insured; (4) Liability assumed under any "insured contract" for the ownership, maintenance or use of aircraft or watercraft; or (5) "Bodily injury" or "property damage" arising out of: (a) The operation of machinery or equipment that is attached to, or part of, a land vehicle that would qualify under the definition of "mobile equipment" if it were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law in the state where it is licensed or principally garaged; or (b) the operation of any of the machinery or equipment listed in Paragraph f.(2) or f.(3) of the definition of "mobile equipment". h. Mobile Equipment "Bodily injury" or "property damage" arising out of: (1) The transportation of "mobile equipment" by an "auto" owned or operated by or rented or loaned to any insured; or (2) The use of "mobile equipment" in, or while in practice for, or while being prepared for, any prearranged racing, speed, demolition, or stunting activity. i. War "Bodily injury" or "property damage", however caused, arising, directly or indirectly, out of: (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. j. Damage To Property "Property damage" to: (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3) Property loaned to you; (4) Personal property in the care, custody or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations; or (6) That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises, including the contents of such premises, rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III Limits Of Insurance. Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to "property damage" included in the "productscompleted operations hazard". k. Damage To Your Product "Property damage" to "your product" arising out of it or any part of it. l. Damage To Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "productscompleted operations hazard". This exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. Page 4 of 15 ISO Properties, Inc., 2006 CG