MSO, Inc. 139 Harristown Road Glen Rock, New Jersey 07452 (201) 447-6900 (800) 935-6900 FAX (201) 447-9468 ORDER BLANK BUSINESSOWNERS PROGRAM 2007 DELAWARE, INDIANA, MAINE, MARYLAND NEW HAMPSHIRE, NEW JERSEY, NEW YORK PENNSYLVANIA & VERMONT Please limit your order to such quantities as you need for NORMAL activity Basic Form Basic Form Policy Form - Named Perils Policy Form - Named Perils 04 01 12/07 04 01 5/08 04 02 12/07 04 02 5/08 Declarations Extension 04 04 8/93 BOP Change Endorsement 04 05 8/93 Employee Dishonesty 02 82 1/03 Forgery or Alterations Crime Coverage 02 72 10/06 Functional Replacement Condition - Coverage A Functional Replacement Condition - Coverage B (DE, MD, NH & VT ) (ME, NJ & PA) 02 60 4/00 02 61 4/00 01 41 9/07 01 84 9/07 Landlords BOP Policy Landlords BOP Policy 04 07 12/07 04 07 5/08 Indoor Glass Breakage 03 75 1/03 Loss Payee 02 50 11/01 Loss Payee - Contract of Sale 02 33 1/09 Landlords BOP Declarations Supplement 04 08 5/03 Loss Payee - Lendors Loss Payable 02 35 1/09 Landlords BOP Declarations Supplement Landlords BOP Declarations Supplement Landlords Expanded BOP Policy Landlords Expanded BOP Policy Landlords Expanded Declarations Supp. Landlords Expanded Declarations Supp. Landlords Expanded Declarations Supp. 04 08 12/06 04 08 1/09 04 09 12/07 04 09 5/08 04 10 5/03 04 10 12/06 04 10 1/09 BOP Worksheet --- 2001 PART I Agreed Value Condition 02 63 1/01 Building Code/Law Supp. Cov. Exclusion 05 23 1/03 Building Code / Law Coverage - Blanket Ins. Condition 01 85 9/07 Business Personal Property Limitation 05 26 1/03 TO: On Premises Money & Securities 05 27 7/01 Outdoor Building Glass Cov. Deductible 05 22 1/03 Peak Season 02 81 1/03 Premises Burglary Crime Coverage (Form E) Premises Theft & Robbery Outside the Premises Coverage (Form H) Print or Type Company Address 01 86 9/07 01 79 9/07 Property Not Covered 05 20 1/03 Protective Safeguards 10 09 1/03 Prot. Safeguards - Automatic Fire Alarm 10 02 1/03 Prot. Safeguards - Automatic Sprinkler 10 01 1/03 Protective Safeguards - Hood & Duct Protection 02 42 9/07 Computer Coverage 03 70 1/03 Crime Common Provisions Crime Common Provisions (ME, NH, NY & VT) 03 20 3/98 03 20 7/06 Earthquake Coverage 03 80 1/03 ATTENTION : Municipality State Zip Code OVER > 5/21/05/21/09
Please limit your order to such quantities as you need for NORMAL activity Protective Safeguards - Premises Burglar Alarm 10 03 1/03 Theft Exclusion 05 21 1/03 Vacancy / Unoccupancy Extension 02 65 1/03 Windstorm and Related Damage Deduct. PART II Aggregate / Total Limit - Per Project (except NY) Aggregate / Total Limit - Per Location (except NY) 02 51 9/07 01 88 9/07 01 89 9/07 Asbestos Exclusion (ME & NH only) 01 75 1/09 Beauty / Barber Shop Prof. Liability 01 93 1/03 Package Stores Liquor Law Liability 01 97 1/03 Premises Exclusion 05 06 1/03 Premises Limitation 05 04 1/03 Premises Limitation 05 05 1/03 Printers Errors & Omissions Liability 04 34 9/07 Real Estate Agents / Brokers 01 80 1/03 Real Estate Property Managers Exclusion (except IN, NY & VT) Exclusion (VT only) 04 35 9/07 01 81 9/07 01 81 1/09 Computer Software Professional Activities Exclusion (except IN, NJ & NY) 01 77 9/07 Liability (except IN, NY & VT) 01 82 9/07 Condominium Association - Directors & Officers Liability (except IN, NH & NY) 04 27 9/07 Liability (VT only) 01 82 1/09 Condominium Association - Directors & Officers Liability 04 27 1/09 (except IN, NY & VT) 04 29 9/07 Condominium Association - Directors & Officers Liability - Supp. Dec. Contractors NY State Bodily Injury Limitation (except IN, NH & NY) 04 28 9/07 01 83 9/07 Druggist Prof. Liability 01 94 1/03 Exterior Insulation & Finish System Exclusion 01 78 9/07 Funeral Directors Prof. Liability 01 95 1/03 (VT only) 04 29 1/09 Vacant Land 01 20 1/03 Veterinarian s Professional Liability 01 96 1/03 Volunteer and Donated Labor Medical Payments PART II : ADDITIONAL INSUREDS 03 30 9/07 Additional Insureds 06 01 7/04 Hired / Non-Owned Auto Liability (except ME & VT) 01 40 1/03 Additional Insureds - Supplemental Declarations 03 50 9/07 Incidental Professional Liability 01 91 1/03 Additional Insureds / Loss Payee 06 16 1/03 Knowledge / Notice of an Injury or Occurrence 02 05 9/07 Appointed / Elected Officials 03 27 9/07 Exclusions (ME only) Exclusion (DE, MD, & PA) Exclusion (NJ only) Lead / Lead Contamination Exclusion (DE, MD, PA & VT) 01 76 2/09 01 87 9/07 01 90 9/07 05 25 9/07 Liquor Liability 04 22 9/07 Operations / Coverage Exclusion 05 07 1/03 Operations / Coverage Excl. 05 07 12/06 Operations / Coverage Excl. 05 07 1/09 Optical / Hearing Aid Services Prof. Liab. 01 92 1/03 Architects / Engineers / Surveyors 06 02 7/04 Assignee / Mortgagee / Receiver 06 03 1/03 Blanket Additional Insureds - Contractors / Lessees / Owners 03 28 9/07 Charitable Institutions 03 01 9/07 Churches (MD only) 03 02 9/07 Concessionaires 03 15 9/07 Condominium Unit-Owner 03 03 9/07 Controlling Interest 06 04 1/03 Co-Owner of Premises 06 05 1/03 Executors 03 21 9/07 PAGE 2-5/21/09
BUSINESSOWNERS PROGRAM 2007 DE, IN, MD, ME, NH, NJ, NY, PA & VT Please limit your order to such quantities as you need for NORMAL activity PART II : ADD. INSUREDS (cont) Grantor of Franchise (DE, IN, MD, ME, NJ & PA) 06 10 7/04 BED & BREAKFAST BOP (ME, NJ & PA only) Bed & Breakfast Policy 04 15 04 09 Grantor of Franchise (NH, NY & VT) 06 10 7/06 Lessor of Equipment 06 06 7/04 Managers or Lessors of Premises 06 07 1/03 Owners of Leased Land 06 08 1/03 Permits 03 09 9/07 Premises Permits 06 09 1/03 Townhouse Associations 03 04 9/07 Vendors 03 16 9/07 Volunteers 03 00 9/07 CONDOMINIUM Commercial Condo. Loss Assessment Coverage for Unit-Owners Commercial Condo. Improvements Coverage for Unit-Owners Commercial Condo. Improvements and Association Prop. Cov. for Unit-Owners Condominium Coverage for Condo. Associations 02 83 1/03 02 84 1/03 02 85 1/03 02 86 1/03 Bed & Breakfast Supplemental Dec. 04 16 04 09 EMPLOYEE BENEFITS LIABILITY Employee Benefits Coverage Form (except NH & NY) Employee Benefits Coverage Form Supplemental Declarations (except NH & NY) Supplemental Declarations CRIME Forgery or Alterations (Form B) Premises Burglary (Form E) Premises Theft and Robbery Outside the Premises (Form H) GARAGEKEEPERS (DE, IN, MD, NJ & PA only) MCL 425 6/05 04 25 1/09 MCL 426 1/97 04 26 1/09 MCP 172 10/04 MCP 177 6/94 MCP 179 10/04 Garagekeepers Coverage Form MGK 010 4/08 Commercial Condominium Original Improvements Cov. for Unit-Owners CONDO BOP Condo Association BOP Policy Condo Association BOP Policy Condo Declarations Supplement 02 90 1/03 04 06 12/06 04 06 1/08 04 23 5/03 Supplemental Declarations MGK 011 9/99 MISCELLANEOUS Rating / Underwriting Information Request Computer Software Professional Activities Excl. (DE, IN, MD, NY & PA) Exterior Insulation and Finish System Exclusion 151 11/97 MCL 177 6/05 MCL 178 8/00 Condo Declarations Supplement Condo Declarations Supplement 04 23 12/06 04 23 1/09 TO: Print or Type Company Accounts Receivable 02 91 1/03 Employee Dishonesty - Condo 25 82 1/03 HOME BUSINESS (except NY) Home Business Policy 08 01 12/07 Address Municipality State Zip Code Home Business Supplemental Dec. 08 03 5/03 ATTENTION : Home Business Supplemental Dec. 08 03 1/109 OVER > PAGE 3-5/21/09
Please limit your order to such quantities as you need for NORMAL activity Fungi / Mold Exclusions (NJ only) MCL 183 1/02 Exclusion (DE, IN, MD & PA only) Exclusion (NJ only) Exclusion Liability Liability Contractors New York State Bodily Injury Limitation Knowledge / Notice of Injury or Occurrence Blanket Additional Insured Additional Insureds - Supplemental Dec. Liquor Liability Condominium Assoc. Directors & Officers Liability Condominium Assoc. Directors & Officers Liability - Supplemental Dec. MCL 187 4/07 MCL 189 4/07 MCL 191 6/02 MCL 192 6/02 MCL 192 12/05 MCL 193 6/05 MCL 205 6/05 MCL 328 7/04 MCL 350 5/00 MCL 422 6/05 MCL 427 6/05 MCL 428 10/98 Year 2000 Exclusion Year 2000 Exclusion / Notice to Policyholders Certified Terrorism Loss Coverage (ME, NH & NJ) (DE, MD, PA, VT; NJ - only applies to risks with over $10,000 premium) (IN only) Certified Terrorism Loss Cov. Disclosure (except IN) Certified Terrorism Loss Cov. Disclosure (IN only) Terrorism Exclusions (ME, NH & NJ) Terrorism Exclusions (DE, MD, PA & VT; NJ - only applies to risks with over $10,000 premium)) Terrorism Exclusions (IN only) Exclusions (ME, NH & NJ) MCM 400 3/98 MCM 400 PN 3/98 MCM 411 1/08 MCM 412 1/08 MCM 413 1/08 MCM 413 1/05 MCM 414 1/08 MCM 414 2/03 MCM 416 1/08 MCM 417 1/08 MCM 417 1/05 MCM 418 1/08 Printers Errors and Omissions Real Estate Property Manager Aggregate / Limit - Per Project Aggregate / Total Limit - Per Location (NJ & PA only) (DE, IN & MD only) MCL 429 1/00 MCL 429 7/06 MCL 434 8/00 MCL 435 6/05 MCL 601 4/98 MCL 602 5/98 MCP 140 5/05 MCP 141 5/05 Exclusions (DE, MD, PA & VT; NJ - only applies to risks with over $10,000 premium) Exclusions (IN only) MCM 419 1/08 MCM 419 1/05 Certified Terrorism Coverage MCM 861 1/08 INLAND MARINE (DE, IN, MD, NJ, NY & PA only) MCM 862 1/08 Common Provisions Form MIM 010 6/07 Supplemental Declarations (scheduled) MIM 011 12/96 Installation Floater - Supplemental Dec. MIM 012 10/97 Supplemental Declarations MIM 013 5/99 Hood and Duct Protection MCP 242 4/98 Declarations Extension MIM 019 6/07 Building Code / Law Blanket Ins. Cond. Windstorm and Related Damage Ded. MCP 250 1/05 MCP 251 1/05 Computer Coverage - used with MIM 010 MIM 101 2/00 Computer Hacking / Virus Exclusion MIM 102 4/07 Computer Hacking / Virus Limitation MIM 103 4/07 PAGE 4-5/21/09
BUSINESSOWNERS PROGRAM 2007 DE, IN, MD, ME, NH, NJ, NY, PA & VT Please limit your order to such quantities as you need for NORMAL activity Fine Arts MIM 110 12/96 Installation MIM 111 6/07 Miscellaneous Property MIM 112 12/96 Musical Instruments MIM 113 12/96 Photographic Equipment MIM 114 12/96 Physicians and Surgeons Equipment MIM 115 6/07 Transit MIM 116 2/97 Antique Dealers Coverage MIM 117 4/99 Contractors Tool MIM 120 6/07 Contractors Tool - Supplemental Dec. MIM 121 1/98 Builders Risk MIM 130 6/07 Builders Risk - Supplemental Dec. MIM 131 6/07 Indiana Mandatory Endorsement MCM 832 5/03 Mine Subsidence MCP 802 1/99 Account Modification Supplement MSO-AMS 1998 Account Modification Summary AMS 002 1998 Maine Declarations Supplement 04 03 2/09 Certified Terrorism Loss Coverage (DE, MD, NJ & PA) Certified Acts of Terrorism Exclusion (DE, MD, NJ & PA) Terrorism Excl. (DE, MD, NJ & PA) Exclusion (DE, MD, NJ & PA) Certified Terrorism Loss Coverage Certified Acts of Terrorism Exclusion MIM 140 1/08 MIM 141 1/08 MIM 142 1/08 MIM 143 1/08 MIM 840 1/08 MIM 841 1/08 Mandatory Endorsement 08 50 2/09 Mandatory Endorsement Condominium Associations 08 52 2/09 Standard Fire Provisions MCP 804 2/09 Account Modification Supplement MSO-AMS 2008 Account Modification Summary AMS 002 2008 Mandatory Endorsement MIM 860 9/05 STATE SPECIFIC FORMS Delaware Mandatory Endorsement 08 30 12/07 TO: Print or Type Company Uninsured / Underinsured Motorists Coverage - Mobile Equipment MCM 831 6/05 Address Municipality State Zip Code Account Modification Supplement MSO-AMS 5/83 ATTENTION : Account Modification Summary AMS 002 5/83 OVER > PAGE 5-5/21/09
Please limit your order to such quantities as you need for NORMAL activity Maryland Mandatory Endorsement 08 40 12/07 Waiver - Lead / Lead Contamination Excl. 02 10 9/07 Waiver - Lead / Lead Contamination Excl. MCL 210 6/05 Uninsured / Underinsured Motorists Coverage - Mobile Equipment MCM 841 6/05 Account Modification Supplement MSO-AMS 1998 Account Modification Summary AMS 002 1998 New Hampshire Declarations Supplement 04 03 1/09 Declarations Supplement (Named Perils) 04 13 1/09 New York Declarations Supplement 04 03 12/06 Declarations Supplement (Named Perils) 04 13 12/06 Declarations Extension - Endorsement Description 08 19 7/06 Mandatory Endorsement 08 60 3/09 Asbestos Exclusion MCL 196 12/05 Lead / Lead Contamination Exclusion MCL 197 12/05 Corporal Punishment Laibility MCL 807 6/05 Volunteer Fire Fighters Injury Exclusion MCL 808 6/05 Employee Benefits Liability Coverage MCL 825 8/06 Employee Benefits Supplemental Decl. MCL 826 10/06 Pennsylvania Mandatory Endorsement 08 10 12/07 Mandatory Condominium Association Endorsement 08 11 9/03 Declarations Extension - Endorsements Description 04 19 1/08 Uninsured / Underinsured Motorists Coverage - Mobile Equipment MCM 815 6/05 Mandatory Endorsement 08 65 1/09 Liquor Liability - Temporary Licenses MCL 413 6/05 Liquor Liability - Designated Activities MCL 414 6/05 Liquor Law Liability MCL 415 5/97 New Jersey Mandatory Endorsement 08 20 12/07 Fungi / Mold Limitations 08 83 9/07 Fungi / Mold Limitations 08 84 9/07 Fungi / Mold Limitations MCL 883 8/02 Fungi / Mold Limitations - Notice to Policyholders MCN 883 8/02 Fungi / Mold Limitations MCL 884 4/03 Uninsured / Underinsured Motorists - Mobile Equipment MCM 827 6/05 Account Modification Supplement MSO-AMS 1998 Account Modification Summary AMS 002 1998 Vermont Declarations Supplement 04 03 1/09 Declarations Extension - Endorsements Description 04 19 1/08 Mandatory Endorsement 08 45 1/09 Mandatory Endorsement 08 46 1/09 Account Modification Supplement MSO-AMS 2008 Account Modification Summary AMS 002 2008 BOP Application ---- 2008 Commercial Insurance Rating Plan CIRP 001 6/91 PAGE 6-5/21/09