HomeMy WebLinkAbout1980 (7 N . wr • .
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1.... t A I N% EXTRA'
Term O Refer Until. C3 O Reku...... CO t
Large Rla► DR Ol.oullawt .Q ❑
Lon Cont POL
WW 10%nd Marine Continuation Endorsement t,
x Jeff ltolen, Inc. dbs Contract Builders
S t 711
p 9......... '
o :.adorrearnttarareprrtap.1;<yyNo.46 IC,.63........- t,olen b !hillier, Inc., b Subcootractot4le
h7 Fs imw by THE HARTFORD INSUIIANCE OROUP Company " ttel AUKA Address
( C+ herein, raid indicated Wain b Ca Cale PO Cox 10063, Dallas, Texas 75207
2, tA+ntinuation Ptricxl: (I he r•ffe(thc time NuIrd in the From 05 08 00 To 05 08 81 Ttrm._..~............Year(s)
Q Pnluy tviimins unthungcd unko endurwti hcte.,m)
F i In tanWetatt m ulthe premium indicated in ltem ).beto+,it it agreed
i Alexander 6 Alexander 500gb9 that the p,4ity pctkA a emended for the Continuation reriod indicat4A
■ in Item t, above.
3 8p Dallas, Texas The Amount(s)) or 1 Jmit(s) of lasurance and the Schedulesstated is the
ea policy rstwin unchaojed unlew oAtrube stated in Item J. or Item 1.
L J tape:tively of this endorsement.
G-rrent tditiont of endomme it, will he substituted at each stnersl
date for earlier tdltions of endarsemenu farming a put *(t6 policy.
_ Fidoratmeot No.
_
CLASS OF PROPENT V OR COVERAGES Umh 0( blurace jute do
e d SO 00
s as er i &
Builders t...........P...........1?S?....,,CX.._.............W... r.............
R......r .....I....... ,...........,.....M
rte } mb s ,e._ . ns...........rtmi..,,............................. eer s
t
eats aim n j part o scy at taws lrmairt rt the e unit tie ea of ertt ual re IkdocGbk TOTAL
H30 ~gy
500. rMI s 250.00
Premium It on Deterred Total Payaat Inception Second Payment Third Payrow
Payment Fleet i f
4. SOMMIA
No. Val Dwrip" Aaota( w
Lhtsit of lusrwa
as liar policy 6 ondorsiuments
i
Lases h to r Ao bar bit corder L able es Interest nuy iWar to the Insured and r r
1HR J)1W 04 08 80
Nothiaj herein emialeed Atli be heW to vary, wire, titer, or extend any of the items. tonditiorn, atrtemeats or declaratia.s *(the policy,other then a krcia stated.
This endurvment shall not be bindin j unlew rountenisned by a duly autbalted ajeni of the company.
Con Naha jnrd by
AWAa fud A/rN
Fprm U-29.4 PbR Printed in UA.A, (NF)
aroma
,I ~97 1.
61111f,tt Rif PORT fo am with INL.Nhif1 1L,Rl\E POLlC1' Fpm /tvS and fledsuewx s page It•li~"r + not S 1,'Y
C" "VI
l It A HARWORD INSURANCE GROUP
f '
Nsu4e THE HARTFORD PoLlcr No. 46 !C 637119
Jeff Holens Inc. dbaL Contract
TMt policy may comair, a ColnsweMe Clouse. To be Xopery )Builders
tullcted ALL horns must be Insured to full Vitus Cor act your ~bdmner~ 1 F. o. Box loot73
~rMlord Jvpera ror spechcs. Dallas Texas 7 2 L yti rT'`
M.M 4 Pnrosd In U.S.A.
I
10
:Kd ~_r . . Q r 0,...,. L,.....
C Trmt Noon, standard time at lace oi rssuance
o11 Yan
user ea Namr and rd ess I'rndue"'. GKIf "WIOM (Mo MY Yr.) t[Intbn Me My Yr.?
Policy Term Escepttonl In California and Oregon the words
500969
Alexander & Alexander "11101, A.M," are substituted for "Noln" its required by statute.
0
of Texas Ina.
Dallas, !cxas
~ L J
+ S. This polk covers only with respect to such and so many of the following clasxs of pro .rty as ore Indicated by a specific amount or limit of
insurance applicable thereto, and a premium therefor, and which Is schedule an Item i. Subject otherwise to all the terms of this policy having
° refertrtec thereto, the amount w limit of insurance applicable to each "article of property" Is as stated in Item 4 t the total amount or limit of imur-
once applicable to each "class of property" b, as stand herein, subject to the foregoing provision respecting each article.
CLASS OF PROPERTY Amount or Rata Premium
Ltmlt of Insurance -Builders Risk 1 See kilt s i
3 ! r
s _
P aRaalSere season trmngpnrt tryst uue alert s.oo e ■ ste txti a mount TOTAL.
91019103 2ft?0L_2B 1 goo 9REMit1M s 9,r%0 deposit
IF ON .7 I
The Total Premlutn Is and Is payable li at Ines tion and 1 at each annlrer
4. SC419DUL of articles of property or of ro r ■t locations and amount or limit of Insurance a ble to rub
No. FulI Descelptlon Amount ew
fAndt of Insurance
1
Ifts poltoy.aooym tho'aoustruotion of 4wela pS and
omwraial- building olassified AS frs>de briok•venisip
brink, iron-olad metal or sexiiii 'ire. resistive all loated
Within a 100 Lade radius of D611411t Texas
paragraph 6 Cubits of V ability t
(a) 1 100000000 on semi-fire resistive
2 44900CJ'-od brick and ICU
3 500,040 on Frame and brickeEveneer
b
t,~ r
(j*)42g5 0006
.40000 mportant '
otlg"` 'I I
7H TF4Rt)
fa~ I e ~u I n e e furl !II
4 n sfl sct Corers
I.oes Payal Any lm hereunder b payableuInterest may f f " IIN aliordsd
1.
No 04 19 79 ~Pq
Cerakrr/glld dy.....,...,.. , . Agent
M•I%.l PdR Prt.itrd rn U, S, A.
T.. rw *r ttf1 41r ql{i 1atlt4tlte itlV 11071 x t 6x.. .'d$ s~;
if 66 09 80 E, Y
THE viARTFORD
Named Insured and Address
Jeff Nolen, Inc, dba Contract Builders
This endorsement forms a part of Policy No,46 IC 637119 Nolen & Mullins Inc. , & Subcontractors
issued by THE HARTFORD INSURANCE GROUP company deslg• ATM
noted therein, and takes ellect as of the effective date of said policy 10063
unless another effective date Is stated herein. P.O. Box s
Dallas, Texas 75207
Effective date 05 09 80 Effective hour Is the
same as slated in the Declarations of the policy.
Itt consideration of the premium to be reported it is hereby understood & agreed that
the following are additional insureds as respects to the job for the Denton Public
Library ar. 502 Oakland Ave.$ Denton TX "City of Denton, all" Subcontractors and
Sub-Sub .ontractors as their interest may {appear"
It is further understood and agreed in regards to the above mentioned job that 30
days notice of cancellation is extended to the City of Denton only.
All other terms & conditions remain as nereir. vtated.
Nothing herein contained shall be held to very, waive, alter, or extend any of the terms, conditIons, agreements or declarations of the policy,
other than as herein stated.
this endorsement shall not be binding unles. coentersigned by a duly oulhni $zed agent of the company; rovided that If this endorsement
1akes atfsct es of the effective date of the policy end, at Issue of said policy, fcrma a part thereot, countersfgneture on the declarations page
of sold policy by a duly authorized agent of the company shall constitute valid eounterslgnature of this endorsement,
Alv,snder A Alexander ! Countersigned by
01 TeMe/• M0. AutADrileCAga~r
34th FW, 2001 8ryhn Towef
V l allst, Texas 75201
10*6 Ro-214 Tot.'Silt
y .9. r, J ' sr +.n ( , , r 1!r y Tr l~f. r•W4
XAw+w~' 0t,'d'r v r4rf• S. .r ~'tiit ~tr~ f r, ~~rY
• r J i.
r ►u'•~ r~t k r far 1 ~,5. 4 'r r • .
'r
Kull l 's RIS and/or
Inslallalion'Floaler Form
(t.aat) THE HARTFORD
Sub to fine +mount(e) or 4mit(i) of inwrance tided in the DKI;fettw%ss apph:abN to this inwrence, lathe eeclusions, condilwns Ind all other terms of this policy real esptasly
=tied hsrein:
1. This Endorsement Covers:
of miKhintry, equipment, described eporti m sunder r Mures to be used In or incidental to the construction, febrUion, Installation, erection a completion
I, iteria rids Supplies,
o l
b, AAerations. Idditions, and repairs to existing structures but In no Instance is covtrage Wended to such existing sUuctures.
"DweRiis" at used herein shall be defined as those buildings designed for dwelling occupancy by no micre then four Ismlliet Ah nlher construction shin be deemed
commerit for the purposes of this poky.
Coverage attaches from tl,t time the Insured property becomes at the risk of the Insured and covers continuously thereafter on premises or site or consrudon; while
awaiting and during construction &0 testing; while be!ne{ trnnpotitd within the continental Unrled States to or Irom ==111o, on motor trucks or trelter,, rail-
road ors, If the re`ular aastwtu Ines Of terries n+YiQding the Atlantic, Gull of Mexico w inland w+tere of the until the Insured bul'' I or
Itructun she11 have been fully completedt @copiedy by l e purchaur, the Interest of the Insured shall have ceased, or the expiration data shown In Ito 2 of the Dedua•
tion/, wkloom first Datum,
2. This Endorsement Does Not Cast:
a• Macmtnety, lools, equipment, and property of a similar nature not destined to beams a permanent pert of the Installation or slrYdurt;
t'joperiy al Wn1 other lhltl lrN bti ! ruclbp i+~e on1}Fs 6u~. `rop'd i1 intertdsd kr W~+~ inI)allatiQr at the yon/UUCtan F~Ie of Iq+ job 1n}urad hxwnder amd rMq
Ipca t o iZ M the it i
y,» not F7 e>fu+a ►0% of l~ lirm , lu r y bs*oc11r w 5ed0A~ w alNVer Is esNr; , .
e, Atmots, bills, reeds, turrency, money, Mats of ;4curOA1, blueprints, plans, designs or speciAcatrons;
• , , .
d. Tra ,~risluebbaery, Iew61, gran or tilantsr
L properly sygrN sir-bproe ;unless In Itte,custody of)flKlariy ec4+duted,4106l S; . :
1. hoody*hill w6uf•bOreorjfepfes:p'fbYm411ewAliifIti 11iWicy6'
e Aff t;+( J0,n+ 'e p11x rho fill It !R ~I~aI►v+ r o~It, "W"I !Q~NoVwa. riots, aril ti«!!mg4 n l~YY*'M Ind 4"Ph 9ATM >~►,4 .s44 'ory
b 14 } .jl " r ty~ ~p type, unless speetfically endorsed fretted,
3. This Endorsement insureAgaInd all risks of direct rywal We of if dame a to the property insured from soy external suss (including Sewall Iwrsga and nivage
Gborips on sNpmeaq coyart t wirer bores) extap~u tteretnaflor, RVIOK t r ' r) 9 r','
11e•l,;" II
Th!s Endoreamtnt Doi Not Insure Against:
l I p((~d~I ~~^(.F so{d. Q r{".1 p t wM1A!# co1c' ll~ ~ l I% *It ' JP4~ 'l Pr inr itl, mss of dmospbere or exitemet of llmpets-
4~si~ T1f 1i',~lrl hi+~1-~, i~'rrJ ty rc~n 4 rq,~. ~I,o wY iaKa i ,n.u ~,St}*revre~ f (.uf d vr~-ii~re
b Rp~1 dIMI r or expense caused by Or rewlbng from error , emission or deAdenfy In design, speaAtalons wxkmsnship, or materials, unless Are or explosion ensues, is
car r• Will 'lability shall be Amil to loss damage of expanse caused by or revelling loom such Are or ezpbslon;
L loses m gamage caused by or ruwning from the weight of I bad extWing the r+±( Axed lilting w to ppq loj opsdtyA eyty,lquilpf" yeast therefor, y, . „ . ,
pr i~N~ (N,~„p ,Wi~h!1~11r ~r~'~ A#1~M OP94l~tE
~4s ~~~r t~If fP?M be,~e1' e'r {rl~ru CUa 1e1t i~1 ~jt h1 _y.rtu,rr' {A luukwa
i R"► 4,
fl4ltl q1 Nll~ e4~JM is
B `r iNmdmt o of i6sufa+nlf (uai for of f ny popt~;r persons to whom the Insured property is enUusled, W.ned or rents d; trot far Int caused by the disho osty d any
f. Un~x~rielne6 loss m~s!erGsus diuppurenu, o stiortage dlxiosed by Uking lnvnnory;
r 'u z c ri'„e I
, Ii. 'Lou a ~~e to elrlu(Icst rppgMas a! rsevitp i by * eeeuN4n4 teom tgy,pl akAdalb 1enlxda enlest Art{ settler 411 two* for jer► of qua tluioolt y,
rVs NICK MSulrl el Ds r~slpl is rpc sec,,, tit teat ear A94~iEc tM 7b1 5~a5i~i DwMf,pau cl tofu ynrt Dr w~,eKd Iglu 11~k A;rtti!ut pcupF tucnisl rapt In Ipi ecruel nryar W
mood or tali
0 matringkcr ecnlching unless caused by Are, lightning, tyckNr, tornado,
41r ,lees or damam altt to lmentt por ovetolrrty rtu fnrningtrlndotthecaused vssed hkle ~byp or rewhing from klkale, leakage.
allit". , at by the vessel being on firs, stranded, fun of In eoWslon;
L e u tad by o~fresulttiinI I;amaeaarrtthh I'sker, Surface w~ia6VNlielos,[lmoohdC waist wavet, We or Weal wave 1h1lfdhnotwatterr~yw olvoesreflEair of stream of bboldiies
offp]vpavltfflt
rr.K~~hI iraY";""y'[1f' r14itl"tlilFoIltd~i~llu0~el hv~Y~ll'z~06 ~XX~rrCrfII NCr[ZUtl+/NAtrrAfercf1~L'CfXMflti 2A
Ci, 1 titAkIdirOO'o4 6 WillI!ldsdd elf/ l' f std lM fldik'lk~1o11dn; iu~ptb4tf W N001 W 1E0 b6fli i disco ptpes, steam turbines or slum engines,
f'kYOIro WOYOWn or d+nngement, unless Are r explosion town, and then only for the loss w damage caused by or resulting Irom Such Sri a expbsbn;
1T, r)'llols`b'taxi x~ iMlld sir ft'id1dF R`o6mrli
m, Ie1 ear jpm loads to the Intl of Uri WII&L w Inwttd piopotyl4t O, causned ll~ily by t eNOr foof1W the
IV j t Lou oaasloned by enlat"mont of Iny foul or stale ad menu or law regulating the tonslrucUonvlopal i or demolition ofrb10Iding(s) or structule(e); r iYl a I rbi,r r F. t4
G
E I
F! 0 00040
am, s
r4 Law q +MIr+Ie Io glass (qura LW joss W fling blpdo)•cepsod, by 4r pelting from p►ne+11 Of miy
rflow from lyep em} or apoo ,
yo~t g,er ,ton s of r a lianas, or the resonant lubge Of ova
vet kry ~°r»+ w'~b r~~ g n kr~tl~u4r+t(+~ or tlr4~.+ucb trN!~!~ +!'d,, ,N~ A.r14~91 t~l
r are Rxr
water tut ,
~ ~~,nnvie
teem hL1e1.1 (N1) Printed I rI. A. 1
7-17
41
►►e r' er. 11'r'~ R , htru,r t ' r, v.. i, . ,
• 5. Oedreitblet 1 ' ~ ~ ~ . r.. adIp
11 to s'p" 111 ftm taro C dir~+l+oni IINII p j ad tad it bo14 by IAi iaurEp h ;y4* adjusted d+4a, or a +EpPIK+Ok rMy! 1f k+biiiry, wA ltiet shall IM MN of
lathlevent all l6611o /amua
tR b*lnte.or yr00eras, s►A dededibJe a;tall+ppa eFp+ratdy b aes;r a .
YcII, Mrtlt♦lej H, at(edurl.
6 LIMIT ' JI•~ T Y ,..;e ; t i a :r~trr [ ,,c;r'I',
1I4 S Eip~pA ~4T BE lIAllt HEREUNDER IN ANY ONE CASUALTY OR DIIAS. TER FOR MORE THAN THE LIMIT SPECIFIED
AND. 0 1 Q l 1 4f YNE ASG 11^PO
!eS OH;
A, ANY ONLdt)1[OIIFO 00 STRUCTURt; wl i, r
B.YIH1ltrIN ~ jl ~I r 7~rr ,~~trt ;fn r;tiol
r E r; ~ r.. r v
I t
VIIAN&Y-11 t
C. 710"TiYkrt COVENA t it CIMIT `
ED Tb fl,doa ilNllilS'bYHERWISE ENDORSED kEREOK; q4'
D.0W
#1 O ~J, S.4AJOWYORDIJSASTft ~ITHtR•I>~CAS~QFP~}I~TI~440RTOTAILOSSIOR¢IIIYACEChAIICESQRANYQTHERCMJ~RCESOI~E%f' NSfS
N
ct
' - cl l Y 1C. 'r cl rC,. li t•,~'I, ..St'ti I`iL'.j7 r-vT 4i ~l,
The WWI shall col be liable In 00 event of loss of damsite for any greater proportica of such loss or damall then the amount hereby Insured bears to the adult veto of
As property OWN ~o fw~pr~y pl fA~ pme 009 sucF! ton orA W411 shall Issm"., U Uas poky ewan tw H Inont br?IE dp or otrr~cRrra, fMs eadi:+a {k ail appy !o IteA
1 A''+t, .IV.Ir•;L' I '.Ir.;.ai.,.. .Pev',,w [ J,v-.^✓t;,`{l~ q Wit,
The Fompanyer i$pe'yIDO~+nedreprNtnllieahatlDe
the Inptpd a or ts lcord~ d Much poflgq y r ale.10 app Imiltad ( I raAwabta Dmoa d n` the term of this policy, or within one year after its termination, Is examine
r wndEtw'nsof lM I ' T d ope(y vlEre4halauntllr, f s,t tenor e4m{
terms 61(t
po Gt" naGOa than not aim or am mp,nar ftod sn of
r rt? r v~ r > r. is n'J „ t ~ ~ ! • T the
rl r irlyr~z.,r "t, rd
ffr. NJyt^. 1i.:ED[rti^,?:rS'rx51•.;r.'~3,fo3niwluwfn"Cjj~0,%';,r•
9. ~en~r ~nap(aaC~!?,' ' ~I t i 19 E 7 n ' f.. , r y[ 1 r C tl" n l r J ILI
The
yAq sh1U e hall fgrypss, t e= lh limy 4f Loss theta i fly QI`h}r In}ura rr)Ich 0 ould IItpch if this inwrana he a:, laetr rReded, erupt that this Msvnnu
notQA,af ~n °}'f4t a y ~ilrjby~lfrl ar~rc~r d, 41fd dn4' f 4,!~t 4 ~I (r a au <I
4 I Ms r
lip x o4a hat e o r o
4III fir j{Gr iUL Pta ~P r;.J Jr ! :7`I 7u
ia. THrftHlel units:
1411 IlAiva a oovles enf "me The WWO of Ike taAtgental Wiled $tria (eufudini Alaska) and Canada,
:Y" tf+tt~'ygrrl~-surf;,rnra'Y'R9Jt:orv,.;:rten}9'~'{D~'r a,::zr,:un~„f:[ol~Jt.",a:~'+
1l,~e'~Tn,"~`11~r4411,u~,~f~Y4~~)'1+'t'pu;A,
~l~ 1 t a: 9gAl.,' 7 rs;,Y7:1 '
t ~M iidPC Iicy~~!! !!h 4~t )4~I ~gmrpm;~,~ ~~Q P~ !,19t !+L~Cp~n, 1 ,vFIP}~ V!f ,fn{"D~J~a,l~a flit( h l~iq ~p alit {urfW N11', i dy
t',"}fttrf ~+if l~~i!'leeb f ~h `ldllil6~r`aiarf oy it dib&l mf61i M ii ifiown In Item 3 of the declarations. Grned pnmlums shall be applied :lairs! the deposit premiwn
s t4►rSI tYtA lNaeaf it Iihalt.lyYa hglrlKAT,etgt,l~.IT 4f1,WA+p/!yr 0(,wWh ue premium shall be due and payable m earned.
a kle,"9010.1 aeulplm,Ibe:tasyfH shall report all adud completed vslurs at risk hereunder up to and Indudina the date of c+wahan end premium 01WI be
arilusted a pm:rala basis.
If)- fa~jM tj~rQr' rvlIr" Li;,iri Uf(A3 M
Rrvolt In, rn111 ~Pleled.v t cT~tp (nsl+~ J p aocur;te acord of buildints or a9rclurta Insured hereunder and report to the tam m on
~r eft the F' _ „lfia~'ey o(rta 'd allp,I 09011 al egmple~pp, It" ql. 140N ld' Wrrclpu p
my premium hereon a montl y X11 » s ion in Item he d arabonl. ~ or' m III ~ X000, d-4 01r4pl,IQ lplk
!5!_.;r,r t I~"l'J' 1r~t•u• r a' suG Io;r,U4tj~ hie 7r•t,rjn !raln!c n.+ Rc?li ref r6 ru~cvd f br,-t::aur~ r txl et figs ~~,:~,v;.ryq c. Jpncr+,li
5' lPtt (uyat,N~,r,ur {tote ro; ~oeat:
Nothing Muin toot/aed:knit be held lovary, waive, allit, or extend any of the terms, condition agreements or dedarations of N policy, other than as Wain staled,
J ilia"c !
r : v r Y . j l i ' r , nr n t r J , r , r J r 1` 4 ^ p , l a ' } p l , i 5 ' f " l r t f I " ' f dl t1,1-:, r. I `a CO i.r liG (r'.v-,~
7 n9 p'1 r4q„rRC. •tr'i t:..J .r, t Ir I! ",-jr ; •ti~f; r^,Er,E rr r• Il i..r I 'I.., _i: it I.. ~fi; llR
it i !1 t•r , .,.'{V Iji r^t'E a ,uj, fl~~ r,';fl r r'.i I7. ~ 'f~~('r hI'a <A
riJ 97~e plv ,!r.zy iit6(;:g1 eivj ttr t. t'r5'4 q~!'K r~; ,~V Ott rf D'•[ t '..,ri .4 ,lJr ire fitgJ'141-
it , V PI 9
j1. r4ib,i, fir:;,l ,t`i.'. P
5t v r fir `r~;l ~ ~ •c1 . J r c^,:hit,'" rr ,SI"~ i r v f.,rS
yi. :v,1; t v .?s7 , :d;A r t t n n u',t l W ~'r+.+ rt.. I,>!' VII Aq i t
r', v ,tF,.o, tt cx )(uR:fi^('ttr u,~t ~F, 7 F'1 Ft6i~:ar,t
C", ~~17 „c i.. !iut tr, ~c j7r<r''tl Srly, P ;;st ~,,l
1 1 I ! ; p'y t !_i l,.U d v{; 7tp,Lr? In, r o ri t ,
I lu f Faj gyp' t;';it,.;.''6t•t f pl r,!. ,t
ICt.
- ~.19Yrt LF'. y.:,
(".'"t7 :re T.: i ,c..,, .l"~nl'., S'.
. ~L~L•,,' 25 r17,1L(;filir Sy t, tlr,~gl OOJ ttrvl
rlc!>It1 till il'~JKI!OMl)
e )r'?('rI If 11 ~l t'IIck Ef)kII
~trlr;eflt,!t {f~tK yllc~,Ul
Form Mrst•a t'
2 ,
areiwaearerr
MWkCIAL CAQAITY POLICY
epees
Item .~j~~ feECIARAT10Ni eaullAwot e1 rMOVare IT at opwurv a;wHrto ertow
to *a ftw.t. wer+• M M a41 wueKA
t rwVVYW A NO. ANON PREFIX K ICY NUMBER
00103 04 (v 007 43 24 46 p Continanld Casualty Company
N OTA Stitt 0 i iiOCR(SS: Number 6 Strad, Town, ounry, Stile 6 rp Coder C) National like InsurRnoa Company of llartford
Clef OF KMX . • p Arwican Casualty Company of R4&d%g, Pa.
ti
` ❑ Transportation Insurance Company
Krok, Ms
L] Trmnlr!rnnftnanlal Insurance Company
COilT1VIC~ •Ui~oERt ❑ ' ' r r
BUSINESS Of 1NSUAM
AtweanON 1. Alexander
tI INONIDUAL C)PARTNERSHIP CORPORATION of Texas, Ino
311h Floc, 2001 Bryan Tower,9~~~~ j.
O ANT VENTURE OTHER ~.1 ~ Dbrae, te><ae 01 ar
2, Pdk'y Firm A TebPhone 211 711•5171 i 16201
I 0 AM 61AD IMt
To'. 7R'Ol 11010 A9bfrfltNOAn! MIA111
THIS DECLARATIONS PAGE IS ISSUED IN CONJUNCTION WITH AND IUAMS A foii7 tirv Ill
COMMERCIAL CASUALTY POLICY
3. Audit Period Annul, unless otherwise slated.
1. TM wnurincs aflorded is only with respect to ter following Coverage Put(s) Indicated speedic premium chrge(s),
AIMS COVERAGE PART(S) PRADVANCE
EMIUMS COVERAGE PART(S)
{ Comprehen" General Liability Insurance f Comp4led Operations end Produdg Wdph Insurance
i Comprehensive Automobile Llabllily Insurance 3 Comprshansivt Personal Insurer"
i AWomotiite Medical Payments InN: Cana i Gallia Insurance
i " Unontarsd MotoAsts Insurance i Sys. Orton' and CortrActon' Prowl w LlaD% Iraaruta
i AWornobite Phy" Damage Insursnco Promises Medlin Psymenli Insurance
s Contractual Liability Insurance i "Wed MIA:4ws iosunlnol
i Manufacturers' a d Contractors' Llablhly Iniuranq Bask Automobile ILIWIIIlt Insurance
i DwnNe', Undbrds' kind Tenants' Liatift Insursno i AuWmobls Medal P"mentt lnAWsm
N jp~ 11k)%1r "!v! MOW** In 1"M
i form numbers of endorsements alleged at Issuana include: i i 16059,51 56•
IM Advance Pro" 1of M "icy: . 1. 1, t. , Sy.
S H Porrcy Period mom fMn one year:
i Gross Premium i Discount i Net Premhrm
Premhyn Is wablt'
i On eNecthil die of Popsy i 1st Annhrars" I 2r4 A (owlary
6 TMa deelanhors page If Mixed In eoluneGOn with and bans a pal of an Insurance policy which Is ampMted with the 6 0106 of the cmrege 412
Indicated MM by an adviirce premium IM1d 0 any by addtlonal dediutions, schedufa(s), and endorslmeM{s) Soo Coverage Put(s), and A any, so oni
declrations, schedules; and Indortlmen, s) disclose df hazards insured hareundsr nown to exist at the tffectiva date 61 IRIS po6ey, unless otharise
stated herein'
1. OurN IN past ihnl pars no Insurer has Caroled insurance, issued to the named Insured, similar b that Mbrded hereunder, Wits o *vM s!dW honlI0
Yeeap N Y irTAT wa "MI an010444, ilea ace, s sot unlusttil rntare,
COYntNligAid by
c3roise AWhorlted Ag1nl
PRODUCERS rnf,Y
( lA7wMSDtAr as, for 7 t,ft ~It,RJ;is iqf; i, kpe M «y'. - ? .r,'..: ~4.cx• en.
7" ll''P. ~ rtdkEgt9t#f
r + f~*+t ,1 OIfIrNtRS' AND CONTAACTORS',PAencTiYE LIADIITEY INSU E
rnr .a emitiOE roN oPEA(1T10Nf OF DkSIiNAnO CONTfZACTOO yMp 3 ~O ~,trp ,e,s~ N[t e; titttp.y tE1, i" ~ t . ;
If~.tit,~itll,~ti9 saej,t^.,,acs, v 'ar, t. a~r.'i!'~' r'.. vYs,s IUPQwq tRt 101 at aetoe,ll Mf ,:Y I.'
iNu.r~1 II~es1 .,e e! , s ~ t ;y~r,c+c, i„a^I!Wt JMr Mt~btl ref kst 1~raftla MM 1►i ' ;~:',^.r
„ ADDITIONAL DECURATI4NS t ,wtva rru',:,. ^ 119-3 ttiV r,1 eat
DWratlon of Cadr.ctor' ,ov- CONTRACT BUILDERSa INC.
klailicg Migrate (order below( °"'814 Vie e SHADY GROVE RD. • ~a t
G RA N6 IRA 1R 1 E e TX
LoCattoll oT covered Oper+tlotn leeAar bolowl , ' • '
• ADOITION TO DENTON PU8LIC LIBRARYs 502 OAKLANDa OENTORa TEXAS
❑ Cheek hire If the following provision Is epplleable, The person or ortenlrolion deslineted 90-0 1I the Contractor W I WeAeLen 1o pep Ih+ premium for this
policy and shell be entitled to receive arty return premiums, it any, which may become payable under the forms of this policy. i
i. f" 49
SCHEDULE
,x r,vene,e LIMITS 0 LIABILITY,
Owner's and CorCrkta'f protective Lir',UHr 1nsurln[e EACH OCCURRENCE AWMATE
,
A-Bodily Injury Liability ,;•r,, $ t $0000000 „ > n s. xxxxxx r
t w K B-Proporty Da-mile liability S 1009000. y„ tt „ r, ,x; rl,
, N.t , r tl
IIIS
DESCtIPTION Of KMAtDS r,,._, Code Premium Dash RA1 S ADVANCE IIIlb
independent Cwtrklors , ui e.,~ id pal 1100 dust v:• .
CONSTRUCTION APBRATIONSW . , 5t ' or !J nr;. 114,0 1p
eT1
CONTRACTOR (NOT FAILROADS)- ' t ,A, halt]` r i
EXCLUDING OPERATIONS ON rb.., rt,,+r nu o. ri~,mt tae:."
BMRD SNIfaS~t , . 16291 9)799.291. .0469. 1':7.0207' 3f$ 60' 1651' ~
EXCESS LIMITS CHARGE 100 56 Ila; I 70J
Total Advance harhm
NDT, !V1
When used it o proinkm bash.
"over mane the total east 10 IM "metI baorod with resp~t to OW16 ns performed la rho ursol iNae/ durife Ihf policy period by Ideponde
cordracton of all work W of Millet lit Connection OA Isch speciRc project Including the cost of all Labor materials Ind equipment twfAshod, use
or doovoted for trse In Uw eseculioa of such work, whelitr furnished tp the owner, contractor a subcoa'nt:Ior, Including an fees, [llawueee, bonuses
or commission made, pant of tke,
L CM11116E A- MILY INIM l1AAILITY (a) to liability ossumed by the laces! under ray contract to agreement except
COYERISE 1--PAO►EA1Y OALUit LIABILITY an locideatil contract; but Ibis esNusiort does not apply to I warnnly that
Wirt performed by the deslgnated contractor will be do+N In a workmanlike
The ompary, wig ply an behalf of the leserad all sums which the leaurel manners
gall become legally obligated to pay Is damages because of ibl to bodily lm*y or properly laarato occurring after
A. be" Itejery or (1) all wort on the protect (other than service, mainto nano. of roselts) to
D. fyelaM 1+eaae+ be performed by or 00 behlall of the ofarel intern$ sr the of tw
to wAfcA ibis ppoorky Splits, uvseQ. by an aeeertaree and arising out of fl! covered operations has bean completed or
operational poor Amid for the MOS Inewed grin contractor 4411111811d in' "t2T gal porliWlif the de i0ted taMrutofe stick out of which;iho Injury
the declarations It to loulioo designated thereln Of 0 acts or omissions or damage arises has been put to its Intended use by any person Of
of the ua" World in con "bin with his general supervision of tuck organization other tan another contractor or 1 ontracfor engaged
601181 s. and the company shall have the right and duly to defend any suit in perfuming operations for a princyel as part of b'ie same praJecli
epinst the Intend sodin!< dameln on account M such i411k Injury~p or (t:1 to bodily talury or preprr<fy dilute arising out of any Oct a omission of
DryMy lannge, even if any of the vile atione of "the suit are poundless, la Iareal asanl of a of his am loyees other tan a krel suparvbton
alT1 or 'Inudulent, and may mike such linvestitetlon ant settlement of ony
claim a wit is N deems topedtent, but the ny shall not be obligated of wank performed fa 1M Solid UserN by to des~Cre!ad CoMratta;
compa
10 pay any claim i tudtmard of to defend arty fa t aNar the ayplltable limit (6) 10 any obli atlon for which the losanl a any carrier as hit imurer may
of to company's 01iIy as bow eahaustod 4y wymenl of iudt'nents or
setllenNrits. still ol4disab litr nbenetcyAs I~awt of u iny nsimllii i,w icymeM compensM
LeohtfaM (e) fo bolify Ply U, any t "Pled of t#1 Iosor d filling out of and In 14
fo Inddeomlt ifa ieolhhif because of i don of to any Obligation of file lewnl
this pokey does not apply: r 6ecaus nutet arising cwt of such inuryi but
AIWA
4eeooeA iovarl
PRODUCER COPY
y{'~y~yp`~ji~4.yyyyyllyyy.W!Y`.r `'('~M .R R'~~f .Mq. yJ ..'Yn y
R!. ..i CCJ 11L1ti ))ETA Y R"~. _A V. ~.L'.•. y Y
' ' ' ' ` 1r ~S Aifi[£a TMT TIt Fol. 44INO Alit ADKO TO THE POLICY 4 ANITIOIML
INSURED~St
i~ QKltl"A$4~r'1`4Xr Ili0ftE1 Engineer
3200 MAKE
OALWS, TEXAS
V"KI1'.C, IIiC. Mechanical and Electrical Engineer
r
2)TiR1fS!Y
13133 No CENTRAL MY,
DALLAS, TEXAS
3I rORD•AWELL ; CMSONp INC.
AND KYER, LANDRY i LANDRY* ARCHITECTS
3141 HOOD ST., SUITE 325
DALLAS, TEXAS 7Sa19
This endorsement Is a part of your policy and takes effect on the 'effective date of your policy, unless another effec-
tive data is shown below.
Mxe! B1 Compfefed omp ete nay ea Ate orament to N'o't'~rryw+ed witf t e, o +eY
to Not 04 64 B/eettse toitA thi Po1feY f y...,,
o. 115d6 T ~t` N I c NO ---"Ltcy NO. 3 a►07 432414
Alexander 6 Alexander
countenlsnwd by 1&q
AwKwlred AWISS allw
G-39543•A
•+41eRi.",' ...vN~L .17J ;R ni ►i U'~lY►wtL►lRt ~"r~'1/~~ w[
7 8!a W ~1
~S 1 WV j W~ AX 4004 6.4' °~tl 10 nE~~[WALos
r...-.. AT-t0fik ! ALE~t,'OER•t~A LLA
ALIIE $
1 ! I t ♦ • ' MMIAfAMG1<</eMAef
MRKERS' COMPENSATION AND~~ CNA Plaza
EMPLOYERS' LIABILITY POLICY Chicago, IIILM;s rrobas
INSURANCE IS PROVIDED BY THE COMPANY DESIGNATED BELOW
Item DECLARATIONS (A stock Insurance company, tVreln anad rill company)
Ploductl No. Branch Policy Number
❑ Continental Casually Company
005031 N' wC 005 44 04 71 ❑ National Fire Insurance Company of Hartford
NAM1D INSURED L ADDRESS. INumbtr i 51(eet, Town, County i Statel ❑ American Casualty Company of Reading, Pa.
1) JEFF IIOLEII6 INC. DOA
CONTRACT OU ILOERS Transportation Insurance Company
2) NOLEN 6 KILLINSs INC,, ❑ Transcontlnental Insurance Company
►R 0, DOX 10063 ❑
DALLAS, DALLAS CORe TEXAS 75207 louiodfilexesof the Insured at of flom uoperations by Alocanaer IS Aloxander r
this policyiey ar
e meonondu cleded+rrbcaledatthe+boread dit ressunitsaolherwise wisastatatee hehereln:' o1 Texas, Ina ❑ Individual Ej Partnership 31] Corporation (OTHER) D~iuasi
o~ ,r t bry'n Tover SaMer
r
er a w , 116Ra6Re HYI I(A-Uhonlr 214 141.5171 OhCy ef10 it TRt RDDa[$% W iRl IN
5.140 To: 5~1~81 fUR[0 6f hates R[e[IR INTa
THIS DECLARATION PACE IS ISSUEO IN CONJUNMON WITH AND FORMS A PART
OF THE WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY POLICY
3. Covt[aye A al title polity applin to The workmen's compensation law and any occtpotion+l disease law of rash of the lottawinq steles:
TEXAS
k, Estimated PATES - PREMIUM BASIS CLASSIFICATION Of OPERATIONS
Annual Per It t10 u' Estimned Total code Entries in this 'Sem, except al' pecifiully provided of #where In this policy,
Premiums elation Are et Hernlnare[ do not Iti~ "c n she other rovlsions of this policy.
2,1670 6607 3900000 5200 COKCRET£ WORK•FLOORS, DAWWAY i. 0
2x553• 7051 3400000 5645 CARPENTRY441VATE Ilia loinCES
868. 3.84 22+640, 5606 CONTRACTORS4XECU1,jVC SOpEwISOR
466. 2691 16*0009 8227 CoOpAc 0R5•PEAMAwlewr YARD
1604 650 3200000 8809 EV:C TIME OFFICERS NOC•PERFORMIRG CLERICAL,
04 `SALESMEN DEITIES ONLY
7.18 IF ANY 6044 CRADING LAND
6~ 6 8810 Clerical Office Em Iolraes N. 0, C. ( (if not specifically
8112 Sdnmen Colleclors or Messengers-Outside included show.)
)380 Drivers, Choulteun and their Helpers N.0. C: Commercial
Total Premium subjat to the experience modification
amlum a Ousted b~!ppitclltion of TOP es r„'tnce modification
• a Premium Discount Credit-Endonemenl Attached a
tlal onstant Rptn3t Constant
= loss end En ans. Constant
8356 otal Estimated Annual Premium i R Minimum Premium
spas t nmium, Indicate di interim adjustments o premium alt be msder Semi-Annuilly; -0 OuIrterty, , MonthI
e•31203•!!I
J t1~0rLetnentEdentily By Form Nlsmber) i 4631130001 i 604A, TX-21i
5. LRI-10 991.1o"iilliRRty for tavtra-tlWl^mployen' liability: 00s . , subject 10 all the larms of this policy having rsfawce Thereto.
'Enter additional locations here:''
60AI1SENCE OF AN ENTRY MEANS 11N0 EXCEPTlCN".
CC/do
o•u ncertienllvra Date Counlusigneo by ~
AuAnnr16rd AgaM
.s « s.Y L ,
y. 1
It
EXECUTIVE OFFICERS, PARTNERS AND SOLE PROPRIETORS ENDORSEMENT` - TEAS
It Is agreed Inst.
3, Such rnsurame as is afforded by the policy by reawn of the tit-sit nation of Texas in Item 3 of the declarations doeSnot
apply to mitm, including death resulting therefrom, sust.vned by any executive officer, pariner or sole proprietor of the insured,
except mxh, if any, as are des gnaled below or in Item 3 of the declarations.
2, ' Rernuncratron", when tlsrd as a premium bass for such insurance, shah not +ncllKle the renumeratlon of any execut+ve
ofhter, partner of sole proplrcior of the Insufed not so designated
Oesianalkim of Persons
ALL iEXECtl M 0/FICIAS
This endorsement, which forma a part of and is for attachment to the following described policy Mood by the company designated
therein, Was effect on the effectlve date of sold policy, unless another effective date Is shown below, at the r-our stated In said policy
and expires concurrently vdth field policy,
Be Completed Comp ele on y '71erf Thfa B orsome"I !e No: Preppared sus! a o
Or is Not to be E,f eeffre Wo .h the Yoftey
Eit y 10eU►CY N0.~ ISSUED to N S LN RSL LNf
~ 04 *f /1
CNA
Countersigned by
Authorized Agent
Form TX.3.2
Executive Officers, Perteers and Sole (4113)
Prdprieias Endorsement-leMfis
form 0.32133.9
tier :ttacsi"l ttavaa arse N es.noietel anrr sham inn eMersrmrot M ttswl sultasael N Mrswatiea of eae eatic7l
WORKM/N'S COMPINSATION TX-14.1
(td. 12-41)
PREMIUM DISCOUNT ENDORSEMENT--TEXAS
This endorsement, ellective , 11201 A M., sranderd time; loans s pert of policy No. b(C COS µ 011 71
.
Issued to
by
•••AuNl+onra ilepresenrefivi
It Is agrted that:
1, Standarb Premium. The premiun. computed in accordance with the provrsi0as of the policy, other than chit endorsement Stull
be known as the Stancard Premium.
2. Computation of ►rewlum Discount.
(a) if none of the Standard Premium Is subject to retrospective rating, the premium shall be wbjecl W the applicable discount
stated in the Table of Premium Drscrunt Percentages.
(b) So much of the Total Standard Premium as is subject to relrospect ve rating shall not be wbjecl to discount. If a portion of
the Standard Premium Is subject to a retrospective rating Plait, the discount on that portion of such premiums not subject to
retrospective rating Shall be the difference between 111 ON# discount which would be obloi"d If none of the Total Standard
Premiums were subject to teteospect,re taiin , and (2) the discount which would be obtained it only premium subject to retro•
swlive rating were Included in the computation.
Table of Promlum Dlscounl Percontyes
►renlum 01s e~t Premium Discount /roa+iom Dist eant
(e,.►~r;al~ LA J1, #1 !6 _ IoNr»I of
ppl . 1,003 Q.0 R 11,450 1,411 3.0 X 2,674 . 2.733 6.0%
1;016 1,026 090,2 1,11$ 1;5919 3.2 4,1 6 1922 6 2
1,027. 11037 0.3 1,520. 1,544 3,3 ?,9773 1, IS 6.3
1,031 1,014 0.4 1,545 1,569 3.1 3,016 :114 6.4 !
1,050 1,060 03 1,¢70 • 11596 31S 3,11S • 1,132 . 6b4 5
1,0 1 1,0p9g71r 0.6 1,,397 • 1,62513 9.6 3' . 3,151 6.7 {
10 0.9 1411 1711 ! 9 3 3, 3S$ ,4SS • 3,Sb4 6.1
11111 • 3,774 6.9
1,111 • 1,123 1.0 1,712 17422s 4.0 3,725 3,177 7.0
1,121.1151 1,1 1;7746. 1,1 IN /.1 4,043 • 1;221 7.2
1,13¢ 1,110 1141 4.3 4,772 , 4,41 7.3
152
79 1.4 11115 10810 414 4,419 • 1,63 7.1
,146 1,1165 ,
1,160 . 1,194 1.3 1,111 1,911 4,S 4,634 • S 971 7.5
1210 1;215 66 1, 939 419. 1,956 1 949 4.6 4 5
,1 1 ,;031 . 5,104 .7
1,726 ,4<1 .1 2:000. 2942 4.1 3,105 • 5,176 7.1
2.
11241 257 1.9 2,041 2,017 4.9 5,177 • 5,231 7.9
1,151 1,274 2.0 2,011 2,133'4 S.0 $1252' • 5,327`` 0 # 5,406 It
1193.1 709 ?.2 2r2i5 .1, 116 1i1 b 409 S ST2 1.3
1;310 . 1,32E 1.3 ,
1,379 1,347 2.4 2,419. 2,345 S.4 S,S73 . S,4S1 6.4
1,341 • 1,366 2.S 1,346 • 7,404 S.5 S, 659 . 5,747 0,6
1367 - '386 1 1167 1 406 2,7 ;466 0,512 S 7 61.64 5,911 7
1,149 1,449 1.9 2.603. 1,615 5.9 d 0 3 . f,117 9
I(Mlinued on laveuit)
WC 79T
'•.,un,..,.a, 12i 1~4 I
[1+OYe a3
•
piKr~r! ►n~rhM Di~
Itt+Mlr~r D1uwM ►tr*wir~ Irlenrl
' I~r~r IntHral ~.~--10,590 10,693 i1.S % 36,121. 11,910 11.0 %
8,131 6.236 10,896 11,2)6 11.6 1?,941 48,686 14.1
,;39 1,317 9,1 11.7 16,661 56,133 14.2
66' All 6,159 9,2 11,597 .11,966 11.8 56,151 66,361 11.3
6,460 • 6,516 9.3 11,961 12,]72 11.9 68,361 81,110 11.1
6,311 6,896 9./
.1,800 12.0 81,111 . 100,766 14.5
6,691 6,821 9.5 1212,,317 373 113,272 12.1 100,769 . 106,215 14.6
6.022 4,951 9.6 13,213 . 13,773 12.2 108,218 112,285 11.7
6,932 +,066 9.7 13,711 . 14,313 12.3 112,216 119,090 14.6
1,011 7,227 9.6 14,711 .14,691 12.4 119,091 126,773 14.9
7,221 7,373 9.9
,5]1 12.5 116,711. 133,516 13.0
7,374 7.523 10'0 11 1 896 698 • 1155,,231 12.6 135,517 . MASS 15.1
7,526 7,697 10.1 16,222 16,974 12,7 11S,SS¢ 157,199 15.7
1.6111 . 7,848 10.2 1,977 . 17,104 12.6 157,2000 170,)64 15.3
17,)03 16,117 12.9 1701770 167,142 1511
7,1 IS • 1.021 10.3 6
e,ol:. 6,201 10.4
1,390 10.3 19,718 . 19,139 13 0 206,141 . 271,175 15.6
1,202 • 19,730 . 20,656 231,176 261,999 15.7
9,791 . I,S97 10.6 20,651 • 22,120 1133,,2 3 262,000 302,307 13.6
8,518 1,741 22,121 . 23,S47 13.4 3020306. 357,273 15.9
9 017 9,240 16 10 9 23,S4S . 25,171
13.5 357,273 . 436,666 16.0
9,2141• 9,480 11,0 25,172 . 21,036 27037 . 29,449 13.6 436,667 . $61,421 16.1
9,161 9,732 11.1 ,73) 13.7 381,429. 785,949 16.2
9,733 6 9,999 11.2 79, 71,2g0 739 . • 3131,733 13,9 786,C^0 . 1,309,999 16.3
. • 10,261 I1.] 13.9 1,310,000 . 3,"49,949 16.4
1010,2000 82 10,579 11.1 31,741 .311,/20
3,930,000 Ono Ovu 16.5
• 4
For AHacr Mil to '
1MOrliff* •'s Com"nyatwn
and tmployeil' l 4slity Policy
BROAD rORM All STATES ENDORSEMENT
11 is speed that
1. if the insured undertakes operations in any state not designated rn lit. n 3 Of the 9eCina1ons, Other than bhth ga•,. Ne,ada
North Dakota, Ohio, Washington, West Virginia or wyomint Coverage A applies to such OpHal,ons
2. If the company is ofevented from performing its Obtgalrons under Coverage A with respect to such GptgtiDns because u.!
klsured or the Company has laded to take the necessary action to bang the insured wilh,n tie workmen's Compensa'•Y W
occupational disease law's of such stale, the company shall feimbu'se the injured for allCJmplnNSgn and other btnrr'!
fripquued of the Insurtf5 under such workmen's compensation or occupational disease raw
3 Coverage B applies to operations Of the insured covered by this endorsement The limit of liability for bOddy miurr by d-seaks
including death resulting at any time therefrom, applies a$ though each slate in wh,th such operations are conducted wire
designated in item 3 of the declarations
4 The word "state" as used inihis endorsement means any Stale of the United States of I men t a and the D,stn:l of coiumb a
5 The insured shall give notice to the company before or within a reasonable lime after the:v'rimM:er•~!^! Su:h opera' .
but failure to gi4r notice shalt not invalidate the insurance The unwed shall, of re lotslld by the twnpa'+y last 0ha'r,r
action is necessary to come within the workmen's compen"lon and occupations' d star! law Of Such Slate
6 The premium bases and Well for the ctaSsilicat~ons of operations in any such start Ma's be those Spot cable unit' li t
manuals In use by the company, and the premium shall be computed accord ngry o :,nt bas's Nred in .',ond t..r I
pol is y
7. Theinsurance0MOrdedbyIhisendorsemenldoes notcoyerfine IOfpenrfirasimt,oseIOntr,ainsuftdfyffeifuretecomol,4%
the requirements of any workmen's compensation Nw
All of IM proviW if of the policy, :nsofaf as such prov4ions are not rntonsislent herewAt. ar! ApplKobre to the jf,su•a•,:t
offorded by the', .Icy by virtue of this endorsement
This endomemenl toting a part of and Is for attachment to the followtng described policy issued by the CN1, INSURANCt tompan,
designated therein, takes affect on the effective date of said policy, urns another effective dolt is shown below, at the hour slated in
said policy and eapites concurrently with sold policy,
Xaut Be Completed Complete oAly WAtr riIiis Endora►iwnf Ja Sof Pn~ra►eC Wirt, the Arley
S oAattobeFfl,fthevith the efiry
r... .
eNOT,Ms apleY No 1l~"ul~t0 IhDOelViIN 'I
~
3 WC 005 A 04 11
O'CNAlinsurance
Couhtelslgned by
Authorized intent
Brad Eons Ml Slates Encors imenl ttles lam 11
ram G-33513A
ry n~f 'wig d~" 4 .•'i t x, ~ ~ y
r
Additional Premium
ENDORSEMENT
Return Premium
Effective on aid aflee 5-1-8019__, Standard Tine
this en4orsemrof forms part of policy No. - WC005440471
Issued fo __-9ontract Builders
By Transportation Insurance-Company Company
I
I
In the event of cancellation or material change which reduces or
restricts the insurance afforded by the policy, the company
agrees to mail 30 days prior written notice of such cancellation or
material change to City of Denton, 214 East McKinney, Denton, Tx.
~tiaa
l
Y
All ofher forms and conditions of fhls poky remain unchanged.
ALEXANDER & ALEXANDER OF TEXAS, INC„ Dallas, Texas
By:~`" Avnw,ret/ rttt.rti.tsn
d7tr7
~:'~y
CANCELATION PAOYISION On COVERAGE CHANGE INDOfiSEMENT '
IWorkman'c Compensation and £mploy*W Liabiliy POUty1
rnerrrrmfr,I issufd 10
r80 and Icrrns a {-Olt c1 Policy 110..r _s•~~S 71
rnrahYn from 12A1 A,Id 6wndardirroo
cl
,r• I I Y
In ilro evrnt of concrlotion or matorlal chungo which roJucee or rellikis Iho fneurance alloidr•d by rho phc%.}ihe cotnpanY 0'1 b rnoil
Jtrf PNoUNe INC*_CPA CONTMCT BUILDERS EUt
Jars tiior W1111cn notice of such cancelailon or moloriol chonao to -
r r se
c, f~ "'JJ lEnicr rwma and addros.l
couolersigned at
Duly Authorised lkpressnlot,ve
#4
rr~u ts•!r
rl•r•7s1
rcrl CK•N MACK Isr Uel) ~~„L
` ~ ~ ~r,..r I „ wv r~~a lr V^ •iPL.~1~Yt'~17x~M1~'1K^^4?'~.rid,~'?~~r/:~~T~*~~'M1''~'?~'"'"f ~r'r'r{;~,,,••c,~~~'~~,0~~~~1.1t v'tY~~iZ~~L?'ti{•i~ ?+,P~,si,~u;
44 :;r, 1',rl'Fy sY 1Y,~
PARTICIPATING PROVISION
• the Insured shall participate in the earnings of the Company to the eiterd and upon the conditions dettrmined by the 6"'d of
ChreCtors of the Company In accordance with law and made applicable to this policy, prrmded that no dividend shag be payable here'
under unless the insured has complied with the terms of the policy in respect iP the payment of premiums.
This e:Idorsement, which forms a part of and l!: for attachment to the following cnbed policy issued by the company designated
therein, lases eltecl on the effective date of said pcScy, unless another effective date is shown below, at the hour stated In said poticy
and aspires concurrently with said policy.
Must He Completed
CNDr, NO, ►Ol1CY NO ISSUED 10 &FC rHE DATE OF 11 OFF lalcu, 114a 0M eor(TaACT eu+lPeas THIS POLICY
o
11C Do 44 04 2 KOWN ti
McWUauFnow ALEXAMA i ALEXANDER OF DAUAS 042•005033
OVA
0 Cenlinenlal Cafoaity tompony 0 Americon Casualty Company of tleadina, Pa.. 0 National Tae lasvi cempany of lfarUw/
0 Sransrantineatal (awwo Company
Tranrpertatfoa Insnrmu Company ❑ Valley lode Insurance Company Partie p,, ,
D
~v~ iuth
Countersigned by Autherited Fgenit
'rpacinq Provisio I
Form 031203.8
Branch: OD DALSAS
APPLICABLE PARTICIPATING PLANS
5-1080 To 5"-~~131_
Policy Period From
1, Plan No. and Dividend Schedule 40.76
2. States Whem Applicable TEXAS
3. Commission Scale
If part o! a Safety Group,
4. designate Group
6.
. Enter on Line 2 one of the following: (1) name(s) of individual state(s), (2) the wcrd "all" (lo mean all staUfs when designated
plan and dividend schedule Is available), or (3) an asterisk (i) it (1) or (2) cannot be used (in which casa short the asterisk below,
lotlowed by a statement as to where the designated plan applies),
Dividend Accounting Copy Sent to:
~J H.O, Participating Dividend Dept. 1C' Premium Audit Dent.
11L} Branch Office Underwriting Uept.
ERDT. 05
a f i
l n"ilk r~
WORI(MEN'S COMPEN_SAYION AND EMPIOYERSt LIABILITY POLICY WC 91 025
PREMIUM ADJUSTMENT FROM EFFECTIVE DATE ENDORSEMENT 11 10.1.15)
It is ajrttd Ihal the pftmlum lot the Policy is subject to an taptrience modification not available at the time of policy tssuance Such elpentnce moddica-
lron %hen atl tmintd, d diffewit from the modification shown on the ponce. will be stated in an endorsement iswea to form a part of the policy
Thit endotsememl forms a part of the pol:cy to which altached, effective from As dale of issue unless otherwise staled herein
(The Infwmalion below is tequhed only when this endorsement Is Issued subsequent to pteolralion of the policy.)
Endorsement effective Polity No b1' 005 V4 04 ~1 Endorsement No. 6
Insured vlrttmium S
Counleitigned By ' " jY~e1C a
WC 91 025 (Ed. 1.75)
tNdT. 16
I'N'LAND MARINE POLICY
1. r t t r 1 id'Y"PROVISIONS PART I Form 4115
THE HARTFORD
Atatandar fi Afaaartda rr~
of TOaaa, MC. l
34th floor, 200, Bryan Tower t
Dams, Texas 75201
leluP`Ane 214 741.5171
a
'rhe Coinpany designated on the Declarations page as the Inauter
(a stock insurance company, heroin called the company)
1
~~;til CiUr;r):j .fl f1 if,t1)
r ,.f , i~ , { ..}l %,n..ft lull 3 t1Y1 +)t• l
J 't
64i inlu(f th6 I1lsured, noised in,tho C7t~tlorrllgpl road. 41 pact hereof; in Z9na*0tlon of the 1NYmenl oI'the prer4101111. fa 1495.4r danla(<e
Which bt4url tirp i Ire poliq term stated in the leglarations, nod to reliance upon the statements in the Declarations and subject to all the terms
~4ji # kr.
tau'f: I,.. ~ 1[ .1' 1 rya't 'Int 'v 7:, hi r . •i ,il 1~3
►N ~N~ AGREEMENT
tabs nsprpltci! aPfk,4e4 A411 be asptated in'thq,Coj4rago F:q&t sement(s) iss6cd to form a part of thlo polity, subject to the stllttlnrnts in and
all the terms of the Declarationa applicable thereto, and to the eacidsions, conditions and all other terms'of this policy ;
I,l r. i i I, r!.v
- .II - ~ .I i rat
,t
r
i
a
ail.
Y"Nio"T kA MIN 0MA,P11
~,•.i ,:,,,t i tslr,a 1,AI4 I.•trr+;!IGrAL EXCLUSIONS
hating or defending against such an occurrence, re or
destruction under quarantine or customs regulations, a.
tlon by order of any govp pppublu~ Alethorhyr~re a
of contraband or Illegal liras a tra bb•
Civil Authoritys Property covered under this pollc against the
peril of fire Is also covered aQainat the risk of damage or destruction by
civil authority during a cone ation and for the purpose of retarding
the saint; ptpv(ded that M3or such corlagration nor such damage
herein or destructl6a it caused or contributed to by a peril otherwise excluded
. ' e
I. Nuclear Sxcluslon, If this pocky
A. Includes coverage against the pens of fire, the Company shall
not be liable for lost by nuclear reaction or nuclear radiation
1. War italic Exclusion a This policy does not insure against loss or or radioactive contamination, all whether controlled or un-
damage road by or resulting from controlled, and whether such loss be direct or lodirecl, ox i•
mate or remote, or be In whole or to wt caused ~y, contributed
It, hostile or warlike action in time of peace or war, including to, or aggravated by the peril(s) Insured against in this policy;
action in Kidering, combating or defending agk% it an actual, however, subject to the foregoing sod all provisions d this
impending or ex told attack, (a) by any government or policy, direct foss by fire resulting from nuclear reaction or
sovereign power jure or de facto), or y any authority nuclear radiation or radioactive contamination is insured
mainta n(rg or us ng military, naval or air forces; or (b) by against by this policy,
military, naval or air forces; or (c) by an agent of any such b. does not include covtra S against the peril of fire, the Com-
government, power, authority or forces; l pany shall not it liable ~ot lose by nuclear reaction or nuclear
b. any weapon of v•ar employing atomic fission cle radloactivt ` radiation or adioottive contamination, all whether controlled
force whether In time of peace or war; or uncontrolled, and whether much loss be direct or indirect,
t. Insurrection rebellion, revolution , civil war, sour suer Proximate or remote, or be in whole or inpa rt caused by, cone
or action taien by governmental authority in hi erin, com- thisupolicy aggravated by the peril(s) insured against In
GENERAL CONDITIONS
1, Mlerepresentatlon send Fraud, This entire poicy, shall be vouchers, or certified copies Ihgqreol if originals be lost, at such reason-
void if, whether before or after a loss, the Insured has concealed or able time and place as may be designated by the Company or its
m4represent dany material fact or circumstance concerning this insure repreanlative and shallperro met extracts and copies thereof to be made.
agcy qr thq;ubj~ctt thereof, or tre Interest of the 1nturl t erein or in No sue exam natlo un~ath ortxa inatio of books or doc menu
Cale of ilnp frittd~br fdlee lY}iihn~ b the f>iaared tt[atihk-thH4id ° .,,,E 'AN ilbther elf of~hi Ebtif[ftlyW anlNleof rft(i[oyglYcreeenta-
,rl p !.i~..1 ln~rli.l/1 `.:9t1,~•f; t,{~ it. '•il !!'.~il I''JI ~r:Yalns~npFtivn wit 4~e,~gg .ate p fpy'
2. Yaluat[ont The Company shall not be liable beyond the actual a al[ he deemed a waver offad f deCepnsewdrich {hee Mpppp yy rr~~ it
cash value of the property at the time any loss or damage occurs and oche; wise have with respect to Any loss or claim, but aUe7i't3dtdf~da•
the loss or damage shall be ascertained or estimated according to each tiotts and acts shall be detm':d to have been made or done without
actual cash value with proper deduction for depreclation, however prejudice to the Company'r liability.
caused, and shall In no event exceed what It would lben cost to repair
or replace the same with material of like kind and quality, 7. Protection of Propertys In case of 1060, it shall be lawful and
necessary for the Insured, his or their factors servants and aultam, to
3. Pair, Set or Parts i In tke event of lots of or damage to: our, labor, and travel for, In and about the defense, safeguard amid re-
a. any article or articles which are a part of a it or Bet, the cover of the property insured hereunder, or sn
Co-
M t hie Insurance, Wei thereof, is without
measure of loss of or damage to such article or tit 11ia; ~}'ry ¢ y nor shall theacis oft a insured or the Com
a reasonable and fair proportion of the total value of the pair or Pan F, 1 rtlering, saving and preserving the property lneured In case
at` Nevins consideration to the importance of said article or of loss be considered a waiver or an ace tance of abandonment. The
f,lr ortkl4s, but in so 4Yf'pt sbppll puGh igef, ,rjafuag4.bn con,, , txpe~y~te10h Incyrro shall be borne by t a insured and the gmpany
strued to mean tota l Ipss llthe pai r or sel • o plnpot htely Its th! l4klt of their rN il" Interikis
/.,I,.1 o- Iii t,, .'.ii.t S., Jrrl--1t f-'ill .If, i!1:, 1. , ,
b. any part of property covered eonslsting, when coin lete for g No n ! Ill t t l a, u E ;,,u e I l r
use, of several parts, the Company shall only be liable for the directly or ire to littlest This insurance shall in r sofas [Wore
value of the part lost or damaged, or indirectly to the benefit of any carrier or other bailee.
ti. Charl Notice to any agent or knowledge possessed by any g• Subro6ation or Loan: If in the event of bas or dams pa the In-
agent or by any other person shall not efrect a waiver or a change in sured shall acquire any right of action against any Indfylduall, firm or
any part o[ Ihis polic y or estop the Company from asserting any right corporation for lase of, or damage to, propnty covered hereunder, the
under the terms of this policy, nor shat) the terms of this policy be will. if requested by the Company, Amiga and transfer such
waived changed, except by endorsement Isn:ed to form a part of claim or right of action to the Company or, at the Company's option,
this poly- execute and deliver to the Company the customary form of loan receipt
upon receiving an Advance of funds In teepect i the loss or damage;
6. Notlee of Loess The insured shall as soon as practicable report and will subrogate the Company to, or will hold in trust for the Com•
in writing to the Company or itt agent every lost, damage or occurrence panv, all much rights of action to the extent of the amount paid or ad.
~hlch may give rite to a claim under this policy and shall also file with vanted, and will permit suit !o be brit lit In the Insurer,'b name under
the Comparay or its agent within ninety (90) days front date of dies the direction of and at the expense of the Company,
eovery of we lose, damage oroccurrence, o nailed sworn proof of loss,
b, Examination Under Osthe The Insured, a often as may be Alct It. with the s a ty tI Or The et State wherein its till ppoo licy policy are fit cone
r to co of The 4 Issued are
rwsonably required, shall exhibit to any pennon dnlgnaty! 'the Com• hereby amended to conform to such statutes.
pany all that remains of anyy property herein described and shall sub-
r hot, and in so far as is within his or their power cause life w their em- 11. Settlement of Loser All adjusted claims shall be paid or made
p yea, members of thehouathoidandothers tosubmit toexaminations good to the insured within thirty (30) days after presentation and
under oath by any person named by the Company and subscribe the am 'stance of cattefactory proof I Interest and lose at the office of the
some and, as often a may be raanablyy rtqu[red, shall produce for Company. No tae shall Ile pakl or made good If the Insured has col-
examNnailon all writin3s, books of accouht, bills, Invokes and other lectcri the %air r-om others.
Form r,si
Page 1
r!
J, W
PAR.' I' T'l!s Daly►aifoas pale, st+tA "POU Y 1' VISICINS PART I-. Past 0105 sad e"Willasealr,~rj/ car, owed 1o farm h hit 4eir~,
I Petssptetcs lit below aasrbeyd INLAND NURTNE POLICY
~J Hartford Fire tosurance Company 3 Ilartlord Casualty insurance Company,
THE +L IW J $ Iartford Accident and Indemnity Company 0 M 't'win City Fire insurance Urnpany
INSVRAKECROUr S
""MtO"O Gb 0 Ifuttford, Cor tecIIcut 66115
The INSURER shall be the (bmpany to (od's
designated herein by Co. Calet & 1' s PUICY NO. 46 (C 6!1119
DECLARATIONS lrerlevi-ene) Ra ~
_ ,tsi~lblwa Lie a dM .Costsaet .
Items
t. Insured's Name and Maf'g Adoreu
(Number, ,Street, T'ow'n or City, Courtly, State, Zip Code) !Pe 0# 1m 10063
11101,14.418, Tow" ?5261 r w
64 01 so
04
Poll Term: Noon, standard time at lace of Issuance- I'iofl -
r-- ~iadu[K i tiaeneiia ABdreu Prod ucae'e Code y Yr.) rx*atton (Mo. Pay Ya) Years
600969 policy Term Excepllonr In California and Orlon the words
~ ~ i ut ~ "1Z:Ot A.M." are substituted for "Noon" as require by statute.
noWid
This copy of policy is for Information only; It Is not a contract
of Toas late of Insurance but attesrs that a policy as numbered herein, and
la"No Tax" as it strands at the date of its Issuance, has been Issued by the
Company. Said policy Is subiect to ehange by endorsement and
to assignment and cancellation in accordance with Its terms.
3. This policy covers only with respect to such and so many of the following classes of properly as are indirated by a specific amount or limit V.
insurance applicable thereto, and a Premium therefor, and which Is scheduled in Item 4. Subject otherwise to all the terms of this policy having
reference thereto, the amount or limit of Insurance appl;cable ;o each "article of property" Li as ataterf in Item 4; the total amount or limit of insur-
ance applicable to each "class of property" is, as stator herein, subject to the foregoing provision respecting each article.
CLASS OF PROPERTY Amount or Rate Premium
Limit of Insurance
1hliLt~frr Risk _ _ _ 1st kalo+r _ : Za
is to entity this to s ime
Wcaot so>n► ~~_!'!44~4_.~lf119-_:___lj ~ =
~ a s_
ema omees a oramews forming part o po scy at issue( osert ardi a soon ales ucd a mount -TOTAL -
M41-3 01340'-!1 s No PREMIUM s 130.00 4
W-MrDMI111IRED PAYMENT A t
The Total Premium Is 11 , and is payable f at inception, and ! at each onniveresry
d. SCHEDULE of articles of property or of ro rty at locations and amount or limit of Insurance applicable to each
~ - - _ Amount or
No. Full Descrlptkn Limit of Insurance
ve 16Y emus `M tsaii~rYw-V A -YRLrt. ~ -
i41 blawilu 41.40siltad d (%lfte6 Witllk-""Ore
bruk6 iroe-clad ffl" er tMti-411tt tafsisttw all locate
then a 100 silt radius of Dal.16t6 Tllci►s
AvWayb 6 • Usdts of Liability I
(a) (1) 3 190000000 on "at-fire VWlettos
(1) 7306000 da brick aid tCK
5006000 0>4 Name alsd brick-voseev
15,000.
156000.
(d) 160006000' Alexander l Alexander
of Texas,
, 34lh flea, , 2001 tfryan lower
0aba6, Texas 162a1
Telephone 24 14t•5111
,,tt
II, Lae Pa;-eel Any loss hereunder Is payable as Interest may appear to the Insured and
No 04 19 79 Coxntaif,trxdby ......Aetna
hl•I%.I r9 I'i lard In t'.° A,
7- 7 '77
i r \ , \
9uil:i~t~ Risk and/or
1nS1a11a11Un Floaler form
(Texas) THE HARTFORD
Subiftl to tint amoualls) or hnol(s) of insurance Stated in the otclaraltons as appt,cab:e 10 this tnsurance, loth iscluSion 1,tond,boni and AM other terms of this policy not eapressly
matd,td hfit'n
1. This Endofsament Covers:
a. Materials, supplies, machinery, equipment, flxlures and lemporafy strucures to be used in Or incidental to the.anslrucUon, fabrication, installation, erection Of completion
at dwtlbngs and other structures as described on leporls hereunder,
b. Alterations, additions, and repairs to exisimil slrucluns but in no instance is coverage extended to such existing structures,
•'Dwellinlf, as used herein shall by defined as those buildings designed lot dwelling occupancy by no more than lout Um tits. All other construction. shall be deemed
commercial lot the purposes of this oobcy.
Coverage attaches horn the time the the"r:"_ ^•_;ady becomes at tilt risk of the Insured and coven conhnuoasfy I Wier on premises or Ole of construction; while
ewailing and during consUUdion and listing; white be c! Uansported within the eanlinenUl Untied States to or from such premises or $411 on motor trucks Or traders, rail-
road cars, and the regular coastwise lines or lerries nav gang the Atlantic. Gull of Mexico of Inland waters of the continental United States, until the )nwred buiidrngor
mr,"Ciurt shall have been fully completed, accepted by the H;rchaser, the interest of the Insured shall have ceased, or the expiration dill;howp in Item I of the Delon,
tons, whichever first Occurs.
L This Endorsement Does Not Cover,
L Machinery, tools, equipment, and properly of a similar naluu not destined to become a permanent part of the installation of structure;
b. Properly at locations other than the construction site unless such property is Intended for specific installation It the conahuchon siU Of the job Insured hereunder and then
not to exceed 10% of the limit at liability hereunder or 125,000.00 whichever is the less!;;
e. AawnU, bins. deedt, currency, money, notes or securilits, blueprints, plans, designs or Specifications;
d. Titers, shrubtdry, lawns, {run of plants;
L Property while air•bofne unless in the custody of regularly scbedi-W Airlines;
L Property while waler-borne except is provided elsewhere in thte policy;
gr AA 14"not - except for the perils of fire, windstorm, bait, aplosion, snake, strikes, Wt. rdvil pomrdotion, motor vehicle and airaari damste tmless endorsed bereod;
Is. "-slab" construction of any type, unless specifically indorsed hereon.
This Endorsement Insures Agalrtst all risksof d'rredt physical lossof ordamage to ins property insured ha any external cause (ncWdiol general avenge and uMge
charges on shipments covered while wlternborns) erupt is hereinafter provided.
4. This Endorsement Does Not Insure Against:
L Lose tic damage caused try or ruulting from weer, list, greduxl deterioration, fast, wet Air dry rot, motel, vermin or Insects, :ampnea at atmosphere or extramn of tempera.
turn, Iatent defelt or Inherent vice, or lose it market Or do .f or other consequentiel loss;
L lass dame a or expense caused by or resulting from error, omission or deficiency in design, specifcations• workmar+,vp, or m.lthils, %,44ss Are or explosion enwa, to
whFA overt, liability shall be limited to loo, damage or expense caused by or asuiGng Iron such Are or explosion;
i Loa or damage caused by or resulting from the weight at a bad exceeding the registered hiring or supporting capacity of any equipment used lherelaf;.. ,
' All. Loss err damage ausad by u rmNol from subsidence, settling, shrinkage or expansion al faundaiions, wstls sidawatks, drive Kaye patios ffooro or eelGngf unleu ausad ,
by or resulting from fire, lightning, smoke, explosion, windstorm, contact with alrcnlt or vehicles;
e• InfldeGly of Intured's employets or of any person or persons to whom the inwred property is entrusted, loaned or ranted; not fa loss caused by the dishonesty of any
aflendanl Or alleadants (amen for hire excepted;;
L Unexplllood lost, myotertous disappearance, or shortage disclosed by taking Inventory;
g loss or dama`e to eledrrcat sprionces of devlren uuud by or resulting from current artifJolly generated unless bra ensues and then wily for loss or damage caused by
such msuirtg tin;
1s. Loss or demee to ptoperty In trsnsit caused b) or resulting Item leAkage, breakage, marring Or scratching unless caused by lift, lightning, Cyclone, tornado, Arad Or by
collision, dnadmont or overturning of the VOW # or by the vessel Dung on fire, stranded, sunk of in collision;
L Loss of damage caused by or rewlting from earlhquekl, nurlecl coders, mood water waves, tide or tidal wave high wrier or overflow of strum of bodice of wits., III
whether driven by wind or not, or whether caused by of attributable to earthquake. `Ihis exclusion, however, ehau -M Ippfy to loss by fire or uplosion caused by perils
• aclude0 In this patsgroo b,
i Loss, danuge or expcfsa caused by or resulting from explosion, rupture at bursting of Wins bw:hn, slum pipes, steam turbinse t, atsam engtna;
L Mechanical breakdown or derangement, unless fire or explosion ensues, and then only lot the We or ~ smage caused by or fesuFAng from such Are u uptake;
L loss of damage caused by or nnulting from fain, sleet at tnow whether driven by wind or not, unless wind or hail shell first make In opening in the walls or woo! of the
insured building, and this compomy shall then be liable only for loss to the Interior of the building, or Insured properly therein, caused immediately by the rain, e!ael of
grow IMtring the building, lhfougb such openings;
NL lose pinioned by ahforcement of tiny local of stile ordinance or law ululating the construction, Impair of demolition Of building(s) oc atcuctufe(s);
14 loss err dsmlgt to glass (other khan glass building blocks) caused by or nulling from vandalism or malicious mischiel;
L yraealhe of plumbing. sulomalic soin.kUr, hulin(of Ili conditioning syslems or their I?Pliances, or the rseenant lukage of overflow from Such Irstemsof cap IAXIS,
unkss the Insured shall have eserrasad doe diligence with rrsped to maintaining host in the bYddifliri at enless such Systems and opphsnces had bean grain s Ind the
water evpply cut off;
form M•1e1,1 (NS) Printed in U. A.
~r~r
a, r % ~
S. GeductilUl
too dim far lost or damage tihail be odlusled separately and from we amount of each such Adjusted claim, or the eppllable 1^1 of liability, whichever shell be In$ the
sum tp4Cd+4d in Item 3 of the declarztans shall be deducted and tome by the assured.
11 the 40141 of loss or damage to buildIngs of 11fuctures, such deductible shaft apply separately to each such bmidrng or Structure.
S. LIMITS OF LIABILITY: TH4 COMPANY SHAH NOT BE LIABLE HEREUNDER IN ANY ONE CASUALTY OR
AND 10EN11FIE0 IN ITEM 4 OF THE DECLARATIONS ON: DISASTER FOR MORE THAN THE LIMIT SPECIFIED
A. ANY ONE BUILDING OR STRUCTURE;
8. WHILE IN TRANSIT;
C. THEFT: THEFT COVERAGE IS LIMITED TO 15,000 UNLESS OTHERWISE ENDORSED HtREON;
0. ANYONE LOSS. CASUALTY OR DISASTER, EITHER IN CASE OF PARTIAL OR TOTAL LOSS, OR SALVAGECHARGES OR ANY OTH4a . HARGES OR EXPENSES,
OR ALL COMBINED.
7. Coinsurance;
i
The company than pal be liable in the event of loss or damage for soy treater pfoporlion of such loss or damage than the smount hereby Insured bears Bo the Actual value of
the aopedy Insured hereunder At The time wben such lesser damage shall happen. If this policy covers two or more buddmgs or slructurn, this Conddron shall apply to each
twildi-11 of structure separately.
3. Audit: j
The company or Its duly appointed represenlalive shall be permitted at all rasonable lima during the term of this policy, or within one year after its termination, to examine
the Insured's books, records and such potion as relate to any property covertd hereunder. This Inspection or exam+natan than not waive or in any manner Allect any of the
terms or conditions of this policy.
9. Other Insurance:
The company shill nag be liable fm loss, it at the time of toss, there is Any other insurance which would attach if this insurance had not been effected, except that this insurance
shall apply only it liens and in no event as contributing insurance, and then only after all other insurance his been eahausled,
10. Tortltorlal Llmlts: , 1. 1
This insurance mitt only within IM limits of the eontinenisl United States (nduding Alaska) and Cenade.
It, Reporting Clause (if applicable): ,
1. Notwithslandin the fepuiremint that premium be paid on the total actual Completed values, the company's Rabifity shall in no event 41cead the Firth of liabddy
provided by this po +ey,
This policy is issued in conydefation of a deposit premium is shown In Item 7 of the declarations, fArned premiums shell be applied agsinsl the deposit premium
enbf suds time ash shalt heve been fully earned by the company, after which the premium 00 be due and poyAble at earned.
J. Is evenl of (Anunatici, lkf Insured shall report All Actual completed values it ftsk hereunder up to and Indudint the data of nnceitatioa and prefk► ql shell be
adjusted on a pro•rals basis.
i
Iteponinif Clause - Completed valve repdrtioL The Insured shall kno in accurate mold of all buildinet or Structures Insured hereunder and report b the compenyan
or DState the fifteenth day of each inonUs the elation, construction and Actus) completed value of each building of structure is of the last day of the pudding month and to
pay premium thereon At A monthly rare AS shown rn Item 3 of the d4claf4bons.
' I
Nothing herein contained shall be held to very, waive, alto, of extend any of the terms, conditions, agreements or dedications of the policy, other than as herein Stated,
i
,
farm 14.141.3 a
i
7: 1
THE HARTFORD
Named Insured and Address
( Jeff Nam, Inc. dba Contractor builders
This endorsement forms a part of Polio No, 46 IC 637119 N0100 6 Willing I= o Subcontractote
Issued by THE HARTFORD INSURANCE GROUP compa desig- ATIM
naled therein, and takes elfect as of the eflective date o1 sny aid pol cy P. 0. Box 10063
unless another effective date is stated herein. Dallasa Texas 75107
Effective date 05.09, 60 Effective hour Is the
same as stated in the Declarations of the policy.
In consideration of the ptemium to be reported it is hereby understood and agreed that
the following are additional insureds as respects to the job for the Denton Public
Library at 502 Oakland Ave,, Denton TZ "City of Dentofna all Subcontractors and
Sub-Sub contractors as their interest may appear"
It is further understood alb: agreed in regards thythe stove ttlentioned job that 30
days notice of cancellation is extended to the City of Denton only,
All other terns 6 conditions remain as herein stated.
NothinSSherein contained shall be held tavsry, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy.
other then as herein stated, y provided that if this endorsement
forms a part thereof, countersignature on the declarations page
This effect as of t th e e of t not be date of binding the policy the policy and, at Issue o1 said policy, authorized
takes effect as of
of said policy by a dully y authorized agent of the Company $hall constitute valid countersignature of this endorsement
1
Countersigned by
. _ AuthoriredAgMf '
Q-2240-2A Printed in U. S. A. V74
4
WT7
r 77
Cotpuridrdil lhia'xi Maine COMInuation Endorsement
,
Q) Hartidrd FTre, insurance Company A M Hartford Casualty insurance company,"-,,
d Q1 Hartford Atcldeal and Indsinn!y Company m Twin City Fire Insurance Company
Co, Code I JL THE HARTFORD
1 1. Nerved Insured and Address
46 IC 637110 JfK ti~etto ~1~10;.a►s'pntift eetr
TTire-nWr-serie orms a par 01 a policy as numbered abc+e, Issued ~v s
THE MAATFORD INSURANCE GROUP company designated theteln, and ind
ed o herein b Co. Code 1 yS20
2. TERM: 12.61 a.m. standard time at place of Issuance unless otherwise slated. 90 16 11 1
Producer's Name and Address Prodwwo code Inception (Mo. Day Yr.) Euplratlon (Mo. Day Yr.) e~-
50096~ In consideration of ft premium Indicated In item 3. below It is aagrr
~1a([aadK i Alacatdar that the poky period Is extended for ft Cadlrwation Per1o~ kWks[ed
hem 2, above.
Oalltta ?lxat The Amount(s) or Lhnnh s) of Insurance and the Schedules stated In the
` rrspecOv trt" ly of ut~rnem ottarwlae !rated in item 3. or item 1.
3. CLASS OF PROPERTY OR COVERAGES Anxwl or Limit of Insurance Rate Premium
s an its i &Wts. 250400
$
s
s
Forth Number of Endorsements forming pert of Policy at Issue TOTAL a.p..it
1007 1 ntialum S 2504,00
4. VHEDULE
No. Full Otaildpilon A"* or Ugh
el laaraase
s
tlu per 7011,er i 68Nralm"t:t
6. Loti Pay": Any lose hereunder Is payable as Interests may appear to the Insured and
n JW 04 06 60
NothhV heneln torilained "N be (Held 10 very, waive, aber, or extend any of the terms, oondMions, prernents of declarations of the poky. other
than as taneln MlAod.
TMs endorsement shall hot be blydrq w tees oounderipned by a duly auVW2ed tpernt of the company , ^ n
[~`IC T z~
~ by Agee*
I sort *n a LP Prktted in U.B.A. (NF) Aullvdiod
•
(Fd. 1_77)
EFFFCTIVV, TII[E I',NDORSI:![E[iT
'the tinse of inc3paioi any rice tlr,e or endorse ent altr~chedashall
of this policy
be 12:01 AM- Standard time'
To the exLent that
terminatinF, enoontstandardctime ponctim Inception
other po nder tills policy shall not become
date of this policy, covuraFo u
effective until such other coverage has tei~ssinated.
•
" r
f
i
17, Snit t No suit, act:qu or proceeding for the recovery of any claim t/. 11Aaa Clause t day {loss hereunder shall not reduce the amount of
under this policy shall bt srslainabte in any court of Iaw or eq uity unless this policy except in the event rA payment of claim for total loss of an
the same be commenced w i-hin twelve (1)1 ntonlhslKANSAS; sixty item sprc,~rally xhedukd hire on. If claim is Avid for total loss()( one
(60) montbsl next after discvwcry by the Insured of the occurreuce or more mbcdir(ed items, the unrarnel premium a%licable to such
whrcb gives rise to the claim, pmvideel however that if by the laws of items will he refunded to the Insured or applied to the premium due
the State within which this policy is issued suet limitation is invalid, on item(s) replacing thrive on %hir h the claim was paid.
then any such claims shall le void unless such action, suit or proceeding iS. Canctgatlons 'Iris Policy may t e cancelled by the Insured by
be commenced within the shortest limit of limo permitted by the laws surrender thereof to the Company tor any of its authorized agents or b'
of such State, mailing to tine Company written notice Dating when thereafter tug
cancellation shalt be rffrsiivr. 'I'bis policy may be cancelled by the
13. AppraUalt If the Insured and the Company fail to agree it to Company by mailing to Iha Inured at the addreus shown in this policyy
the amount of loss, each shall, on the written dcutand of either, made or last knee. n address %riueor notice stating when, not less than five (S
within sixty days after receipt of proof cif loss by the Company select days thereafter, such rani e! ntinn shall Ile effective. The mailing of
a competent att.) disinterested appraker, and the appraisal stall be notice as aforesaid shalf he Ioffrci i prord of notice. The time of sur-
made at a reasonable time and plaor. The a{{oltrnisers shall firs) select tinder or t' • Ifeclive (!air rd the cancellatinn ctated in the notice shall
a competent and disinterested umpire, and Luling for fifteen days to become I or the lr.lu:y ptrkxl. Deliver 3- of such written notice
agree upon ouch umpire, then, on the request of the Insured or the Coal- either by tn- '.t%uro d or by 14 Company shall4 eq .:valent to mailing.
pant such umppire shall be sciected by a judge of n court of record in
the State in which such appraisal is pending, The appraisers shall then If the insured canons, earned premiums shall be computed In accord.
appraise the loss, stating separately tale arlual cash value at the time ance with the customary shoort rate table and procedure. If the Com-
oI loss and the amount of loss, and failing to agree shall submit their pony cancels, earned premiinn shall be computed pro rata. Premium
differences to the umpire. An award in writio of any two shall deter- adlustrucnt may be made at the time cancellation is effected and, if not
mine the amount of loss. The Insured and the~otnpany shall each pay then made, shall be made as soon ,it practicable after cancellation
his or iv, chosen appraiser and shall bear equally the other expenses of IX-comes effective. The Comppaany's check or the check of its represents-
the appraisal and umpire. The Company shall net be held to have tive nwihd or delivered as aroresakl shall be a enfficient lender of any
waived any of Its rights by any act relating to:,ppraisal. refotni of prcutium due to the Insured.
In Wllness Whereof, rite C'onlpany has causal this policy to be signal by its President and by a Secretary, but the
write shall not be binding tutless countersigned otl lh: rkciarttions page Ly it duly aulhorizcel agent of the Company.
W14,
Secretary !'raidexl
d
i
corm 41115 Pogs t
r
THE AMERICAN INSTITUTE OF ARCHITECTS
A!A Document A101
Standard Form of Agreement Between
Owner and Contractor
where the basis of payment is a
STIPULATED SUM
1977 EDITION
THIS DOCUMENT HAS IMPORTANT LEGAL CONSEOWNCES; CONSUtrATION WITH
AN ATTORNEY IS ENCOURAGED WITH RESPECT TO ITS COKPLETION OR MODIFICATION
Use only with Lhe 1976 Edition of AIA Document A201, Cen••>fl Conditions of the Contract for Construction, .
This document has been approved and endorsed by The Associated General Contractors of America.
AGREEMENT
day of Yh in the year of Nineteen
madr: as of the
Hundred and ajy~d
BETWEEN the Owner: The City of Denton, Texas
and the Contractor: Cor.trait Builders (Jeff Nolen, Inc.)
The Project: The Construction of an Additior, to the Denton Public Library
The Architect: yand aHeyer11Landry& & Carson, Architeots
The Owner and the Contractor agree as set forth below.
Copy flight 1915, 19111, 1925, 1937, 1957, 1956, 1961, 1963, 1967, 1971, 0 1911 by the American Instllul or Archilects,17)5 New
York Avenue, N.W., YI'ashln filon, D. C. 20006, Reproduct6sn of the material hrrein or sutAlant4l uotalion of its provisiont
wlihoo+t permisslon of the AIA violates the copyright laws of the United Sutra and will be subject to legal proucutlon.
AIA DOCUMENT AIM a OWNER-CONTRACTOR AGREEMENT t ILEVENM EDITION a JUNE 1977 a AIA# A1t)t•1977 1
91977 0 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORX AVE., N.W., WAWINGTON, D.C. 20W6
1~ kF
ARTICLE 1
THE CONTRACT DOCUMENTS
The Contract Documents consist of this Agreement, the Conditioni of the Contact (Ceneial, Supplementary and
other Conditions), the Drawings, the Specifiatlonc, all Addenda Issued prior to and all MMifiations Issued after exe-
cution of this Agreemert. These form the Contract, and all are as fully a part of the Centiacl as if attached to this
Agreement or repeated herein. An enumeration of the Contract Documents appears in Article 7.
ARTICLE 2
THE WORK
tlaie lwo k as used required other co b;dhDommenbr,ct Documents for
The tractor caption hall perform
The 02Oakland, construction Deof an nton, Addition l Library
Texas, a d miscellaneous remodeling of theexisting
502
at
Library Building.
ARTICLE 3
TIME OF COMMENCEMENT AND SUBSTANTIAL COMPLETION
The Work to be performed under this Contract shall be commenced as set forth in the Notice to Proceed
final
and, subject to authorized adjustments, JAWxttM Completion shall be achieved not later than
(Here Avert any ,p•cial prov1Voni )or liquidated demaaet relating Id failure to complete on dme.) Four Hundred Eighty 480)
calendor days thereafter. For each day after the time for completion
Which the ,ro~ject remains ineompleted, the Contractor shall pay to the Owner,
as J-iquidafd Damages, the sum of Four Hundred Dollars ($400.00)
AIA DOCUMEMT A111 a OWNER.CONTRACTOS. AGMEMENT a ELEVENTH EDITION a JVQ 1977 a AIM
01971 0 THE AMERICAN INSTITUTE Of ARCHIUCTS, 1735 NEW YORK AVE., NN., WASHSNGTON, D, C. 20006 A101.1977 2
ARTICLE 4
CONTRACT SUM
The Owner shall pay the Contractor in current funds for the performance of the Work, subject to additions and
deductions b: Change Order as provided in the Contract Documents, the Contract Sum of
The Contract Sum Is determined as follows:
(Sate here to bass bid of ether lump wm amount, accepted shernases, and unit prices, u oppllcabb.)
i 1. The Base Bid - Eight Hundred Seven Thousand, Eight Hundred Forty Six Dollars
$807,846,00
2. Omit one Stair to Courtyard (as set forth under Addendum Deduct 1,100,00
No. 2, Item No. 1)
3. Alterlsate No. 1, Addendum No. 1, 00
(Change Built-Up Roofing to Elastomeric Roofing) Deduct 7a455
7-
ARTICLE 5
PROGRESS PAYMENTS
Based upon Applications for Payment submitted to the Architect by the Contractor and Certificata5 for Payment issued
as as pro-
by the Architect, the Owner shall make pnoiwess payments on account of the Contract Sda to h the Contractor
vided In the Contract Documents for the period enddnit the last day month follows:
Not later than Twenty (20) , days following th+ end of the period covered by the Application for Payment
Ninety percent ( 9096) of the portion of the Contact Sum ro ( peg0 9i) of the potion of the contract
equipment Incorporated in the Work and ninety percent
Sum properly allocable to vend by and cation ;,x Payment, (eleesstththe site of it e aggro ate osf previous pa yments made bythe
In writing, for the period covered y the Application
and upon Substantial Completion of the ensue INt;r1t, a scat( sufficient increase the ttlrl pa ants to
Ninety-five percent ( 95%) of the Contract Sum, less such amounts as the Architect sha11 determine for all
Incomplete Worts and unsettled claims as provided in the Contract Documents.
of not covered of where M the Contract Vocumenu, hen insert any provision low llmlifna or ,rduclna (he amount retained after dN work reacMa a nrtain
11010 Of compledar.!
Payments due and unpaid under the Contract Documents shall bear interest from the date payment is due at the rate
entered below, or In the absence thereof, at the legal rate prevailing at the place of the Project.
(Men insert any rare of interest aareod upon) Londl
and
crtdil
c^nsu
ocal
the lou ionnof this 7roiM andOmi*fwwlif marr allots the wNdity oflshlo "1 oe.SpMelle ssi 66*4 "Id
Ownsit aandry CoIsm end
princlparaplaces ofrbusinetthe federal Tr
be oMained with respect to deletion, nwdifkairoo, a *that rerulnmenu such N wrfuon d4cloturN or wdvertI
AIA DOCUMENY A111 6 OWNER-CONTRACTOR AGREEMENT . ELEVENTH EDITION a JUNE 1977 a AtM Attlf~1b77 3
01977 a TILE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N,W., WASHINGTON, D. Co 20006
ARTICLE 6
FINAL PAYMENT
Final payment, constituting the entire unpaid balance of the Contract Sum, shall be paid by the Owner to the
Contractor when the Work has been completed, the Contract fully performed, and a final Certificate for Payment has
been Issued by the Architect.
ARTICLE 7
MISCELLANEOUS PROVISIONS
7.1 Terms used In this Agreement which are defined in the Conditions of the Contract shall have the meanings
designated In those Conditions.
7.2 The Contract Documents, which constitute the entire agreement between the Owner and the Contractor, are listed
in Article 1 and, except for Modifications Issued after execution of this Agreement, are enumerated as follows:
(Ust below the Aareement the Conditions of the Contrad (Genes!, SupPlementary, and other Conditions), the prawlnp, the Specifications, and any Addenda
and ac opted alternates, sftowing pap or sheet number in all rases and dater w6b .re apphrable.l
1. This A9reementr pages l through 4
2. The Drawing, entitled "Addition to the Denton Public Library"
consisting of a cover sheet, Sheets A-1 through A-7, 0-1 through S-5
and Sheete MEP-1, M-1, 2:-1 and E-21 and P-1.
3. The Specifications, as set forth in "A Project Manual for an Addition
to the Denton Public Librarye"Denton, Texas." with gages as listed in
the index, dated February 201 1980.
4. Addendum No. 1, dated March 17, consisting of a Cover Sheet and nine (9)
page,. l
5. Addendum No. 2, dated March 21, 1980, consisting of a cover sheet and one
(1) page.
ARTICLE 8
EXTRA WORK
(see attached sheet)
This Agreement entered Into as of the day and year first written above.
OWNER CONTRACTOR
The City of Denton, Te ae Contract Builders (,Taff Nolen, Inc.)
Bvl - B t
AIA DOCUMENT A101 1 OWNER.CONTKACTOR AGREEMENT a ELEVENTH EDITION s JUNE 1777 a AIM
01477 0 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AW, N.W., WASHINGTON, D. C. 201106 A1014971 4
ARTICLE 8
EXTRA WORK
should any extra work be ordered, the following applicable percentage shall be
added to the material and labor costs to cover overhead and profit%
(1) Allowance to the Contractor for overhead and profit for extra work
performed by the undersigned's own forces. 15
(2) Allowable to the Contractor for overhead and profit for extra work per-
formed by a subcontractor or material supplier and supervised by the
undersigned. 10
Greater or Lesser Depth Piers or Casing of Piers.
i
`(1) If the total length of pier shaft exceeds the base bid depth x the
' number of piers, the Contract Price shall be increased bys
f Nine Dollars
t 9.00 ) for each additional linear foot.
1~ ;~2) If the total length of pier shaft is less than the base bid depth x the
number of piers, the Contract Price shall be decreased byt
Two Dollars
r"I ( 2.10 ) per each lesser linear foot.
,(3) For casing of pier shafts required by the Architect or Engineer, the
Contract price shall be increased by Six Dollars
6.00 ) per linear foot of casing.
3
_
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bE~LAFlI~tIQNS ,
1
~Ig~tOtt. ~ti~tt~A1tC~ '~Ottt~An ~
LOS ANGELES, CALIFORNIA
SAYAE & , So, . Inc.
:4wlirwrili~a Aftlwarrr -
In favor oh JEFF NOLEN INC. DBA CONTRACT BUILDERS NOW & MULLINS,
Audrey; 814 . NFS'C'~ Skjjj GROVE ROAD
GRAND PRAIRIE; TEXAS
6 ' +j
r. j A tttttnaPr a Alau~elt t.~
T1ry» of Coverage.-rit, 44?►.
Y r 1^ ct!~RZ
311ti Floor, 20011 ryerl T4
1 Do 4a T" 16201 vtG~' '
A jj- i + r ta.
.t . r r Ttldp WN 21/ yN~61T1 trs y,."rf n 5 t •'r t'.
In tho amount of. $100000000.00
^ t , } r s : ~,9 1n
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f r! i'r ,~;r ~ i i . A r 7 rr. t. ~i. t~ 4 f!^„a (S♦}
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12i~L a.m.On e S , day-of `HAy >?9 t M :r[aa
and ending at 12101 a,n,on the 'S h dayof - so r , 9nt
1fAi 1981 ) .r:' „ ; M r1 r.,)
rr.t, rt >tt$landard Orne at the piece of tocatlon of dake Insured, and In IReOfdwof vAto taritlb NW conoitldna~'oi
the forA' 0 itt child Md the 'Sfabderd di a c t, r
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•6000TANY
Ontttd at HOUSTON, TEXAS SAY & 1990, IHC ~Raa~orNT
this b.t h.... day or. 1i,AY.. .,19., •
. AMOINAL POLICY By » )1
aA%j
stttlw 1~fNt 1,.~1 ,
,
Y
MUCUAA INC CLAUSES' k .a
c. i
STANDARD
txeX ~ J(~J~ m-a!Retr reraaj
(hrdu any Wt~4~4g~turi:'ucln`aseJ 'y ff~pr.~d undo any Aabirfy oewn5l W this h lfq does not t
a ' lprf
(a) Otto triplet k whtcb an Inured urda! A death or d,slrue( r' 1 }
i ~'+uof Mutual Atomic inK
" ty Polity also lns,arrd su ra a reactor energy halw'h
f7 liability ilnQerwr tns of r k~cteu Insurance ,bsot,rb6k of Csnadi v ant twills
ab
its termrMl,on Aa4ra erhauat,OJ M ih If tmit of IiJbd,ly: of $d. by Muctr'u
W",
antis be in rfesund ukQx any such poFC
(b) faUn,ng (r,M IM blaordoul rnopfR71 of nuclear matfriJl and wdh ;Hper u+b'IitT Insurance
faction pursuer) to the Alcmre En ifitl kcf of 1954, or anx Ian emends 5ry Iherhr, or ? n mwr 1 ou! fa
i; to inde,nmM from the 8n4ed Stiles,gf /prf a ,'''M fll Ins Derson Or r
~6ri rt~ a aaalration is «avired to maintain financial po
f th,rWl, 10ah arty parson or organ.ta n ~~1 q l~ y 40
pq y ~fp 1 +d liiun~r hadAl((ti shit nM been issued would b,, lnlitlcQ
! agrytyy I]~!t 11 1 ~JC~I t cl t~l t („"wtil! ,ttrd Stilts of America, or any agency
ni Under Any 1114!C11 PJm,edts Leverage, or under any
:E
ppetl to boo,lr fnfury t:ctn,sl, d,seau or death resv ;nuDppia nenUry PlyrgRats Prov)sigq lafplnl to NnmrduU medical or wq;ul rulet, to ,xptnses incurred Otto
1lry lot 10 or prganuutwn. t hone the fiu3rdous p dDe Dlti cl nuclear maltrlai and +f,sur }
It Under any liability b,arage to injury, ucaefss; e r tout of IhJ openYon of , nuifar facility by raj Valson the nu
. +ear m C- rrf (l) i t al any nuclei? facility f r reSaittd>R f~om'SA! h r ' J
(b) the nuclear maawl I owned by. Welioltid by 6r on tirhJlf if: 4Jl insured 0 21 des bteay
ll d'scMrtedrorf dispersed Ihaefrom; , of F. on if
N an insured; a S paplai~i il.lPen1 !lit' or, ffa)fa ft my UAtt Paslgysa l
(c) 11.o Injury, ucsnns, slur,, cloth of destruction anNS cut el the furnisAin f M+fQ(+a4 tries' NOClssf~'slor
~ry 14 Bthlp7heaf'dt disd6~eQ b1 1f dr on behUf l
I pi%nrong eonstncrgn, ase dea h o operation or rise of my the lu facih}p Du( Inured l'ki&ly`fdI eGtw1~ p
Of polsessiAns Cl C+nads, this exclusion (c) applies only to injury to a drifruUph of proper at nilfhhlR~'i}.q',Cw en! !p FOR with (he ;
i i As uses in this a mean 7., !fi'' Ito IvAdtT" ~a of '~im
s terrllonrs
c
trie mi eriJl"o lode or'YpalosS i $ wr• a
nY~leu naluiel" mans source mafrNil, sD! Q
r
lot; "spi~ MW4 ~j LOmpoRt PI,
'ayprodyq T+}rLI to, (Ae mr/n n 1 i ~~'o tfr tedEl of A►prtidtKt ltf(JfIJr;
1 manna) l) tef
( con fpia t tart tht,n to the Alm c to W Aridly f+ahq unl and d2)> Haul nr tag eg rth h+s 61fn tread or uposed to reQietron iq J nudeu Herat nyya1410 mans
or it A innorn i y
ent h or (b) thueof; rudest fJo'I " .epanlaq by fry person or org,nuation of any nuclear farfi In
~-a (1) any hudetl rawat, h moans
h dudes rithln the delial.
h1 arty equrpmlnt or device designed or used for (t) 1104ntln the IIOIO s of uranlum or plulonfum fn cmri Q,11 fit
procelsint of Pacaegglg 101144, g D+ (T1 ►,weasnng or uu'ifting spout fuel, or (3) hasidliott,
II''r (c) Any Wiloorent or deriu used for the
tcustody of the loured 11 the premises processing, rfaarjGting or llbying of
any cambflatfon thereof, a mom than 250 qu D'} ant or dcMG tl l eped~,t dewn~yiitiroi ae~alt ifn'l~a i fne the total i
~N (d) srtystruelure, bask, IAA+rItb1, premise, ag(alAfil nnnlum 1]S, lc; yr.p 1 r,) 2S time piuM~nof much material In the
ufanipM, or
$ f 41'1 ^~k I
bdude~ th kN,. 1kAkR aM1y f{ ~ (lKt >k,o4nd or used lof,~ attic dy disposal
apparatus esign/~or used to ust+in ou did "rz "tf"d1 44 eMrgkAS 0441144111011161111:1111 )ilia and ik 41111 p>b Dad /or ' j "r'~ t ray' Ji,
r % WItA nsper lon~u7 ~QI6 v ulf worms V4 f~rU+~ign ~~a~a tJ ~~d4 prlaclaf' IlNens
RADIOAC~TtYE CONTXIItJIjA* ~E>: l' h~t t~ dion r+k 1 n~l
reactor reaction, nucNlr rlaatbk w radiacNse rsn4minat(on ho10ew DAMAGE f taco
bit aNE r reacion, Fin It in bswnQ }al,; towa~pg ~r ~f p ~ :ar
damata uyin Nr retie and 1 fl aneae ra scliols, Ruclo r 't vs SfRI.}!fiitb a tndirac!!y
t enh iron) that flre sM becl to The ~ se f jful Poef e r r hoes +orunuclear l nDINO hew4acra tied fit n or rad4ectiw n~fUminehon any lou
ar rJ~dffa~ien or tadifqq eU !Op klfn, +'ffbMt'hE ) r blCtllttO rer in tau w damage emusrf by ruder read'*".
tANY Wf 1 by i1 AI i arHh i~f l ' h i F) ~-FFit:f{an noiea~m
~ Wru' 'fe2spl/d try,holl gillbo ~ij'dtfa~l(i8u$16f11(1V343r1'~'ji the 4 1h~~tl'i f d yt,~~,,"
Toll eft
rwK7 Atli not J~~t t t ~1'bT~rear,4-tAt rlMr 0091V I ilk ddtbrk
TMs Insu)ane~ to +nJd4 and of aR the 10n8en consent of dtyrl i Tolo, rtC fn Im"anoi)}Rbrl
WbIrA its 0400Y d is I A to to oonsldl)eQ u red sublod to aft the prorisbns c domed hisreon,
po atelf her died any prartlans or lops Of s Conditand ions wan+rtdea $et forth hu4in and lit any form) or e bched wa
MovfskA 1tROd hlrrit (1sup( a►
S anti ny fsdorsem4nb attached
not 61 IRl r4st C~u/s t and 2 shah wporstle such poll ppp11 t his Ally forms or In berMo,
ended. ry Vrorisiofti ht so for me they u1 (acony ~ml its glbca4d MrHO which Titer
TMs huq may is eancallod on s!^qw~~ D'1feMille gltndu/ Clauses t alld
Pongr MAY Ito bt finceftld, wnw'fMtMlr~; a st 1 4 r
annnn~~~ td the A1wnQ or by+sendin !o tM c 6g1 (Jlr~li"s~I s pfim/iJtit I ~ (h(6fh►N~rj1f ory~~ytpr~f this
AgaA4 by ni ~~la illig rtln!eto14ad ti IU Tidi'j'ddrnl ~n
JA}°'o t ~t R 4
act +110x1 j b the nNnt►onflr TAO Comj441 humion ol?in waimunNpremlum apu t dlMrNi44 ht d onZi~4n~kF'tiSl4trMre 'art„r I on dome
Hawk aRAu by the Camblrty of the AssrafA4 Artbn ~t0 days' wnthn
a) MrSREPRESENIATI AMD fR of TMs r f,efeo! ~~t o voono
flood w urn) N the creel of
ado of the cabled thu policy shall be IQ If the Aswrod hat can $led or misreprtsensad a f ArateMl F1 lo
a (n CAN of Any fraud, attem ad fraud or Was swiar!n
of thereof, whethu befor or after abet by the Assured fouchb Any m,t4ro to stla b
CoorERArroft oy toaarnrrtg this
WALL lt pprr drams
ctsng PAtIO n AMRE TM Assured Abaft cooporlto to the company or Iktwedca or Use
11Nnng rid tirlrfg evldam. obtairttn pray And, Y IN Cfthe of t, It ,}tend fee tin
TERMS USED IM ENOOR C attendance of fHteesles end In the Conduct of Oft no n n to tul t find shah esslt In
If bl clamed wbstllffled EMTf. Whatever the cord " dlrwril+n"
Ali Appears fd an endowment attached to I is rot
.s DW OUNTS. h fs son dition of this ry' ~ ~rois Id the /eNarltbhs
policy thatQ nplandlydiwn+l gp~remyiugm Hil I harged
OW flitut" CC~ 1mpQ0~1111 S. N
fromoAssettinj a tightru~ld 1-Mi 11rRlej Of ihli111flr;gnoi tMil to larmif p$h'ot eff/Ct twJi nr or!e c'hdinge In airy raA rttMN (at not
1 I top
r It rat 1 j 1'~ rte or as 4
(Ipp~[r~~ gl Asid, except ~f,iflNsr At feaugQ to fares a milder
ti Mre the rd` ; 1 A d Ilia i m n +
smarts lehreln tM J at
fM M
my of lMj 'ro~ NIA nail p=.
f --J, .3~r i r~ g to this lnwrr~ N!l~rJ+if N+y~A'MJ itS y q 11
w w l ! a f.,,I
- 5,,.,h.~,1D.l.j~t~~` ~ s~rr,►.~3.; t.~~ c"l.X;II r(:pTrJuiira r
"a ttl Ct~ t+i. YAK 10 ,i1r~f! t r) " ro M. ' ' _M. Y ! ](1 kin)
r
4 3) V, APU2N; YIIjOR AI I A.1.13111416.i
UMBRELLA LIASILITY_INSURAK4
a + r _ OICLAPATIONS
ITEM I. i•I N"ednwrad. JEFF NOLEN jIINCA" DBA``CONTRACT BUILDERS; NOLEN d PIULLI14St INC.
M) AddaUOfNIIM"od' 814 NEST SHADY GROVE ROAD
I,. + ,GRAHDlPRAIRIEI~: TLX11B
ITEM 2. Limn of U•W4ty - as IIII AororI III
(a) U" n d In raapat of each 6"uff@ to S 14 006,
n „ ' IbI Lfmi1 n tl+e ~regae for NIGn ~rlnwf penod irheri 1D61C+CW , S 1'j 0004 OOO, 0O
Ie1 Daductblf ar+lount 25 ~ 000 4'00'
(SELF INSURED RETENTION) S
ITEM 3. Poky Pe IOd: NAY So 1980 TO HAY St 1981
H ..'C 41
ITEM 4 Notica of 0ect rams ICo+ddion 01 to. The Comwy and /or Seyra I Toeo, tne. 4635 SO ut htae a t lr iie y ► 25541 {
G1 ! of I'
REM S. Wrenoy(Cond km O)r United States Cu»ney tbui ton 4 lluc8! 7127
ITEM II 4 Ptgnient bf P~Nl,alitllCdMdNlikt t Ib, Elie CorA t~ aiid/a ~iy+e S'ioab, ti,c. I I
1
` r1 i'e tla4ilr .IN~a.l3iF'3,` '!?r`3i:6 'I
SCHEDULE 01 UNDERLYff(in11~ZUW;Al
j
i
rips: I Obucv tz Y t l ; w LIrWT80f tJASIl1TY:' + u + . =,I i
: , ~,r.;r a r'a l'yn~.. tt yl~~ 1 .,I
J'f~r5 f ti 0.M074 fr'0 YJ. v'7 P l ' 19 LP5•±, ; I " L p IRIT 1~ 9C5T :u i'(r , ,S J„! ! y'v:~^'t ~'Ir► Mwr'R'i
r:[ +J: J,l'>< `9 92f-4 wi
M4d t, ti 2
"OTRANSPORUTION INSO'RAtIbL"
`Rl y;,di il4 iCy nJ'7
t',j4 +iM? 1
C011PAW Y 3 I . W eeehannenu
, n 1
M AMt
10 htYJ,~ I"0 td^'.UJft y+~ 1 { ,4bilCq t Pt IG 4!'I rw~ IQ $I'~d 9tfl t017&7r • M 7<7M1 }fyr. ° M1n ~JI y7n n1. iU C ' ~ 4.yY300 WV ~.n.9 t)
hB Are of •rrl It, ntg ~fb Due41 t!"77 D8 T'l!,CMa ,7118 h%lA1vI K xl v'U4~ 1 ta:xl4t? J~ ynF 1. SS ,rid ,K T .~qp r.4!' ~ A•~'I' ~Y KH1
D%Yr~ Lt4 Yl1pQITh'r~ 6.11 61h1 11,9 ~f~h<R h; , ~n4 10l `0f ~.rl;nD T44 91+•I tle of anb4 nC ) ar'I Y Y 1 S
t 9 ",11J 11-4 '}rltD 4 q r~ ~o+ Y., n_~., , V
1 ifyfit♦'ihl'f1'•IT^Cq,,.oiXNle~t14!KMt100~001 ..QL4tWhUcaance
f09+q,1}Y+d,CG y"KgRrp~..y.s ~ S ~qp~ .s
Iznl.palt0 ~ ).l0 M1'.6 ,:`V1'nr ~1 LR; L410¢).1 e ,9 c'X'Pl :r~rr•~~gd'nfq; J'GT. a V ~o tlI 10 •i ul fiaS ~T31 4
Bugle Ltme s, .
' kit PI +u A.:btVB M -a',hrg pPA 9" If-) t0 N•nr,7 dl1'40 he I l t'e H .f°,TlT10®+pl Utn,bsl9 ~.:+I Ayl PV trtyt"b J(N e1 hrf,VT`rL 4iit,
I II4+ltYI
om 10 -III C8 "!:'o Il"' 4r1 }C', `1Kttt t'n4 i'Y 6G Y1tl/•Br1r rG+iud r~6 Bdi191Y7 f W D L4'y .C r N1R An 4A}`q I, _d t np6rvt+Y7 A Clra.IFh tl eeo11 (ILti11M y ,i
c
J1 (~~+.uyjy~/~~1j~~, Fuc Gr, r a 7 n ~ , l , > nl p'+I . rn 1;.~, N,,Lf+'*r~t4g4 ~r....ut4' f.11!0 2np?t ,
y1 IIt~~7 d~~~,,,'~~a'11~~;yyf ~tt~~~~~yy~~. Y ~~p M
~yLy~r{~l1yAyf b L} to f }.w •
^y', 4`q 4y yAT rt^r<:71Y:~.Y~ 5f~i1)t/yL~Y 4d r
, ~OhTS1Q,Sf~.7~7"'V•'p+l,n
'TT?'+^"b° )`nA
= 2SOr 000:00' eid16Y~lo1►
r1 SOMO D O~nOAO..QQ l7, i 9 a+Icll>~►t«+Oe
u, 11` 1q tynr'r prlI C2 4 1 V" 41,E+5'.1 ".'1001 000• ' iaAl000YRenCe
h p. 2 1 LA, p 7p Le 1 xy it, i aI]2 I)n R':,,Il1. I Pt IQO I'. ` dl. IInIT Il; 1~jj~ ;,,4,~~ L04, iAl
6.npl,?G'~J . a riF•,,,. rl: J I~r, :lC t:.7r
W4 P►oD~, ~ Lw^I
1;' y vG!ttl l: Gi' Y+ Df yY'J] 1C4 4"d~)i+ i7:,O 1:;k4 19 I)4'9f.t7 IN u d 19R 34,""Il li rorpJv,I y:+U 4AI IJ'i rn'yr1 f. Io0 nr at t!°:1 ~eWA *
TRANSPORTATION INSURANCE Er"Ploy.a'1 .B) S 100 000400 oneardan
C~ I ttnvl prYyl ubn~ 4+i 1g06)'b'F 11 I
tiPANY ' V
~idn`swwo is made AN WCW*d wbpcl 10 the 10149 p MV AI end co-41ia+e end to M* lend
M ~.4 3 ttt 11P►fI41 wfYGfI we hKiw meat l ooe of /w Mtiw,rleel wd ww"I t, T )f, bi
111YMdOM1raad41dt11MN0uIh4M4ppMfg►t7Pq/e~V14ed ~aptr,ltop9Y;ra„ay4,'rG(nitC.r,n}l~r/.llnpr,}.l l~/e~lyjo~}~.t4t a^ et rfiri' I„
L) f I' Fy'... i (M -17
V~~l~ V I Ia t~f W"gidgilO {IfAd 1~CE ~COHPA{~ l
Alleched b end lormnq DM of Inky No.
t'DNA! ~CONTRACT BUIt,DE1tSl`'"j'~ til "';!1" }Id'r)aa I II^ ,1 4.r.4v ke 1'I M: ,1 4 r (
: +ro 1t„1C4 R, 4` r8 t 1 n hae r w `7l/'1
EV~~I I Aid; Ir,y 9N: Y, ru'd: +n to Ml
DATED AY: 110I TEXAS r,, il.: rr,, 11 S SO►NO,It ! •
r~'Lis~1.1a-Q.
MAY ~
' This 6T11 MAY 90
I ry'~i l4f ltrr'll:•v,Ynd rts'4r.dis[Tvr'9tr'f,..a"!;lyr+ly+An'nr:G1D'.A,44t1k,nl•lne h4"IeN SI~I M,rI tK.,n,~ fr A.r,.''Y7Q, i~
!S1
110001/ II Iat
{1I
'r i"'r', 1i ry _w
a
iir`~~NFreTJ~w~rtfi'L SL .1~.« ~I' ••iN~
UMBRELLA LIABILITY INSURANCE
Named Insured As voted in Ram i of the 0%) r.IPWO a, WRe.MeQf NVr 11RpOOVY. "-Wed, ait sted comprrl.e or owMd r4
controaed oomp►rbu, u now a hereaMr Con.fltiel "of wWl v6imo "Ott notice nu bout pimm f0 A* ComWy pwOV4f r coed IM
"Namur haled,l
'I.. '
I. COYEflAOE-
Ina haled atoll be y hereby aDtpa»d I&"#g. oty by oubje :1 rel,Ioon of the the ►7!eot a4bory mons• jolvis end Pa dilioM Aersin" 1hent!orwo, to h""
1M h'AXed f« all owns fdreh
(o) YnMSd uo0n Cote hawed by low,
« Ib) usumed undo ConprACI bf,aptaem I by_the Named hawed ond/Of any ok+Fer, diteclor, slockholdw, pwftf of employee of
w '*Ofd. while aelinp in his the Namur
up9eAY!N h•'.
for drn.Qes on se unl of -
1q.•j ,ai 7~.': :'i I'j f r~': b~ f`~Y[; :••,9 EfJ?1! i
(i) Pareon4l In uxoas
1r ~~,,(lY tiRG~ 0 ~I,t i. 014,, r,+ n n. s~t~.•
, t'i. JF' ,IroJ Q. it r~( •r :r ...,t.t, bS•'i3 j :t
am in
caused by Of arishp 00 Of each oeevnncV happen" ! u,, ~q #?I~ pee apl009NfM'9" M NItMb.M+Srrtr!p Apreactem
M, OEFINSE. SETTLEMENT, SUPPLEMENTARpY A '
As 14604015 OCCwrencas Covered axrder III ppoky'b~ulncn Coveted ~unSer )Re'unQfr/~~pinii W#s as W64 Fi kit' of
Widef any of woWeClhle lArimce, tai Company Mal: t . +,.r ! cJ . t
la) defend in hb fin me and D4MR any>uR apahv N he~,rr , 7 ~ a r.. .
on'iddobiH fh'~rlbf, i ran a pr _ _ _ . , hf ' In il such out IS ll
5ett~~ent ~t and.. TaBf~~i'~ swed rr!der the wovf5lon5 01 ft Poky and sNknq demepea
n.pot al~or! a tdl • Utz s i!tJt r c im «wit ae may W deon!ed e I by me wy; 1!! ~1M`~,}~A111t Rqf ^ .
pram+ytg6,A,n~gngy~ie!:Iteasa attec►lmerna la an amowH not h fsCef:S of M+e irnil o+ MbICRy of dwa pNky, d wemfum5 on twcw
fe(!Art~qq~ in ~ch defended std but w;CtOUI any obip bons b apply jot or Arnilh Such bonds. aR Matt tu!Id epahsl IM hared
'1lkN`iG111AQ Vats Incur, ad by pre Company end all Inlwasl toauhp INK the entry of Kidgmgnt untit rw Comp" has prd,
Pans nu5D46edered of "MOM" dart of such 910WWI u does rest eacfed ore"of ft ComWy'a llablity tnerw;
4,10 so h/ Rf drwf6sw!s f *%was&, otter ow loss of 8"s. Incuhad at the
r.m1d t Rnrlm4 Canpany*s feta,an.
TM > Mb" amount} fttead under 00m inmsN mWeemanf, elicapi al NRtemark Of claims and auRs, Addition to !M
We Of JIM j'b) CO IM Declarations. and such defense and suppktwiLl peymentf &W not be ftWW as W off a
illJilgff/ AN WA r5 oaGMd in Dahntlion 7. 3
Theaprow~sbr!s of this hwrinp spreerMr4 so* Only Wdhh tai United Slatsa of Amuica• Is It oriq%~ s a
any of q,eN~rheiod!Cppg4 gars the Company may be prevented bY'1jW bYffM 60A irom CWyhp oul 0WW trfAr
APSP
wRh*"OW I*(I?S t Sri r.
WILIMROPLIASILITY
t! I,441r+J a•.nnr:rl v1)+00rq
f 7^e~xl, 0 y "I only bi]igif wthe uf(Y6I0 net bas Me SAO" of either
W 04 "Oval W'QKinp inWlanffa as NI out h the vNched 4chedu4 In h
a suf4ts O O~,irv „E.O,f sped of each oe«xrenu Coveted by Ilr!datlyYlp
rssda J e,prnrrr7 Yti9 ZOA brK
4t~nrlbj, IDe.atpa,nl as set out in Ram 2(c) if the Nelarridns ullmata reel loss in respsCl of each murruue not covered by ud wgls e1p
Inswriee5•
I,tb:~5~~ O~j,t)Q!~,r'10i i (ii• FiI5a11N~C Iedlhi~"~uf+darlyingLmRs"l: :'01TA1AjW•1APr
YA /3110 )
R y G? rJ~ t r' trop .'1(x: r.!~x !f 5i!I 0~ Gne ,f'My!,Gry3J AM fnGif~V'7 rt pn?~P.~! 9rl Cr li r!'h;P Cr1gR ;;•6 l; ^a m f S>Nrw,rnl rr~f:.':
~1119M 11~13WalblDa!:Mralrgflf4►aafnnsprctotaaoetrrrrntt~ ylorwii111'1<1WWrf`k&1f16)
dS1'~ii,1parfy;a uch anrwsl oerbq d rY,q the cunancy of Ru5 Poby h r bi,~1
of Persorw lnj oy 11 Olaf of Ron •laltl by
OGCUp6tanN Q ep uv 4 v br s Or f elbetr 1Y000OfS
~)2A5f1f)7 o~•suci!o-braot~an,cnA
r tis h he event of redo tg a f Irhaw of 1M swoe mate of Isb4fy under Mid a~uf~n~~i qr~ y pf3~~ ~ ~pa'sp~ ytq Snot
poky 5ugacl to aR the Ianns, cond4
an5 and ditwtgn5 hefeof anafl ' s~T i . u,1n
+ f t ) In eve t of redultidrrp 't d H of the reduced undary rep W4 2 AS •f) ,'A7 r'; fr; l 11 r !'a
!o rr J 1l a d s nr
t1,12nY1IR ve Wiah/uth n p8
1aM u^denrr+p nsurar>da YAM
The nc luw or addiwei hwvun tar of more than ono lnSwod Mat real
h tai Docbrtlane opMVe b Y1C»ese the Co^i0anV't M!MS of 4tMMy Myond Most $0 10M
s"Num
_m :..l.... _r...t'.`!M1 i.~ 'r'l' al s!'l. w•, r_ ....,tS.• tJ...
ENDORSENErr: I1 EFFECTIVE: IIAY 8, 1980
CONTRACTORS LIMITATION ENDORSEMENT
IT IS UNDERSTOOD AND AGREED THAT EXCCPT INSOFAR AS COVERAr.S IS AVAIL-
ABLE TO THE INSUPED III THE UNDERLYING INSURANCE AS SET FORTH IN TIIE
SCHEDULE OF UNDEIILY114G INSURAIFCES OF THIS POLICY TO THE FULL LIIIITS OF
SUCII UNDERLYING INSURANCE, THIS POLICY SIIALL NOT APPLY T0:
(A) INJURY TO OR DESTRUCTION OF ANY PROPERTY ARISING OUT OF
(1) BLASTING OR EXPLOSION OTHER 111AN THE EXPLOSION OF AIR OR
STMI VESSELS, PIPING UNDER PRESSURE, PRIME f1OVERS, I1ACI11NERY
OR POWER TRANSMITTING EQUIPIIENT OR,
(2) TIC COLLAPSE OF OR STRUCTURAL INJURY TO ANY BUILDING OR
STRUCTURE DUE (AA) TO EXCAVATION, INCLUDING BORROWING, FILL-
ING OR BACK-FILLING IN CONNECTION TTIERE141TII, OR TO TUNIIELING,
PILE DRIVING, COFFER-DA)1 WORK OR CAISSON WORK, OR (BB) TO
MOVING, SHORING, UNDERPINNING, RAISING OR DEMOLITION OR ANY
BUIL0I14G OR STRUCTURE OR REHOVAL OR REBUILDING OF ANY STRUC-
TURAL SUPPORT THEREOF.
(B) INJURY TO Ott DESTRUCTION OF WIRES, CONDUITS, PIPES, MAINS, SEV-
ERS OR 0711ER SI)IILAR PROPERTY, OR ANY APPARATUS IN CONNECTION
c THEREWITH, BELOW THE SURFACE OF THE GROUND, IF SUCH INJURY OR
DESTRUC I0NN IS CAUSED BY OR OCCURS DURII4G THE USE OF IfECHANICAL
EQUIPHENT FOR THE PURPOSE OF EXCAVATING OR DRILLING, OR TO INJURY
TO OR DESTRUCTION? OF PROPERTY AT ANY TIIIE RESULTING THEREFROMa
(O) ANY LIABILITY ASSUMED BY THE INSURED UNDER COINTRACT.
IT IS FURTHER UNDERSTOOD AND ACHED THAT TIRE INSURANCE AFFORDED BY
THIS POLICY SMLL NOT APPLY TO ANY LIABILITY ARISING Ota OFt
(A) ANY PROJECT INSURED UNDER A "WFAP-UP" OR ANY OTHER SIMILAR RATING
PLAN$
(B) ANY PROFESSIONAL SERVICES PERFORMED BY OR ON BEHALF OF THE IN-
SURED, INCLUDING THE PREPARATION OR APPROVAL OF NAPS, PLANS,
OPINIONS, REPORTS, SURVEYS, DESIGNS OR SPECIFICATIONS, AND ANY
SUPERVISORY, INSPECTION OR ENGINEERING SERVICESI ARISING OUT OF
THE PERFORMANCE BY OR ON BEHALF OF THE INSURED OF SUCH £ERVICES
IN THE CAPACITY AS AN ARCHITECT, ENGINEER OR SURVEYOR,
(C) ANY INJURY TO OR DESTRUCTION OF ANY PROPERTY LEASED BY, RENTED
T0, USED BY, (Xt IN THE CARE, CUSTODY OR CONTROL OF THE INSURED,
HIS AGENTS OR SUB-CONTRACTORS OR TO ANY PROPERTY AS TO WHICH THE
INSURED, HIS AGENTS OR SUB-CONTRACTORS ARE, FOR ANY PURPOSE, EX-
CERCISING PHYSICAL CONTROL.
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED, 11116 ENDORSEMENT IB
ATTACHED TO AND MDE A PART OF POLICY 1N8633I6 OF TIM MISSION
INSURANCE COMPANY.
ISSUED TOi DBA CONTRACT BUILDERS, of &I
DATEDi MAY 6, 1980
dAYRE 6 TOSO, IM
7 r1.9C 5'-.;' It A
TIM/ IOLICy IS SUI,IEC1 TO T4E fOLLOWI NO W iNITIONS:
1. INIURIO -
The unauNff,ad word "Mwrad" %wharaliv wad in M poky Includes
1 of th1 OacUralane 1S+ parlMrsh p a pw+s ranhxa. tna peMarlryp W
1+41 the Named In Wed, and, it the Named Insured is deWattd in 1'•0
_ 1.Ytinhl./.~Q dti* oo }nd any pa.Vaf or member Ina.-0 uAV itr w411 1`0119*0 td his 110 tV NOut*.
101 J Ina Named Iniaad Is do"nalad n ham 1 of the OOCIVIdbns as an Individual. the Wrson a dowe'aQ lift ee!v.vfRh vopftt to the
conduct of a business of which he is the w4 peowKlor, and the SPOVta of the Named Inured with reaped to Ina t of Such a r,
busnaa:
1c) any olker, dreC1W, SIOCkholder. 0a1 or o"loyee of 11a Named InSIXed, whits act" h No C40I as Stxpj and any Qrosmatgn w
ppoinator unlit (I/p•cl to real aaralo monagament led the Nartisd ln+urad,
141 jmvYlierson• of o4n latltih. IfUf ~tif Qt f~a1410 wh0~j~, I~~ Narfl/d Wild k$ 0044ted by YYIw of a M,yteR owWaEl or 40"~t to I)MVids
r
hawiitce lartlt 11 I, +ffo?ded OY MNI po,cY &A onN rd tr+• Satent of iulcn gbigatan and in respect of oparolgnr by or on behW of the
Named Insured pr o1 INC044 01 IM Named M5~}MM or 0 RatAW# uN4 by Ih• Nettled hiurl0, f
f ...1.1.11;; additional hwud VO WOO 1M NW*W Inturid Uhdir #A ookyl holuded In iho the Inlur 16 r • 1 tR provisions in
Condition B, but rat for braider oovd esl• MNn l,'dwbWA l0 iUth iddBot+al ISSiI eb l,nbr♦ till AyYi i e/ a Ni oiA h attached
SchedVla .r y• ro'r .J.wr..,;< f ~:r.'.rr1 r'.j-;, ra' ISi
Ilj r Ivclk(a 4 Pwni4 4Y 11+a tvvntd, inured a area fw we In WW W the F!~ Irteued or fo +tly snit ►ef named by Of
" ad uN 6f,If11 ~1{pMp ItijpYed, 01 prpson >'1" w" WA /utomQWw e' waWt and +nY ptlrfon oi'olglifitallWt tegely,
rr a',,,3' Mae eCh++l 1+faoflhe aulWt>r c' arereu! w O Ma permkfllOh'OI M11 NOW Insured. TM
nuia~~a as by klrs sub-0fv' 01. with nwiet to any penan M agarti:ation other Mvrl Mae Named Insured, Ifwl not +oWy -
1. 10,61#10~ 6( dtbWstlon o? fd'W a vAl or.IdtilOy~:'~kiof, opil drip 4t iworloeai te~p.y&~ shop. Dub6c garar, a" aparley.
Nrvlca ltatlon. x w wrap pl c. "h fro"'," Inn ocqun~l ~!I4~!9 9!~, o~ rM ovf!+Nkao!Mr•,:, n . , in
w 0y n.~ o.a , loo u , lair': 5 t , e z 3.•.., lion or rrw
T to any mM1YaChrH OI aircraft. lrUSh enpne,, Or eytalgn eCCealonea, or any i'V& 1 amllott I or • or t
• n „ rt a,h+l^ I "WOW Of 1140 relvecOVS WhOMY•+• G $Wt# WO raltp✓~e 1d YH'o~ ~ ~ ~ W ° sow ~n.nsa~ed.
+ , CnR r,i. d ,yin
,ie V"1 ,,1 erJ Ix+l 4 G 7
# . G:' ~)dt rfi~►ol'fo i+N t,ItYti alafidrkoDil$` of ifie?a<rl; to the oyvna► thi~aot or ny errlploya d each owns. TNS arb dhwon Ih ,nn rent
+pplyif fe,lfiCtsl}1~InrtR+IlfeDf ) V,r1Q~, ;41'~ {fl,) QV1,!+_ ,A.+.f f:, a.✓4~:,"p,rt,
T-1 V11)11 rnaieer,, n~f" 6''sD
11~i+ rf,in.d h,y non owned avtona a+ «++bar of nlirinouNlwld obyN waa if such
4. with (aspect 10 an o
sulomobiti is o,uned In ful or In port by h+rn r , bcd eh r l n . =,r ~f+ a ' a r.0 , y+e nn snT
101~tl 9M?n6 tplcrtub yh ,EUSa W+y'''k t'
2. PERSONAL INJUIVIS
n <r ens K;w rrr' 9 rnU kr
1'Pe►fOnM Y4f IAWK:9rMflW1 d f i 1'j °W"1 IIIINrir' 1 t /t
50 ell n;)'t1t on
MnC n proaa+fkn.
41591.110h. $hock. ,ICItAN,, di"aNr"abilty. w" attest, fat" an hun4own 111110
Doe, cr !!,l,9#!~ o! ~2XAA1!'kwto * A e v Sal
t bM. own" of depilation or CAY'aclel or InvNbn of 0 of or'- o~••a0
3. /11OIR1ITYOAMAOE- e c No s ta m h A J X01 1q~AUt"yt~ rt
This farm "Property Dwf%W" vAxrelver used MnM Seel men i I I OV1114e1 hkMY 10 a destruction of IonifibN pooh; who occurs durN Inc
poky period, nckov the loss of use 1tlareof at any time ($IPA' M4er frh n," ~r!p ~ltpi~lf~r ddllf~R f'P) l►nhr,iafM
tint sdordot""PlotlalUUa,o1►b/f6loiffilt ~Y1~' AI1ailA++g zlu y,r;~l~al9tlloTTO31.av2a:v:,,r~a8,s4r
1.'*ADVIIIITISf110LIA6II11Ty-~ _ y%qr)aionB604p:rl,-A Volt
The term "AdverlasN Usblity" wharever usad heron "man',
v
y rV: ,4Cnu N'. nib{yrl sit r~'n r,n,.+nifl Gr °4dt 1 r'.R K'"~. b14C ! i11 *:'11
6 ~~sNlenl yLlbNl~wIW1eM ~f1 and {Ki •t .+47n ,,,:o lrrnn,d re wN•,r is 11 +f er..n t ,aw@+a ,r4 al fb r Ir ~,,t„ ;r•y
12) Mybirlkrgemanf of CopyrOt or of title a of INN
yan UpperfirekllpWceryrao1'
~::;~,SCI:r f•F?' H^f}k;f :#09►k> !a0>>0ROW I F,
i•I My Invasion of I%ht of prlvaty: .
-onwndled or +a•9•d to have ben comilli ad IM CW seyehls•m•m,' pup,tlly ertkia; woimw bf *w w alAd' r" & '04 kaA4 vi6ed',
,dliart"sonv"s. 1°r 11i1pQrW,0,19:Jen: ryf;.e:i.,niY~F~G1. (rI
1. OCCUMI[NON - •>u.:„Ay,paYv1~n °5yns,ate„tu+,~Y~t
t't e ' ~'Odlf 'i6C1" n it IM y OW-04t, fff'~~-0(to"0r# kIKpoMle to
condklOn, wfwcn tneapectedly and unntntlorsaly result tree b♦~aTx duk+o IM N" wMiod All such
eworverotwb,uni+►yfneam+Q r. 4." na;+a~tk,q.lR'w l!'"'9k'"?IttP! 1Pf?M 't►+!1.~ "+dorNgooulrffrKrl
y■, Iii `~'~nlf yr1Q li l:,!ILi i 1 b 'f +,n%t- 17 I-" n' C ' 4f:, Jt y n r nl lU ^(~f7~,7t'f,
9/f.1 '!w" ~ .rM~o,!] nh~d 1,1116 . t'r )'r6rJ b'1 ','g;4 7of IJ eG nl ,u, .r f ] • r.,f,yl ~1 " t1,~. d vy d 1 , 7, .,•y
a rr. 1-0.' r:,,,,t ,u:r, .r x.c^0v^a SJ flEo :f f.:.l r, a 111
The term -1)~s" Include, dmega for bath nd for ura end bas of lervkee I' Atnq from pen V4 Inllry. i
1. ULTIMATi NET LOrcf 7u{':,y.,}n Hr. `q 16': NI ,:711'.,:. n:., ~:T'~,.,r r. i,r. +tr,tlCtil rCd',:rrn Y:., „[N ~,t_^hL 4`+11 +'4 ~l
11
r., .I ~ omega M p 0,1110 h t(.~q /lprey0arrt film Ilan :'l kows Nei Look'$ shag mean the rolY MNl`h tl4e va"w w vU § k~
M. Owi" a A it.bow" QM1i1N410 Pei OY tfaafrl of osi sm 4r1••; lyep•Ry d•nl•9a i, rl+¢ifl" lparl/atfdl. f W a, ttwpN
canon w CAmwom+N. W. anal ale ntludr nofo -}.+geditel and hileref cnafpN end ea ttls+te Pfd a+<
and IM oohs: pf•mkrrnt on +ttwinent or appal bonds, Interval, egw"I low do,%Xrs, lawyers, riwNe and hvaho" a and otw Waona for
Itiogew. NIJemMlt. 4440 ant AN InvlsNa ion of clatT/ and WI1s Mfich vial jim of / 0w4# w*6 df tiFy OEE~I??1rSE+1 10"M fl•ni/dM,
a Kcludlnq"rM NaAt1 of Mae Inewed't or of Any und6l" Mlsuwet's wmnom employee
n':eaTMCnrf',ARy.IRamwNel vb#pine'INil',fdiiltllia,A:6117tR'b,lNlfl'i 64lneios. X084'arvowIr}g,cpSKY►IMIrIMK1^S•'
K,,,r,..r.w~ no- .vrf • ra :~"ii; .'Cn,"'u
r C' u•
S. AUTOMOOU _
The lerm'"OrrObae". w1i used harm. anaa mean a land motor vehicle: trailer or semi-trader
4 11. AIACAAPT-
Thy term "AkGah wherever used her", 11110111 men any heavier thn air or fighter thn bir &WIA OOWW ed b iron spbrt p~s or property f
10. PRODUCTS LIASIL11Y-
The Iedn "Products Liab lity" includes me ' PrOducls Hatwd" and "Completed Operations Hazard" dented as Ioaowi,
Its "Products Haird" ncludss bodily nryry and property damage ari" out of tan harmed 1nl4ed's products or reliance upon a rep•a.
snf411100 Or warranty made N any time with respect therew, but only a the bodily 1n1ufY eK prdpeny damage occurs away prom prerhnea
owned by or ranted t0 the Named lniured, and after phyWal InsteAlion or such PrOdWs Ms 1*4rl refrutuished b orw&
"Named Insursd'a products" mens goods or Ofool i rtsarwhehXW. bob, hkoi Or 601ribWod by the Named in sured or by others
Ve" Mdp his M D~opO. r 0 My Cpnla nK IMre01(o1Ml thin f. WNCIeI. MJt "Named In WCfd i PrOducb" OWN not ftlude f vww&v
04clw~a of tlwtf tfwl wc►I pon taller, tented W or boated. bar use of cows but ha sold."
121 "Completed Operntioni Hazard" Inckrdes bothhn ' eep~t4Iatt
MMTPmY +OrAe M any ihle wain reaped ihenlo. DW only If IM ObdIA *4*irY of d 1
MY ar 1NOtty d' d ow~ 6 *Fo'q ai00 rP~prls hive bean
f01fiNd W.aDinoonfd and oMurs away from peon" dw4d by OI reritfd to t0 han daiV
,t r,,~ r ft(. i tiffll hlrlhhad h boMeOdon YlMweh; Opwlfarronl "bit debm" Cbrr1'p1t N bwl~a~Aifl 0 1 tenale. Dens `
la} when ale oprN ohs to ba performed b a bean t1+!!7Qln ¢ a
F> „r'as;q m"r ea r,7. :r ++~r,;atq t 4r6 '~,De OI,~ 6~~ .W1kdlReC rkith44L* paWlCQntpIOY~di,
q
Ibl when ant opNNiona to be CMrormid by of &i b7iluN bar tits NeFnrld lna, id d p +e sHf'SI IM .rya
rkc U rr , q t F: y r+ t OOMNgni have been completed. or
_ r ~~JA~~rq t kr~~ ~yPrF, ltl AA ..':.h'ffi ~f 1. Mr,tJ f.~. ha f .N,, 't41 1511!7.v1 t^ rr:501 'a
~f~t r lino 'bow a subconlraCbr Oe din~eQ~f~rleee has bNn pus 10111 Mtrfhtlld AY Ell ~►~O Ilbn q OrQYwtM Ort F
Y MQ~pfJ n _ O 'Li C Htory ~ ~ 4srDl~~ S !!?N.RION~
^ r' Esnt I G: vrJ^ tJdT ,w, .-V r1nu.E Q9 t,lcrra Yet Y 1~ i ~1 rel. r '•t w 4 c p ;
Opera:ioni which may require further service of miihlAarkrf' rr otr , "rth~IseeeherFt , y e . ,.t, 1; airs 5
~y + k b 1~ol~k~l8t1 fpafr ~ec
"!K
1, t'u~vkC D X11 "0, ..-!'!'?;'A a'i;'^wt~~.f Q,f d9 rf , n i1tAI Of any defect 01
nip .+~'I ~J1.Q:Ttrgr .}a.i F.,y fUA =ul+-.':t.y '+i Lr~tii rte:.:'+'k
The Completed Opefationa Hazard Joss not iiie"
bodily "0rWOpfrlydamaQeerlsingONof -73tALV,.VJavI4i.AJ9 It
10 operetiona b cower ^fion with tan b n o
~~yy.~ w~~yy y~~- ~~gy~ryt
s=?.~n FK.;G4:•(wgi ~ r.+~~~~'~I~II~J'!Q~W9i1MY4rDSQi.arWfoufblaCend+6brtnor
t
Y`•[ .mY,}r,11'1 r ,j,i 6~.":{'~t+RJat,?r'1!a'~C^ fJrX'.no~[n"Yn~ ~7 N:rd~IWn}rl^`r !mot t.! 1@9;4!'Sr ~6, ,~!.r.~~_r...,12f hP.'0 4 t94J?R +xnr C2q f.~L
Ibl M ea fwihCf 64ib T1i iAI~{{4ar~0 t OflaOrlXdM~d W YrN1{ied ma}felyt t0 h tin rrv !6 f 1'n !J n r' Y`Sr;i r, I v':y r
11. ANNUALPEAIOO- crone „3~~i~IP4 YTA"y 4'J1t r
. y ~,ry n'6 ;'J'S'L~j~~~,',~N A!a9Je ydyl'1rrtp! 1 (,,`J.. H.±9t r7 el r', H i , r~r,i l t i ny.ym trr, iv nyran to J ..~.»f Sr ysh8ll Yf f d'.!"~ t+,n' 0'1
ThfIfllRl~rAlMrlrl/Ise~'f~!Il"i rPkrirrai~ll~ontsre'r a >3pJ~(f~{6d~ (,,i,(_r , •,P,,,,,i,.~x4 LY,16 F r It fie. G !2L4 f +j :w L, + Si Y::f.'•.,
DJ~r~~Yrv'T1.^7ar{4QL~i ~,~~ati►C"37C~.~1~1.^~JAf ~pl!Q4 tiale911faa fTOl!CY''iA T'~O tJ G!'
TH44 POLICY IS SUBJECT TO THE FOLLOWWO EXCLUSIONS: star
-'rTIJIAdi1lCNtglTg3YUA
This Policy shwa no fipply: -
oa':; ilGrr L.'b'1 i,yl.' K.4p.y 1w y'L,,:R,}~,re;,7, Y'.:J4 17 x910:+I
(a) to any ~ion for which the Insured "Any company 1611 ka in{Urer tM be held liable under any
re k rglObyment
comw"tion or disability ()Wallis low provided, however, ON this exclusion d•,)fa not apply 10 ty of OVWS uiumad by per Named
hwed under contract or apsameni: e,](M21 tar, St1'.rIG!'!Vr.r! 4p•+Ynyr1 151
rot 10 l y rWW Property Jamage or edvertisoV Ih1ay sr" N a me w,0dof M Oii~'psrTr>flrj?I}d Bar t vMltilis' lSl i~hfcl4 phi Mlfured is
e r aftner Or member nil rvf kin li not ds4gnalsd n Ifus pNlcy as a Warned e!ured.
^
;,ICI,.- fA,b}1,91us~ol4^9'914.~5'ywtynA+Khha+r,9pbeen0►lvsicPiYwNu!edadnhoyedlewRrpMan,N k,, , ~ j1 , ~ r f , P,i+
(1) @ delay in or 16th of performance by or on b*W of fhb Named Insured, of any contractor egreemerw. or
121 the faiture of the Named Insured's products or work T '"t eau u .r
iad(y}1DY,{~1r~3,~,?,9°~'N1, ~I mf.H+YrNtd Iryyae~l fA meap IM Iml Of ttAltotmnc..
.:,:r c~:> a c d„~fy OMCSid tlrlrabrlt +b~rlnke } r.o!t*!
h~.61'7,',F'e',fp'. p, 4 y.nx .•;,1 .~A , rw r
r 5? C )'++7 Y k' t'
arr.,:n2rr.
UU 1nIf a1~tdJMP1'doii inBF ly id Ibis df Iris $1$thN pnp bie ~roper~y r~iuAnng the 8~ nd accgeMal vpnRyy"f}1~n~~pry
destruclbn of the Named Insured's prOducli a work WO(med by of Od behalf Of the Named Insured eAer Much pfodudl2(iAdrtl have
been put b use by nY per140 Or organintion other than an tnsurad.
Id) b YhpldlnMtr rmoi}lt,m3friiietp aktep,rdj,MV 1dt,rR:"t• *:r!+9i"r72 .;,dab 2°5t''I'~`/r5i4'!T
yroperl , damsge 10 94 Named Muured'i products nsng dui Of such products of any part of Much pfOdVefa;' L 20 J T 3A 3 r A M! T JU . T
:,sx~~~!1.~Q~1~~!11~~4(~i,N'1~f/MYl1,!fblpel:IlDei.fatal:NpliOertynl0[bas'DfUa101a1e'N~idprffQlid'1'+11bYir; NrA I1~
r, ,a r gf NN .`!#a1P9 ~1f1N Op pl My props(!Y al wt►ok wC►+farodoCls or rarer iofa A pwrt 9 6W ~/d01111k''r N® 1R 'ef'Pf111T "UtI ll
t':ren> :Q~'I{1lItfMA~Rr~4~RkMRRQf1nRMnownb~.Yep.Qp.ddeletpaafiCNfkylh!WNI:"eh.f~:~csrrr~•.:'!tDnt ec,rn.,,, :.,ytana,le~
J!Pj, F. J b h: t,i'JS. '.Af l2 iYl'rl✓ I nIJV
»tr~ a>nfY 1412 t!9l4rMlN"~4a9kvilim19Go**4'+desgainathakivilot-,e: t P;,r In ri` 1, Ck ear bnd Ir'9^,!.. '.6 I:N'rirr'%r r :r,.;~!e
I1) talk/f OT r:~t rd'r'n9L.;r#rF`A4e lniyFi^Ip'1.r15"?'i ~rf li~]Rt'9`.ttP{0"t 1;9245#7041 ii-.nt".,('."u^:J`r!
n, eo~calnaGkf~,l','1.~^~""?1,~~~!t°,~~~+lids.~+ts+q!a1FrP~vlrrVa+~~+na,garipfwvoonyl,~.daaaa+
dtbn «ftf+rl~f;`
,Ill
kt.,7SlS n,l £ ,,.rq .
.,rapt;122r'E<:, ~ $i
121 Infrnoement of rplgMed trade marks, service Mark or trade name by use thereof ee Me r~plslNed bade mark, service mark or bade
natos of ooods or "N ea sokL oyatad kr eat a or N&M"•d, but
tt*a anal not res»e b rates aX titdgani:'
131 noorreci deecnplwn of my rucls or toamooty;
14i eMalake n advr4aed pr+c e. 1
Ipi e■cept in rosoacl of occurrences taknq Discs in Me UnlSed Ste;! a of America. Ns terfitorles or polissas106S. or Canada; to any isbedy of the
haurrd d+Ktp or ndirecty occasioned by, heppennq Mrougn or in conaaw.'ncs of war, invasion. acts of foreign enernles, twaai;kee s -
Iwhelher war be declared or notl cmd war: rebeaon, nvowhon, inavroclorr, mtlllafy 7f usuryW pows► or confiscation of nNt7nsAsatia+ oi
reCutil,on or destruction of or damage to property by or under Me order of any goven'neol on pubic or kcal authority. .
III) to any lab lity ans+ng out o1 the vblsi on of any el atute, low. ordnance or regutahon proNbitiV diacnminalwn or lkmiWgn because of race
CreW. coW or naloralon gin,
14 to bodily"or property dsmaoe ans" out of the diechrge, d spersM, feN•N a escape of arnok•, vtloon, liool fulltias acde
to)dc chemicals, kwids or oases. mte materials or oP w Mtl 16. contaminants G POa BMS 144 6e
t+pon IIYId ~M,ed daa6,~lapltere r71 y.
watercourse or "of water; but this exclusion does not so* if such discharpa, $4persef, release or escapa is f as rnd ~erde~al
61 in tospecl so family prolection (Uninsured Motorist) Coverage.
. - - • Fre epf inao+sr as povefage N Ixdrded b ih• tMtrrad b tM tx+detflrrig lneurM+e a as sr t eft n Cif IltlalCfiad t3dNdiM, YJi Ly_VtIR~7, ~ap(p~ry
11 . 9o txoOsflY diRfaOe lo. York performed by a On bshaB of the' Named MautW all et •ie rrbik br' 1 or
t
malwsals, We Of equipment fumisw in connection rNrowiM: l d!,t ^
M k the Istiiliy of any Insured hersurWsr for asmA anal battery conm sled by or at the i iirectbn or %uch InsvW Baugh w- 0 b•r"
"a resulting from any eel aINgod to be "WA and battery conmitl•d kw the ptrpou of pwentirq or firnirwho in the
t 5 r , r „oplr", of yj(QM 1, a it r Ins a 01 prey"&* pars ow "W" a Prapvty OaKNO,..A ITN 1$1}t0lydtSC6 ' ovs
sit Uion snit not so* lO the MOBty of rr w+~ea l+lUrrd W pMfsbhOf s+lW to ylltiwfit~16 . f3flflN If It A. III
'4 n tv. ` s» t •d
lllda7E4cyw(alabove...;?! rl-r~pr` '11G?.l„!1:z:t15~,7lm+'u y'w. Tt•' S ,
i5w,_n'_+r, ar-,,r~or;sao~!.rlr,M>;awt.ne~:,'J,u;~o
(ml with respect to any 4wcfaf Owned by the Insured e■eept kb ft of the Named loved for alraNt 1`01 Owned by trod
and agreed that Mis 41 xcknion shat not so* to the isbiliy of Me Named tneved for persond hjury it
-alr Mrebysifi;`GhiNdWtA MaDR1y
b already exc"d unties Exclusion (a) above;
j C C^, ...,t .,,1 i ra l:r Rail 4F,RJ RE. 41", o, ~U rl?5 '@ ICn Oy,.rl g Vi 'r;tiO V 'F ~i !,a:;141 r1,,M 1:r 4Q t.fl ti>7t-y Vf., .R.J
~ W , 7eilll (e IpeN b stq MleteftrraR ryaeNd by Bi11nMSYd'Yrhoi Ba!•Ir fr0eef brfn7lii biik+id rlshtiQ df C ~ ` ' r a~
+ s :all the Named Yiu+►W for wMerareR ool Orendd W t %ft at beet uhderildid sl'id' v 4 Idaf' Bkf~
m ' ; T the Narts4 in"" for pe(soAM Mtlury Id "k erw0yAi; We" oudit NDINyid *,k ikfLrdtid rR~f
A... t) "Al '•2, , - tl ."1 Pr,f ! 7 ry9riv Y710 'f ASV 1Cr
y: lot r b rig ernpbris with nedeet b trytey b of ins deaftl of anonief ih+Oi•yd• Of thi'iNitli tFeApltiy~r ti+ i'
L J J Itl^aw~.!,r,.u+•',^s7n+w.J-. ~a1i'yTA~':>T"IS POLICY 15 SUBACT TO THIS FOLLOWING CONDIT ION! - j
r0aJVJ0Zv1l0YA YJ1gVA)WAd 94
A. PRIMIUM-
gait io „?'nit C?'.?^9f ?ad !L41 q5^a YM1F 4~p~ eml be`aro b't! T,1,iz;xJ nvtO yI:!ny Yn8 tq C9'u t;.~ 9,'!1 ''p}`-:!rtj~+:`I TOY.' J''~UnW e'i b) Ime.+i'rt N
Unlessoth"se proyWed for the prrr r.n kf INS lbicy ls a Rat yeflMlAi"ahtl bfibl ii,b}i~#id'id~MlfirS! e~~bF'~ biaAdf)d M~ I~or~ B
snap ~WAAV2NiP3HT0 -J
9. ADMONALUfSUREDi-
nF.'f ,gr';-J t[1~Jq vd D1t3:Oi 0'.a lPa a ~rt?8„pg a ryfv8^i ^J 1 4t llCr.YVC. G' 19'u7 , ,a'4J '~"c ~I M bin6 Yf2 k Y i J' ) b"F ~d 4v 4)tH 7; f,
In so fyapf sit Adioonof insueds being Added 10 Ma ctidvel'pe'Vtdsr lei Llri yifp MfitiranCii r 1 14P, A fro
ohd be Slyep Iq Me Canpany whk* theft be enritlW so c "Is ah'apph*vt fdddohd flrshVh►tn hinbrl
C. PRIORINSURANCBANONORCUMULATIONOFLIASWY - r,Gr)a911Z M
11 is e0r•ad MM if rty bee covered here~ w 060 oovered in W" a •i per! ty!dM arty other ixt:ia poEt~
Vfe ft"bon dale Mrao1 Be W of "W" hog so lsaued M`+4 In"d bf+w_to
Me stated in nerA
n
4 tb the h4S! Qn
c000n401 W loan lrndsf such prior. Ytatrafice:' ! 2 of Me OeClratid" aheB bf teduoW by tiny aAid Qull
.o .,...:.,,f ),'x. :•'rC`s: ,::,J R 7n,.~r 11i•, t..,.1i 7p1,. r..~il „3} nt..,.. uf.,!,A
0,4?1;1"CONOMQN* APPMABIB TO OCCVMTIONAL GISI(ASE W I r'.1.-tT i ) 9 1 .),M . t J ` 5 Y:', J _ 1 9
nil^.filiiir/1+')yE " . -,g f'.,.-."/.1. 1.;.' ✓f-1 ..rS 9t_ r;f hIT , .n.... MJ
±*Jwe►0e pera0nal Wy Oath fx non faielf by egoupMionM aaaeeae etfaleaiad p MY eirok►fas b1 tlii Ha1,afQ, fi
$11~ F,
ame forms and conalions (eaoept"regrds the prsrr . the amounts and Innts of hbtify and the renewal
apreelneM, k si M dr
as may be added to Me undo yY+p Insurances prof to Me hapw" of on coewencs for wftkh claim is made hereunder. Z l u N AA 3 .14
L INSPICYION AND AUDIT -
vvrt d#Aminia'itQrJ!r1GyJ Uryr~r!1.Jif.'7yraMqV5.a~1r719r'tWEfiPt191 iYNR!rlrte?' :7(-6 y7t9rR%YJ,r11§ .61RU'A,)h1e:!C'N
t ,a 1. ~~►r) ♦,~ir ja I~},~ i.' e.» '9y41 i nGn1J t:
akMig (fiM••Orvaf nor li or b any raftaropi4t ther sni COnMNule alle atbAs~11n ed oS~r•~+~ rY&~8rMYw. f~4emsdor .
mane [ma nor Me m
eon
Io delennne 1fr warrant Mee such proW y or operatbns are We. rN 7,r/ of t l A , O
h~~ti1 *sey~Nais~ 01! Plt¢!f(ygipp{ ~Nf••( wMHn
The Comilieny Mr" yews agar M may + III $K
` 161
F.' CMU LIAMnY -
h 1M .vent of carne 0•l hen s" by ►s•IOn of personal ot/N. by any wnobY•• a sane haurad hrander to •erch eroRw hwr•d i
hereurWr Ie a rr ed spa +at wAdn a cWm b mods
"Wallis poacks had laud to each Inaved MrfvW: Of may be me de In, this same mairvw b d {
In k%s lapse Run "S I Of CAdml b" mods by reason Of damage to p y b4-! pV to any hwrfd hnf~ Nor p h"~ b. or mry be. t
Policy shat cover such Instead u whom 1 c may be made In rot fame marmot as R sopwarf, p01Ci01 had been
4Wd b each R sixta twreurlder.
No" contained herein shat oporata to inuaue the Compny,$ ins of taMly u set forts in In" Aor•arnsry Is
0. NOTICEOFOCCURRENCE-
Mfnevw ate hsteed has Information from which the Insured may rIssOn" cw4k#de that on occurrant» o0v1e4 hr•UndM hVohvs Inlteies
or davnaps which. In the event Mat the Insured e'totAd be held Noble. Is likely to >nvoty INS poilCY notice shat be aMf as elided in Rem s of the
OPCiwationf Is soon as praefwable, aov%W. hoivtver, Rwt talon 10 pate notice 01 an ooew
propA at he Or ;a li b happChNp lid not apwr
10, InvOtvt INS poky but tvhlrA, at a Wr pat 1. woYld app•r b plve rte to elfkM hIr• Y t+tder, chat nee not alluaa Anna.
fl: ` A `I~StF~NCE~IVDbO.OPF.ItATtON~- • , , r '
Except a respects hsyr
Inp Awitena l R, Rw Company shat not be COW Upon b ueunt Cherpe of Ih• "Mamw or do*%@ of any eldm
v ll ~w yA or at w n11imito now Its hr"d bull MM Company shot he" Vw two Yb Mats of patent M6,0006 UMq to alwwo
underlying insurers. or both. in sins defense and Control of any Claim. $,A or aoceednp raleRv Ip an
oea,nenc•
i ! InygNos,W WVW@ ►N019nabN Bill b Irtrow• Nw .In
tA+~pein t d•1•ni~ bt soda claim. soil M proCOeNnp. r Y whkA a 1•M M hW►ed sold me QdrnWAy sftiN bo~lertlf * C'
1.~„rAi!PEA4r~.*+ i rfi: "Jrg7U•f i tll.>s-w'1 h t r ,
r,~y, rat : b Jr9~~la' iNJ'7 )U0
C .rC• f~1 ang C ft. .,.A, A:) C'1 ~ rte I 1:•n r 6 r r4i t9 ~i';:'r J
0 8ti.4els" hweta a" wit Io AW*w a fu rWil in awcoss of tot wAhp Itmss; Its Oynoony may
11p ~ wf~ £9fk+~Aeftltr 1Aq OW to Ili for OW tawa~M ooata and dlsbulaaryyy and 1ntMesl bA
c n u fri is ivAnf IAe 1~biEly, s,a Cvoo~mopny for ulbmar• not Ipss exceed IM strwlnl set _ i~Orn•nq anti r.'
o0ewoncI and in a0diben the cost and awpenae of W, appeal ben n Matatitd Apreirrleftt M la any one
t c t... Y9 t ,a,, t;a^ t' : eR 1 Yr v C,,.n. •+,5
"'V par,? n'1
"'V of reryn it
Lt Xx,k P.l l..k aufd n'}Gly ~7~.L1
~tid•dn ,,a L.,~. IGa~'rL" r
t:
I.lsDisty under this polcy wsh respacf to any 000% r•nce total not ortwA Unless and ynW pat ymilurod, or the Inaured'e un"lying InK rr shot
4 Qrl y 5lf talpA Ooc1RfwO l14 Inoired idol awke d deMles CUM tbs enY fos'ti for Idich the
~M!~'M a ! pl RtinlPll 1~tN JM hal+rad IMI l+aw yard ee
ae►eltrtt Of tdRlttsl• nO IOIR M WACSfa al >"w
MIN 101 Of Rte RMll~
tx•4f►«l31044-PowwodWag Mrfry6M~M*wMbwdttAdMwr•dafler I, 11W404 $OPINV tine clownanl, and IN Company. R any oubs•W" payments anal be media b Ras mill on
+I4lj / f d~flr+i~'{rd ri cf woe' an* d"'s`ap MW poky.' 110 cola. av0A 04"6 Mss be OW and p"It' NIM vi Isol
9. BANKRUCTCYANt.NSOLVENCY- Y+'Oc!+t7r~i? C HiN't) lr~ i dHi G7 t ~HC9u2 2t Y~+:'>g 2iH!
d t01thebr ~ Utsr3Aq * ~L
& 13 ~ ~~6,y spa ~ y 011M hsurfd a anwwyen.wwbyWrttpr aMp Rte InaWed rnf Company Gnat not b• deleted NIL IV of !M
~ y Qr,~~^rws'7..GP F. ri )'7 r.r1t 1[.! I'+. m. ; rn• e..:.7 r,+^, ifd. n5y~17L 18n
L. OTHER INSURANCE- ,na
k Olhar Vold and CoWid f Infix~e w" any o1Mr in"r is evrlabls to Ih• instead CovrInp a 136 &ISO com*4 b ~Me poky. olNer or .S
h ~~Q}~gfp ? ji j*t f PAA , POyl. R4InWili Cii0 wdod by We by Man
a in2~IRfJwlhr~istn 041licY all W M •aontr We" shit hat OondRAhs with
~ bll,SBflMf~ Iv tt+tka allot Rolwr atlDlR•r to ~ tarn, oortdtsons arrp Ittlkahoru orwAw Hwranca.r, l tl r
M. SUBROGATION-
. 'ell 1'rzltlJ af:~ YUITAA'UU)NON C..1A 3=~'XAq U2 M: rrpt~q
roQ~f ""M INN I j tip "44.Covfvftl fen haurfo's oghl of rKOVery notInel soar pets0rr or uffw ormy la ss~ y; . h, atiffl,►+f'rstpod sn.+.apnod owl in oaf of any peyowrlf
Iwr•uWer, the Compn Ny in toft a *l offik
%lfef
y WIN u+Sle Iwtckidriq 95e Ineteid CaNlCafn•d in 1hf a.rarCNe of such fiphft 01 IfcOVNy. The shat follow the ahtbls the! any Inleraats (+nclud Me InateadI
Ihal Ihot have paid an emoted • abp ea"~'te wnbh dryly dbe 14 o o ?~;O
ritimbwoed up to R5• waounl Y Payment her•undsr, shat hell Qe
paid by rhsm: IM Company is s:M b be taM~{rl•d 0u1 of alley tADrfC1 liYy firaslMq 06 tl5 hAtiltbBAf M
held. Lrider; lastly. I~~~Maaa~~' Inl t its f~~~ the ~n edl ~ a accvtr" t~eHe ices I are entitled b Claim the rsldue, if any, Eap•nao naceefary b
r' ~Y,r'Lb a 11.:x'9'94 pits klW/adI 00nCNnEd. in to rod bf lhW.AA6@ 1
ter. t ' C•°5 2 "'G t 0l a n95:7 »PI b s. ZG A:. a! ran v}:) G'N L'T+i! e'tY
N. CMwNGIS- oSnV~lrneGe bn.e)~++.;-4w,r,r e. cr R, x'r
l^9r.'Jr'h4 fC!'o-,: yl9 .',rt w„ -~:•eL+9.6 I GS+bCG i71r'. d1
Notice to or knowledge possessed by any parson shell and affect a walvr or change In an, pit of Rail pokey or slop #MCo rr nit o sass .1
n righl tetdr ~ Ierml con+pnylrm ueertInp
q~e ;t WM
r+emcwt rrnrr t •rlYe •QbM~ft.f•f~M?iJRa.f~i!pIDyRlIAWARfRgAIS/Wdlglor>naDarlRalof
;;.`,SMJ na ft.'"
ehthid nOJ 't+. Mf'.9'1! rrr 7r YI!s .irS;Tan,^!f (.'k.lA.!r !'1 '-~1 ~r✓,HIJe'Sl •71 e.~Xn1
0. ASSIGNMENT- y,~r~r,y,~.9!seraerttldr,r.~ Ott,eQoros;ufill led -Awwe~n„tsc01
»Assfow,"'of16W11111 OI11%p sf+al~+oK e 6 $1i"i"1"T YM" 'l h r,;r t,~e er,r s. a is • tiros wad a~T
w,r~,dN d. es• + ~w "IA~y~y
. • P(W ~IART 11rt $/4t a IT 10G d If i $3r 7f
fSl
r
CANCELLATION-
Tine poky may be cetcalied by M Nomad insured by surrender thereof to Ma company or go wthooled re iresenlabves a by me" 11 Ma
C0011,04rty or go suthonzed npresenfNwes w ition notice staling when thNeaher the concelat.On snae be orfec" This poky may be cancetled by
she Company or its au z*;I representatives by sanding by registered mesa notice to tin Named Insured stating when, not fats Mel ftty 1301 days
"Woofler, concession char be •ffective The murng of MtK• u alo(es 4 by the COmpe r G its aMronred reoresantetives to the Nerved insured
°j of the address shown in this poky shelf be wlfKient proof of notice. and the insurance under INS poky Mal end on Me effective date and hour of
'r cancenalgn stated in the n)hce Deity" of such wnnen notice 4`1411111 by the Named Insured a by the Company or their respective representatives
shelf be eoufvalenl to mai6ngr
f it is agreed that rresoe0 va of any other items or conditions cr,mfrned in this policy or endoill"sols attached thereto, this poky may be
cancotioc by tin Company or iti authorized representatives la non-payment of any unpaid porfion of Me premium by desvennQto the Named Insured
Of by sendinQ to the Named nsu red by reg stared mail, at the Named Insured's address as Mown herein, not less Than ten days' written notice slating
when the cancellation shelf be elective.
N this t oficy Mall be canceee%; by the Named Insured the Company Mall retain the customary Mon rate proportion of"premium for the period
this poky has been in force M this pu k y Map be cancelled by the Compar,y the Company shelf retain the pro rain proportion of Me premium for the
period this poky hen been in force WK.a a wCallation by the Company Masi be effective even through the Company makes n j payment or tender
of return premium vrith such notice.
0. CURRENCY -
The premium end losses under this poky are pay" In the Currency slated In hem S Of the Deciarskons. Payment of Promiurn slid be made
as steed in Asm 0 of the Declarations,
R. CONFUCTINOSTATUTES-
In Me evert that any provision of tNs poky is unanlorcesble by the Insured under the laws of any Slsie or O*W Xft&bon wherein a I$ cWm*d
that Via Insured Is 11" for any Miry covered hereby. tx Ouse of rloncomWanee whit any staluls thereat, then No poky" be anlorceable by
Ce Insured wish"same'lied as if it Compiled with such stsmo.
S. MAINTENANCE Of AND RESTRICTIONS IN UNDERLYING INaURANCEC -
1
it laa condition of this poky Mat the poky or pokles referred to In Me ahw.W "Schedule of Urnderyng Insurances" chap be meintaired In hues
effect during the poky period without reduction of Coverage Of limits except Cdr anl reduction of he aW"Oils limit or limits contained sharer softy
by psym*V of claims In respect of accidMte and/or odplrrences occurring during Tie Period of M Policy, Folure of the Named Insured to Comply
with the foragong sins roof Ulvafidate No poky bug in She event of such ralures. Me Company shit any Ins W4 b the same ed1ent as a would hevs
been hell the Named k* ild Oornpsed with ft sans candihom.
t
p1
v~ 10
' R
-CHAV& Distribution to:
ORDER ARC11MCT o
AIA D0('UX1fNT G701 CC4P:-TRACTOR
• 11ttD n -
oTlitR ❑
CIIANGE ORDER NUMBER: A12
PROTECT; Public Library
(name, addms%I Denton, Texas INITIATION I)All June 4, 1981
TO(Crrnlr,lrlurlt ARC~1111[C1'til'N1rICCTNO Library Remodel
CONIRACI I(M General Construction
Contract Builders
814 w. Shady Grove Road
Grand Prairie, Texas 75050 1 CONTRACT [)Ali: May 15, 1980
You are directed to make the following changes in this Co„n_tJracL
Existing interior concrete: One (1) coat except concrete
that is now painted yellow which will receive two (2) coats.
ADD THE SUM OF: $3,675.00
~ p ~VEDr
A~
. g 198}
CI HAS NG EP .
PURC
Nut valid until signed by both the Uwncr and Architect.
Signature nt the Contractor indi(dkl his . grcenwnt herewith, including any adimlment in the ContraU Sum or C'ontr,at lane.
was 1. $799,291 .00
The original (Contract Sum)X~1S~11x~'XK~~KK~ S 15,563.66
Net change by previously authorized Change Orders . . . . . . , . 814,854.66
The (Contrail Sun)) (1SX~ 1 9]P11~(iS1S~4)<3(~xlll prior to this Change Order was . . S
The (Contract Sum) KyWXMKX'V')kXXJ(XXXK will be (increased) (X1XA141fX'& xJSxK%+UAJ $ 3 675.00
by this Change Order .
The new {Conlra(t Sum)(XXKXK*XXCCfd1114X*Xx%4)() including this Change Order will be $ 818,529.66
t )Days.
The Contract lime will he NXXrXON(S7 04ki14dtX9 A) (unchanged) by .
The Dale of Substantial Completion as of the date of this Change Order therefore is Authorized:
Contract BUl11 ders City of Denton
Me eril.andrY 6 landry__...
AY lit ood Street, Sul t_ a 325 cWTrthady Grove Road °AfflRE McKinney ,esi
Ad ess Address 1 050 Denton %as 76201
D as Te 75 19 Gran Prai le x. _
o/
BY_. BY
dune 4, 1981 ATE
t)A1 E SK~L ' UO
CIIANr,E oRU(R Rlt 1978 Fr1iJION AIA* 1178 G701 --1978
'N511rlIlE or t,RtHITEt iS, }73', nlw YtJRtc M'F , N1A'
I'' ~1.\SSRICAr; (RICAN G711
•
CHA{~QG - Distribution In:
ORDER OWNER ❑
AIA 00(11NUN16701 AR(Illltt 1 ❑
CONTRA( lok ❑
IIEID 0
01MR
PR( )11( i Public Library CI IAN(;[ ORUI R NUMBER: #13
(nano ldrin Denton, Texas
TO r( untr.lclor): INITIATION I)AiE: June 4, 19131
F AR( Ill iE( i'SVI(ItiECI N'): Library Remodel
Contract Builders CONTRA(-CEOR: General Construction
814 W. Shady Grove Road
L Grand Prairie, Texas 75050 j I CONTRACT IIATE. May 15, 1980
You ire dire(ied 'n make the following changes in this Contract-,
Existing interior sheetrocic - One (1) coat of paint.
ADD THE SUM OF; $3,075.00
•
AP V~D ,
1981
DENTON
PURCH SING DEPT.
n vali(1 unhi .ignt•ri by bl+!h the UlsnOr and Archiierl.
Slgnalutr (It Eho I-,,itrionr indi(ates his igrvi,"writ hrrei,sith, including any adjustnwjit in Ill, fontract Sum or Conlm(I Innr.
The original onlr,l(I Sum) (XXXIXXKXXUX.XXXBl,XQU was $ 799,291.00
Net siian}',e by pre"-imisly authurizcd (Ilan);t• Order. , , , , , , $ 19,238.66
lhr IConll,llt 5u111 i+XJSKXXJ(d9UXd(XXXXXXk prior to this (hmige order VV'as S 818,529.66
The i(- oil Irael Sunrl XXXXJ(XAXXV*II!KAXXXXXXK will be (increased) YXXXXXXV) XXKA*XK*
by Ihis Change Order
The new (Conlracl Sum) XX)6XKiXNXbNXXXK1)§XKXX) including Ihis Change Order will he S 821 ,604.66
the Contra(I Time will be (XXX06NJ 6 OdXIrrXXX-A,l (unchanged) by
The Date of Substantial Complelion as of the date of this Change Order therefore is ( )flays.
Landry 6 Landry Authorized:
,MMe eyeer r, Contract Builders City of Denton
Ay11 ood Street, Suite 325 CVhRW11&ady Grove Road (IYJIRE, McKinney
Addr ss Address Address
Da las Texa 521 Grand Prairl Te a 750 0 Denton, Texas 7620!
It -
By_ _ ity_ tiY
DAiE DAiE
AIA DOMMINT 6701 • t.Ib1NGf (JRDER • A ~11,11 inllln,14 AiAR . ^
111E AA•11RII A',I IINJIE W AU Illllr t5, 111',!.I\V'1r ILL
" 5\'f \ 1V', VC 1`.!"~l.,ir t"J, 171 1(NNNI
r,~pl- -1970
•
r
CHA G&
R'% ()istribution to:
O CCC OWNER El
AIA 1)0('UAffNr 0701 ARCHITECT El
CONTRACiOR O
FIEW 0
OTHER f7
PROTECT: Public Library
fnamv, address) Denton, Texas CffAN(1I ()Rf)fR N(l&jBER: H14
TO (Contw(1Or): iNIT1Ai ),N4 i)AII.: June 4, 1981
F ARi I[( 1'S PROIICT NO: Library Remodel
Contract Builders CONTRACE io k( General Construction
814 W. Shady Grove Road
f Grand Prairie, Tx. 75050
I-. J CONTRACT DALE: May 15, 1980
You are directed to make the following changes in [his Conlract:
Interior 6 exterior metal; facia, window frames, door
frames and metal doors - one (1) coat of paint.
ADD THE SUM OF: $30182.00
40
AP ~
8 1961..
CI DENTON
PUR RASING DEPT
Not whd unlit sipi(,d fly herth the Mricr aid Architeo
Si;;nalurv of the Cnnlra(lur indiralrs his
at,rrcmcnl 1rrn,~till, including any ddjubimenl in the ('wilratl Sum or Cunua(I Tunc
the original (Contra(t Sun) XX%XX)Xx HAXXXk*AXXX9N was
Net (hange by I1r('601-10y authori/ed Change Orders .1: $ 799
. J 13.00
the rContrao Strrni llGl{w.~KIX)tOf)tixlfiplix M)4XaG dour to this Chan e $ 21 ,313.66
the onira(t Sum) fie order 1415 $ 821 ,604.66
)(X'11K')6Jf!(Jd)PIEX*EtxkKRKkI svlfi be (in(rcased) (didWfiGM,ifd►: OG)QKD(MkIldl)
by This Ch,ingi• Order '
the new (Contract Sum) ikkK~PRkKNKJ(JWIr)dMDfa>RYiIEZ including )his : hange order will be $ 82 ,186, 66
The Contract Time will beXkVK1 YJ0)X014IXK XX40 (unchanged) by Days,
The Vatf, of Substantial Comp[et[on as of the date of this Change Order therefore is '
f 1
Landr 6 Landry Contract builders Authorized:
ity of Denton
t BB
d r( T c 1"j9
Ad( es, i 2- a1 harGroveRoad ` E. McKinney
Adaresl
Address
taf +-T yZ1.~~-- n s 6261
BY
DATE ' ~2~F3pf.~'L=
rE Jun4,-D81 ATE
AIA VOCUMItNT 6101 • C11AN(4 okou: • APRIL 19,76 11)1110N • A10 • X,,,
lilt AMERICANINStiloTElifAR(Illlr(ls 1978 G70i --1978
aya`aACa~ fAroar
srti 4A►:,"rCIAL tASUAW POLICY CNA L. sows
tern DECWUTIOIIS owumm d voova o ar ter coway ots4mTED I Erow
N nap nww" Irr'so 0. W" 4941 to 00"M
N AnE R
1 ~pROC7uG1? R NO BRANCH 'FE r r POl IC -V
ccP 004 77 02 27 ❑ Continental Casualty Company
005033_. - an of Hartford
NWIO t"ISUREO G AOORESS: INumbel a Suee1, icon, County, Sute 5 tip Codel Natlonaf Piro Insurance Comp Y
1)=F NOEANi INC. MA 2)14= Z NJUDEPM American Casualty Company of Reading, Pa.
olvy= BUULM Q Transportation insurance Company
P.O. 8C>?C 101163
SUI IN1SS OF INSURED: El 011PAIiC.M Atexander 8 Alexander
PARTNERSHIP 10 CORPORATION of Tree, Inc.
INDIVIDUAL O inch FIcxx, 001 Csrran Torrey
[I JOINT VENTURE ❑ OTHER Dorian, Texas 75201
TeleCJwne 214 741.5'71
It et Am e11A0AnC TIME
POICr Period'. AT TIE A nfr pE TIE IN
To: c PO 1 aUREO AS Sr.~CO HEREIN
THIS DEC"T10NS PAGE IS ISMStR•EMD 14 COL ~ ALTTY NPOWiITH AND FORMS A PART Oi THE
9. pudic P-rW Annul unless otherwise stated. Qr ~Rif1f2~
e. The Insurance afforded Is o* with rsspect to the following Comage Part(s) In-keled specific pnmlllm char s .
ADVANCE COVERAGE PART(S) PADVANC S COVERAGE PART(S)
PREMIUMS
Comprehensive General Liability moan a S Completod Operations and Products tbbNity IMunna
Comprehensive Automobile UabnRy Inslxana i CompallomM Personal Inwnnce
.2
915.
41-
Attomoble Medial Payments insurance i Garage Monte
f Uninsured Motorfds Insurance = Owners' and Contraclon' Protective Liability, lnwrancs
Automobile Physical Damage Insursrta t Premises Medical Payments knsarana
{ Contractual UMUly, Insurance 9 U,* w* l Awlsts Insurance
1 Manufacturers' and Contractors' Uabill Insurana S fleak A:ro,rwbdl Litb1I&j Insurance
: Automobile Mid" Payments Insurance
= Uninsured Motorists insurance _
Form numbers of endorsements attached at Espana kc4udsON022AiG"5431%iG IIG390031G31670JQ390261
Total Adverse Prsmlltlt for tins policy.G39066AI((390201G39021AIG:;726CiGMIG53.91G9903051
- 1$i2L$14125d1L4114fSL.JL39Q?1~1
5. n Policy Peru more than one year: A9271Z10-69i=3-31fa31661.'. Net Premium
S Gross Premium i Discount S
Premium is payable'
On eRec,hrt date of Policy 1st Anniyerfay S 2nd AnNvenary
6. This declarations page is issued In cohlunction wRh and forms a part III an insurance policy whO Is completed with the addition 01 t~ S ra(e part(s)
indicated 1bow by an advance premium Is N any by addtwal declarations, schedule(a?, and endorssmarlt(s) Such 4vera0e Part(s), IqM any. Ideons
declerldons, schedule(s) and endorsement(s) disclose on hazards insured hereunder sown to exist it the eHectfre data bt this policy, 'Inless Etherwise
stated Mreiwo
7 During the past three rare no Insurer has angled insurance, issued to ihl named Insured, simnar to the 1111011/144 hereunder, Si axeotMrwtss It" Inereln!
'ANUKAO VAX tmy le[aa1 "ae oct"1011•', MEN 00. 1 set VKXARE ■ INSW rr.
CDC '
Countersigned by -
r A,tfMr@ed Agent
G 11995 s
Fa; attachment to Pocky NoOCIP004_ M .
14e !</tN "I evelsretteas all sclle/airt tehtrt Are Fe Comple%it Of Tk Cerefage Pad Iseeksted Of Ass N 14 Tba Annyrfate NA.
J COMPLETED OPERATIONS AND PRODUCTS LIABILITY INSURANCE p MANUFACTURERS' AND CONTRACTORS' LIABILITY IhSURAHCI
COMPREHENSIVE GENERAL LIABILITY INSURANCE ❑ OWNERS', LANIORIIIS' AND TENANTS' LIABILITY INSURANCI
CONTRACTUAL LIABILITY INSURANCE (010101led Controls Only)
ADDITIONAL DECLARATIONS .
Interest of named Insured in such premises {check below) location of all premises owned by, rented to or controlled by the named insured
Owner D General Lessee ❑ Tenant I I Other f (Enter "ume" a rime le(flos as sddfess shown In Item t of decunuont)
Pal occupied by named insured (enter)
SCHEDULE
Coverages LIMITS OF LIABILITY Coverages LIMITS OF LIABILITY
if combined umits App l row Uver,s es A a a
Each Occurrence Aggregate Each Occurrence Aggregate
'A-Bodily Injury Liability a e $ 300,000, 'A-Bodily Injury Liability
'B-Property Damage Liability :10000004, $1000000, and $ =
eB-Pro ert Dama ellabilit
'Coverages for Contractual liability are: Y = Bodily injury liability 2 = Property Damage Liability
RAT ADVANCE PREMIUMS
DESCRIPTION OF HAWDS CODE NO. PREMIUM BASES aoorsr ADPEArrx soollx rAO'arx
INJURY DAMAGE WAY DAMAGE
Prtmises--Operations-Esulatoft (Number at Premises) fc1 ! Area (sa, it der 100 wN, or Ana
{ rnntsle of Onor gtier VDO ey~}p.~.ae~n 7~~.re ~lumbu Inwree a Per andin
MX MUD= A2TA= 300, in,
Elaw FM PPMEW Mm 279,
♦NM-yDWNW F IFx 26• 24,
IeIQLTOfR EM 1Se R,
Ex= L' CM CEO ,
Independent Contractors Number tonSri {roes
CtT 8011AD SNIPS
16291 400 000e ,0423 .0707 1696 Ole
Designated Contracts ft) cost (ff er $too 0 Cost
(b) Number (n~ ~ f Contract
Completed Operations-Products 10) Receipts (d~ Par 11,000 of Itectipts
18 sails if Par I1,000 of sales
ISM 00 =4
.'!V•
7N 1 6980
>i2~1'.11- 114"bYl6f'm -460 -430
00x4" J" room 740, 657a
CNA
(Cvrrl
Far auethnNni to Policy Na =227
COVIRAGEPART
COL
COMPREHENSIVE GENERAL LIABILITY INSURANCE
1, COVERAGE A-BODILY INJURY LIABILITY $oot, lumes, acids, alkalis, toxic themials, trquids or gases,
COVERAGE B-PROPERTY DAMAGE LIABILITY waste materiafs or other irritants, contaminants a pollu
Cants into or uMSn land, the atmosphere or any vii
course or body of water; but his exclusion does not apply if
such discharge, d,tlrrsal, relesse or escape is sudden and
The company will pay on behalf of the insured all sums which accidental;
the insured shall become legally obliguted to pay es damages I) to bode injury nr
tx.r:wse of g not ii civil property damage due to war, whether or
will, rnsur rect,on,rebelhon of revolution
A, bodily injury or or 10 eny act OF cnnefrt,on incident to any of the foregoing,
B. properly damage with reslMCt to
to which Phis insurance a lies, caused (1) Gab,I,ly assumed by the insured under an incidental
1'n by an occurrence, and the contract o,
company shall have the right and duty to defend any fuit against
the Insured seeking damages on account of such bodily injury or
property damp even if any of the allegations of the suit are f21 expenses for first aid under the Supplementary Pay
groundless, false or fradulent, and may make such Investigation ^snts provision;
and settlement of eny claim or suit as it deems expedient, but (h) to bodil inur or
the company shall not be obligated to pay any claim or y j y Properly damage for which the insured
judgment or to defend any suit after the applicable limit of the or his indemnisee may be held liable
company's liability has been exhausted by payment of
judgments or settlements. (1) ma person or organisation engaged the business of
manufacturing, dna.titetinp, selling or serving alcoholic
Exclusions beverages, or
This insurance does not apply; 12) if not to engaged, as an owner or lessor of premises
used for such purposes,
tin) to liability assumed by the Insured under any contract or if such liability Is Imposed
agreement except an Incidental contract; but this exclusion
&w. not apply to a warranty of fitness or quality of the
named Instill products or a warranty that work per- fit by, or because of the vtolaaon of, eny statute,
formed by or on behalf of the named levered will be done ordinance or regueation pertaining to the sate, gift,
in a workmanlike manner; distribution or use of any alcoholic beverage, or
{b) to bodily injury or property damage arising 00 of the ties by reason of the sellin
ownership, maintenance, operation, use, loading or unload- alcoholic beverage g, serving or giving de any
Ing of
to s minor or to a person under tea
Influence of alcohol or which cousin or contribuns to
(1) any automobile or aircraft owned or operated by or the intoxication of any person;
rented or loaned to amy insured, or but part 10 Of this exclusion does not apply with respect t
12) any other automobile or siren; ft rated l liability of the in wod or his Indemnirea n an owner or
person in the course of his employment by any lessor described in 12) 12) above,
Insured; (U to any obligation for which the Insured or any carrier as his
but this exclusion does not apply to the insurer may be held liable under any workmen's Compares.
automobile on parking of an Ilion, unemployment compensation or disabili
premises owned by, rented to or controlled law, or under eny similar law; ty benefits
by the named Insured or the ways Immediately adjoinlry, it
such eatontoblle is not owned by or rented or loaned to 0) to bodeY inu to an •
any Insured; l rV Y mployu of the em arising out
of and In the course of his employment by the (round a to
Ic1 to bodily injury or property damage arising out of the any obligation of shot insured to indemnify another because
ownership, maintenance, operation, use, loading or unload- ~ofs din not a of apply arising
liabllout Hof such injury; but this exclusion
y sssurned by the (round under an
Ing of any mobile equipment ANio being used in any incidental contract;
prearranged or organized racing, speed or demolition contest or In any stunting activity or In prsctia or (k) to property, damage to
preparetia for any such contest or activity or (2) the
operation or ,'t• of any inn tinnoblie or trailer designed for
uses therewith; 111 property owned or occupied by or rented to the
insured,
Idl to bodily injury or property damage arising o A and in (21 property used by the Iruured, or
the course of the transporation of mobile equipment by an
automobile owned or operated by or rented or loaned to 13}
any insured; property in the care, Custody or Control of the Insured
or as to which the Inured Is for ar; purpose
le) to isodpy Injury or property damage arising out of the exercising physical control;
ownership, maintenance, operation, use, lading or unload.
ing of but parts 12) and 131 of this exclusion do not apply with
respect to liability under a writtra sidetrack agreement and
if► any wateruaft owned or operated by or noted or pare (3) of this exclusion does not apply with resp•cs to
lamed to any Irow
red, ne or property dam lp (other than to otevaton) arising out of the
use of an ol•tras,%r at prem(tes owned by, rented to or
(2) any other watucraft operated by any person In the controlled by the rwnwd Insured;
course of his employment by any Ins ; 11) to prouppeerty, dsmags to
tnsured selsin Premises alienated r ny p the named
but this exclusion dace not apply to watercraft while ashore g out or suds premiss or any part rt (hereof;
on premises owned by, rented to or controlled by this (ml to loss of use of tan ble
flamed Insured; phys?allY In d property which has not been
JurW or destroyed resulting from
III to bodily Injury or property damage arising out of the discharge. dispereal, foliate Or escape of smoke, .pore. (11 theItestsayisold insu ed of myfconi
acct or agreement, r of
0.39001A DWa 02 CNA
It1 the failure of the named 1nsuNd si products or work ill bodily Injury to My fellow emoloyfe of Such person
performed by or on behalf of the named inwrad to injured in the tour of his amployment,or
meet the level of performance, gtrshry, fitness or
durability warranted or represented by the named III Property damage to Property owned by, rented to, in
insured, char of of T Occupied by the reseed insured or the
1wf this exclusion does not apply to-tat of use of other emdoyer at any person described in subparagraph 11,1.
fengible Property relutting from the sudden and accidental
PtiVorat injury to or destruction of the named insured's This insurance does not apply to bodily Injury or pro y
products or work performed by or on behalf of the named dame ansm Pertinsured after such products or work have been put to use vrnw" out of the condpar of
any partnership or joint
r of whi ch t he intwed is a partner or member and vh,ch Is
by any person of organitat+on other than an insured, not des signated in this PchcY as a named insured.
(n) to property damage to the nort»d Insvred's products arising Ill, LIMITS OF LIABILICY
out of such products or any part of such products;
(o) In Property damage to work Per formed by or on tw hall of Regardless of the number of (t) insureds under this policy, 171
she nomad insured arising out of the ivory or an fx'rsons or wpanirations who retain bodily injury or Property
any portion damage, or 13) cralmx made or suits brought on account of
thereof, or out or materials, parts or equipment furnished bodily inJutY of in connection therewith; limited as follows praMrty damage, the company's liability
Is
(P) to damages claimed for the withdrawal, inspection, repair, Coverage A-The total liability of the compare for all
seDeaument, or pas of sus of the Mined insurerl's products damages, including dam y
or work completed by or for the named Insure I or of any of bodily Injury swtala~bfooneroramoresr set as t !rcauw
property of which such products or work Fars a Part If y persons o date result
such products, work or of any one occurrence shad not exceed the limit bodily Injury
properfY are oon or from the liability stated in she schedule as applicable ble to "tact
merktt or from use beuwe of any known or ewpeeted euurente"
defector des iNency therein;
Iql to property damps Included wtthin: Subject to the shove provision respecting "each occurrence"
the total fiabilit',f Of the company for cil damages betatre c4 Ill
111 the explosion hard in connect on w th operations all bodily injury Included within the completad apratione
Identified in this policy by a classification code hazard and 171 All bodily Injury included within the products
number which includes the symbol "x; hazard shall not exceed "aggregate". e limit of bodily Injury ury liability shred
to the schedule as apgre"te".
(7) the Collapse hazard in Connection with operations Coverage 8-Thr.. total liability of the
Identified In this policy by a (Aassifiatlon cods be s
or damage s
wMcompany for
number which Includes the symbol "c", or because because ofganizat oall rganizations s off 1tyM result damageoirwed by on* or more parsons ;
of any one txewnnoe shall not
13) the under ound exceed the Itm,t of property damage liability stated In the
err property damage hawed in ton- schedule AS epp,iuble to ".Kh occurrence".
nection with operations Identified In this policy by a
Classification code number w 4ch Includes the symbol Sub)ett t:r the above p'Ovlsion respecting "tact occurrence"
u the toad liability Of the Company for all darnages because of all
11, PERSONS INSURED property damage to which aIS coverage applies and desulbed In
any of the numbered lubpoelgraphe below Shell no: exceed the
Each of the following Is on insured larder this insurance to the limit of Property damage liability stated in the schedule as
extent eat forth below: "aggregate"Is) If the reseed Insured 4 designated in the declarations as an 11) 311 Property damage arising out of premise or opera.
Indrvidnl, the person w designated but only with respect astops damage rood aon of
t a a receipts remuneration basbassss contractor`s
to the conduct of a businat of which he is the sole any y for rot for , including prop.
proprletor, and the spouse of the tamed insured with Incidental c which ing to I$ assumed under any
respect to the Conduct of such a business; es, but contract rktluding p pro t0 such premises u opera.
lions, but damage included In
IN if the Messed imtvad Is designated In the declarations n a subparagraph 17) below;
partnership or joint venture, the pannarotJp of joint 12) dl WOPenydame
venture so designated and any partner or member thereof course of " witting out f and emelng in the
but only with ronflaci to his usbllity as such; by operations independent contractors performed for the named Irnaattas and "nerd supervision ured
ision
{c) If the named Insured It designated in the declarations as thereof by the nursed insured, includlo;f any such
other than an l~vidual, partnership or joint venture, the Property damage for whist liability IS aesumeC under
pa confect relating of such Opproperty
organization so designated and any executive officer, but any t this as Incidental
director or stockholder thereof while acting within the damage rising gr out 171 des not include property
scope of his duties as such; premise arising
the Aor repair at
Owned isingnsd by out or of rented d to the A of
arned Insured or
(d) fey Prison Pottier than an employee of the named Insured) structural alterations ar such premises which do not
or organisation while acting as real estate manager for the otthhvolvo er structures; changing the site of or moving buildings or
nerved insured; and other
W w th respect to the Operation. for the r,r 13) all property dams" included witnin the products
p faca of loco. hazard and an property dame" Included within the
motion upon a puotlc highway. Of mobile ape, ipment
registered under any motor vehicle registration law, oompieted operations heserd.
Suc
h &W"sle limit shell apply saperstallif so the property
Iii an ampfoyee of the named insured white operating any
such squipment in the course of his employment, and urn sa described in subpar 1, Sea roul121 131 y , ly and ese to and
ubpar►grapfxe 111 and~7) Sep a respect tt to each
00 any other project away front trerttisn owMd by or rented to mM owned
person while operating with the permissiirs maned,
of the named Insured env such aqulpment registered In
the name of the oasrwd Insured and any person or CoverpesAwid 1111-For the purpose of determining the limit of
organization legally responsible for Such operation, the company's liaNfity, all bodily Injury and property dam
bur only if there Is no other valid and colisetfble arising out of continuous er repeated errposure to wbstantiN
ksiwone* available, either one primary of axass basis, the Sane "nerd conditions shall be Considered ad wising out of
to such person or organization; one oast"once.
ovld~dthat WW*Ph ros or pnleation shall be on Insured IV. POLICY TERRITORY
under raapact to:
This Insurance applies only to bodily Injury or property
dams" which occurs within the policy territory.
y ^.~.:yr t
For of achmerd to Pa1rcy Ro. _0:i! M7D227 ___y,_
MISCELLANEOUS LIABILITY EXTENSION
Si AND ADDITIONAL DECURAtIONS
The Additional Dedarations and Schedule blow Are an Extension of those Issued in Connection With the Coverall Port Indicated Sy An Q In The Appropriste Bo><.
❑ COMPLETED OPERATICHS AND PRODUCTS LIABILITY INSURANCE ❑ MANUFACTURERS' AND CONTRACTORS' LIABILiIY INSURANCE
COMPREHENSIVE GENERAL LIABILITY INSURANCE ❑ OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE
CONTRACTUAL LIABILITY INSURANCE (Designated Contracts Only) ❑
DESCRI11`lION OF VAIARDS land localm if different Code Premium Bases RATEIZ ADVANCE PREMIUMS
from addnlt shown in Item 1 of dKisfations) No. As defined in BODILY PROPERTY BODILY PROPERTY
the Schedule INJURY DAMAGE INJURY DAMAGE
Pmd>pV mis, l1AICII SE)Ti'w Up
OR S7J= WIN >c1 fto 6CUKEWS
FALOMM OR OONM IDIO'R1HIT>Cltla
MAPAM 17745 0)390000. 1.723 .602 672. 235.
CATTt"8M IN S M CANS'rtlIICTIOlT CV
Dk?j9U XiM NOT ]m inS
90= al =w w C~CI~ IMMM PKVAM
15145 0)3400004 .732 4414 256. 1419
Emwasm AIMMMM muOt7Gti
ND Off!' 8
15192 0?22,653. 16042 AN 239,
944
~ 8'1oom
Olt MhTj$= 42264 C) 51000. 1693 .263 3S* 13,
E1EP08T! 1'0 Z~:
GIRAUM Cr 14PM 0731 III' ALL? 1931 1442
N IC
CC VMLV= ON OR UO FAMILY
MUM 15163 20665,000. 1414 .279 1,103. 744.
GAL QlXMWTIlIG VJUD c;
JBIJ - 0IIT PRIMAINUMMID)
15164 IF An .524 0341
RAM 1-e+' 2 S,tto1,I IN= mme
G 31810 B
j'CNAlins mace
For ettachmenl to Policy No.. amo4Y102YL_._..
MISCELLANEOUS `LIABILI>Y EXTENSION
SCHEDULE AND AODIIIORA. UECIAf AMNS
TM Additional Oedarations and Schedule tletow Are an Eatansbn of Those Issued in Conneclior With The Coverap Port Indicated Illy An Q In The Appropriate Boa.
❑ COMPLETEO OPERATIONS AND PRODUCTS LIABILITY INSURANCE ❑ MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE
COMPREHENSIVE GENERAL LIABILITY INSURANCE ❑ OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE
CONTRACTUAL LIABILITY INSURANCE (Designated Contracts Only) ❑
Premium Bases RATES ADVANCE PREMIUMS
DESCRIPTION OF WARDS (and louhois d different code As defined in BOXY PROPERTY BDDtLY PROPERTY
from address shown in Iten t of decmalions) Ne. the Schedule INJURY DAMAGE INJURY DAMAGE
OR Im OMVTAX:1IM OR
e >p vm OR Rmvm
X71= OR am at
OR MY X=VATMar PZLLM OR
01100=0 BEtYDfeB OR CU1111m
V=nvo 16111 IF ALLY .745 041%3
_.r.......
1,103. 744.
>MOINTiLLY AT= 276. M
s,reletel l
"°'OB ~'CAAlinsurance
gt`1fllii~I lrUT
►E1tSONAI INIUAY 10111.ITY INSURANCE ►lt
SCNEO111I
The inlurance alforded 'r. only with respect fo 110111081 Injury er*mIl out of an offense included within such of the following groups of offenses as ere rr+da
cites by speck premium charge or charges.
Ceverago LIMITS OF LIABILITY
AGGREGATE
Personal Injury Liability Insurance P-personal Irjry g 300a0 0
•
nwre s utrupa an
%
Gimps of Ofltasts ~i lvnco Premiums
Gar
k False Arrest, Oelerlion or I isanment, or Malicious Prosetulron 1 •
B. Libel, Vvinki, fk4mation or Violation of Right of Privacy
C. Wro furl Entry or Eviction of Other Invasion of Right of private Occupancy
Ads of Promises Operations bedlty lejary premium Miaheam Pzaaiam I Advance Areruluru 180
Additional premium charge `•rr~ esclusion kl $
MCL
L 1d - 041 Ad a Premium lYiy~
t e VEAAIII 1-PI1S0NAI INIUAY LIAinITT it) to /srso"ll iw}ury erisrnl out of a publxtlion or utterance described in
Croup a concorritig; Any organization or business enterprise, or its products
The company will pay on behalf of the World all sums which the With of servkes, made try or al the direction of ecy hear id vkh knowledge of
shall become legally obfrgded to pay of ilamsi because of Injury, tAeaein the lelsily tMrtol.
called "lenoal Iajw l sustained by any person or of anudion and arising
but of ON of more of the following olfenses Committed to tht'c0nduct of the 11. /EASONS INSURER
Moog flows business' Tech 01 the following is an leewel under this insurance to the eelent set forth
Coup A-•falsr artist, detention or imprisoomenl, w malicious prosecution; below:
Group 11-the pubjcafipn Of utleunct of at libel or Ilan lee or of other defsma- tat N the manned Insured is designated in the d4cluati0as as an :n6vidwt, the
Cory or drsparaArng mater al, or a publication OF utterance in violation person to designated and his spouse;
of an individual's right of pnvacf; etcepl publicationt at atlffances lbl if the rimed towel is dailnalee in the declaratonS as a partnership of
in the course of of related le adverlisiol. broadcasting or telecasting joint venturt, fie putnashrp or joint venture so designated and any primer
u14v,Ues conducted by OF on behalf of the Marnel Issorel; of member thereof but only with respect to his liability as such,
Group C-wrongful entry or eviction, or other invasion 01 the fight of privalt kl if the earned losurel is detilinited to the declarations as other than M 04-
amid any
occupancy, ndual, partnership or torts veniwe. the pflanizolron while to sclding within esilneled a the scope
if stcA offense is cmnm 1!ed during the pocky ppeeriod within the United Stilts of of ahis eculrdvt duties as chat. dsuch.irector or slockholdet lhertoT
America, nit ternlarret or possessions, or Coma As, and the company shall hart the
fight and duty to Vorid any suit against the loawed seeking damages so account fhig insurance duet not apply to prgAal injury arising put of The conduct of
of such pereePAI to ory even At any of the allegations of the suit are lr0undless, any 0s,nurarK or test tMwe of which the Inured is a primer member and
41st or Iraudulo* and may make such irtvssfigation and settlement o any claim which is not designated in Ihrs policy as a oarnel insured.
or suit is it deems ettledient. Iwt the comos,y Poll not bit oblrlated to pay any
clam or tud sent or to defend any will erter the applicable limit of the Company t Int. LIMITS or LIABILITY; IIISOAEO'i FAATICIPATION
liability Mom sshausted by payment of judgments or settlements Aogodless of thl nurribtr of 111 insurfds ardff this policy, (2) persons at
organirallons who sustain personal injury, of L31 claims made of suits brought
an account of personal injury, the total limit Of Me company's liability render
Ealefleoa the covefage for all damages 0811 mot lotted the limit of pectoral injury
This insurance does not apply liability stated In the schedule as "aglreltle."
fat to liability assumed by the lateral under bey contract of agfeemtnt; N a participai on percentage is stated in The schedule for The loitered, the
company Mali not be liable for a Breda proportion of any loss than the difference the its to per"Pal Mjory arising out of the wilful violation oI a penal
s4"We Of bolotbe bane perce le end one h ~ f cnomptmt of pthe ay balinen f f pontoon
ard+nance committed by or with tM knowledge of consent 01 try leaarslr oshall f a lots to effect stlllemen+o! The loss, and, upon rotifcalton of the action laken,
lei to personal 1*01 sustained by any Pelson as a result of on Offtnst directly the aHl Insured Pon prprnplly stimbursf the company tortfor.
of indirocity frl.ted to the employment of Such person by the arned Mwnl; IV AMENOIR B#IAg101F
fdi to pit Nil lejary orlslnl out of any publitNien r utterance described to When used In relefence to Isis insurance
Oroup , it the first In unsure publication Of vttrente 01 the we of trmr:af t
mdtrial by a on bet+A~f of the amen lesartl war made prat to the effective Injury j oultolAan oRensedle wFrch this hi nfwMpncyn~ippes because of PentnM
dull of this rnsufancr,
MON*WW Allow
C•39Oi8A OVA
This endorsement modifies such insurance as is afforded by the pmvtW,jns of the policy
relating to the following:
COMPREHENSIVE GENERAL LIABILITY INSURANCE
CONTRACTURAL LIABILITY INSURANCE
BROAD FORM PROPERTY DAMAGE ENDORSEMENT
(Including Completed Operations)
It Is agreed that the insuranro for property damage liabilit) applies, su~)lect to the following additional provisions:
A. the exclusions relating 1u property damage to (1) property owned, occupied or used by or rented to the Insured or In the tare,
custody or tontro' of the, Insured or as to which the insured Is for any purpose exercising physical control and (2) work performed
by or on behalf of the named Insured arising out of the work or any portion thereof, or out of materials, parts or equipment
furnished In conrectioi therewith, are replaced by the following exclusions (y) and (z):
(y) to property dem.ge
(1) ey the lass ea for sale or entrrustedrto rented to the insred, or, the Insured for siorage excet with pact to the use of elevators, to property held
(2) exc!pt with respect to liability under a written sidetrack agreement or the use of elevators to
(a) property hi behalf premises the owned by or rented to the insured for the purpuse of having operations performed on such
property by or on Insured,
(b) tools or equipment while being used by the insured In perform'ng his operations,
(c) property In the custody of the Insured which is to be Installed, erected or used In c-)nstruction by the Insured,
(d) that particular part of any property, not on premises owned by or rented to the Insured,
(i) upon which operatlons are being performed by or on behalf of the Insured at the time of the property damage arising
out of such operations, or
(il) out of which any property damage arises, or
(III) the restoration, repair or replacement of which has been made or Is necessary by reason of faulty workmanship
thereon by or on behalf of the Insured;
(r) .~PIth respect to the completed operations hazard and with respect to any classification stated below as "Including ComnIetsd
operations", to property damage to work performed by the named insured arising out of the work or any portion thereof, or
out of materiels, parts or eau pment furnished In connection therewith.
B. The Insurance afforded by this endorsement shall be excess insurance over any valid and collectible property Insurance ((including
any deductible portion tf iii available to the Insured, such as but not limited to Fire and Extended Coverage, Buildses Risk
Coverage or Installation Risk Coverage, and the "Other Insurance" Condition Is emended accordingly.
Classification:
Supplementary Schedule
Premlum Included in q&gfage Part Schedule
Basis of Premium 3077 s Rate Additional Advance Premium i
Coverage Part Premises Operations, 2 "91
Elevator Independent Contractors, and Completed Operations ~ If s
Property Damage Premium DKU ,
Minimum Premium for this endorsement S >~a This endorsement, which forms a part of and is for attachment to the following described policy issued by the company
designated
therein, takes effect on the effective dote of said policy, unless another effettive date It shown below, at the hour stated In sold policy
and expires concurrently with said policy.
Complete Only When T rift Rrd.roomenf to Not Pre1 ,cared with the policy ~
Must Be Completed Or to Not to be Slrrtive with Ihf Poi(ey j
ENDT.NO. ►OIICV NO. IssU D 0 ((ff[ itY[ AA
rHla [NDORSE EHT
s tx,~oar~om
111111111144ALN" pow
C'NA
Broad Form Property Damage Endorsement Cuunterslgned by-
Includinj Completed 0>siations) Authl)Head AgerA
b 3~
71 1
r
nawls~oorr (0) D= WT AMPLY MM tMSPcr W D=T s)r,M apt PSCMW
am= Ansim ol!` (r = walmmat OPmw=N OR M nxx,o M
Lof)DItJ(i OR UN=Ws Cr ANY WL T cNIM PIM Mr ILI W1t MI
Piiav= s= jrm=w zo Hoer am SY 'ice nc= on in im o m
t= To CAM PEMIS OR RWFIt1'Y MR A Ctgt=o
BS PD
26s 24, 3NMe
7hli endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effecw
tivd date Is shown below.
It~td Complete ORty When t~llo NS&rsentnt l og rrpwe wriih Polky
Must Be Comp )e Ne! to be N/eetlse th ! t Peliey
p 1
CND I. #40.- - LMOO ZPOLIC I{fV D10 11{EM
Colh{t!signed by . ...u.(
AvOorit{d RwOMnutiw
G-39543•A
t
1
Tir IS UHDMW p AND GM= THAT E=AS Mi 9 DOES Wr AMN M LIAaII.I'f!
AFt1Sim Ism Tiff sERvw4 OP Pica 0t.~C mvm= m s ON OHM OR
IOM P FM OjSn*SS PF420 I FUMSES of 7M VM OP TOWS
DZ PD
pyalimt6s ISO 50
INCUMM
This endorstment Is a part of your policy and takes effect on the effective date of your policy, unless another effec-
tive date is sl Iown below.
At la! Be Corn leted comp lets onry w el~tl, a Endofj~Iment !r of preeppaare with e o iey
[Noll P Or !e Not to be site Iive lh the P01ky E y~ ` p
NO. POLICY 00. IteU[ 15
TM~` NDOR~~MLN
7 CQP00 M227
CountorsIgned by /~s7 /7 ~~t. cr 1tJ
Authorised Rwountaths
0.39543•A
~.ih r N v ~ r , M -+r..w~«. r -~^t a .'~'q+. wy~• r-..`y • ~
1T IS p4mD ma •dic LOi= IIy]m L3}Q'!'S cr Lt11Fi7L1'17f
MALL Lift SW a 000. vim M WTI =/5W a 000. PMf AQ S
AS »fm'S PM 'YlIE C1TY CIR DMQf .7t1B CIW*
This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effec-
tive date Is shown below.
Mret ad completed Complete Only When 64 Bndorltment to N-1 Prepared with the POILV
Or Is of to be Rjett{rot with the Polity
ENCT. W. POLICY o. "FIRSU19 o T[
UEM t MEMT
9 OVM77=
v)i
CouMenigned by~~r1
Authorind AWesenwWo
CM543-A
y ^ i ry V M?; i r a r .rl y J y;
~ . i ter.
For' attachment to Nky dro_lom"
TMs lijldade Velow is tot Completion Of Yke tonetaftK Ctxerags latrL ~f
COIITRACTUAL LIAIKITY ]WRANCE
(Ebnket sr Desljwtld Cetrbeid
SCHEeII[
Coverages UMITS Of LIABILITY
EACH OCCURRENCE AGGREGATE
Contractual liability Insurance Y-Bodily Injury Liability $ 300 000 XXXX01
a
1-Property Damage liabi;4) $ 100,0009 r 10000000
I. Nsignated types of written contracts:
lnsufinto is pfovlded for contractual liability arising out of all wtitlen contracts unless limited by the incluslon of an X below:
Insurance is limited to:
n Contracts executed during the policy period.
within 30 days following contract execution, or; it executed prior to the effective
t.] d Braof this cts writenno6cen 30 days is In following ppossessi policy of t effective date,
The contract doled between
and -
pertaining to_
❑ Contracts of the following type:
2. When on X Is entered in a box below, the exclusion identified by that letter does not apply. Absence of in X In a L7 means the axdusma opplies.
f~1 X ~ X
W ill ln} t21 Inl Isl !2X t
Code Premium Buses RATES ADVAKE PREMIUMS
D[SCAtlTI411 or NAIAIirS No. tenor ILLY Or t ra~uuIL, e t
e) crpoon er t~ Ni ii oft Cos
fates ttll For el a Lies
AtS7c&-~
FM OINEPilGB 16281 q} 500,000. 0331 0169 1660 850,
As dosignatad in I above m mu DFPO81e!' 42• 210
a
tt Y) lu ••2 ~1
When used as a premium basis:
10 "east" means the total coil of all wort in connection with all contracts DI the type dosltnoted la the schedule for this hmrsna with recpect to
which "sssl" Is the boils of premium, regardless of whether any liability is assumed under such contracts by the Iaxared. N Inctudet the wit of
all labor, rMtodals and equipment furnished, used a delivered for use In the execution of wch work, coauthor furnished by the Nsered, or others
Including all fees, ollowlnces, Dowsmes. osrr commissions merle, Nid of due. t ~f~d
nstallation i rrvvicing o repair,e~iaceludeiuiee, Aber thin taxis whla
lfl " ributed duri gtthilrpolky flartodoind clarlg drdur° jythf V~oSicy period " I by
r.Ae isamod baling and tech others coiled it a separatellem end remit directly to a gowsmental didslon
atno~aA
OVA
for
attocti to Polky No`W '
the 1111#01110 Behr Is Fu Completion Of The Fenowfnt Wweroa(o rut; k~
CONTRACTUAL MOILITr INSUItML
(Blanket or Deslteate0 Comets)
SCREDUH
i
Coverages LIMITS OF LIABILITY
Contactual Liability Insurance EACH OCCURRENCE AGGREGATE
Y-Bodily Injury Liability $ 300,000,
XX10UlX
Z---Property Damage ifab,lily $ 100,000. S 10000004
1. Desl`nated types of written contracts:
Insurance is provided for ceotractual liability arising out of all written contracts unless limited by the inclusion of in X below:
Insurance Is limited to:
Q Contracts txecuted during the policy period.
O dater of this written notice 30 which is In possession of the company within 30 days following contract execution, or, if executed prior to the effective
policy, days following the policy effective date.
t] ;he contract dafed IUtween
and
pert+ining to
❑ Contnels of the following lypc.
2. When on X li entered In a boa below, the exclusion Identified by that letter dons not apply. Absence of to X M a O impart the exclusion spplit&
W !11 fn! 121 Ins (31 !Ol X ipl !411 X ~ X
CESCIUPTIDN DF NAIAIIDS dodo Premium Bases RATES ADVANCE PREMIUMS
No. mwo~i~tLY rRao EA 1019! o t i
e Number
er Contntt
n a; jar
tes ; saoo of cos
1 or $1000 of na
cat31i3L) V- M RIfi~-
FM OClS►F: 16281 9)500,000o e0331 .0169 1660 85.
As designated In 1 above
t~tlfII.Y Oit3F06IT , : • 21. ~
i
r i
va miua~ •2 •1
T8 40a e 1
UYlmen used as a premium basis,
f11 "cost" mans the total cost of all work In connection with all contracts of the type deslthaled In the schedule for this Insurance with respect to
which "tat" Is the basis of prefitum, regardless of whether any BaWly Is assumed under such contracts by the Imad. R Includes the cost of t
all labor, materials and equipment furnished, used b! delivered for use In the exewflon of such work, whether furnished by the imnertl, or olhere
Including all fats, allowance{, omits w commisslons made, paid or due.
ID "ssfes" means the post amount of money charted by the used lasored or byy others trading under his nama for all goods and rodods sold or dis,
tributed during thb policy erlod and charged during the poky period for Irstaliat on, servicing or repalr, and Includes faxes, other than Lases which j
the assail laturad end wcR others collect as a separate Rem and remit directly to a governmental division.
frI1o14A
CNIT POM
A , a
X.
r
71
77
r.
Fa s+tachnent to Policy No. ~`ay`s'
CONTRACTUAL LIABILITY INSURANCE
Bu
COVFRA41E PART (Blanket or Designated Coverage)
I. COV(IiAGE V - CONTRACTUAL BODILY INJURY LIABILITY (ht 10 IOU of lrW d t"*]lot property which lief not berm ph YS,caOy ,M
COVERAGE Z - CONTRACTUAL PROPERTY DAMAGE LIABILITY lurrd or desttoved res,dnnq from
11; a delay in at tack of performance by or on beliefs of the named
The tgmpony will pav on behalf o1 the insured all sums which 114 insured, insured of any contact or ag rement, or
by IeaNUn of Contractual liability assumed by hum under any written ton. (2) the failure of 14 Mmad insured's produces of work perfolrted
tract drlrgnated in the schedule for the snsurance, shall become legally by or on behalf of the named insured no meet Ina level of per-
obirgalerl to pay as damages because of lormanae, qualify, lrtneu or do.ifi y warranted or tepmtsented
Y. bodily injury
7. prop+Y darns" by the named inwred;
s
to whnh this insurance applies, caused by an OtCUrnna, and the company bit this exdus+on does not apply to loss of use of other targble
shall have the eight and duty to defend any suit against the insured sessionqq properly rewiting from the sudden and accidental physical injury to
damages film account of such bodily injury or property damage, even if any of or dralruction of the named insured's products or work performed
the allagdl,ons of the wit are groundless, raise or fradulent, and may make by or on behalf of trot named insured oiler such products or work
such fnvesfgation and settlement of any clam Of wit as 11 deems espd,ent, have been tut to use by any person at orgarnrat,on other than e'1
bu, the Coitipany shall not be obligated to pay any claim or judgement or to insured;
delerr) lit to property damage to the named inwrd'a products rnrnq a t of
Astron it I11 any winsuie Arght nt wherein the company not entitled to exam. such products or any part of such produtts;
cis: the iwdd's rights m the choice ofartrirata s and in the conduct of
arhPmroceedrngs,om ill to properly damape to work performed by or on behalf of the
named insured a+isrng out of the work or any portion thereol, ,r art
jud hmi+ on the campany`e Uabrfity has been ax• of materials, parts or equipment furn,~.a.i in connection therew,tn;
l21 any d1 alto the applicable
r'+nl of udgments of fettlemerls
MYfleled by D+Yr
Ise) to damages claimed fa the v;ishdrawal, inspection, repair, reptacn•
Eaclullons ITM exclusions apply unless stated In the schedule to be not ape ment, or loss of caw of the rumd Insured's products or work corr.
pficsr pitted by or for the named Insured or of any property of which wrh
products or work form a part, if such products, work or property
This insutance dots not IpplY: are withdrawn from the market at Irom ute because of any known or
suspecteddefecl or deficiency therein;
damage architect, engineer or surveyor,
sal it the umpired of his indemniua is
to bodily injury or property damage rising out of the rendering of U) to bodily injury Or property damps arising out of the ownership,
the failure to tender professional services by such insurdor in. p intena t e, opei eratio used Inloading orr+ngd or aof Hired imob 1, facing
(11 dommullt. including speed or demolition contest or in any stunting sctivity or In practice
[t! su ovs. delbn signs or approve) of mad plans, opin one reports, or preparation for any such .contest or activity;
de or sp ecifitalions and
wMYS
(ml to bodily injury or proper+y damage Nosing out of IM discharge, ills.
121 wgserviwry, inspect on a tngineerjrq services; penal, retake Of esupf of smoke, vepots, soot, limes, suds. elkahs.
Ibl to bodily injury, a property drags five to war, whether or not de• toxic chemicals, liquids Or gases, waste materials or other Irtitamtt,
eland, entil war, insurrection, rebellion or ravoluton or to Any eel contaminants of pollutants into or upon land, the atmosphere or amy
or condition Incident to any of the foregoing: water course of body of walrr; but this exclu+,om does mot apply if
such discharge, disperut, release of escape is sudden and IccidentN;
Ic! so boldly kljwy or property damps for which o.M indernnita may Ina toproperty damage included within ill the explosion hared, 121 she
be able 1 held 1r ems eorlapec Maard, or 121 the underground property damns" haerd.
111 as person , agarstenon engaged n the business v O mansion. Y at property ddamage If isin out of the eomserueton,
luri ng, didistributing. i butinq, selling or serving alconolk Dfveflgesork Of 101 l ow~ihip maintenance, repair opporsuon, use, loading or unloading
121 if not sa unpaged, as an owner or Nara of premises used for such of any wanrcraft, if the taod.1y injury or property damage ccavts
purposes, awry Irom premim owned by, rented to or controlled by any Insured;
it such liability it imposed fro to bodily Injury of property dame" arising our of construction
(i) by, Or because of the violation of, any statute, ordinance or oparati-ans performed by of on behalf of the Insured or his indemni•
regulation peru ning to she sale, gift, distribution or use of Ies within 60 fate of any railroad right of way;
any alcoholic beverage at tell to bodily Injury Or Property damage included within the completed
(ii) by reason of ohs felling, serving or giving of any atoolsolit operations heard or the products hazard;
beverage to a minor of to • person under the influenv of Irl to liability assumed by the insured under
alcohol a which tauses or contributes Io the inloxicalion 111 any Incidental contract or
of Inv person:
but port (it) 01 this exclution does not apply yloilh respect to liability 121 any usher contractor agreement insured elsewhere in this policy;
of the Indersol as in owner or lessor described in 121 above; of which would have been insured tMmturider but for the Ix-
fd) to any oblgation for which the inwred w any carrier as hit insurer Mustion of the limit of liability applicable thereto;
may to held liable under any workmen's compensation, unemploy. II) to bodily Injury or property damage rising out of the ownerthtp,
memo. tompenution or disability benefits Irv, of under any similar maveaenance, operation. use, loading of unloading of any aircraft by
4w; of on behalf of any insured;
le) 10 any obligation for which the Wand miry be held liable in art se. (I) lobodify injury, or properly damage arising out of the sole negligence
lion on a contract by i third party beneficiary lot bodily Injisry or of the under miles.
property idempe aripng out of a project fa I public authority;awl
this ardusion does not apply to an action by the public authority or
any other person or organization engaged in the project; Ili PERSONS INSURED
111 so popelty damage to Each of the following is an Insured under this insurance to the exlenl cal
11) property owned at occuped by of rented to the Inwrad, to. th below:
171 ptOperl i used by the Insured, or (a) If the fumed Initiated Is desIreted in the deelatelroed as an indirdu-
131 property in the care, custody at control of the mill Insured or onto of, the person so designated and his spouse;
which the Insured ottor er any any purpose Ixerctsinq pkyll hyucat control; Ibl it the nand 4rure/ is designated In the declarations n a pautner•
wising ship a joint vartture, the partnMhip ter joint wbntvre pdesigPetd
1gl p out of such ps Dramwisis of an of #my part thereof; eby she named Insured and any partner a member 1Mrsol but only with ragttct to hit
out liability as such
two afteraurcir rem
G-3g071•A CNA
r M
-7 77
' t
A tM nMmad insured s designated In the declarations as other than Coverages Y and Z- For the purpose of determining the limit of the
lit am Indwyual, partnership or joint venture, the organization to dosiq company s 1la llitV, N I bodily Injury and property denser wising out of
noted end any executive officer, director or stockholder thereof c0 ti^*~ Of rePlIta ~e Nposur out substanttawrence. ~ Nen«N condi•
while acting whhA IN eccipe of his duties as such. tion This tneurance does not apply to bodily injury or property damage IV.POLICY TERRITORY
orising qul of the conduct of any partra sh1p, corporation of joint venture
of which the Iruuftd Is a member, partner or subsidiary and which is not This Insurance applies only to bodily Injury or property damage which
designaled in this polity as a named Insured. occurs within the policy territory.
III.LIMMOP L1AS1LtTV V. ADDITIONAL DEFINITIONS
Regordiea of the number of (1) insureds under this policy, 17) persons of Whom used In reference to this Insurance (including erdorsemenis forming
organhetions who sustain bodily Injury or property damage, of 131 claims a part of the policyl:
made or suits brought on account of bodily Injury or properly damage, the "contractual liability" mans liWtiiy expressly assumed under a syrHton
Company's liability it limited is follows: contract or sgrotment; provided, however, that contractual liability shelf
hwurb it prd~y ender a w irant , of ttewak per.
°,cisrage Y - The total liability of the company for ell darnagewieN 4 q quality concha rued " includi
orial c oacubodily Y
by am at Ion care and sou s, because
by one at more persons as e result lt of of any one nonee ah le, i not exceed famed by or on beMl! of the named Insured will be done in a won rwn•
the limit Of bodily Injury liability stated in the schedule as appliabie to like manner;
''nchoecurtenet". "construction optratloFlf" Includes construction, reconstruction, installa•
t,ovnage 2 - The sotal liability at the company for all damages because tion, fabrication, c ion, demolition. &Iteratio alp i~~ w~fxof struc
the e of of all propurty damage sustained by one at more persons or organiratioso ground, eai~ ipmoni at
tunnelling, r ixowing,,axa melon, Idling and back filling,
the Mule of any one ooeurrenq shall not exceed the limit of props Y dsr
age liability stated in the schedule asappliable to "each o"urronce' . "euls" includes an arbitration proceeding to which the Insured is required
gubjecl to the above provision respecting "each oocurronce", the total to submit or to which the hrwred has submitted with the company's tors,
stability of the company for all damages because of all property dot-no" to sent.
which this coverage applies shall not exceed the limit cf property damage VLADDITIONALCW401YIDY
liability noted in the schedule as "Mragats". Such adgre"la limit of liability
applies separately with respect to tech project away from promises owned by Arbitrations null be entitled to exene se all of the Insured s rights in the
or rented to the named Insured. The choice of arbitrators And in the conduct of env arbitration proceeding.
tt k"Ta ~a t. w',_; ".r
r
. 1111.... ' . , ; •
(rrrplrtrr fi
im Fl T rFw r,w IAI Ihw.. ~N.+rr 111.1.. Nwrr. Move &NOW
! AFK.1A ► we" 9sn4re 0001x14 1, To" 910* 4 ° " I W
r tow IoiNr4 wNp►k y~ IwTdrl W l W Y/to"
YtfYa I tMYYy PiarlM ewN 14YSy ►wrrrr
E (1i* wttraF4 /rrrM 00 24 &W*w liF►My Icwrr M.eM 14y1y /w. Fa Sm"W crue,
e4ir1r41Arir~ tlu 11x111 etaaul Irrram fan A.IO 40rMd ►tMM so ftm frr4.f ►rrrim
};*,:!4'Ac! trccrt,.r,~µ'u''L ntW pl W tt! tD ,
W ,,lya x~4. ~
1000 .0 2543 4,6 7561 9.2 30000 17.8 59053 18.4
1001 .1 2632 4.7 7686 9.3 30325 1719 60323 18.5
1021 .2 2128 44 1616 9.4 30656 14.0 61649 16.6
n'`14;$,%~v f .3 2831 4,9 7949 9.5 30995 14.1 63034 18.7
10~1~ ie 4 2942 6.0 8087 9.6 31341 14.2 64483 18.8
.6 3062 5.1 8231 9.7 31695 141, 66000 18.9
10805 f ;~"_>1 71192 S.2 8379 9.8 32058 14.4 67591 19.0
1095 7 3334 51.3 533 9.9 32428 14.5 60260 `
' 1112'''' .8 ` 1469 6.4 6692
t; 1070: t ; 32908 J<.4 , x 71013 19.2
1128
1659 315 c 8858 33196' ` 1411+ > 111118'' ` " 19.3
X146 ff47 r 5.6 9030 10.2 33593 14.8 74000 19.4
J1R;ersr c, 1,1:r t v 4055 .;c o-,W c t c 9208 4 t 103 1 34000-' 14,9" t` "y" f0"' rj
,1182.1x. 1.2", a 4286 1580 112194, r `16.4 3H18 15.0'' c 79W015' 19.6'
1200 1.3 4546 5.9 9588 10.5 34845 15.1 81305 191
1220 1.4 48,39 610 9790 10.6 35284 1512 83732 19.8
1214 c t'.cr 1.5 1x,,11 i 5028.:;1rc 6,1 e. !^t .10000 "10.7' 14133 13.3 86308
1261 3.6 5082 6,2 10220 . 10.8 36194 4 t . 89046 20.0; t1
1283 1.7 5139 6.3 10450 10.9 366,67 91968 2011
11105 1.8 51% 6.4 10690 11A 37153 15.6 ORCS26:3
J328 1.9 5255 6.5 10942 11.1 37652 15.7 98422._ 2Q.3_
1352 2.0 $315 6.6 1120'~Ji'.a~fy3 J8164 t1t14~' 1102000 20.4
137? 2.1 $376 6.7 11482 11.3 1402 2.2 5439 66 11773 9230 116.0•+4y+1 105857 ibb00: 2020.5
` b
1429 2.3 5503 6.9 12070 11.5 9786 114490 20.7
1411x,10 of 2.411 s1~ 1r3S69Trcn„( G•7:6c''t•ErF tgfibtfl 1"F;fjj.6ts4;v 10`# M
`":ur t,, a Flcei 11$362 200
1486t-,c t r'Z.a5 7n F ::1r15~. ",trq 1~~~~~, sz rt r a.J1Zq tots 40046 .1 t r~l6.3 124667 20.9
1511 t.s (~rP~r,41° 1~7 t+r'R7Z. ~'.;.n ,18099 it ¢~7p 11.8 tort r4I5.a! Ctr Yr,~.ttC c i~~~~ o , x101 r ru ro';
15470 t: c: Q,}+~ u 5771 c ~,Vr 4 10(s is heFt:ate jt sub l 1 F 1 c tfi. tT,u usq p~ !'r tk 1 ~•Q , .
f61 1HitL&.cr cvt4U ~r`y tjq nutm ,,e s~~'7C ;nl~k~etr: t176030.s F :21<t
fi~+ ~ 111 sJh zr:x. ,)5 ~'c
. ll'4 Er~J f d:rt 'v ! x1'.11 i`7r4 f.iitl'1361`7 "C Oi Yl 6.c 1,111. t{ .4r~7 r. rFj~~;yp,~'
}p! Ti~~ rti51
1813'•! N t,,~34 w '9tisf v I'r 14!011 t4c f,t ♦ 1*k: t 1
1sY ~l ~ 151622 21.3
1641x' a' r; • 4 r= a su 16 I1r~ crt {UC qq`'
~~j1 r , t[ a Ft 1111,j~6a 1x1'1 d41t¢3U .UCS *412 ..f, 44114, x ,,7,14.1 nn.r 460286', .1 1,4
16e~ t,,nr 1 l 7 ~I14y >U F71717Lri4 f 15246 F,74. '112.3' 11;11. , 9, r 7:17y1]y 1~' Ott< r {~,.~y,~ 4.y r q I
17251? 0111 t7.?10.11 16159°i" fyt:r04 tcr. '11~1~6i4 s, t 4'J6)r;I FV'I' 4 00 t1~Wt7"ul tarot t~17~~JXJw1Ypc+spF'l t 114.
F c 9.^ t Vp'( T.t~4r, (.!F ti o .'It')? J 30r;a1 1?CL"'C, MC. ?1.6,.'
! F 1 t 46364, t 1, 4,u'17rlr^t 14103449 c 21.y .e.,c
i 71~~rt(t r4 4 f4 :+c rst t~tc.r~-~ cy IA;rf'i; w; S ~t i
u nui4ca Jt -r So 16910 12.6 47143 17.2 201776 21.8
list 6 14 0.1 17548 12.7 41949 17.3 224400 2310
lt9~ttu„m.L> C0nut LO ,.t(' NIUN 7uo' '11112J#0 1G491 . Yta t
tntu ?43P14'::•4 "cuR2,0 co,ct
1049'1,rotlcryy.1y tr;,v+! t• t~ 1 Yr, yc,e tts'; anr1::FUt ~=~rr~,t,al u bL ^~i7t
y1ry~ t,,r l84 t1'F C~~rr ` ti;47 J btttt',1r Q.eleo~ c~TXIIJ t 9647'.rc evt 116tic in: 120711 t:'t' :143It r'J'
•y~"'"'r,"M 2034vil p'F r'..66917c 1/11 114,4' 1vF L 19788:,P;114e. alx'.0'`4~'c b8k4f:lr .,t4J1q:~ 1.~a,? " S2b cts :x.,.222'. t,.d
2055 3.9 6789 0.S 2Q6 7 131 53468 37.7 330000 ?23
2117 s:,' r er 64 yarn.. r }}~~~~a 3F.9t ~yey«ci fill r'( r 11 t, h a;
c,4r C1'rat'ti4q uYfC°4e•,a~•✓ 2 XCc ONu~ cu'.,~32,,: '114 of n• ; etr> 3314 11:11. 11,`.x"yy tt; e3
~6ft y i t 1$2430 17,11
2174{rir, C44.1t1 r14Y 'tE9➢7'Jgrlq 4,47 nlp ?r, nt6a7J, ti'{ ~ 10 t>r,(41 i Ccilr(r .S r. 4 Nr ,ZI:T 0t t}r
3' 1717 EfYi`~' Y>Y9 4313 22.5
2239 4.2 7100 3.8 23647 13.4 54467 18.0 500000 22.5
rT Y~'191:01ut 0 Yf 1'.~ 'SIL~~zlt.:,,r.: t (f'Rc4r 1,01',461 f, 7`F,'. 1'! tx 13.4 N/Fq166061. U(1 +Ut•14.1 o; q t`11%60t0 D'r'•'i"tt 1U *tMq
2301 4.41 7323 9.0 26572 13,6 56667 16.2 500000 r
2460 4.5 7440 9.1 80344 Ps P,143r7,ntrt. 67036 18.3 1~0 6,0
NOTL' 11 the Total Standard PremtUM IS betw
is that Ohown for the 10jver of such een 4mounlf(wo of 1M amounts shown in column (3). IM premium diKOUnt perceMa6e applicable
,
'If the Total Standard Premium 4 88*1Q.00Q.Ar mr, the premium discount' ptrteMrje spptkable sAeB be dstermined as IAe
wnlhbd Itve ~ of` 2.6K !or the Goat 1500,000 and 23.1 % for the portion over 1500,000, i
fill •,,'•1r rJq 'r;FUUrur~F
J k' rxs 406 10 : r-q I1FV11' ~tJ,c,rur ~bt:n3,c(vlf+' Wtlu,fc,r,r tt ~f;r3r+11' 44r'rr0
fA ;~jtr Ctl`l t, t.'1'tFCf^F riVt ~IM'ciC{ 11'1'01174 a' t7 M6;' rd Ili iy e t p..,,+Y', 1111 R]'J ►
. f ' x11!'4 1,1'1 Fur . 1,' L+.I i:R
f,r(. IIt. ,;11x' rum tci tF11 Fs (r {txt,' p'rtxu, 1 111 Vi ~ 1 a C
Te auk^" '
4„i 1^y t ; 1t ^F r Cl'.v r fir '-'I (M'4 Vi l,th i l 1^ 1n 111. 11 ,f
Pf*rWUM sct3unt c p- - Texas
rofto 0.331260
(t ;4 Thts andorsemrlM modlfi•r Isla provitbm of the policy rolatiry to AN Cadnetuat, Orvt.
Slats', Elevator, tdattufattu•ata' aid Qor&octon', owneme, lanOlordO and Tenants', Owners'
of COr&adon' Protocta►a and Product leounna, as well as to, Miscetlarsom llatAtity
Ineunmm Ibr Mood ftanita. OpWans, Optometrlab, Phsrmscists (D"ployad), Phoo•
tlrreplets and Vetnnnartafu. ` l,r1a' ; c d
Ic i'c c. 4`•f,-n Iot1. ;(v,s)i.14 - 1 ' 11 ya.. (r,._.. iQ 7P 1,.¢
.P 3- 7 , T71,71 k?1 ♦ .r
r
_ •
PREMIUM DISCOUNT ENDORSEMENT TEXAS
(Ga,nlrel Liability Jr}surance)
6
K is Rretd that lh• Premium ppeertalning tq Taxes for Geeyfal Liability end Medical PayrllenU Insurance is suD)ect to discount in accord
a- with the fblldwims procdddrl:
.1 -Texas Ge0u+1 Liability Standard Premium Such premium ptrtliniira to 7e41 computed I~ b cordarice wi(?i (he provit nr of the
policies dssignaled in Wra,gr+ph 5 •fof, other than this endorsement and eacluslve a' iM + Iiatidn~f'd Ole rating
plan, shell be known at the Takes GeWiral i I+Qllity 5tandar6 Premf um.
2. `Tr+t+t Stapdard Premium for All States. The General Liability a)id Medical Psyii.ents PrWigrk completed in ►tcord+rcf.M(ith the
provision} of the poligltas,peai nsteda 1 paragiaRp4 4. bueof, of~er than this ef+dorsement Ind uNusivr'of'the opChc of any
+My Promiun),I~ turn Meet ,"rsement, ,or other
tatresAve rating Ion, any Ktorffatic PremiuM Adjustment Eitdorsemont, ,
premium pocount Ondorsamont, shalt be known as the Total t tbrWard PreiftlluJ
rt. ~1:~3 s' Il'3 :i
e r iaat+ t .l
r Prsmtlum ,a4ount 4- 1rt ts, g C, i 10;5 1o I t, e i s 11
"'I*) For p4llcy periods Qfyne year pr. less- i~,vs Genar t labil'~ty ti)egQlyd PnmlpRtishall be:avts7ect to the ib tiabte
I \ e discount khentageo fbr lA Total St Atisrd Pr ~ruirt oM+lned sash the Tabli It Texas P um Dl rlty Geneni ki rl ty}. '
the
I shall b1
I s' (b) ro► p5tiey periods`t rlrore than oRe year ' 1h1 pekes Gen 'Val Lr•bility S~. +,r44ord Pre 7, it Iscount ((cemtages l 4tated in s ~ Table o ?Terns
Fromlurfi Oiacounts tGkdartl Llabil opposite thQlact to Average alaIe+ble
WI[ total
itamdard rlmium forGyft hl poI cis w lf h shat eet!rmined bq fyiding the Tplll Slander' premium lOt tha policy perfdd by the
1e term of d'pa clef It+h and fractions shore 3 1 i 1 ~ "s'. I j 'I
II
I¢ j (c) If totrbs3aective ab ff apWicaat to a part WtNil premium e rtainini 7QQ ~lr}}x+s. IN am~1ppl1~int of rRfii-utnddisciunt Itable
e
ny Wroospectp~v
o the T1xa1l, Genera 6tand r Premiu i Mkisive of ah gremlumlUDect to 40"Y'
1 ^ iH tone blFtw~to (1) Iscountg dtermrner I Iying to praxes IJlbilrty lidard Pamir clo the oppiltibte per
rtion
!?itan~otes 90t ad im qI T111a oppoloV*41 To)+ StLi>ifard Prorh and (4)'th Iscount d aasmined'b~r,lpp~ ins to th {po sold
1 ~ S iI nr' W►`fiNd ih
1 i! g 1 the T•ra bb Wnyr,,ttyy lands Premrv '+1bM is subleLt fi; Peteool{plttiil ntinee t app b~ Ilk • Kup s1+tsj b
Table oppa5 1 w mucI TotW Slanoard "gkiv5% as is sut4gt to rdrpTp}rp iv raUnPre i sfieF~
a Of rieaa rrndrTable luf?Dscount HRentagse`f(WAI Usbilit~r).r(See ta~l or%l at~ 10r•of•) ! iY:3. G
9r3 t 3 t IS~.9 t '
~'a~5 S 5 Z'i3a It 6 ~ t t Policy:11.ur+bars 1 VIVA, Cditluled $t>Irl6ii rremium`
11985 II'3 ?SeY.1 Ic'd 3~`,6i•n c
ills. S'I .3LP e1, USC~YJ 5Gm
ro 1 L.3,a @e ~ tts,.~~~n 1 32rr, 4.5~~.
13zs r1 I
1 3Sg 1'21 brs I~ S 6015
2Se;r P ; fCn S s
5i~ii A1"~a~ SOS
I auk ~I as e 3 Iomfe!
,Tohl
1,,23 es ~ IOaso r Q1 I
1.41 i e a~•e r a 3 sc r
Apgjo praml" discou pWnl.:ge baWW on I aaatlotated advalf2'11 stand rs) p "Ium t g3STS-- - -~~e Tall foe W594 1 sSt3 I! I23a e
:b a sill 3oa is s
I~, r) I'3 t'tr(' aritH 1J? 3titt2 1? l 1
TNS;1edorsementi ethich to rM 1et'a+rt of an't1~ia lot a ocAh0it to the 1P` Ewing idlttfh t%d pobeyl dQued b 1151 c~mpony d{[ linaled
(her}y~~akes elfejtlon th• fly,ttrle date of sfld po1K . drdaaa +nother'4ffective +itil hown 01V, at Ih i+drJi red in fl a polo
and a ee tOncu ' ntty vri is %yjpohcr. t? ar+3ry 1fl r S
( W4Wi 111011 y N' ' h of h h rrrn td I f Porir
_I 14
1;:'8 Mail 8i'Cenlple r 7:a ` 2 S 0' NN t ~SJ.lirt ritftl 1 Pofr y 11t 1]e p• la Sp
a : 6. r I su X31 8'a sSi3B tell P i[TNGGrtf the
Ir»a 33'It ~ ~so~>3 lei P1a31 ,1a'o
017 , S vaa~ r 2
Iu 0
rnywMC~ I110if 3 313'01 i i' S C'4 t43 I t o
C NA •7 1 3811 48 SdeL a
a ~ a ~~.•i> r~ e:e9,• lee
y Ilse ieIE ao 1 Itd iy~3Wi I9y
1 343; t'a 1f SfP a i 3G3S7 IR t
tr}"1 r: t3 1 1tq ? ~3
nlened by., .
I e e
arc (u
' - _ Aul ant gent
ti~1J ,r,r a M Count
prerr t1~11l Discount gndl, • T Rasq, +i) i i n• £ 11 n Y ' 21'•i•.~ r u r 1 w M I..,
, (•1 f
r;;,4•11le1< r, L o. 1 f Y r>• { a
I. I 'aTr• ti°Y+•, 1~ ` ..rY < 4l YiA Y"I: lV 1, r I,.[*'tl } I~.i,1 rl: ilF.N F.1
k~w".ar r'r,,, i'~PT~ ,'RI4)M a a.,. / )IP ♦ pan. knri• l
,
► II AEG Y• 4,.,.b
' es.(Y : rn,:rrrv rv Ar., ~ In.L••, y., ,I ,MN ! 1 .4+ .w. ~...r
'4*I tint«r-b l"1 v-R
d 5
f5
(E
TAIL ledorsement forms a pert of the policy Io whkk attached, effect," on the mceptwn date of the policy unless 9IW*Ke slated kerein.
(the fouvring Wermatioo Is required e4 r~aie~1 i`gpQ~sr is kseN "ke"Im to preparation of po a~.)
plintment effective Policy No. ~u2Z7 Endor•ement No.
Nified Inured
Cow Mersignedby
(Authorized Representative)
GENERAL LIABILITY
AMENDATORY ENDORSEMENT-NOTICE
Ones)
Ik fespecis bodily 14ury liability coverage and property damage liability coverage, unless the company is prejudiced by the InsurWs failure to comply with
IRE lequiremerd, any ptorision at this policy requir,n` the Insured It give Wks of action, occurrence or loss, or requiring the insured to forward demands,
Hlices, summons or other legal process, shaft not b.,' liability under this policy.
>3~~l1 (Ed. 5-)3)
M.,
01,
s
t, Osl
`JII4J
This endonkmenl forms a part of the policy to which attached, ellecbve on the inception date of the policy unless olherwne stated herein.
(The Iortowinj inlormalion is narked only when this endorsement Is issued suEseclunt Iii preparation at policy.)
Endorsement effective Policy No. OC"04770227 Indorsement No,
Named Insured
counlersitned by (Authorized Representalire)
GENERAL LIABILITY
CANCELLATION PROVISION OR COVERAGE CHANGE ENDORSEMENT
(Texas)
In the event of canceiblion or material chance which reduces or restricts Ihinsurance nallor d~~ the policy, the company a`ees to mail 30 days
prior written notice of such cancellation or miler'-1 chancc to. ~r
(Enter rums en6 address)
214 L. MCKIINIVf
0519 (Ed. 1-72) COMO TMS
HIM 13
i
THE ~(,1' IEOULK KLOW is FOR WMPLUtON OF "'t rouOw1MC ClWERAdE PMT: •+"~"r _
COMPAENEKSIVE AVYWItU tUlUTY INSSIRANCE w, a y • r, b►f~ '
SOINU
The mk$&-M ahWded bony Will respell ro aura, of N 10W"ll Covaun Is are r4c !ea by A snwhc kV of hmrb of Itabhh N limit of rw wmWys hsbili,r
slamsl eaen su;t Coversat shah be as %UW hlruri subkd to all the le,nn of this pchcy haunt nlatme Uada,
i>.... r Wrerqu EMJU N UsblRy
Cornpnh"P a AalmobNe ElaW4j kswv4t EACH PERSON EACH O=ARENCE
C-kOb klwy Usbildr S250e0O0. s;
D- property Beetle t.ialrky f iIKKKIUI S 10000000
EACH PERSON TACH ACCIDENT
AutowabNe Medial Payments kwrsna f-Mod" Prmarls KKKKKK
"told Metaisu Insurance U - Onlnsred Motalsls S ''"S)_14---4
COMPREN:NSIVI AOIOMASILL EIASKITY INSUWCE
1. Dwne/ Aid It
.
Unit tam a Cry and Sete in Which Aulwn,*W Year of Model rW Body type er Model, Truck Sift, Purpose
Win Be i vincipally GwaCed PA Msme Tank failenap of his SestAl Cepacily 01 Use
FaCE 1331664E
Rediue of ADVANCE PPfMIUM
Unowipw
No, iS I SeMoW rial No, ift, Mtt~ Tar ory Clalp PMyrn b
sls 80" 1*11, RopMy Damns
SW G31664L 4,228. 4,253.
2, Well AateMOMW ^ B t. P. M
t. sOms When Adoato" Pour Est Raba Per
Will Be PtV4,y Ik4d INre0
MUAS, 'iElSA4 PASS Pia AM 2008 20114 _ 23.H? LIT
3. NoerMeMl WINNOWS locetiat of fleadgi mars of " ^ ' E .01
(e) Iiw 1 himU-Name of Each U1 P*wd Named Raw h f w
ZY ANY MULAS, mm AM 3.599 ItKLO na,
(b) CUM t-~filifla 0 Awap (01 Clef I EmployFe~ It" Pr to
IF MY QAI2aw9,=w .461 .23 nmo IlvCL.
Toe 051. 060.
raa~ n~rn
30983. 3,9929
WTOW101 MONM PAYNENf1 NtU MICE_
DGSOAT10N Of AUTOMO8::03-0*10n 1
Ili O "@"W wuo*k (4) O Any prtoraeb6e desated M to kh" rid desipaled 'MV
(2) L7 Any libel NA00"I (6) O M, eorsaswAd astismel6e
(3) 0 My Nansed MW 1rMb pe ftw w%MW 161 ❑
DESIDNATED PERSON PWAEO DM O t
I
DNMSORE6 MOTOMSTS INSNRANtE
DESIGNATED INSURED
Desaiption of kaered Nlo vay Ynhkles (ChocA wwopriou boa)
O Any w WAU owned by the hauled Mww
My FrMNa puenpr ww oW owned by tin WW hosted
Q Any hioirmay nhidl to eAJch an atlattres -.a•A ;latn hsued to aU umN NOW
Ar k~ Ina1~M ~ ;A Ow WO.As C IN OdO b, IM Wets OW and A N"Ay rehkfe owrwsnw of Who d bmuoed Mdino to Poo PWW
by tw slow Q Any rne6le rr~alprneet own./ a Nase/ b,1nd b the nlr ne of t1M aamal atuN
C Mai
439070/
PRODUCER COPY
•A
J vr:
y sr!.r. 7 v~
1 241b. PERSONAL INJURY PROTECTION ENDOMMENT
(~esle Aeteree►7!e Lle►ilitl lewreecs,
Cernlrfhlgiire Aurense►Ile Lle►ifi leswrence, Wnse Inwn..n)
, I ~µ.71W7JlV r~2 1' Ise
I forms o pat f Po1i~y No. wed to ~ ::,J !.,.r:, ....r._, b,
This indasemen , '
YY th e., 1., r.I.F... y.ia . rp 1'au LFa 4'. ..w a.J .......a1 n4.,....... ..r{. L . 1 . L.._ ,-~.,G u.J.. ..LL r..r. r:.L..01 Ite 1~geney.'.L
v (Nome o1 fnsuronce Company)
located (uW bred, slate) ' slid !s etleciivf (root
112,0
1 A M. 5landard TIme1
ftha Infernlslleq s►we Is ,rewired still when thfe enders~reeet Is issued su►seoueel to ►reee►etioe 111 tAe iseliey.)
This endorsemc7;l form; a port of the policy to, which otlocht !r effective from Ifs dole of issue unless otherwise sfoted herein.
o-r++~Y r r4r+-irk.+--f------.+-ya.a..c.~..,_.::;
""ten , 11 :r 1 i. ,1 i ♦ ',.G 11 l C} ir..: r.
. ,~G1 Clivereji UMlferof 1lspllity Adrsnu Prtmluw
PsisonoI injury, Prcleellon Coverage f 2,ppi each Pert~n '
u QlrlrQe,,6e».
Desetipilfst if Witted Melet VehfcGs
f ICheck ospropriote blockl G
0. Any' autonlpblll bwnfd L> the named (nWreQ ' r 1 fa-i 4,
n Any plfivoie P~HnOet ~l9n+PbiN pwMd•by,the Homed Insured "
Any rnotoe vehicle to which ore alloci*d dealer's licersst 010111 'cued to'th1 ndmtd Insured; 1, r
j Anil Irglot thitli desiOnoll4f,h ~ iclo~4tipri} of Ihs paliey by ~he' 1eli.rs P' P.,Qnd b rnbl9i vt1 kie gwnenF~I,D of rrhKh I
rt P0vired durtpq Ihf ppLC~ pGn py eh~ nomtd,infulkif os o reploiemeni the:' far
i 1 1rMi 4l i J ' ~ ~ ~ I
, / ^r•1 h r tlp.7f•yrq ills.' wy rep •'1L f I"v [u F / LS rr, pJ•p.l M1ei !A-r
r 1 t • <^.1 rFt .i 4! ~ ~ {rJ.. }4 . r,u:•J } P: 7. C'y9 .Tr` ~"r I. 17..
iii c si rAli o o41hf D+,Rtnium f l7tili irsdorsemenl„the C1~ ny 0greet wisb,ll+f nsnysQ )ntyred, snblece Io' o!I of. tM =1
provttyipp, yy~yyf JXislmenf and 0 of she provisions of the policy except os mod tied herein, os ft llaMr.
PIRSONA4,ll6tURYr,~ROTICTIOh',• I , ,.1,,, e
INSUIlINO''Atj'R'tiII~VINT P r ,
in oc!&" o?r rdr'whls~he'~irovl~lon r( Xrllcfl. ~R 06 ! 0f fElri lnyu~onci tad b(~ekoi 0nd all Iktt omendotory or wppt7~menrory
ehefeld,' Ill! cbm~sdn rF 1 ~y y 7 Ct Ar 7 i.l.,r 5,i r ' :v O
a e. e
f!) I~ hl;meb ~n`slridbr`ohY mt`eslsef `61 i~7ti iniure~e ha,4ehold who'swtolnt bbdlly Inju*y, taus d by occ Qent, in 0 motor
'I vehlCI accident, bred r, II / l 1 1i" n a }'ia ~l IFb t'. G ir:`n It
wet C ror ,C r lit D 7 i
r 4&, ~iot~g9ns 'r 'I~IIry cgsfi4d P1r 0%!¢f?'►
s21 qn rr'_ t 1
tt~_ VV ti~ 4 , yefI ,
~,fqh ~,~$~NI~ o~>~e}~e~frJlh a rlr ,j 1t 7~ x k 4'I I ( CI • lAe 4 n, a ,Nr 1•.
1'b w~1 e,rV.,SIfI ~~uc7a Phl~lp'm0l's lhf Dtrl~fsli0(1:Pf, fig d insyttd.4rc'he spouts of the Insured it o residetlt of she
iul•.y^Jj1.R. 4 ue:; a r.,U :'1, r iu '.w ..4 l 11 C'^: h , 1 ..7,..5E c.; 1r r 1'f 6Q v 3 r r 1+7 n,J
for fptlej ;int!!rreE by svth ►f~4.e p:nas within ef7rss yron of IM ~atf 0 such ace, rfnt for.
fl) oU nosorwbM.add.rueeesary modic7.! eslpenus fncuas¢,for:urvicee fumi~vd,-and F' "
121 i91,0kjh 0erw ssistolning sucb:bodlly.1tolu"38 bn Incomd of wogs produ::: of 1h► time of such eccldMti belisltst for
ps 1~{ ~COn~{Ayltpln!l1,bX IYCh.P4lApft th~~ $YI7g..psg,diStflA~Rr 17411,fRN+tl,et"IsaiWitit, once
f1 . fh~ sp~,sy~~ fnlog YAb,bodtl ,In)vey Is. notvioa jrt'i rM 9f1~tW- , pfgQ et}4t IlN lime 0f ►VS t 000idenl, benefiss
s 4 Si ~i( q t M"U41Yl~Ce4 b,U ss~te N41geV!(e4 (a1f~llN^~l- "rykfs Qr¢ogrlty.Peiloc"Ad,by,such.5q
.i inlsr i•F} r1 p] ♦~f 1 eon /1, ail 1r1n0 , :',.Q~ ~h~ ~O,TJiy,Dr i4~ily 1 ~sl!~ 1i;:1 r a f
during the Period ~f, f~fh ~~:i IWSAI ,,T;IT~TI f~I t t } r ip~ lC: y !~rtr L, f_ e'1 c4 td2r
I%CWSIONS I : , r,
This Insulahek do1!'I1ot' 1r tc { 1 J :f fk a xc Iv } _,aF'J "I ip5 gyll, GI f ;y y'
s i~F I ~r~,, ~.,.:,s ,JJ,<
1~¢ 1 1! ? 1 f. rlIt" W.r 6f r4U r4 1c,r'~ , r:,s 1 r W.14 r ) A:",r q M, 4I:q f, `,4 err s...It"i )"I ni.
yn~enlibfalfy couifs vhe ociiU ~esu~ I in the boai~y In)ur~ of we i 6erwn, or
Mki"I I IcMT sustolns bodily Injury while In The commission of o falony or while seeking to elude lawful apprehension or arrest
} -,by a,r low's nig"r9w.ol licigli.,, il ,4,cr,. q!d,l f G '..vl ✓u.7 r tF , 1 ' L ):.i , 1t { t .~'.:,a
(b) .io the named IrmAtd or,eny, me( pt the Insutedls household who suslalnt bodily injury while occMJr4 tf tMrouoh`;
a / . bei+g,sMuck by o rnolor ryehkle owned by lxh r4msd imuted er any mforlber tO fM insured's household Mhkh to not +
I. rC r,r ;'.UV, t.+ C•r N It. YiG 17 v }l r~r•.f l7 I r s ~i-1
'I'!Ht 'v.Pf IaA ~n~r~ ~Qf Y~I~~.I r't .Fri i, ,'b'I IQ QV r.lllt l~ l1f, r} 1 S'l I e 1 tr `r tr l LP. i . [ R.r1~ 4 1 i i. rJ i ~I•
r- ~rA ,fa,l,rf i,-F r r 7;r.'tSllr RIVIR11%poI 101r'►ORTFIIkPROVISIONS)'}'
I it 0 Jrl ire v lp 7 e'_ r . ,T i.YI 11.i .1,'n,l I 1 i .V 1 J,i , 1~ 4 5SR nl
V .r.'1 1 rSrii r y 1 r Gr'7 'a.
'v,,, ! F V rr, 11 71.,1 J 1 r .c'. (1 f1 1rt'i 1 I?. FI ! I}m (~1 1 4 I T r.G l~~r l..
11 I i~=f f`~1~, a^,cu Arvlp ~ rrc'r Gq r7 f '{`rr 1 ..~...~1 ~ I~
t 6 Ir1n lr e
~i(f5'1 rJ,5J1 fl J+'.61. ,ul. rl 'I .r f i.~ r.i t:u~l.r! 'V I~yl ........:.1.1n.....4...~
t~ t (Duly Autfioriecd ilepreseMetrvel
1014"f/l1~%1IFi~I OV 'N/URy Pis SCT10N iNDORSIMINT
luels SlfsdsrJ Aurs~fnnsl 1 111dersernent
~evlsed Afrll 111f1;~
et,:raq :r►r't J' 1416
' l~, er ~,oo~: ynptur; P°W l,.gctMwt ~
1Gt1~ ..err ut1C;ti<A bti..iti1~'nrt fG4L~fl~;ln^(ids
LIM14!Pof Lf~11i~
Regardless 0 "he number of Persons inlurkf, palicies or Wds applicable, vehicles Inv ed a etq,ros moG; the 10101 ag9fet,0te
time of liob ~~y 4o bf~efill of every hind for loss or a■yense incurred by or on behalf 61. qnl plrarn who wstalns bodily in-
jury os the >u6F ally 6A• accident ►hall not exceed the limit of liability set out in the schedule of this endo lament. It the per.
sort receiving payment under this ca•,sroge Is also makinngg a claim apalnsr the In}}ufed under bodily Injury liability (overage of
this policy or against the CoMpar,y tJM& heel "day irWO 0*09401 shd WiMa4d(Underins tied marl fists coverage of this policy,
such Insured and IM Cwswr shall be entitled to an olfat, credit or deduction against any award mode to such guest or passenger
in an omosrm of money equrd• to the 0mounts Pow by•thf @*ner, operotor°or the Company under 11persome Inquiry pr0lectioA" to
such Most or, pasumv Grid 1►+e~ bodlly lnlyev 11pLifity and unir.IUndlundSrinwred m otalsts cov/royal of thte oe kY 404 Woreby
omende•1 accor dingire p, N~Edfd, ►lpwtv hIng e hreln she o direct action ogoinit the Company
shall be construed IO OUI';. _ '9
~r, hoc
DtfINiTIDN{ ' ~ `
• :w i 1
"ctr l In~eni~ IvrI" means t6'e difference between I a monthly rare of lncomi being corned on the dote of accident and in-
carne ties lye tiring tlV'Period of disability, measuring Income on the date of accident as follows:
1! 1a110 ktx"a is a toiary or fixed remuneration, by the montlly rate of income being wined on the dote of accident;
s Cf1't:pa; fbl otherwise, by the overage monthly income acwolly earned durLtg Ine twelve month period immediately petcedinq tho
Jaty of GCOStppto qt f 1 14 Inpi;9d has been engaged in his occupation as al' the dare of occident for a period of less
tho tjselJ dtOn: f I 'GIN age ff4nthly ome city4IIX fpr'd t ring that period;
"11get4;s f tree e, i{IE•r~1;' fPe. s OIg~!Y ~46f fir. bone fit oSIVF^cat►'e• 14(1 be~pusf.o(d~spbihlY.ri+}+IHnO from Inwred
bod ly In)yry,'•which Prrvent I~Ie n1V !d piston from perfoffning,the yu st iol duryes bf icusyal accupot'on;
"Ie1ft~ le)ury'r,mean; bodily inlyry,,,ii0knefs, of diswle, IrAludin¢ off:`l,4t.gny lime neyllt(sg therefrom; ,
'iseerrse'r. means wages; salary, Pips, Sommissions, professfonol fete, and other earnings from pork or employareMi ,r
11040me of, was$ prflvter" • means q Perim who at the, time of on occiCfnl was In an occupational status where such person
w4l, lQrning of ptodvc°ing in o"i
"Inerrfl.ntfter vehicie" means an aulomooHe owned or leased by li,e named Insured which Is MOW In he schedule as on
Insur d ni fg vtl,igts )0 hlPh :bpd,dy. ~nly(y.lig§llity,ttcv(lrgp! A(.l OQUSY-QpPGaM ; o rr cr , ...,,,1.,y , ,Mt
Sr p►teeef" ~+1ar~1,RhD iDeR for f+e4eyscly medical, surgical, x-ray and dental services, includrna prosthelic devices,
and nec fsl5~,dmbularxlhasp lo,olefedQr?R~nur>;if~, aVol, f4M~gi services;
iumunEil'tef the 16 ef I a seJa 014mtons a rei0tly the ndividual named Insured who Is a reotdenf of the same houses
hold; ' . ,
rmeier v14111e" means an outoMA1,14 and any other vehTEle;'intludlrvl o IrJ,la, operoted'or designed for operation upon a
bubiie food by ony'power, other than oniTal or ntu+culgr povief I
16 l `off 6rjonleotton name in the deciora4,on+;
^neAf (06ie4" 14alts the p41'
IrtflbtkCf/tNf1)Ptlhiant in or upon or entering into or alighting from;
lee:0K4lefilMiW4'Ml9lt°fYMills person and not a comoroflas, partnership, association or business home,
L CON~lITIQN~ , C _ • G i,:i
G}, P Jar Itrivlelifs t 1`" of As Y+swino opre•ments. (xclus,ons Of condit*$ of the patrcY sh ill opdY to the tnsuronpe ol.
Idrde by f is tndomerr+enr except flu cand,tlons "Notice, " "Assistance and Cooperation of the Insured," "Chonjes," "ASdgnmlm;'
l :Canellotfon" and "Ce(tONNOAS" and any tndarwrnenl whkh sp/ulically rsfert to "Personal (nrury Protection.
Z Premium. If during the polity period the number of lnsurrd motor vehicles owned by the homed insured at spouse or the
104 n "c?fy the Comoany during the
nu fiber of asoJai s,SjC"JA.pl to sWdid( to he, rigod,lpiw+d-S rigts, %1101137 }neared shalt noti
pal fir b,}rl¢s{'g fiery illaniift ' ' d ?1em s},oll.}ff ftdiuS ^t y`''r r+l~arµ0MP List by the Carlparty ) It the
it
jeo A 8 6rhY►nliu `t}x7s Y'ompu ex.e e t a vance D'remiJrin paid, the norr~d in ured gailt Day t excess to the COtwpany,
the Camparty shoif niftier to` (het ess red fAVAOd the 4ri►disf/d ydffkh'dald by'AAN MOW.
,I~,7~ Yfrf A 4rkl /el 1t1 } M► Nisti ';Alt wuv as Dfactiaabfs, and no later than stir rronlhs offer the dote of accident the
(fer moklnq claim shall a ve t 1+1 ompaof writfen proof of claims, Including full pp"ticvlyrs of the nalure and extent of the
ihllr'rCls"O1ld irftlthwMt'fficlfnld1.;N1 PIfflbiafed ono Medical •xpenuf incurred, the mature Lnd eatenf of actual income lost, all
such instrument and papers relating to Income as Iht Company may reasonably require Io establish benefire for toss of Income,
and such other information of may assist the Campo y in dethmlNry tho geflrtunl due and poyollt. The Injured person shall submit
to menial at physical exominatlons bf physlcf9~t+ ctte1I~1~ 2~r L1}~ 4ATQp Y.fr of the Compor(r's expense wh2Is and as often or
the Company may reasonably require and list ~i?#Ai lSr, liA ifi1 f! t' Sf~~f' try, lncopociry or dea+h~~ 7 0l repro sentottvt,'
shall upon each request by the Company execute outhadlation to enoh C CO M 111 lopies of records.
such forms
Proof of claim shall be mod1 upon forms f~ur 1;y t nY unl I e 7hpdr4v .rwll have !9 9
ttfilehlA'filfeFA`dbgi'b11Mt''rk'lt3lrfit`hol4ce of cldfr> V'~ersbM`M+dk1 ttoim ►hall wbm+: to exominour)n r oath by any per-
T!
son named by Ipe,~4J@t+anvr a. subscribe the Iqq~ ipi may reasonobty be fequlred° yq.e,ts wnturlnw
4. Other wreetb If l4to it other Per no Injur1 pro f(fion nwrOMt against 0 lute coveHd by the provitl0nf of this an.
i dorsement, the Company, shall not be liable under this po s foreogreater proportion of such lets than the applicable limit of tic.
bll,ty stated in this endorsement bears to the total oppl+5Q4S4 4114( f liability of all valid and collectible personal injury protection
insuronce; provided, however, the Insurance afforded h u all be excess over any other valid and collectible personal Injury
lv A(41tc'+ dnt"~aZF gvo'lQb R~,f~f ,~n11A.~p~4f+9„ t y In~mlioe,aik the,ih ~~Ofr0liMhold:;r ,.,NGt rr I
ldynleef tali. i1ny Payment under this coverage, Inttudirio benefits for lass of Income, are Poyobte to the person who
.t dpbtegAraal.,sha~tsablfd,p►rgonilt,gn upeeny}cpete¢+ninor„to+lw porsennpr.quardionwh•►witwlodYa~s+k►rrftifwr, within
th r y ddys offer sotis omoceii proof thereof is recelved by the Company. Subject to proof of claim: n 1 i, ; •`i t 't
lot accrued medical expense and beneflfs for lost of income nit potq r wary Ire wtekil
(6) StAVginehls lot a perioJ of lets than Iwo weeks for which the Com~Aie 10io6fe afrt Ooitobte at tnminolion of the dis•
ability period. ,v~ _.G 44 ice+u C. C4 il,A,1,
6, Aelien Alelesl Cern►eey, No 0etlon Ino11 lie ogalns( the &mpony unless as a condition precedent thereto there 0101, how
been full compliance with all the items of the policy dnd of this endorsement and until thirty days after the required notice of ac.
cidenl and proof of lost have been filed with the Company.
1N,, s,r?iG •1iey,ler111, TenN7,y.iThis inpll(fOrtM to ateidtnil which octur during the policy period of she policy io which
the endorsemenl is attache , in the U t 7~1jarico, its lunfalet and poswuionb at Cdnoda, or while the motor veh;cb
Is being tfansootted beMeenjV(t&lptr,Sg1% Yn,cwo`!M f!,,p i,t► l„rn,ru,e' Cottle i„rrte.,trg
iRL1't vn,gtuef;fe f'0P1fas I~rn,e4u'
310' 6E920Hvr iminn t"uoitC1 om p9fre; t2Ew~iS.C
.114 _ y .~l
ci 0
.10
10
fill j
g -y 8~ Cc ! .a . P t rq
4 b
s If
s
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Fx y yg i
0 4114
fib- d _..bI lit
r
t ~ 1A 1„~ '~.s .b v ,y' ~ , iSQ■'~ f,•. ^ 'w _ }typy~! ~ _ y ~ r « ~ ~ to
~ .
sill
~Eo:. .E ~ g ~ p 5 r F sE ~ r ~ ~ a ; p~ eQ ~a
ss yy4 _r~ C-r _
-r E 5„5~b~~ o =g Y 0E, '~4BtYbo> g i^ ~S ~'S 2Y'= i
OF~j(i7 I E.Y 111 !v ~ tO.L' ...sue ~ ~ `p. ~ YCL~~yj ' j ( E Q ~ $
E a ~ G ~ ~ E F V ~ ;N ~ p ~ 'u ~ ~ p • ~ g r ~ ~
;fy N7~(1 "F.7C Z 9 T f. V R ~•j , Rr V1 S 1
It 11
n~a~ 'S Q,w O' ~ ~ ~ i ~ ,CE 8 ° ~ y ~ r g G w ~ ~0'~. ~ • i ~ ~
£y5~y^_ pCN yp8
_ - g
~zr la81
02
.O OV'~ ~•i ffijC~ ~Q/fir C~$ T~L C~~'r g~~~._£C OEr4 R~~ T ~ ".C
Eo dfi - i E ~aSo~g~lGS ° ° 3 .`lD . - a 9<L~f!ES
g ~ $ g g g • , It `6 b N Its
Hj Ullf!
-01
P-g b 0 +g « ~ s E'C T a g C O o e g (taS' .b, il
02.
14 L, I b - 4= a . ~ glil
6-1
~ R w g ~ ~ y
r £ • ~i
6 oil 081 01RIJ h
10 09 0 -.9
y ; . Y 2 A, PR 1UM DISCOUNT" ENDORSEMOTT'I'i~XAB
AVTON011MC LIASILM INSVRANCL
This ondatNMlnl`lornts a'Parl of boticj NoM227 Issued to by the at Its
A"ncy
(Name of Insuror" C,)mpany)
located lril _
I zod t olio.,'.,., Y and is effective from
if tnlonaatlen .
ve to requlr.d and w1uo this endoru.mssf t, R2 01 A M, S+anfard =im•~
Issued subsogeeal W ptiporRtlon pl t5p •;wbcy.f
This end,',ISomoet forms a part at the policy to which atlached effective hctn its date of issue unless otherwise Natod herein.
It Is agrood th,l the ptemium pertaining to Texas for Aulctriobile Liability, Medical Paylnonls insurance and Personal lnfury Notocllon coverage
Is subJect to discount in accordance wlih the following procedure:
1. Texas Automobile Liability Standard Promldnti Such ptemlvrn portalnlnv to Texas camrilod In aaordance with the provisions of the policies
designaled in parogrop'i 1 hereof. other than this endorsement and exclusive of the applieotlon al any twirrspwcrive rating pion, shall be
known a1 the Texas Automobile Liability Standard Premium.
r
2. Total Itendard Premium for All Sialls. The Aulomcblld Liability, Medical Payments and Personal Inlury Ptotoctior. cadetoge premium come
Wild M accordance with the provisions of the policies designated In paragraph 1 hereof, olher than this endorsemenk ant exclusive of the
oPplicatlon of any rflloppective rating ploa,~ony 4uiomotlc Premium dtusimeni Fndciserpent, any Premium Raturn, lot! Endors•meni, or
other Piomlum Dlscounl Iadorsetnent, shall known as the Total Stodlldrd Premium.
3. Prosduot Olseoant-Toads
(al for Pettey perlels of one year or tea-The Texas Automobile Llubilit? Standard Premium shall 1>0 suhJacl to t applicable discount t.
percerrlages lot the Total Standard Premium obtolned barn the "Table of Ttxos Ptemlufn, Discount Percentages iAulomoblle ub6uily)" i,
set owl on the reveria Side hereof.
(b) rot Policy periods of were than one yeps-The Texas Automobile friability Standard Premium for each annual p•tiod or portlon thereof
l
during the policy riod shall be subject to the applicable discount potp4enlages,sia+ed in sold 'Table of Texas Prpnlum Disccurl Per•.
centages lAutomoMile' Liability)" opposit?'the T661 Siondord Pramipm for the policies for each such period or portion thereof during the,
popsy Pot", e
(c) If retrospective rotten applicoth}e to a Pori all the premium portolydnv 10 T•xos, the amount '61, premium dtsoou,1t applicab)~ 10 the
Texas Automobile Lwblh+yy Standard Pr"ium, oxclusive of any prom lNtn subleci to any RstrospeOive Raging Plan, tthalf be The d`Iference `
between (1) the diseount d•tormined by 6pplyfnq' to the Texas Au tomobile Liability Standard Pismlum the oppltcnble porciontages slated in
sold Table opposite the Total Standard Premium, and 12) the dlscourd determined by opplylnq to-that Penton of the, Texas AU+omobils
Liability Standard Prsgtium whkh is sybisct to, rotrocpocuve tatrng,the: aPplic#rt percogtogs slated In sad Table,ppposlte so,ipyeh of i`
the Total Standard premium as is subi!tl, to reilospecilve rating. ,
4 _ , , feliry-N~m its L malod-/LOudsr6 Prey ?
.i i
1, ✓
Fir
t y
aa Total i I e 9 a s
1 ! i '11 g n p f 3~•
ea aJ u, If
Applicable premium ptitcpniages k;'ased on tots! gxtimated odvanc,ap plandard fomlur~ nr :s d
' " frt 17
Taxicabs, !ivory, Buss „Pond Long Maul ~rpckmop y { • ...lX r 3 i y )
IJeI I;
Ocrage Liability l „ r1F tf s J{,
;J ~ , 7 t p. t'J ./v yr 'ri dG :)1 L,f
All other, including 5441 Buses it
j d " > F a il• a,b
J )1 i a
}SRC RMNSE SIDE FOA' Ill OTHER FAGVISfONS r
r ,y n . , r . 1 , , " f 4 tl
(Duly AuGbrljtyd Ropresenf tiY,
FORM 111A. P11CNI D1wpV)tf s,4VlgSCNLNt-Mfi (AS Q I 'I !
, J
fetal da~
M CndorNtgfpl•. ` , r., t 1,,,,
.leea 11btep>flie
a1F 11. N1A,ecs y) , ,
vi!
rrir J' :o.
Trt"{VF! !J '41 1)1;?C. }tl',•1.1.:? . ,iii l );^1G~1 11') : 1, IV1,1f'11A IAi!nISVp,~~',
t . ' m DI A fb
XAS ' P
rU ATS MOW
LIABiL1 'tNSURA CF.
Tart Tau. Taxi.
cabs, cabs, cobs,
Livery, Livery. Livery,
izi t'tA Ib,Vuses All Butts All Buse! All
Tolo, a 1 OIMr Total and 01her Taal and Orhet
PY rt}trU;~Fbdof4 1,11 r.tV.•a 1MOxyy standard Long Irv Slumlord La In.
emiom Haul du4164 Premium Haul d"rq premium Haul rludtn4
Bee Truck. School lee Truck• school see Truck School
Nolo (1) men G..r ii!user Nole (1) won Goroges But" NOW (1) men Gotafits Buses
(1) 12) 13) (4) (1) 12) 131 H) (1) 12) (3) N1
$1,900 O,o% DOM, 1'66'x' 1a +145.40f"` if Z3%^'=6T4' 52% $60,000 8.7% 129% 122%
1.050 .1 .4 3 6,600 2.5 68 53 62,500 8.8 13.1' 123
1,100 ' I 6 6 6,800 26 5.9 4 65,000 89 13,1 12S
1,150 .1 8 .7 71000 2.8 a,1 5 67300 90 133 12,6
1,200 2 10 .9 7,200 29 52 56 70,000 9.1 13,4 12,7
1,250 2 1 2 1.1 7,400 3.0 6 3 5.7 72,$00 91 13S' 128
1,300 2 13 1.2 71600 3.1 5A S8 75,000 92 136 130
1,350 .3 is 1,4 7,800 3.3 65 S6 80,900 93 13.8 139
1,400 3 16 I S d,000 3.4 8.S 59 85,000 9.4 14.0 133
1,150 .3 1.8 1.6 8,200 3t 66 6.0 90.D00 95 14.1 135
➢'3 t 1 ¢¢~~00 . - . } 1.9 1.7 8,400 36 67 61
95,000 9.6 142 136
1'050"r' f'1 20 1,8 8,600 36 68 61 1D0.D00 96 ?4.3 137
1.600 .4 2,1 19 8,800 3.7 at 62 105,b00,s 97 144 138
1,650 t 22 20 9,000 38 52 63 110.000 9.8 145 13.9
1,700 A 23 2.1 9,200 19 7.0 63 115,000 go 146 14.0
1,750 .4 24 22 900 40 7.1 6.4 120,000 99 147 141
11800 .5 25 23 5,600 40 71 64 12S,000 99 14 8 142
1,650 3 2.6 23 9,800 4.1 72 65 130,000 100 140 142
11900 .5 2,6 2.4 10,000 4,2 71 66 131,000 10,0 149 14 3
1,950 .5 17 2.5 10,500 4A 7.4 6.7 140,000 10.0 14.9 144
2,000 S 2.8 26 11,000 45 75 68 145,000 101 150 14.1
2,100 .5 2,9 2.7 11,500 46 716 69 1so,DOD 101 151 14.5
2,200 6 3,1 26 12,000 48 7.7 7.0 162, SOD 1C2 152 146
2,300 6 32 29 12, 500 4 9 7.8 7.0 175,000 102 153 14.7
2,400 6 33 30 13,000 50 7 A 7.1 187,500 103 153 118
5 1 80 7.2 1 80 72 12,500 lot ISS 1400
X74-`'9.1. 14,000 5
2,700 .6 35 32 14,500 52 6 1 73 225,000 10.4 155 I S O
2,Bgp',:,; R, }4"'38" 32 MOOD 62tpr~,`n;Gr9~r%9~c"!Cry; 500 104 156 160
2 9~ 1 36 3 3 16,000 5S 8 3 13 250, 000 105 156 151
. , =690 .7 31, 3,4 17,000 56 14 1.6 262,500 IDS 15 7 151
t d 1,100 ,7 : 3,8 34 181000 6.7 : 8.6 76 , MM : 194 ; 151 IS 2
cy 'MO 7 138, 3S'" 19,000 SS 89 97. 297600° -IDS , 4457 132
F ` 300 7 !I 5 20,000 59 to '78 300 000 105_ ' ? ISO I S 2
6 a`, ~,.'~1b04 $9 4y 79 31 5At.SD~E.,) 6a )~3
3,400 59
3,04"1 7 4.0 ~,6 22.00 " so as 7.9 325,000 jr, 6 15 8 7 r 3
3.60rr, 7 0." 3Q 2 ,000 0.1 '68 79
337S )n »
4 7, t 104 15,9 153
, 0' 1'54~d4~ I d , J$ 9 I S.3 .
;,1(nr4,,4,11 1600+».ryou.i1, l,t4,4 ,,•3,7.1• : 25.000 y.. ,.142,11,18.9 10 t, ";1 1, Si,
10 ,..4;159 154
7 41 3.7 27,500 63 90 81 375,000 106 159 ISA
I.,, r ~ 4(wo t1+•1 ;4,Z, 318, 1 .00 5,4, 85, 387SO0. 1106,:x115.9 154
1m r. r.a u.,;og41400. .6tAO. 4a 14 3.8 (732,600:. 6.4 gg a q9 40000 60, 101 6.0 151
'';•,i~1v!n .:r t1.'--i-444,400 .8 43 3.9 35,000 7.2 103 95 412,500 107 ISO 1S.4
1. „4,!100 A 3 3.9 37,500. , 7'4 ! D 7 to 425.000 107 160 IS S
$,900 6: 4 40 4Q,QbQ7.4. 111, „103. 477500. 10 ?1 160 151 1, 1 „5,000 9 ,45 4.1 142,500 r t 2A 114 106 450000, 107
„160 155
lb Al @1" 'i+t'; IM °"S.IODV11 P+: I1 47 13' " r + 45.000" + 60 1'-117 109 462,600 107 160 Is$
;5,400 l./ 4 9. , . 4 S 47,500 82 119 112 475,000 107 ISO 15 5
r 5,600, IS $I 46, 50,000 83 121: 114• 487,600 107; r 160 11.5
,,VVplgfls •p: fr.lfis,9001,.;:.q•,: 48,.0,„;63 48 62,500:,.,..._64 124 116 ;.:600,000 , 'W,flote 121,
8,000 10 64 '49 SS,000 05 125 118 and Oyer
6.206 92 66 • s p 57,500 as 127 , 120
Notes- (1) d the Tolol Standard P»miurn Is between two cf the amounts shown 1 eolumh (1), the premturn discount percenta7e
1. applicable 1s $hot,.hown,tot tho lower of euai' onounts,; r,
a A,? (e lotpplrpS~tqq~pr~~pp[ pQ rffnniurqq~s 55OQ QQ 0,r $y,~► t}~~ e{ JGt sok pe 0i ¢pIr ( eoch subdivision of
!p r t`6u olkoliils Iliit9(1117~IM~i!(dA~3 a7f 11 "8 defcrh4if~n$ ~1h' wee 4 (3 Iii~~~ ~ 4h4 rel i ~i shown in (b) I•N the
first $SODODO of Total Stcrn,4grr1 Premium and this percooigo j gyp in (c) 1pj 7v p6oi6n'bl fofhl $tandird Premium
over $500000
Subdinnlons of Aulomobrle' , Firm Pal,on over
r' 'u Liability fnsuron:e $500,000 + y,-$500000
µ 1 Ydslcgba; L rely,' 6u3eti ctli"d l ~ 5'9 ''.u s x.$5.4 . , , 107% 110%
„F~V,•;`r•t Garage Llobdrty ynl!.t!,yifL''lIb'DG',tx'ter%•rtrYVt 7•..".. 161 I65
All other, inciu4tPVchgO ill'nj(1'.'\ XmCUI1w, F:Lmool; c'Y1r::b1,G 111i: fry`,' 160
•
Oil,
s~ b
W ? oil a
- LL b a b ~
N ~ bb
i 4t,
6im
s sr le
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8 'G b b
1" 11 1 1 1 11 .1
~e ~ ~ ~ ~ Ly■ycajl b t a
Q s b y b b
~ o ~ ~ a ~ ~ ~ QQ¢adQ
N
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Z t ! ~ Isle{ o P ~ ~ ~ Y • b ~ ~ ~
^
q ~1ab
11n, t*
I Imp
, 1C
TX-03.69. AMENCACORY ENDORSEMENT-NOTICE
e
Thiy lRdarument loans o pall of Polley No. C=4770227. issued to ...r._ .
by Iho . at Its Agency
(Name of Insurance Coiopony)
Ia91td (city and stole) " and is effective han
f)2:01 A.M. Standard Timel
(The Inlorrneslon above Is required only when fhls endersernenl It issued subsequent to properotlon of the policy.1
Thiy "dorsement forms a part of the policy to which attached, effective from Its doh of issue unless othenvFso stated herein.
This endorsement modifies such Insurance as is afforded by the provisions -4 the policy relot•
Ing to the following:
COMPREHENSIVE AUTOMOrAt MASILITY INSURANCI
NASIC AUTOMMILE IAEILiTY INSVRANCE
GARAGE IPSURANCI
~s respects bodily Injory liability and property donta/o liability, unless the company Is prejudiced by the Insured's failure to
compply with the redulremem, any provision of this policy rtqutring the Msured to gift notice of action, occurrence or loss, or ro.
Iluiting the Wilted to forward demands, notices, summons (v other legal process, shall not bar liability under this policy,
4 20
(Duly Authstised Representative)
FORM TX-03.69, AMENDATORY ENDORSEMINT-NOTICI
Texas Standard Awomobils tndorsemeet
Proscribed October 1, 1916
i
` 2A. EXPERIENCE MODIFICATION ENDORSEMENT z
Thrt t1katernent forms a port of Policy No. 0=04770227. issued to
by she . at its Agency
Wome of Insurance Company)
I0cote0 itily and stole)
and is effective from .
(I
x,01 A M. Standard Tirte)
Ithe InforntNion above it required only when th;1 endorsement Is iuwd wbueuent to prejrerelion of the flobey'l
This tndorsemenl forms a part of the policy to which attached, effective from its dste of issue unless otherwise stated herein,
If Is oti eed that such of the coverages of toddy Injury Llsbllily, Property Domoge Llotllity, Medical Payments and Personal
Injury Protection at are afforded by the policy are subject to experience nosing in accordance with the Automobile Liability Ex.
Pc'rienN Acting Plan for the Stott of Texas. The experience modilicot,on applicable shall apply from the effective dote of such
toting and premium adjustment eholl be made ;n accordance with such modification, subject to the following provisions:
(a) The mo:;llicafion op licoble to 1}o policy as of its effective dote sholl remain applicable unlit the day of
.0/ . 19..0..., or ~
(61 The next marmot unnlversary rote dote, at whlch time the rates then in effect and new expcilunce modificotion effective
at that tl.n,r shall apply for the rcmalndtr of She policy period.
IDfi1. 1 21
By ,~1,?'~a. _ .a a............' a~
~ IDuI A rthcidled Re resentollve) '
i
' A
i
FOAM 99-ERPERI[NCE MODIFICATION ENDORSEMENT. t", 1
Toads Standard Anforneblle Endorsement
qr»bed laneery ib, 1975
1
~I►
71
Fy p , r
w f sftaclvnaM To ~f~67702}7
Far FotKy
T"I so~6W WLOW 14 FOIL COMPLETION OF THE FOLLOWINO CObERAGE P^ tTr
AYTOMOkI PKYSICAL UAW INSU MCE
icCNEOUIt
The rnw&w afforded IT uNy with respect to such of the Coverages as are mduled by switic premnwm Owge or &jrtr, ar„t Can only to
a) IM Warta That hM a speufK PrOftU"h chrlad to indicate Comsat and
b! 0 ►lRd AufomatK, loch ooveago for nevRy aopured sueomodles as Is designated by Code NumW%I'
Covraagets) tIM)TS W LIABILITY ADVAKE PREMIUMS
0-COMFIPE14ENSIVE s We
P-COLUSION Insurance is afforded only with F.sptld W %wh t5#373.
AuWoi*lo Physical Darnogr Insurana Q- FIRE, I"TNING OR covand wtoeubdos a re designated in the s1#946.
TRANSPORIAtION scrhedule s AWI to The Vinrh of L"trly OWKated
that Automabc: TO O No R - TNEFi Therein. The Asinanca for any deser"d cover" spa. i
wtanoblo applies also to h repaeerneM, subled
S-EEAWINDSYORM. RRTHQUAAKE OR EXPLOSION to al the toms 01 ate policy hevNhg 0erence t
AI>senu CA Miry Means 21 NO Thereto.
T-COMBINED ADDITIONAL sum s
V-TOWING $25 tar each disahlenwit t
fatal Advance Prernhln 7#685•
CMRER ArTOWDIUS y
Unit fown and State in Which Automobile ear of Model - body Types wit ModrL Ilium Site, fail Gi
No. Will Be hincipatly Garaged T, a Name C.praM OF but Same uo+rM of
(Si Serial•No.
$~B 0316642
Mots of IN IP A 0 . Heavere and %sinnr, C . Cesunr.-,1 "ACV' . Actual Cash Valve
tau yawn
oft I NO" AM w Omit h
UNrt Of Month II t* q oritt fa saM eei eMn 0A4w Collision
' Opefa110nt Yq w v F1RpeM (latlfih -f
Nr In mh.L Rrdasae Y whd Taq, M Use ratan Mtn Ave w "xr 01dud" 'w OAK*
1wY
s.. E1316 _l~ _ A"
nor r rrrw k h " irw n n w ra.rr r AOVAKE WMruMS
UPA Co- pre too l q% Mr, taw COahQrrd
Nor rwwa " AdMo%A I*"
t s s s s t s
s s s s s ` s
- + Code NumbMilla Newt' AcauMd Vehickslileol Autortutic)e-
ficept with respect to bailment lease, conditional sage, purchase agreement, nhorljage or uther encumtOnce, the named Insured is the We caner of every eoverel Rata.
wobk described herein, unless otfherwlsa stated
AMlICASU TO FLEET ANTOMATIC INLT
Maa+nnrm LemA of 604N
' Code Number(s) for Newly Aopuired Vdnclr'
Enter one or mots of the Vowing code numbers after "Newly Aa,;+ired Vehirlot Any ores covered wtsmobita t 350006
IFor Fleet AutormRticj' la indicate Re covoagn applicable to any newly squired lutewAlts
vehicle (other than replvemenlst An„eevanone Iaetart1 MAN*
t . all corer" *A&" as 5 w ncludmg vehK]n teased to the All eonrod rAwAlog 135#000*
2 • all re"Iered avrof k%tomoMag earns Maur"
1 . all cow" w smsb4s .-4 the private 6 ■ escludbng, under Colhtan Coverage,
palw1w Type a.ry vehtck not having an Actual Cash RKMds to be submitted
l m all eevored sifism Res of ffv Corn. Value of at least t [l AnwlAr O sera wwary 0 euvirel 0 mowr
rreruallype
G W)2 / r.......r~..
sir/ hrtxt d~liatM4tY disc in the WiWd/ r applicable t ornONs. . .
t•t.' s~~tr Es" wrier the cowifige afforded for the ""'of IM ConFtians of the PONCY shstl'@WV to tltie wdwvice
odv7fsd~babfs, tsfovidsd tADI it Such Uerut Of lioM ca vv wexcept "Intpattion end Aid a",
1rodsw "fub0g~tion", `Cha^f►e".
a stated amount St shelf tespere~.tr 1io IS oand 0e not es"i "Assignment", a Tkil irrursKS
eed M qty PQ,d4S ~y M a4o bf" ;cN"iCd+o bW 1~ 11 dtioH or4tiom rllaM
idov
din' , be , Aa~4 Aloo sp fpp~pgd by ilerraif 1n~ured i DYtiei M [►eNt ~ Lois t Ili r + : n
1 I
,
et~eaf 4gy'valyY, ' r ,
, yy
end t a *IW / If to 1ppi sShot, he Icabis stereo ptcseM-Odorto* mm ',I i",~ " If fAt In event /keesd in eM Hsnt of forth nrnW hawed dsn
IM`fY/ielrfnNl)n'limit t.,r* i
wsofaipbde, ber•. tp,;rlpt,edin
ofl % ItY' (s) protect dhs =1Z1
h
insurance appld any (cans n bKt a dtm+9e
I ` IMe io she'Aimed insuree'e feYure to pea})ct'OA not be
t!, The told Nerlit of *a- eornPMvir" INMllty- for, IM loo' directly re2ovi.r,eebfe "to We 'thsUrsollic tesibnabte` etrj,lMes
nds hiappen iry tut of which boo b6Nrti
attribvttr.l b a ef sAafl not d4K.tltfP04 In ellord+ng ouch protection shed be deemed
`~~►d' Incurred M Ohl cbmpony's rsgurst:
(b) IIA notice IAks6f es soon so practicable to the company at
`til li`tb ti'tl'e~r~rid'Iuteh+obRn at any one tuaeion, the amount, if of Its ifrd agent echo also, ittin ilverhtof theft or
any } cad in the schedule Of the "rtaximum limit )f liability" la She b , .
Simi ' ~a hr6eny, to She tid+a; '
abpgr1} tha(tto, s11b eel 10 the eboye prOy 110nt respecting any
on 'eao¢ wtoenooki ic) file with the aft"" ehlr~ g( npaYi, after W. nn }worn
ptoof of lot{ fin tuck y,fo
lot rmal ldi, dliy Such'v.loarr+nroN IS
s Cqf~ pwend aYbmobgn, the amount, if any, elated in the the tompanr may, reasonably require and, upon the
eduTI ei the "maximum limit of liability" spplicable lhereto eompany't ragwsl, shoal eaAbit the damhaged property and
` 4, Mieet to the sbov/ provisions respecting Ii) any ors covered committorMamietion under ash: '
automobile and Iii} *my one lotaeion. (M'eocpa'nii `Will coil 'longintfi' Yid, 'spar)' chi ` company 6
r,.
IIIPOtICY PERIOD: TERRITORY; PURPOStl Of USE request, "it assist in making settlem/nts in the rt.nducl of
tihis tins`irir~a ap plies o Y to loo wnidl bxws dernrhq the polity uillatd Jn epfpr any 00t eleonlrPbWl 4 4empity
ek.4fQ'/~te)IRp. Y 1r~ o tie
iQl~n}i' Ay pllr in
period, while Ma covered autOntobNs' k'vYitTlin" /Ae' United Stites of 1MYY!rSi, 4a 1¢~f,4sf ws+rc~'If+,n
America, Its twritaies of "slillborl6t Cehlds, or 61 beF09Iismr~onrd ~[+nithM~r~idr~1'aPWI~s a, i?ha 1 the !h moll
luari ~d
between porn thereof sold; if a"sawed lutbehoblis described in the elilli i Nti flh{f • jivlq iridCnei s bbsi n rq ii e
a hmdul/, is me;ntalned and used liter the purpdtei 'etatld Mnatn as nfanda1 wilnatses;
floWill thereto.
but the milled f,twrad sI11f1'noi, Iirepj'at lira oyrn coil; yolurUiiiy'gslke
IYiAObI'410ttAtOS f1NITgOhi$` ` ` any payrihsnt, a+'iurne 1ny`obiigafion, offer or pay sny reoird to,
rtcovery, of .)lplon propeny ce incur troy ovpense other than eI
too, 4 a see rf+lponcl to this Insurance linduding enderseme ns specifieMv pntvIded M this Insur/rocs h, r
faminlWn a$ thaponeyl:,„
"carnpte body'f means OR body designed to be mounted upon • 1., Payment la Lou situ fftd,tulomobik and equipped its stooping or liv ng quarters; ,•,Wlth sistwi
to any for covered by this Insurance, the conopany may
"eaMBioo" Inure fit <JMision of !'edyeled Mansell inoth'Aroother pays !Of MA lots in Monty, a may:
`,yp,py~~lett,or, I~ff{{'~(.1t a„ .JhiFtd, ),Q which it Is attached, or Gil upset of such 18L;. 1 11 1
repa;r Of replace the damaged or stolen property, er
pOWfd'iYtaRlOlre `q
M.,:><r' v; .a or~;f.!:he.ry~4+ru ,(bl.leturP N ik,RSptl+cr:any ppkn trOperly to Ma'Nf11sd
~~ommkl~af re mw~xv „i v , imiws}f.,wilhMymM►.Ior loy fnulanK damagetMtivi st
any tine old: the Ias is so paid Of the proptrty is to
c f1) lOrr ir*0111161441ruck, pick-up, oao~xess, sedan at ,41 , I^4''teplec'ed,er
c,,v. a.tlsatf.nee
par,el delivery type. including truck•toi trectors, traitors and the
c9 ' semiuaPiert; rnsd w die wJnspmlarah 0 delivery of goods or Art„IE~I lOp,lft,,,iny~f~ yPat,f!'Rf~Wited of stolen property at
'rfFc pl:,hR~~1J~ar' Ic. fr
or.
c«ai`'f1::'!,f~IHrgGmWl?f3Rl'rRBhrlrPla t xbr; +r; .s bYtiK+!ltsahMlgtnQrh+g4aroP^ltoliieegmpany, ,r, o r .',r
Oil m allied priv•ls p!aonysr type vehicle used for retool of
tm, tfihahsaladdivwyi~','` 3. Awskul ri r,:r-,1, ,,~l, c)~ 1
icn-tt%*vw@4w"mabile' mums a fond motor vehicle, trailer or 11 'eIrllerte0 •tS"` r"`InO 1~fyycOntpa my loll tOragffe ~f lO tM /ifWVr110!
p malme r,ntty r. iaIncluding uudtdIncluding its thereto Shut o (but rot not hnctanduding r tobs. yvsering equipment lase ahthef'naYi within 60 days after proof of
low is filed, demand on
prrmsM
epWeal htM pxlonat allatta);y'ehith IreSlKfe+r'+,"" " ~ rte " 1" apptels}~ol, the tor. In such event the named Ofaured and sl+a'asd as i
1 : t4. .
J. slu a Klttt e,tPtlPp fN.IpPi+>8 p ,')eft 0
1 1 r] t.
Ka~ Lolval( l Ike Ichedul1, bv'desarptio~l Of otherwise, n a 0ompiiene and d+sintnested l+mprte. / awitist a I state separately
lowered nrtbmabils Idtvhldt Wit"Gfaflce'aypl,et am she wtoM'taah Voilut'ehd that Wlliftht'bf leiP'lyd failing to agree shall
~L4 4'L c+:,_n a a t..-• sumr~th } 1u1d~f( genets to the umpire. An amid in rooting of any two
(eh ,i~r~ yr d ( gin + ,half 0 timda t~e amount of lose. The named inanw and the company
t.l 14,lI Igo the oriented Insured fat a term of not less than ore shall fachlply'itt"chosen appraiser and shall bear egitohy the other
yearurder an agrtenant eapraodY prohibiting any right of jihpsli0e}.0(iflf+.OpPro101,"*TP!fll• 'c', n',
r.111"4411 Rho letsor or overt 'A u:e such vehicle during the term of T j
qY ,hall not be Aso to Pave waived any of in rS~hle by any
)r 0 httA /#Np~t fo r $ X11 PpaL4oll "played by the itj 1Q Pppri}tsllc., t t +
named aniseed tA npair`at pxeharl; a
E rr r r i
r r n n,r Ot 4. AraioM AlarAs(C6rhpa+yr
Holed, such veh+cls is roomy acquired by the Nq~ft'•41a. sh have been ro ompasy untele, at a condd bn precedent
r,onlblyd( o>oo,ISP„t(tK11 tA>reio, th ro@ e sAsll heow m fdf eomplilnee weA all the arms of rn.s
rarned Insured during I'%@ policy period provided, however, that: Irauranl 'nor until SO days allen proof b! loft is Oiled and the amount of
Ao automobile or as of the dale loo isdotefmined as provided in this insurance.
r e ads}, r
! g op
de r
h'"~''r' r~ulObd a y , rhoI~e Eq„M tyj rdreFAlVii~^N,u, s , r . r,~ , ; •y -i a. '
J,iJ r., „ ;err „ r > Of the named lnwrd hoc olbh l^sunnlt'Mai lest a fart6vertd by shit
Ili) IRr ,.01611141¢ insured f$mif,es ehl company WhAVot 30 days Irp Wind,` lhe'lla"WY she hall be liable under 111,/ PMSea~eo' for"a
«.,,101)oeangsucitdaforaoydltal'"r'"II.x ~rexevpropartionof olIM than the oppl'efiblellrylbfhabrlrlYsllled
scurf"'Fbierid't#rtLlilbblb"'i 'n~in'~t+elurye`~vvel+' f{'ovor,446 or M+ the soh fl, tplt to the total bwocsbla limit of hatrlrty of *1 val•d
LnJt9ealtS'QMlvfRfiMf'11QlAaY Urdnndual partner or eaetutrw officer and ~A e' IP yno ~ l1 ~1 sl ~r h APT llolyeof"kvorIin
of the named Insured, unless specolicaily staled otherwise by teti ! eY~°'a'li. Try„ 4Z 4F.114,11,11, ►WICY
pre f ~r 'l lfi " Illy. scows 1.Y lp
r' srcf4dpNl1ltM fQfmi(ya,prlatOf P4tKYK"urS ,p n q,., ~qq ~ y~ ~y pp
an1hl+eNt1, r ~i~~tA, ~M+q Mti f,Rft M,4fY.1alSQ,{rod KRp1il lien
rr e"JPk . ')tdrllGl~lhd aeu'xnul lop at dsrvpe:
1 tr t Jt+d .
•,private passenger type" means a 41-vvhrft I" motor loth ce of the g. He /trafil Ifo IRA"
prrvetf Passenger Of satron wagon type,,
None of the (Ya NilOnl of this mwgncs shad rnu+e deecUy or
u to "Purposes M Use" I Jl'I I JYi lt3l f k l,If,tiilCvf l:4itlr1tC11c1N1fltgt'1/fla+1 of any carrier at other bales lot hoot,
q e f ortint" meant ere primc! f0y in she business octupathon of y. Teems d lowrann Conformed io 11e0tvll Li t'e
rrimKlerr4`% cd insured at stated In 164 600apoltons, rnclud,ng
occas onol use forpenonal,pluiw/, family and other butinea Terms of this oMYrymcf Which are in conlllcl with the siowtts of fit
pwpplee State wherein this insurance is Plotted of hereby smendr,dy to tonlorm to
!'pleNhrts and butlnrr" rraant personsl, pluswe,famPly god Such staliites t[, ri it'}t1.11 li7 kv,'-.e l"
bushmess Yee.
;bjrvn.,a si-3 }ror:an„ ,a,v.tr4 a '~:b;cer~,+,'+.r.;4►..~ -r~`.,~~.,_
a r~+r f:f^ua F~ a-/7Ql1irt 7
ern 4,a,;,^4,, J,, NiMsmfM 10f" b.Nrl
w~w/a w♦{,rr',JtR,. 7, •'•4 hl:v':"...y t 5atn,i 9 •A 1 q r a R P<r r! ".l t ,o, r.ItA aA r'+4, it t.r
WVERAOIt f,~!~'~' aa{ car a , u 1 t'.r 11. :^t.')', If .r r ' 1.41 .,lr , (Y'1 ' M y, ' a.4 ' b re, ( ,v fy- 1/t J.+
16. _r 1410 'j°'r.4+#111 NU [ dF , • ~H,:a ry .y"..t I e•J V.;jry+'h^.4 PHC
It 1 V, I- AUTOMOBILE PHYSICAL DAMAOE INSURANCE
..r. •n,♦ tv;4 _.-0'c, ,•f 4., 'n. 1 t . . i' L'.+'IY ~.i ds
COVERh4t AGREEMENTS; 160oad 10 the tomworalnK sod f^ , pq~,Ee, and ISroyn.sif,Y leg+r Ins
1. The tOfnplfly mnt gyro'p I;on pf tho Ref Mr t filif 1, ay rhoprQe ~t
I pay fy loeo to 10YRrad automobiles under: P ty !r> udi r 30 {
14 4}e of iM t6 hy.pay% for the h»r. it cats IP Pliant!
C°vo4x0e0-C0A0NEHENSIVE uchlhef6"tudlitrrtitjury~ IShallfortf,cetdSOOfor Invpneday
from 'aAv 44LiE"eAeepi colhslai;'tilit; loi 16"OurDae of Not not
~jp~ IQI+I
°°orrayq, breakage 01 Slaw and rasa bused by m,4t,lrt, felling
1. Such insurance as h afforded under fact 'eevonage optAvis seParitely'
01 Jet, theft or larceny, windstorm; hail, voilhiquate,: to each e00nd aufo,iwbdo, and a Iand m01or vehicle and one or"
+IpJOSion, root or civil commotion, malicious mischief or matte lrailfil Of semar11,101 8111tried 1116ftto "It be'hefd'16 be
wndal,tf!t'; watfro 11o6d4 or egllidipq with a bird or frnlrrlpl, shall sftssffIl FQe*r!d 110101'hob,ln as respecss Irmrtf of liability and any
not bop clt+mtd loeapuied by egIIWOOl; , aeduttibte pronnorls appi'mit thereto.
'
Exclusions
CO",r+a~-cbulsroN ,
A s rni ante dp ~ i
. J y to tMl IPPl'Y _ .r.,, , ~ r r„ • M • 1
caused bycollision: tat fo anV'tt*Oed'e4IOMbfaile while used as I public or liver
COwrregeO~flR , i113HINI~l0 0R TRANSPORTATION FMveWnCt, p.Ntu Such use is specilrcally declared and described in
mused by _ ; rAa Itl+edule:,•.', , : t-,.. .ti
A , ! r r l V ,t,o d4R1aRR.W140 a clM Ind Sant ined to
(Al N FS pt.1Oht rills. (11 Mae and flat cor 1. .
(b)unp a ove,,gwf1Ip sudden, unusual and foully r^ lii rtes, "r y 1 v r
Operation bl my timid heating equipment serving the r a r
prem,ns rl4fvhrdt the"cbwlied aotoorr ile is located, Or ON) mechanical or tlacirital dbkdOvin Of failure,
tcj the Slra 4drhgsihl ing. bur III collision car deri,tment of any r „yevis~ sy ,dtarnage, ihl,`IIII j rastA of 9th of ' r ,
tOnwyllri in a upoh VJhrth the tbvfiad automobile is being r~#Yd,1je1. f, ION, fOK 14 by this,
tron6ponedf:v21 a; 1'..,1 It < I I
..v I
.,-.,t;' of , ...I 5 rtr 4,,. :r. (01~1011ffs, Vnlesf 1 i'ri '.rr ei,,. i. - Gi 1s.a 71,x, 1'712,
fiyr NwTHEFTM 11 it Ioa'bt COlntilocal milli aij bct e}ta urn* cause'li oit+a Tai'
ousad by tills of to-t'ency; oilrhed by this insurance; w
i^:I tv 0;c n n1ir, (,ill, OorfloP4 by rrr, pr m
allCiasis mischief. cc vandalism Or stolen
CowragiS - y'NpSTQRM 1A (k, F;ANTtIGVAKE flR E xPLostoN and I o q!~wbril, ton caused by Wchdamage
cautbdbiv wtwatornt hid,authqua'RR M oaPNoildml 1"' '9fcf 5r r r f R'
14,r,' •uC~n(1 u9 i,rxp If' r q v_ r• f: i.:
CoverWTa'COM1111N10ADDITIONAL- i1:*r . ,r (d) to'Ossd*(6'1 11
noted by 1 i ❑a. '^41 r. R NNr It f^, 'ra r, t~,U :,r tV
If) war, alfteltt,*r 0,1101 dodarreQ. civil ward it,wrrtCNen:'rebea,on of i
rQ[[rt+<sluix'''~rl~ei~gWks"'Itm,(fmii N,41 us it* of a port al iors, '~VufrilaI at log ioy all. OIL condition : vilicden1 to a" 01'-tMy
wl.,!! JI!, Ir,I
',V 14?. re 1 pI rI J7~l b, ~'..n e ni.,,, '041-1 n rr S•~'•J r'.:~r r,IA'
`.++f~ 1 a !1 ~1 :,rY4..a t., 1" j 4, , e (il/ r4 d'08 t°nt/frliJlplwn.
let 1ht forced landnld of •falNna 'Wooly iirefett 61 Nfli'a nA man rrq t •rr
~i,try,, r,1 (f)rf.~t10>A1Qr o„ r l,,a r,.. •i, i'7 %'r fV r i„~r.,r; 11,. cl~...r <a ;,,YA
o,!'-tnp~~a{l^,i a ^1 z f.,r,t~aq fir z.t rJ f:, CO
1dlenatfpglArnt><hNlpgrtdafilmJerviLaJ 1i` 1'y 4^,hul• n PIS i-411eYi`a, (N+ iMlrUmtnf designed fir the receding,
t.' (e1 fluid or"ry*M iMteh, or eproductibn. Of recording WrandmraeproMMlduclion of sound unlea such
of r .;.y1lflyneR,INrfnekufpant ie y inuaH+O in the coveted
crifo , t -rf.h ec „r 7 .r•.:.,4. ~r
yyU .a jj 7] uy~IIkke~ y 14AN (p /1e
Cpl la~•fY11a110r ILM7 01 water. 4 ..t.,.4 ,f.'.. +t,,1U101~10biN: C•. ',r .rr. a.. ;w r7:,..., ;y9.r fit
1t of q v' r„cm e.,A
I n'r f fpecffr~ia t'-`1l `Hy `1.011 i raE''r~~, 1,¢~~,~.p hr.~cr~ -yak ,
dUI~1d tNaY,,!~i #1 ~ eh coveted wtomobilt, v ,,1'.°, Jli'i 1Sr`"I Ifuu~rii~e' de pll OF the $ cr r' rng1 ~rrtplod lion. t
61'unden the Comprehensive coverage (eattpt at to low from any 'ecordlrpandrtprp"isonof sound,
",M %%t 120406 do,tfibed in the Fifa t4hIAl11p bt TO MlfotHrdn ''r r t a • h r c
t}JryJ , r
s "tiwtlragtlladtsnldet A4aCoiiflofredlMi 4!k!4 rf) to hlta It? 'do Ne bri,s~uiitIV ilvii~v
I qRl q„
o ~e ~ e
i. V dnlyl for 1111141 im0unt W'Mlth Iodiriot#il 61 till and Plot
Dil l ro~,
aarac11r11, d any 11a1id to Mo lthw de as Yp{111eablt 14' bath S
lii)4i`i+der the ~om~rne~ AdditiorU~ cove a aifbf adult ' tMrlof;
HI t.oA1RA d1a 1A10idt sR'Ilah'ao1! ~WNl/f b~ G~Ifdiffua mitchlef or c~ i,,' r,.r : +rr ,i ru ,,,arrr R fit, +u 4 ,r" r r 1,,c l of
vandalism. (9) urndieWt`64VrAeAsJose jflab.fheflf',61tr,9'Alf6flb'{s014 ag
4u`1
s",au s 1 nJ I,r1 a_'A r'.a I r s g
Z. The company will payiundep ! e err.; n.j 1I c,, IO coin Vertr toyno!,t1r011 by any pf'10n ,n pOffetl,On
r'r. ,o1ni:.r~,t1 I,,,,i o., 01 4GI r1";a 44. Of f tovared ad automobile W10f110`ie: Lndel,a'MdmtRt:Jt+lei•R'Of1Qt I,Onal; pltoq
COwt9a~/r}¢y purthe►eairctmeMlmorlgeefaothugntumbfonce:r Fla
1 44 irr{UUK pgfr 3yi e„ : ,1 t A r,ql»rJ . I,;c
for lag EM Ohl under th~''~oA, rbA' real QhK~i ij flr t
1 ~I f ~ necenl~ltd by the dsabr„aunt of D+ v~r7~11 iidJ f ii '
►~~EE1l~~
cove .1 I , ra ldtld4 e1C i10 a Die hG ,h~f` I yl_ ~,~a
ofd, erI ¢F~If1r9. EA, M! +(lplp}eQ1,iAItNCO *,A ei
rya 0I'K1^,i T! 'i'' ,1•S a u'iiu I' V 1 f'i tr'+,. , (i) under tli f y Sfb9lr f4a FFaf lpOUflle Or t losror~ n4 ~gmp,ned
3 iUFdItMehfAAV11091Wtv1143$19"An 41.:.i,•:, Addrtionjf't6iieffigh,Id ~dst4Fte11tu1p9h~r1~ 1F,N trib'•.V tt`Mrrel
vohe , f'NOtWIhdl rhtfn • ,
In a,oj ftqgfti the applicable limits of I:abifily, UH company will: yrcrr„ t 1. 11 1 : r"" l.f , 4rt r,'
41 Hith tespatf'tp tcah tt ,.,f II UNIT OF LIAN III~Y•, airy t.,,n:.i•r,, s,; 1
rdR "1/lien srbGnil6a tl t{silfdldaE'11irYAr 4 ,
p1Y INY+nat Raaraie anaaafna4na'afalgea'Itx'1Mkhtiha MerlWd IMiuIW' r,+ 1• The hrrif bt'MIY ECmdiliYa limit hty'r(61"No's If 'itly"brie edllold r
becOMPI legally liable, outamobth'ihifl Adle fiffillo Yeiw6f ~ihY fb(14AInjj,yiNo un[f t'`
I. 01:. I r. 91 1 1 .1 1, I, r 1", ra v t, I 11 Ir ,v: R
Al INmb4dN tha'na W IAMOS, 1" '11110 avehf Off Ilitl1YOVited by the lal lh~ OcIpef iash.ylfw Of 44 eP!If/d,o 0tiaedails, & is the lOU i1 +
inaurant♦ W in: ant ye a'oeMfH1' aWdJne~iN"'sf tM`~(liYatl padaegerl' ° a pail thereof the actual cash aiw of Such pa, to of Irmo of
type Anot WA04 Ra I pfrblfd W i,Dtfy, bdnvlyiltfi SIM thOff'41f11AW 61 • " 1 I"I«ti l~f un ` 7 In.n, . v r ~►I r,x'rlk'i 4'i„
theft fNi~Ol h 0 vhy an aWOmobilt dealer), for espente bl nN "W MIA11' N?+1"fbit' W*f'ir3Yurl? replace such citified
incurred 1• + 1 f i et1
III ,F41! ul tfl; 1 Q 401f ~u.IPfROblM t t. • wtOmuu¢~ile of part lhere0 with 0116 pl IoM kind and gwbtY.
during IF riF° ~124:I~-S'Q}+ #"'f Iu5+1,1.+1efd,.IrN1;bTSr1 t+r"/4nitiT+'3egb~tiohlor'~IbiN?1S1 r'°`J S
rr^_.J 1, rj ,r v 1.. . : ` ~ 1:. r, i l 1 r . "~1~,r,ua •4 ,win ar.~ I w+l r)a'n1 s .,1 ~ ~ ..r ,
o 's rtr.f w
i, L,i(R YAINCf FROM 1 AI' Uqe.,J y•.1 t ..aY'"r-
yIt in,
I'r `P: , r if 4 P 1' V1 v ta,y,.r) r 1 1.:4 [u:r1 ;.a 41 rot OfJt t 4 ry.,;l f li r Lr, 4
0.1QJ,~1er' I.,l , , niI Ji,.lnrr,vl''4wrv'ai,•,ril 1)N(?I{if',';t
F
kl it limit of f *ry et~lt d i lov e IN
~Gpt~ 1 IT10Prf
ullgrosilae,provided oh„ it sod umli of i roll tOn! of IM polity apply to this metur ante
•naad as a stated iinoual It shall with respect to '~/'nil+nt". "btlO.ttion and Audit", "t;tbr tsonV11111n10016
1~pg pQI q ~.d oqe
sunnce rise
•
, ~ ~4^t, eft' .lao.~q 44404M~t tpP~.#q Not adby /Irobl~lupj/t~~' d±i)1 1j16 1r5¢tal f lolsial I "Tito h M
1:
:I
to #4 ab01'e + x „ a . 1.' NMsrA tFimred'i DutNe M Eient'o~ soli
y tywnt exeeed
thd, ~1 if sorry,. prolnfelo dlil /bl OR hh ' , ' (rl As W lao the fella. ` r t
~ the amoum) K ally; sassed M lase pc heduN aa'the''4rktlkexf'm limp Ins oM 1 Burned inured stuns:
. a "",ttl" OWN bM wilted atflailieblle. 1,0 VII; 010 1 a , 14
,Itch
Insurance vrlfe(bar. qr NI
aWies to the too and any funiter lost or demele
1, The dotal Mink of the` tompMhr'a' Ira Ity for /h loae"'Ukattly " `h t to the' AcMad inctylid{ failure' tdotitf sa+ail not be
t,' ' atWbutabie to a largo h/ppening t>,at of ethkh loaf dbalre shall not
::1 h l (A ryeec..ebrrrabH 'ilrider Hitt';' fmJnr,1%: aloriafNa erpeAies
tolroo) In affording such profoQion shall be deemRd
Inc tetrad at the coK.p/ny's request;
11`Ib' W
sk*IM "viiAd"Iirt'e6 .1so at any one location, the a.nounf, if lot 4'lri holke thereof as soon as practicable to the company or
any,
iptpb ~ ~ afro, in the event DT theft, or
'c i din the ssch as ubjecttto the'above provisions respecting #my kl f 1e ew;lttt 1111 'Pit.,
,w ew+r~ 0,19riwwN'
q th ~ I shot IWe,h tyyorn ' sch l5 ail greyed automobiles, the amount, if any. staled in the proof of toil e'uch'~ti .,W in1 otud,rip such
infamitlof`as
d ii the rnuinwm limit of liability" applicable thereto the company truly, reasonably require and, upon the
aublect to, the above provisions respecting lit any one covered " company's focyost, sha'i exhibit the damaged property and
automobile and (ail any one location. submit to exit"nation under oath; 1
tit:, ,r till eiidpeieJhi' 'rA' 11'f I'-
III PERIOD, TERRITORYtPURPOSES OF to ~ 1 ~ d, 'upein` tl+t Mmpiny s
-j r c r~;, t , request, shell assist in making settlements, in the conduct of
The In~urei~b y in o~,Iy'i0 tote which Wurs dur,rg the policy yi
stf arid n ! f
.y prey a y piss y1 COn1rii,i~ Q derr+ ty
period; while ths beeerYd wlomobNa N'enthin'tta Untied States of r, r, ijlNQJ' h hif NP
fC1IMI!
America, its tairilbriet W pasetsbM; Or Comedi or No betn4trihipbfted ,r a 0, { w1~ ~QaP.'c} ' , , r
betwoewporls thereof Ned it a covered bu iS;4411ll rNserWd'IA the ,r yI ii "~~pplIt , a.. Ih{li altEaiM ta(,r+Qr.►o
sriaf~ jnd
tchoduley Is maintained end used for thi puepbias s(itlb'Iheriln as 1s it i ' fJc nSl ~ly,},y fvtde'nce and bbtofn,ny It,e
applicabiethereto.''..s:.., allondanee01villhersesi
1t/Ab'bifjt)NA~ niE~lNiffdN~' ' ` .,Ml • " but the rrlA* I, ,led h f ho}; fii~egfj his owim Post;je6tynunly'make
„1 ens,'es ihs xv, 2,14alian,'o11er or 01114"
ain !ny re4rd lot
YOMM' imiid' A `riteranti 16' his Imunna lnnduding endoitements recovery, at.st en property or incur any aspens olra than as
forming a part of the Wity):specifically W ded in this insuranta.ni~~ ,...-v,
"tamper body" means a body designed w be mounted upon a
rrovtrool'oujorpobilp and equipped at sleeping or living quarters, Payment ment for hiss
,"solution'" means lit tut WII" of a'edWfed ftlomObile Ixrillf o4 othsr pay . i for l wd Ion to any lot, r,rTly by this insurence, the company mW
°r ss in ions', !!~y:
ZjT;,1,gr,rnth },,yeTlrR 19 which it Is attached, or (ii) upset of such
bfi t~ LL .v . r, _ , _
vend Ica{alto i e; lei repair or replace the damaged or noten property. or
a~oinrnjretaj ~peu rt avn6, lDt,fltutn al Its •.iapoolse any stolen properly to the roa old
s:tF) ,,v.,, IshvNA"with p`+~!n►.tor am rnulunl it"#thaeso;/r
the Icy is to paid or, the property if w
Co.o6l aLfarld,la0ltK. Wilicts161 rtlw truck, pick-up, arprrn, sedan or I,., t1,14 311i ad or
panel delivery type, Including truck -type ltactyr,`trader A and '
r'rsrom~milred~a~sra; pUpsred0rJoor'l',the itrMtpdrlatloh'bl delivery at goods or (c;,, , R E~,r9t,1, Y (p,.~'ftiyDa Jt1R, tlR?+ged or stolen properrr at trio
(;o.nie.7r ~r!~7GLlrtlY1 )T`111b csFrlRCr ~Q~k Eli 4rfi)lil.1., iti nT~l~~/of fls' soar rIi`t i,"mgr,va;a.^a!.r,
III&An~allowed W delw~ate passenger type vehicle used for colon or but,si!ehahagl Agpbagdottl4yMlotri`,cpraparsY.,.,R„i, c, t,e;su
Ya ,r.
Cl`rtMvKpeldlebltbiq" mans a land molon vehicle, bailer or J. Appraisal, Ir+ tr=:'or Ott
semittala. Including its equipment equipment it {i, i r •tr rid . r r ''~M + sy move nyr i~,~ .,.,,s xanr4 yr equipment and other cae Aaerf
Erqured i throb sal to agree n to (11a oitwuAt Of
pernuMnllyi attached thereto lbut not Including robes, woofing fosse /Ither mayjwnhln 60 doys offer proof of loss is IIfed, demand an
apparel W Wsowl a111eftl: odI Weilhet r1 10lr..,, i 0 11 1" ,ri nppliats,) ,gtrtho loss. In such event the named Insured and pail company
W1 1N?s4nirlj"in'iK`e' ichedule: y"deio~pbi a oifie'r'riiu' gas r III dQj t l liglplfrl~,emel~,y~r. jnt.th<I 6ADSeifflit "I„1sl!sl!
Wiforad suteew►ile 10 Athidt this tnl0ttanc{apphW Arid 1s' the t ~ /slue al adianter 0 umpire, The aan slate sr eel s all
n..., n 6 i rF,a ~.i 0, "t,~ , it". 'tlfAl V'allll ahd llq' tIM84ftt'M IOSeOW'/ii $Ad s th tailing l0 peel shad
I~ n
;vi t,~! I• "ti~. 'M~'' fl '7. tiw~ runt;:,~ M Ire'+m'~ sit 1;'~; Ifnll ('heel to the umpire. An herd in wiling of any two
"it or ei"Of t~e amount of bu. The namW Insured and the company
slit itifttAo ,l4lhe named Insured for a term of not kit than one sMH+'eaalp1y)tte`thbssn appraiser and shall bear equally the other
y/ r ulntodeer in agrNlnant oxpresdy prohlbitirg any tight of As rtph~a Ifaor or owner to use such vehicle during the term of t1Ttf C.9.PI Ah. Ihalll n00,004 MQA
ot be holdlttl.,,r.a i,
~ir ny shall not b! Mid to h ~s inspired any of its 0011 by any
COO w %N u ni join jg"ttp1hff M #p t?.fZlfldyh MMloyed by the
" Irsswed or
miMod for b repair or exchange; or 841 itrOl'9 to AW1441 fslit + y r c,. lit,: y a, m p ri ri. Dp i
110 1, WO.C.1, l'r q4: At'tidrf AgalMt$tt,15pW 41 car v b^lyt tn
C~'•~ i~ top, .4tlignoled. such whicle is newly acquired by the thnTtoftif~ieiirs~asif bi~e pe,thf.c l pp ny ilncwhlI CNonidition pr precedent
nsmedlnsur during the (ohtY period provided, however, that mpl
1rrWretlrep until 30 days after proof of for is filed and the amount of
tau autompopbile, or as or the date u Is diurrninod as provided in this Insurance,
rr 'Y,.'>I dfri POi % hrsh$~^iSei bar ~l~ b~i P rr, ~rad 3 , t si{9 i,.r, '.fit:
t,h,~ h: , uol
Gl1 1~e r nalpetl Insu+red nO,.,tifJ,N „j she u. r.E if ~,1b 9' I'• net er r , ,:I !i1 ',e n, 1 ,I e.:rl a,.t
t . the cor/tpany within ' JO 't If the named lnturod hill lothh tMuronte agaiMl i sons covered by lfitt
v ..,r) 141ainllue nsuredrydetife o he y 0 r n t, ,t doys IfNUreridl," Ih/'tampany ~ incit be liable urfuer this ii'ku~iilcP'!ot'a
bUr''Ydare4 Rile)A66haW`W$y'nil('rnt~uber~"vj?iic(ir~riiieb'by a iinn tM Mop DrlMrrgsti to lt the e Mos total atkansetspplrcaappe limit of lists ht of all lil d
rJMVY td Rb f 1 tint 91 l cab silty o all •ai d
Individual Palmer or executive ollicer and' th car !'cR fu fltP, ref, rah
of tho named ins,md, unless epecilitatY stated otherwise by fn o 1stla if, uX ~~gm
I Lv.endplfa.mrteol,jarmipg+IOOmt otan pglsrvp'u n is ,.u " rj Y "h r i f, f~ 1y l2ot oh 1 4 oippp r c
1 014 t1"1t"f'~,R!rA41Q 10Afmd accidental Ion or denutt ; ~y if lh til'P l^ l'1s.Ps( F' vai~V,ll~kl tP~it,I~~t?If
"private passenger type" moertt a 111-whoa land motor whpcra of the InsS f♦I?
private wiienger or slelion wagon type; 6. ere lerrhl lolail►s
n 10 "pu7osse of u"', %lt None of the proNsionl of this insurance shall rnvre ddetrly OI
" oes of meant ue principally In 1the 11 busl~i ns i ou t' IIA etCvf i]VYWONCIN40.04bowi1 of any carrier or other bailee for hire
t.,.lr,lyyC'(r V ad enured as fisted Fn the dKlaiations, Including
7, Terms of rnwrantaConformed to tu,y,e 61,110
oeta swul sea lorperlonsl,plusvre, family and other butineu Terms of this Insuranca which are in conll,ct or lh the sltilr,lH of Iha
purposes' state wherein this insurance is flow" are hofeby amended `tot1 conform to
t'pleasure and `Nriew" meant personal, pleasure. Iam/yard luchltelulli, tors iol4'".'rui i E',I y: yr'I.~~`A1G.n y
but nesi via.
0270. SOUND RECEIVING AND TRAWSMITYING EQUIPMENT EXCLUDED
Damage Coyly A t~aot►s(Ie Policy, Auto p or Combination Policies, Autemobilt Physical Damage Policy or Arta
Physical ttached to the
IT j ena~i}e a
IAE Ii4 it only to such eF the coverages of Fire, Lighleing o"A Transportation, Theft, Comprehensive, Collision, Windstorm, Heil,
4e or Esploslon, Combined Additional Coverage or Dealers Supplemental Coverage as are defined in the policy and for
E sl ~won In
wrlill taveroge is afforded)
This endorsement forms o part of Policy No. 00004770227 Iswed to
by the . _ of its Agency
.
(Nome of Insurance Company)
bcc+id (city and state) and is effective from
(11 01 A.M. Slondord Time)
(The information above It required only when this endorsement is issued subsequent to preporotion of the policy.)
This fndasernent forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein.
It Is agreed that such insurance as Is afforded by the policy is subject to the following additional exclusions:
the insurance does not apply:' ,
to loss of or damage to any device or Instrument or a con,binalion of devices or Instruments designed as a Cititens Bond ,
radio, two-way mobile radio or telephone, Including its accessories, equipment and onttnn04
This exclusion does trot apply to o Citizens Bond radio, Including accessories, equipment, and (interim for use therewith,
that is dos( and manufactured as on integral part of a unit in combinotlon with one or more of the following:
AM radio, FM radio of lope player. `
This exception to the exclusion applies only to such units installed In the vehicle dash or console.
VW9 04
By It"q
(Duty Authorized Representative)
FORM 4917o--SOUND RECEkVIN)1' ANO TRANSMITTING IIQUIPMENT EXCLUDED
Tens Steederd Ieme111e ti+dotatene
Revised Jaeue►y 1, 1971
{
,
f
Aw.
F.
-.x 4Ar
TX-10-69b. MEXICO COVERAGE-LIMITED
WARNING
READ THIS ENDORSEMENT CAREFULLY!
Aofomeblla accidents In Mexico sea subject to the laws of Merits only-NOT the laws of Ike United States of America, Unlike
ilia utlted States, the Republic of Mexico considers an automobile occident • CRIMINAL OFFENSE at well as a civil matter,
(m semi cases, the avenge under skis endorsement may NOT be acogntxed by Mexican authorities and the company moy
NOI# 1 61 iM411099. YOU Should canxldef purehOSing autsma►ile coverage from a licensed
Mee
tHA ltnlYnma Company Wept COVO Mexico.
Ykls endorsement does net apply Ia trips into Mexico that exceed 25 miles from she boundary of the United States of America.
This rndorser.,ent forms o pc',t of Policy No. CM04770227., issued to .
by the at its Agency
(Nome of Insurance Company)
locglfd (city and stoit) and Is effective from
(12:01 A.M, Standard Time)
(The Information Its the blank spores above Is required only whom this endorsement It Issued eubsegnent to preparation of the policy.)
This Mhdorscment forms a part of the policy to which attached. It is effective from its date of issue unless otherwise stated herein. yy LI;1 OF COVERAGES
This endorsement applies to the policy cmeroges listed below,
COMPREHENSIVE AUTOMOBILE LIABILITY INSWWCE
BASIC AUTOMOBILE LIA11AITY INSURANCE
AUTOMOBILE MEDICAL PAYMENTS INSURANCE
PERSONAL INJURY PROTECT13H INSURANCE
UNINSURED/UNDERINSURED MOTORISTS COVERAGE
GARAGE INSURANCE
AUTOMOBILE PHYSICAL DAMAGE INSURANCE (Fleot Autemotk)
AUTOMOBILE PHYSICAL DAMAGE INSURANCE (Nam-Flcotl
AUTOMOBILE PHYSICAL DAMAGE INSURANCE (Oeafars) {
/.~•v ~;tip,
TERRITORIAL LIMITS
Thte endorsement extends the territorial limits set forth in the pelts to lnciudo coverage durlrq limited travel into Mexico.
Limited travel means Infrequent trips into Mexico that; (t) do not exceed 1'S miles from the boundary of the United Stales of Aaer.
Ica, and (2) do not exceed 10 days of any one time.
APPLICABILITY
This endorsement applies only to Loured persons who live in the United States of America. The easemsbife covered by this
endorsement must be pprincipally garaged and used in the United States of America. If either of these two requirements are not met
this endorsement will be void.
LOSSES PAYABLE UNDER PHYSICAL DAMACI COVERAGE
Lasses that occur In Mexico and that ore payable under the policy's Physical Damage Coverage will be paid In the United
States of Americo-NOT MEXICO. The automobile may need to be repaired In Mexico. If so, the amount payable will not exceed
the actual cosh value of such lost at the nearest point in the United States of America where such repairs can be mode.
OTHER INSURANCE
Espensee for M04INI Services---The Insured may have other valid and collectible outomobile medical payments Insurance ep-
plicoblo 10 the Owned or nea-swned eutsmobHe. If to, this policy will nal pay for losses covered under the automobile msii pay.
ments provisions of this policy until all other such covoroge Is used up,
Parteeal Injury Protection Coveregte-The "other Insurance" condition of the Pervnol Injury Protection Coverage is not changed
by this endorsement,
All Other Cavereges-7he (nsund may hove other valid ppnd collectible insurance applicable to lases covered by this policy.
If so, this policy will not pay for such losses until all other volid and collectible Insuronce Is used up.
i
mWo 1 25
(Duly Authorised ReprnentativO
FORM 1*10•01I.--MEXIC0 COVERAGE--LIMITED
Totes Standard Automobile Endorsement
Revlld August 29, 1077
7 r. ~ U~ , s rte" n
l
TX-03.31. LOSS PAYABLE CLAUSE
hies endorsement forms o part of Policy NdOCP'004770227...... issued to
ty the Insurance Co...... of its Agency
(Name of
lutated (city and stole) . and is effective from .
(12:01 AM, Stonrt:.d Time)
iThe information above is requlro/ only when this er' Ktement is Issued strbseduont to preparation of eke policy.)
Thls endorsement forms o port of the policy to which attached, effective from its dote of Issue unless otherwise stated herein.
This endorsement modifies such insurance as is afforded by the provisions of the policy relot•
IN to the following:
AUTOMOBILt PHYSICAL DAMAGE INSURANCE IFlett Awtartams)
AUTOMOBILE PHYSICAL DAMAGE INSURANCE (Non-Flees)
AU rOM0111E PHYSICAL DAMAGE INSURANCE (Dealers)
Lott r pnr Q-iAtr r m u ...._..f....._ ......................................Y....appear to .
B~t~Lr g s
rid this insurance as to the interest of the oment Lessor, ConditlonolVendor, Mortgagee or cif her rcd ed atty
' d h secured patty or Assignee o1
i10-rient Lessor, Conditional Vendor Mortgagee or other secured party (herein cofie t e Lle"der) sholl not be invalidated by
any act or neglect of the lessee, Mat , Owner of the within described awfomobllo or other Debtor nor by any change in the
titlt or overtenhip of the property; provl ad, however, that the conversion, embezstemant of secretion by the Lesste, Mortgagor,
iu(chaser or other Debtor in possession of the Property insured under o boiimenf lease, conditional tole, mortgage or other recur.
ity agreement it not covered unv er thls Insurance, unless specifically 1 Nlfured against and pro rdum paid therefor; and provided,
also, that in case the Lessee, Mortgagor, Owner or other Debtor sholl hvp;ect to pay any premium dut under this insurance the
Lienhotder shail, on demand, pay tithe same,
Provided also that the Llenholder shop notify the company of any chonys a ownership or Increase of ha:aid which shall
tome to the knowledge of sold Llenholder and, unless permitted by this Insurance, it s.."+ll be --,red thereon and the Llenholder
shall, on demand, pay the premium for such increased hazard for the term of the use tt of; otherwise this insurance shall be
null and void.
The company reserves the right to cancel this Insurance of any lime as provided site its forms, but in such case the company
shall notify the Llenholder when not lest than ten days thereafter such concelotion shalt be elfh:ne n* to the Interest of sold
Llenholder therein and the company shall have the right, on like notice, to conul this agreement,
if the panel fnwred falls to tender proof of lost within the time granted in the policy conditions, such It nholdtr sholl do
so within Onesyone days thereafter, in form and manner as prov;ded by this Insurance, and further, shall be subject to the provisions
of this insurance relating to appraisal and time of payment and of bringing suit.
Whenever the company shall pay the Llenholder any sum for toss or damage under this Insurance and shotl cialm that, as
to the Lessee, Mortgagor, Owner or other Debtor, no liability therefor existed, the compony shall, to the extent of such poyment,
be thereupon legally subrogated to all the rtghts of the party to whom such payment shol+ be mods, under all securities held as
colluferol to the dtbt, or mote of its option, Pay to the Llenholder the whop principal due or to s~row due on the mortgage or other
security agreement with Interest, and shall i4reupon receive a full asslgnnsnt and transfer of the mortgage or other security
opntement and of all such other securities; but no subrogation shell Impair the right of the Llenholdor to recover the full amount
of Its cloirn.
Whenever o payment of any nature becomes due under this Insurance, s.porote payment may be made to each party at In.
forest provided the compony protto: the equity of all parties.
1980 KM 8/0 18358
1910 ailaIUM !6685 , e
1979 teIli00ftt 16658 By .............................~=r~ 4-~ >
(Duly Authorized Representative)
FORM TX-01-3l.-LOSS PAPA/Lt CLAUSE
Tester Stenlerl Aularm bilo En/ersemenl
Prescribe/ Oeteber 1, 1114
1Pl10~1'. 1 36
1
PARVIMATINa PROVISION
,
The Insured shall participate in the earnings of the Company to the extent and upon the conditions determined by the Lard of
Directors of the Company in accordance with law and made applicable to this policy, prOvided that nr1 dividend shall be po-yoble here-
under unless the insured has complied with the terms of the policy in respect to the payment of premiums.
This endorsement, which forms a part of and Is for attachment to the following described policy issued by the company designated
Ihereln, takes effect on the effective date of said policy, unless another effe.,ive dale is shown below, at the hour stated in sold policy
and expires concurrently with said policy.
AIM He Completed
tNOT. No. POLICY NO Issu o To EFftCTIvE DATE Of
MCM THIS
`:+)w _r PM004770227 im iJ m f 1NC. 08A OOtR" V= LU
W40
CNA AM"MMM 11t1D AIlOUV1DM -042-405033 i
i
1 eestlatatal Casualty compaay ❑ Amlrleae Cawalty Coatpany cf 11e4din~ ~a. ❑ Na:ioaal the Iesuraace unpany of Hanjud
L7 Truspoullon Insurance We Any ❑ Yslicy forge insuraea company ❑ Traosuetineatal loswasa Company
Participating Provision Countersigned 1W
Form 6.31203.9 Authorized Agent
Branch: DAUAS
APPLICABLE PARTICIPATING PLANS
Policy Period From '5/0/80 To 5/8/81
1. Plan No, and Dividend Schedule 22-1t 22-15 15-15
2. States Where Applicable TOW TMW 9'87W
3. Commission Scale 15% M GMM
If part of a Safety Group,
designate Group
6.
Enter on Line 2 one of the following: (1) name(s) of IndMduatl state(s), (2) the word "all" (to mean all states where designated
plan and dividend schedule is available), or (3) an asterisk (a) If (1) or (2) cannot be used (in which cast show the asterisk below,
followed by a statement as to where the designated plan applies).
Dividend Accounting Copy sent to:
O H.O. Participating Dividend Dept. L] Premium Audit Dept.
0 0 Branch 01iice Underwriting Dept.
i '
k .NI`.,y .Mohr `r,. 1h*w. 1+. ' .T !4.i
e
/Y•VM~♦f~W
3111 WODD Vlo
11 e W5
This endorsement is a part of your policy and takes effect on the eff;~tlve date of your policy, unless another effec-
tive date Is shown below.
Mug Bo ComPlekd Completa only W~t~ `TW) doroom#-xt !e Not Prtpared with M o Paltryf
t D , , "My No ;o T ~ Is Not to ba Rjeetfoe with the Polley
WWI= 99
Coanbrsianad by
Awftor4W RowoiorFA w
3.39513-A
AM
>M PCHM i tai ID C.
528 +Kitig Wi} iam St Set
Salt"A~nt6hi6', 'rexag°' 78204
A~
This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effec•.
tIve date Is shown below.
Complete Only When Me $ oreement Is Not Preparem +ot~ to the Po[(ey
Must of Completed O to Not #o be 911etrve With the Potiey t /~c
. K$ FURY 0. 14 [ ?Mli [N II of
OXW4M227
C' A
CoYrtterflgMd 0/ Authorltod Neprew wl"
0."543-A
e
/WVaa W~YW y~r7y~ryy
.
12 CP Mechanical and Zlebtri6tif Engineer
13333 N. c urrm EftY
L11 UASe TMW
This endorsement Is a part of your policy and takes effect on the effective date of your pc!!cy, unless another effec-
tive date is shown below.
Mwt so Completed Complete Oaty w et< hie Endo tto~enunt le Not Pr7we with the Po iey
--~~0 to Not to be Ejeot{vo with the Pocky pp INUT. . IVLIGT elp. Iii [ TM R~ i
28 c4untlrs1grm by Authorised ReprowntaAA
0.395,3-A
r
ArJDri'MNAL nVUr%- D
a
CHATUS Pe Zbtt 3truetural Enginaer
3M, W.PM AM
mum$ MW
I
rhis ondorsement is a part of your policy and takes effect on the effective date of your policy, unless another effec-
tive date is shown below. 3
MwtBe Completed Complete oily Whom This ERdorumeat Is et yrep ared with the Po
Or Is Not to be Ejectlroe eo !h the Polky
LR R
29 M7702"
itMA
Countersfaned by ~C lI"
Authorited MWesentetIve
0-39513-A
' AilTON10811E E:!TENSION SCHEOULE
For attachment to Policy No-w
OAUTOMOIILE UASIUTY, MEDICAL PAYMENT& pil UNI ISUR,EO MOTORISTS INSURANCE
D AUTOMO PILE PHYSICAL DAMAGE INSURANCE ,
1. Owned Automobiles or Covered Automobiles
The Sched lea of the+ liubte Covtra Parts are extended to include the followin
Unit T wyn or City In Which Ye (of Modal Sod Ty p( ik Model; Purpose Motor N). Radius of .°ritory O RC+diuc orl No. Ptint~piby f, iped
Trade Hame Bu ISu ng to; or t (S) Sefial No, Operations Lade lass
1 fJ~f1LUWAY'~M 1977 FORA _ 3/4 T._P/o C _ 6 ft11S41 02 OM
2 CYIUABITMS 1979 001. W MID C 5233 02 em
3 tN1Zi~ oMM 1970 ~ P&B 8305017354531 02 3
4 maimI'TE>m 1973 Hh"X Oa4' TEiM C 2321 02 8C13
5 winjorm5 1979 1= 3/4 T. P/0 C SM2300 02 8C~1
6 /AT.tAi3AMS 1979 FM 3/4 T. P/U ~ C 51fT 02309 02 am
7 pAL2r1SiTF.aO1S 1979 13/4-T, P C 58N02936 02 9M
complete for physical Damage Come" Only ADVANCE PREMIUMS
MO~a pNt w' p, !f; ' Amount .t rU 'l of Compn
Unit Uninwred Bodily lolury oputy Oempp
~7`r'tr C;dun°,;, hansive Cuiiision Plymend Notarises
No. hmuse U SAM 0. thud Vow
1 xv 254 129. 310 36t L 24 1420
2 65 0 AM 750 2 -34j_ 2
3 3.4 50 250 21. 77. 18 5. 2. 109. 1),9.
tat 26v ACV 230 2760 147. 41. Sz 2s :2:":_ 24
(2) 2 1 1
5,000 AM 250 _ 1524 51. 340 4.
5000 AM 250 Mir
7 $0000 ACV 250 1526 ' 51. 340 0 Z. 1-144* 1 142,
Toeal Adrenca Premium
&W. #32
'Unless otherwise listed in each entry the Amount of Insurance Is "Ac:uel Cash Value,"
I ~ A
EXTENSION SCNfOUEE 064604T)Qi
AUTOMOBILE ~
Faoottxhment 10 Pdity No.
A 4VTOMOBILE LIABILITY. MEDICAL PAYMENT$ and UNINSUREt+ MOTORISTS INSURANCE
0 AUTOMOBILE fK(SICAE DAMAGE INSURANCE
1, Ow-mad Automobiles or Covered Automobiles
a SchaduSas ct tha s :,aWa Covers + Parts all Iounded l!to include the lolinwin Moth No. 0 Radius
Town or City In,Whi,h Ya+r ind odel Bad~rucl Siiior dat; Puu s W or pysrssi- ons~ Cods or Class
Unit Automobile tNd 8 l51 Serial No.
No, Garaged Tnda Name But Seating C+P+tity
Printipally I.
t3 f e 1474 CPP, 9778, 02 3
TWA- 02 3
g ,4Y•-.
6885 02 3
10 'ii00►8 1979 WD
u 1977 DM* a" c Q 551L_?27 02
465811 02 3
12 a9~8 1979
P c v=';5$ 02
13 aem 1980 rm
~ TW 2
14 ~ 197410~"K A0 CNREMIUMS
Comploofor tit DAM COW IN 10 n1 y
Unit fajjm N e.,~ ov ' Mount of ~ quit of Compre. 3 Unlnsuad Borth InjurY OpertY Oemttpa
ryY hsnsive Collision Payments motoritu
Yss~ coif yOi1n~ r ee ~t
No. I.YrsA"aN MCM44%. st"itid All etliu aavc,°MO
8 7-4 SO S9
9 k 50 250
10 12-2 50 2 17 . 2
27 0000
12 ii
tl) h 4 1
4 2 000 2
Total Advance Premium
A
. 32
sunless otherwise stated In loth entry the Amount of Irtsursna Is "Actual Ca us
o stae+ t (y
' 1.'; . sw+-. :,°.'i4'4{i1 ..,.y- _ r. .«s:.... r. . ..~►~.~~..r...'S ~L'y'ylMy!.
AUTOMOBILE EXTENSION SCHEDULE
0 AUTOMOME LIAIft.ITY, VEDICAL PAYMENTS end UNINS11 ttED MOTORISTS INSURANCE for artechnlent to Policy No.
Q AUTOMOIILE PHYSICAL 01.MAGE INSURANCE
1, Owned Automobiles or Covued Aulomobilee
1 e Schedules of the 000 It Covers Parts ora extended to intrude the followIn
URII Town or City in Which Year of Model Body T. 6 Model; Purpose tMl Motor No. Radius of errit 0 Radius
N0 Automobile Will Be and true Sue; or of or Code or Cho
Principally Garaged Trode Name Bus Seating Cafacity Use ISI Serial No, Operations L
WJMrTPM_ 1974 MM Dw
cHUa►s~ri~s isao ~sS1L,___--- 2 ~
17 Oinm mw 1970 D-z > TgL C P2080
02
,
U nhum RE08 1974_ l RCK D" _ C 2_
19 DAUAf3 rlSbUt3 1972 LOFT Tist«_ ~ 14145_-
_02- 2H=
20 L AM I1E m "j-0_-*9-z P-"-' _02- am
21 NmW Wm '1>aKA6 1980 --c 1 0649 02
Cam tats for Ph areal Oam>ge Coverat Only ADVANCE PREMIUMS
Mep1A N Ret dyM, •AmfWnl at
i K ~nal Jm~ ranaa t.r
~nll Comprt Collision tnourad bodily inftsry op>rty Damage
No, y1w q ~an Raw Ul~ i m OeruatVo heneiri Paryrnenb otorlsu
Mrchnel Mal. r:4uil. Saud Ydw
104
35 6 00 . xv 250 47.Lr
(lf t
36 5 opt ALV 250 UA 64. AIL-&-2-1 144o Lao 17 2(3#)50* IYN 260 .67.E
6
(4)
ON ..2s 69 63. 620
21 6oS00 XV 230 I lao 99
Total Advance Premium
Me, t 32
'Unlaa othorwise stated in troth wry the Amount of Insurance Is "Actual Cash Value."
0 31664 4 l
AUTOMOBILE EXTENSION SCHEDULE for ettechrrentte Policy No.~Ox2-
+ t, r
Q 11141 OM011LE LIA11l1T!', Nlfolth PAYMENTS isi UNINSURED MOTORISTS INSURANCE
U) AUTOMOBILE PHYSICAL DAMAGE INSURANCE
I. O*hed Automobiles or Cowed Automobiles
he Schadules of the a lictble Cover e'e Puts are extended to include the foil win
Model; Propose (M) Motor NO- Radius of erritory O Radius
Unit Tp ul nn City in Which Ynr end odel Badyruck ILA; or UN (Si Serial No. Operations Code of Class
No, Principally obile Gaangraed Of Trade Nsme Bus TTSaming Capacity
2 L1P1IIs11S~a _ 19'79 Z~gw_
319 _ 02
~i11Se'i!?.1GL`3 1973 IIi'P~
r,
.
241 02 8C~
s
~ iJAtLAB UM 1967 Ctll TFX 540 9990 02 em
19 CV if2. C ADVANCE 4951 PREMIUMS 02
Com is for Ph u1 Dim Conrags Only
U1111 at°tm wra ,e`r mc~el t N Compre Collision Uninsund bodily lniury operlY DamaP-
of ca„ „ U"r rv.a "t a Mnstve Payment Motorists
No. wr~"a,ee U to , [aur16uudYAud
22 ~ xv 250 1840 62. 34. 6 2 144. 420
RS00 XV 189. 48. 4i. 3. 2 1449 142.
23
154. t>Z, 34. S. 1440 1420
24 ~ xv 230
1500 xv 250 Ve 9 m 14 14
25
(4) xv 250 2 , 1429 41. 6 250 246
tq Alf - 1 2 _ 6
28 ISO
Total Advance Premiums.
Me 0 32
'Uniea otherwise stated In each entry the Amount 01 Insurance Is "Actual Cash Value."
o steee e
` r i. Sol siiKhm"t to policy No.
COVEf'140i PART$ ours
COMPREHE'iSIVE AUTOMOBILE LIABILITY INSURANCE
I COVIIRAGE C - BODILY INJURY LIABILITY Nona of the following is an insured.
COVIRAGE D - PROPERTY DAMAGE LIABILITY tit any person vAtile engaged In the business of his employer with
company will pay on behalf 01 the irnsured all sums which the injured respect in to the bodily course Injofury his to aemplny foyment;ellow employee of such person
The he shall become tevaliy obligated e f to Pay as
he dam,
+pas because of
. (ill the owner or testae lot whom the named insured is a sub-lesseat of •
C bodily Injury or hired aelomobiU or the owner of a nonovined automobile, or any
D. propet ly darnage agent or employ" of any arch owner or testes;
to which this insurance olvIies, caused by an occurrence and erislng cut Glut an executive olf,cer vAth respect to an automobile owned by him or
of the ownership, maintenance of use, including loading and unloading, by a member of his household;
of any automobile, and the company shall have the right and duty to list any person or organlis6on, other than the named Insured with
delonil any suit against the insured seeking damages on account of such respect to:
bodily Injury or property damper even it any of the allegations of the
wit Ire or uodfess, false or fraudulent, end may make such Investigation 111 a mots vehWo ►Mile teed with any trailer owned or hired by
tfld aelfler"ent"of'Inv tlnwoo, suit aili'deemt ekpldlerit; but thi' r •such Petition or allnieotion"not toverYdby like iMuranceIn
ply enyNeff" or jtkgman the company iexcept a traifer designed !or use with a private
c h
gongs y'ehall ergs"ba obi t is tr to
tfefated in alt after the llpplitatrla lirhlt of this cowDanY r liability hot Palfa g*1 autorryobhaand not being used, su ,~usinKS purposes
it
baler tali Wltad by peyrneht of {tsdgm enter or Settlements with another IypM {t14iii ivgh ipff), of
~112) tl. tfalfef~ (~t111 Wfd 1YIt~ 1AY motor .llRi}Wit ow or Mind by
Exdt{F)on/ , ( { 'i,•A , k i . , a t+t Pori or organleaud" and not covered by Iinsura Ke in
IrNlsr ince does not apply: the company; l In,..i
Is) to liability assumed by the insured under any contract or agreement; 110 arty person' while employed in or otherwise entailed in duties in
Fu rconnection witb In 1 tor9opile Ines, other than an automobile
IDs fpP obligatigry,for hictl,thl, I yrloop Any if+r41r, hh1k 1P r
{ndY held Iteb. X , shy 211 R! Ill 41 Z'a busiau cspeiatad by the ntme%! i dared.
~t n+QyK err, rr rnrr , r, v took
sa
roller{ forrfDYle,tten pr tJ' ; 6`y! Mflewrgr~tlftx„smilers Is phis insu4nce dws r;a apply to bodily Injury or property damage
11 t
, , ,a , ,i x o6sinl Was 111 a nonowned automobile used In the conduct of any
fel to, bdily Injury to ar~tyy'SIMplOVae of thi instifed arisinU out bill ah'd lnk parwlrshlp'or loins venture of which this Inkstred tee pai ts»r or me'tit sir '
the course of his iMpiltliliient b4 this Insufad 60 16 any oWlgytt6n'ofl and which Is not designated In lhil poley'ee e'nomed insured, or 421 if
G' 1 ,lhR It~e #Qit@,$pq%rnni1v another because of damapas wising out of the', named 'insured . Is a'•' pormiship An outomobge owned by 'or,:
Such fnrury npiitrreq In tiie.lwne pl a Witr+er tllpl~CSf
~4 }sal e><f4t+kgn QR S1Af }iiP4 to soy WFI! iltlyfyiloopo.Ry
aft / to too 1(D, ptAYerytta~nt Pt yrrW; ins i lyrist to III LIMI?S Of LIABI4ITY r s, p t„un s r e
i }l?enef t/thlffj ate Q e~i.j11Ph1rt~IrMIMatyJfJtttllf~Itl, rti,lui tl~r~i~~2~~__tys~~~iL~~pN n:r,n n0,' ,,,1er, r !r 6
}ctxlpf Vi?dl!M 9ntpeRMtlgllifes4 ti,i} ti, fte9ard11N.Pf if~rrl4?f 4f t T, ,v 114,!hMR to,) K' r
y kmMlc
fd1't0 rata 1iz rIP
B l~+t 4t V RIF
s
pltsyliN'dah1N{Ft , Of dlmp ffNNor h n7l br9p Vi lfY yrY~U0 *s
oenobil a tMs s e c s
t; v agt}{c t~lY1k1 bl t b4h>Z4 1y~flrPated by the Insured, at Ilebllity is i Rid dfellov h W°' n tit ! policy
o
r ~r y rdttft7Whldt`'Ih k+tbl rltl t'fCPsi~ypurpblilralih4e' avei'i6i ~``=r1+e¢Iriinit df 6ddijy' ~nj~ivrtiil>ttitt/ suie0ir~ ifn'sclldull s
t " $ftg~fitcrN ZdiHilbl, b 1 tttA}I'p16'tl•rt~ ds Y td Y 1i~dittkY' a epMke, 1a+'rrgts psryort't is tine limit Ot She compMy'a liability for
r ` rlYite p1rjl w tl ti palter it alit hl ti "ro"d 6y lht'r' ail eaMk nas; lrxludrnq 0errtapes 1w ari and sou of seret ew, because Of.;
" i1114n1;e I Ha n. +u l,ti rnrr [ ~l sir badill" Injury 'PJIUWAd is OW"Non res r 1111 rawll oh tinyI Dne•
a~act«Z p t~r•t,r an! anrxr o,.t as 'ra +,ia r e,t,'r1,A cr,r. oFkbrMengelbV{iuhhfAgo,tFtabor"Pravi~nrtsawtotpressiPraols'I:l
fell fp,I ll~x ~ily!X ~eppAfty {adlepa,dW tO ya[sYl (ihlr, pf,AMtr th1 tRl~1 rQ~i q~ X for ail damages, In-Juding damages for
declared; civil war insurrection. r i)orl or rwdv~on or to any act
1^I tifi'ufSYidrtfdh"irlli~Fts `id drY fbf a o ,R „R1 bo4~y) P rI~ by tws►of~
~ ~y Apr fifth rdtpeCt to era
rare tt, pY.g~d Anil ~ A~,R~ led, r
t" ik~fYRJi 1l voP flyEt' I wI" I lilApey'i So,l~~ifinii>a'Y Paf+M?r'b i!rawelbrf; Simi t Rl 4RnYI, i sNt,1lI l1~Sap 1(~ i?t~bf+ t{ e Ds tplrr+ad"
1, IP)I 1,; 1 f i i~
(f) to Godly llin Wy.Of Pro; t6 temspl a S nit gift 91 She die/ttetges.' "i},d14fOt onfo r,r. c .n t a s.r {
r. 0sperliaill.lalwel, 9( aKlfsO g111[11AkD.,Y1DM1•loots uMfse,Pgidlr, COlrffpeO-c hJ,l?SeII'foil{tyB(tha, nylorFlidrtsppestsecause
a.. kNM. Htrlk,eisMtikEls. ~(q'NilM,W710 to p, , upoel/ 'S TO, of ell property damage sittalned by use more perooes or organl:a,
„ Irtipnri . epntllrinenta pr,; llutiMo .1 .171o . upon,M9d9di TOe. 116"1 as Ilia faault of any one oc•arrencs shall not exceed the limit of
ftlr ; butjth}f,yxojus~on pf~yfly drmape Irab~tiry stated In the rrheduie a aPP1 cat le to "auk,
p F W adv OMfsal we,
ta,Pq NI,Pr,etcepe ll ocsWrMOf'. ,
„itfltAlDf,1 y .~nal~ch „d dip, Iw CbNr'aiw" C alert O » For the pt,rpotehaf detarminirq test limit of the
• J
It t r ,I + I l• i, ebenbiWy, i Aabihty, all `nDdp Its1Wy"Property damato *$oInp dvt 60
11 Pf PSONS II VftEQ cbntlnubts, '6r"tepeetM kiro ire to j"liAflally Via ume 4steli
Each of the folicirfirtg it on insured under thi, inuuanu to the extent, conditioM theft be coniidail0d all arlsif+g gist 61 ono bttuNante.
sMlptsbMOW r ~ ~ ~
IV POLICYY'EKRITORY"
Irk till nis giid Insured,
Its) any pitfteW r Of raecutlve ollicstr thereof, byl with retpaol fo it, ratoT~`un inswlufathiltrste the aIsAtrenS Wit, tp bpdily )"jury of era xty JAtkI+;
ilQry >desarlbep M pratN+nh Jiff, prOl eM1,
r„ nonownld ouromobl'a only wile such w/optoWhs li,beinii asap (q:. d( )ltion of Ya ly ur►ilwy, 1,, ! . ;
Ohl Dullpeu of tis h named iwtrre ; I . , ,
(cl.any olhIrf`'peN6rl rirhila'ualiiloen'owned autatabieW A`filled V %DbITIONALDEFINITIONB S
automobile with the permission of the named Insured, pfovtdod his When used in reference to this insurance lincluding sndoreerrsMte
,11 vii I ocie Can, or Ill he is nul operating) his other actual use i0fiM1n 'apart of thepoikyjr .
df la' Vrfh ttll`tkb~e of surh permission, but with respect to i , -N
bodily injury of property dimoga arising out of the loading or "autom"Ito bA"A moos i the business or oct+upalli" Of 001004
unloedrn) thereof, Such other person shall be on Insured only if he repairing, serviciF4,sto(ingor PMkingeulom$WW : ;o ti,
it "hired aulnrtiobNe" ffleans W loniobtle'not j6whed by tha W MV
ft) rlettea4' yrlpyyerpf,'t~ieA4tomo~~(hata,,. , ' IntdiedJr'hr t (Kiq~ l~dlritr}ykti b' ((ltifr tbfl6ehdRo't%W
121 in wApl ystoof this rwmedlneuredorol tu9rlessee oribpfrowert, ~jWijrad yp' all Te1'1'pfFs i Y >tirY:Avill ooli"Kf AN,
(dl tiny other person or orgFnlration but only wiih rerpact to fill or its named insufer+ or (b) on amployM or agent A the awed insured
liahifily heralnr of gets err omiltions of on Iniurad under la), Ila) of wha Is grented in operating allowance of any wl for the vet of Such
let anove. .sutomobib;
f.ee' ~ ~ e ~ wlve..•r'r seer
iAV~ a ~.I CNA
6 7711?'/"
(all a highs i 0 which wltkh is owned by the United States of Except it provided In dN fontry ewd parlor if the Insured had other
(iI{Cc~I ,ttppf'
alp. C+!M~. e, swo a pO t obdlvWon of any such similar Insure" evenebtf to 1• m a to the accident, the
9overnmertt or an egenly o1 sr* of tha foregolnp, dr+i6(py lh111 be, deeme,• - to eecead the It" c! she tl~p tcwo
tirrutd of IfsWI of this Iit, sha'Ad ns.4h other 1ARirsnce, and the
company shall not b1 Noble for a greeter prcnhoroon of er'W Ions to which
this cowrege sppllss than the lrm(t of 119411ty hereuwQtr beers to tf+a
Vi A015ITJONA4 CONDITION! sum of Me applicable "Its of Iiebility of Ni Insurance and such other
tAriranoa.'
A. Premium F. Arbitration.
If during the'Oolicy period the number of insured bilhway vehicles
owned by the named Insured or spouse or the number of dotter's license It any person rne~lnq cleans hereunder and the company Gs r.,c +gree
pietas (sexed to the tamed Insured changed, the nomad Insured shall that rich parson is legally entitled to recover dameW from the owner or
notify the company during the pocky period of any charge send the operator of on uninsured higlInd ry *Iclo because of bodily Injury to the
premium shall be justed In accordance with the manuals in use by the Insured, or do not agree as,to.thp amount of payment Which mgr be
comptiriy. If'thi earned premium thus computed exceeds the advance owlnp under this Insurance, then, upon written demand of sittwr, the
premium paid, the named Insured shall pry the excess to the company: It Matter der' Fnafters upon which such parson and the company do not
Ida, the company shall return to the named 4noured the unearned agrea shall be settled by arbitration, which shall be conducted in
partipn pylgLJt tFUr Insured. accordancf with the rulp of the American ArbltraVon Alsoclatlan unless
. , . otter:fZs of eonductinp'thy a~bItrltloh'its *odd td betvieerf the
8. Proof of Claim; Modkal Reports, Ihd:ed ji the dtxnfrehy;'lAd jt o"t 4pOA f1i bwl/druWeral by the
As soon are pfecticable, the Inured or other person makinp claim shall "11141bl's h* be entered (n any corm harirq LvIsdikkWti th ttlef. Such
love to the company, suntan root of claim, under oath If, required, PIrKM and the tomMMY esch agree to constder Itself bound ani to be
Including full. partieulard, of :1, nature rod Want 91, thil judos, bourt4 by &MY award cased/ by th1 o!bltratonporauMt to this Msurencs.
treatment, end other details, aMering into, tjtl determination of the 0. TrOd AfraeAtent.
amount payeWo Iwdundar. The Maurrl and every 00of person, mehing a - t ':11 ; ,
clalrp hereunder shall suirmit to dxaminstlons under oath by any person In the Ivlpt of,PeYnN^t w any pfrson,wder this insynrici:, , .
.nomad,-0y the company ands ribs the »ma, 14 often r nNy (a) the componY "I be entitled to the extent of such payment to the
reaswnsbly be required Proci of claim shall be made upon forms pt"ill, of, any setVOV;ns qr. JuOpmfpt thlit May nfYlt 4t he
NrMsh(td' by the' dolttbtlhir"bnW thi toHtpel+0 tf+r11 haJi hitid'to exarof} oS tiny rl~l of. ric 11' r rip lrut' Icy {ail t}+s
furt1141t !tier forthe'sN 1n IS dfyi'affor r I 1f f r~ y in u apes 'La b
tfi e¢aINn4~notka'til tlalM. =111t on (pay e sa f
,r. os - . WYmmt 4 mldj:; ' + `4c l ,
The lpJufid person aM1{ k+bnilt NptiY+kM txam3tutlone by phytl c4ns
selected by the company when and as often as the company may (b) such person the" hold to trust for to benefit of the company Ah
reasonably r/o•Jlrtr a +d he or In It,* event of fill Inca try his leosl Hphts of recovery, which he shall km against such other person of
ropy sedutiw, or In the;40t'ol his oaelh ,etpt Wepr(sat+tatlvi of a organiration because of the damps w re the subject of elalrn
person or *one e6tiddd tor drN'theyafdr; rhea 00" lick tiff heey~,, " 'r*41 (u;n~der t;this Ineb/ence
the cortil>rfryt" krcilie 1lcrliioilihtkiti to'enebfe chi t'ert1 td obtfin { ~cl weft pardOR sl+au`tfd'whLk I"I`b droN td'tleurY 11nfi sl;Jl"do
medicalhp6rI rid ei'bf1111d
hbthihf 01111f k* top►aJudloo Koch rrghts•
C AstfitariftFittd Jlortbl (rte IHeflied;i.l x Ii•r p' rj c I, nrl,q o , "
f la tint , +4 t
,►equ t~ ill 11f rnh~~ 4Y wfr yo(1. ~h#1 x a
"IAffi~ 11f311ei"of otJYA'dndw this Insurance, the company may require
tttGUph.111Y resaft}I f~t^}f.49p ^y h'1 or
the,I1h111 talc •4Fb eetlpn fill M. 'be (,"OwY.or appropriate to t '
!N r ~e
'era Ris;/fit 0 4Pr!efila,liVno. riY 4r.9rtNnf4`{(ort 'sP de~~ mepq nom such otAir' o
r o ~ l '1ti "fit bar
ah f ►1, t n p son peniaeion, atioq to
►1 41lage()Y,f i111, 4r,tttnMeyy6et 1 r I~hd1h a~gyrip on li r ri-I IakiiM IN'M l'rieMa of wt payon: In the event of a recovery, the
age cPm r 1} C41hP1k
a
era, a tat n M e fandaniQ 1 r jauch }W+hY shall W reimbursed out of rich recovery for expanses,
W party G tom s war It In connection therewith,
0. No u' .Ia:F4i ir!41'ttAr.MY~~1yt1(p .,flSf§1! r
14P~. 101 such "~P"R'shMl'~etgtute sAd dOW to the tompeny such
If befora tnd tettlppeeAAy RiakeepY$Meltl bf lobs haF ei the' IneuNd AniftMfnti Ahd papers' as may be leporepAeN I* delved Me t'lphb
or Ris fpsp faptedahfatfve'shMf 1nst1(u11 ft ty fepat'RETdrI f I~bdity hyu'ty " lNhd bbllgitlons bf Weh"person and ter eewf+pshy astaWkhed W this
t h~/11,Vyt~WWyany }prl~noA~ .orfO,trgawrll~rL.tion legally responsible for the use O.f,.,ar ~:'OhFlflonl! e q yr .;n-,uro} ...+~ns+ to (PA r, vl;'I, , N'
"'~'1PT. fTIRnr. I1]T'i •~RGINi cTRlkttt •,~Qf p~~T+1r^~ sv 1., y iP.'.y~lA
IrJ+ j Red 4/Yi j F,;,l9flth /~M fS H. ~iYm+n10~ i,or by the ~onWanY I
1ej~ p~
q~ 1 S{ vbYr Y
lhreprawrl t e84!t>s['1~!!1 y. fp Pt~t1,R9h1PMIY. I llaf~,pf, sY.~filMhrt!, J~rfVpoK, s Yr a~
HaNtotMlnwrldk ..,xrr
, r
E, 4 Ntlltrettlb , , Ibl N the Insured be a minor to his parent or guardian, or
W)* ipiPKt to oodily Injury to on Insured while occupying a hghway 10, it tf)q)nru•(Nl b to h4 04FAvino fpYO, 4th w14
rsK a4 ht
whirle not owrNd by the named Insured this Insurance shall apply one ~ '
y le to Y (dl to u ed r }
IN astMd Ir4rufahFl'oWYilty"ttsfier"Nrfi3>Sltr IMUWhIi awilabfe to such a I~a!Wff p u t by 1Wf4 Ks w such payment or tea ,
insured rind applicable i!Y Ndt vahkW N prImary'lnulraAte; and this perlgn„~,ep(fY s+hrl,pi jto nee 1t,1M tampel whlc „wi psym►nt
raPSryem+;,:
ihetortrice'M111 theh'appfy wif Id tit/ innbunt by'Whlch the+imit of
Itsbflity Yof Chid toviNO4 ixtlads the efspIlcebl11rndt bit Ilability,a such povlded, she cOMN41y may at Its upNoopay any ornountdidhuaurder
othM 1 intcd.' In accordance with dtvk: as Id) hereof. n
i I Sri +1,. is'[1 ~Iii , i' , r. „ i [i, i1 a u:, J, y rl 1. r . 'li W. r,'h . 1„ 1 n: r~i ;rh rq r,-.i1V
10,
' N.' JrI. t) ! 1 f1l C IiV Y7V I!t I lV[I If'1IA 'h-., , ,V 11:a ,,1 , na+lp
f %llt '('r t I:+.,Irlf A utlrtlrh IrJD rilA ,0
0IY''i0:,'t li"'/iA( V11)N;,f11 :1f r1VP:f[ ! }:°~:Ill(b:S-(
f
1
UNINSUR40 M010RISTS INSURANCE
i COVERAGE U -UNINSURED MOTORISTS fdl The crvnD4 ~Y rha41 mfrs be et,:+wI"d w pay a"'3ar tilt tnturfnu that
Part of the dn,nari which Ihr In u.,r f'1 mat to @,,, rid tic srover
iQamaeeelorBOdlriatju*rt 11 DM Ir f OWme, l ;5,11.4.4 eh an um-weld hwo•"ItI, "hies 0, 11
r+pfau„+tr llxrer•'t to,, mlrbrai eyes P'l to Javatlla under
The company will pay all erns Which the insured or his Ipal n ad,cal payrrent' crtveraof of 114 potr'y.
roprfsetitAt}w is III b le~alfy entidfd to fail at donl6ges ffOrrl the
owtler or ilplrltM of on uninjured hleitwH hired/ boteusa of bodily IV FOL1Cr piRICO; TfRRiTONY
f++jury wstIfined by the, kssurod, caused by oeeident And hieing out of the
ownNshlp Inalntenance or use of Such uninwtd highway vehicle: 1 nit inwrf to ss pl.es Onlr Iu srr < cntf whirl nttu during ir. w~ilry
provided, jor lhi p irpoles of this coverigs, diterminatl0n at to,ryhelhel Pat,p,t ens w dlin the woy s Amsoc id tt of or
eta.khwfed et slick esenutWO it legally entitled to recover loch patw,,,r,s,or Csnoda.
demsoes, end if so l1ep the amount theeol, shall be made by agreement
between the insured or ouch representative, and the coglpany or, if they V ADDITIONAL QLFINI TIONS
fail toagfe,Pvarbitretrpn. When used in reference to d„t Insunna tiMtuJ,na end~,IUamfnte
No judgment against any person or organisation alleged to be legally foes nga part of the reticle :
itsportsible fa. the bodily Injury shall be conciuLive, is betywsen the
Ineated and the company, of the issues of liability of such person or "dedoruld Invited" mans an fine.,-'dual nursed the achedula
orgaffiretion'at of the amount of damages to which the insured Is legally under Qnignsted Innl,ed;
Mlidad unless Such judgment is enletd pursuant to an et;rol' "Ih;alhwrY veh;cle" n»nns a land motes vehlete c. ,.a-ter Other than..
txoseeutd pY the insured with the written consent of the company, tat a tam type tractor & other equipment dmignd for uts
tadpaleft~ > . i,,t::, t Qfluipally Off publlc roods, rAvilo not upon p'ikdic roads,
Title Insurance does not apply: (b) • ' -;rlclo operated on falls or crwvfer-treds, or
(a) to bodily injury to on Insured with respect to which such insured, his (cl a ;fhicle While located fa use as a eeslderrf or premlul;
legal representative or any person entitled to payment under this hit and run vehicle" meains a highway wefikfa vi filch causes bodily
}nwrenea small, tfAlttoyt written consent of the company, make any to an insured arising out of physical contact of such vehicle
settlerttent with any pereolh or orgarti:atf0{t Who may ba,la sly liable In iM insured or with a vehicle which the Insured is occupying
+t.
threfp, , tM tins rl the eeeidane, Provided: '
Ib) to bodily injury to on Insured while occupying a highway vehicle
(other then art, Insured hidiweY vablds) o mad qy tho-Horned (a) oOwers cannot wnrr of web {~Iw ained l~i,Identify of either the operator or
Insured, any dyknalF4 lnS u+t4 of apy,lriativ t~TF1dMt INn ~she spa,~t1
housahold ai.tha fMl~heas designates irii'4!e9..4 0916 t) 001 OL (b) ~ 'klbur Ix sonierfrhe ors bold behalf "I heve'repl>rtd the
struck by si ch + yanfgie, but thia fhcclwlon daxl!fPt apply 16 SIR:,) as idant within 24 hours to spolki,Osoce or judicial offiew or
named insured or his rFtativ's Ile .o4opy(no a If str'lfk, 4U , . ~ to'the Commissioner of. Motor Vehkia, and shall, brtw.iilo4 ,
htghwsy "Wells owned IN a,4alo gd.iMUnd.q Intl, atiyNi , i,.,:l 'with the Company within 30 days thereafter a iNtamaflt YrdM!
qqw his I"eggssl ~ representative has o cause a
kl a as to inure directly a kdlregtlV to the benefit of any workmen's path uush lbofal thaetft on lrwerreislAq'but ofiuUs actident for der'lialdl'aoainst
compensatkon itr.diaeblllry,bt+ tn..urriar tx,arh~' perAgn Or I person a'perrons whoa identity is unaecertarobia, and
rargeniaatrrrh ;trirrttfy4ne es g asrgy}ralf uncle, afty wPriy)t~my tl ti ~pn the n t there end
eomp~nsetlon a dlseblll bnefin law a any similar tiw n9 w -
'et the canpamy 1.(A to th4 w i t s !
~p~ arWWAS
Vela whldh a klstuFed WAS
11 IERiONE INSURED t r s I r e,'r k)~r~key welleWl~ leer ft tj lon '"tfiadeft'
' raOCrt of ilia fl OT Vff
E* 'ilk illq> l3an lmuf`+o,M'0Vr,lhb k 1~4~{ ro t►tr;!4 0'1'
set fOrtit ow "insured blowsy vehicle" means a filghsyey sehkio,
!ar , .r„ xr .w tllu,;r yehla;tetdToth
b) 'dili rhimd irsulad arid any designated insured and, W,bite residents of gal de l+t +►+y ~iea~! fl►d h w. P
I dte'lW?Mi household, the spouse and relatives of either; }rT it ty 1 14`fl<A°
ib? any other person while occupyint an Insured highway whkle; end
IS) Ib1 N111i temp Orr. Y site w irihdw4htls~dhi e
anYbbP~ger~qson Sul i Y'e.`~.iii ' hj l(e11 it Yd 1o tIk6N'r because s 6 a1 ds 1Oia
~ppttet tu4tarr,le by an' l„" u 141t OV 4 n / G lY^I;{~ III~Ie T V~ 2 II"Y?•''
the IMwart o o T~t' ~relv' i" reel to each Inarad,esapt k~ pp~ r S by the A" or dtllgrtated Inunj or by
CCi "I p k ^V 11 , r' ! i' " 111 I ^ , e I o r eidens e/ ~h f hrceo
yip, 1' fie t r f t.:,gnA ml^,a q t,,~Jrfhp{,~,.. ~~s'Tirr eTJ' 'IG~ wrp .1 CI+•"?"7~ r) Si'@
milk ngect to the IilKib M't,e'ROm Its
KlBIlI' .t 1 to cl nUAII' 't 'r.1A9iurt vnnl, 1 p:;e but the form 'Inuredblowsy whtals" Shelf not include
111 LIMITS OF 41A6111TY !d
'h rcr,
Ira+aiqu t' tu., a 1 tla bi slaw 4pnvlylMe,anltlliuch
Rpsidbss d the nur~+br o~ f~l pert~ rs or orgenlsl~ orn wQho erj {+,ijy~d111d'dhiep0lkjl(r i r; eyes
InNiild! oAl~eY dsle'p01ldy,'121'persists who sustain bodily Injury, (3) r i%r1 I. IJ ran iI ry Lrx'w cc r,•r~ ~~ss
daift)r6dt Of'lblN brbg~hton eeshwntaf fwdlrY lnjhrry w N) htghwayri All a "It ids nhile berg used y11riWt des permhe.~N►.M ~,pw,4ri ,
M!15tAkt4J'Itl thip~gllf~a rll~:ar I•'dl.v;k0t% In dllli Nafler.IUWWIplpphs, and tog above, a vehicle owned by the
(a) The limit of Ilablllry stated In the schedule its applicable to "each named Incur, , any daignetAd insured or yued i«snt of the
ppeerson" If the IIm of the Comissny'l liability for all damages tome housellotd K the named a dwiputed u
baliss of bodily Injury susuind by one person as the result of any (lvl under wbpangwhs Ibl and J0 above, a whklo furnished for
one accident and, wbleet to she above the goblin respecting q [ 6" AM ill 1? ~ I.~'~ Of the named Insured or Any resident of the same
parson", dha nt " mh of r ill limit the In the company a 11 i
dormhages becow acboicaue Is of the total bodily Injury sustained b by tw by two or more arm mae persons occupying" moons in or upon or entering Into or alighting from:
daury
n the result of any one soeident. "stales" Includes the District of Columbia, a territory a possession
Ibl Any amount payable uncle, the tkms of this insurance bcieuse of of the United States, end o province of Cersdo;
bodily Injury wstalned In an ualdont by a parson who to an Insureduninsured highway vehicle" mans:
N^di! + i~,f AY1'fE' III t» rlo,'ced by
u " "'w IN), Ni~ly,a Yshide r4th re#p t to the owrsfship maintenance or
sL itid by the
111 NI w>Ths Asld on amount OL IUw~ rdilY 1n1WY 4ri wl~~Ah~'f~ i ' ~ o'yf Wi 14h' ♦ch~frr# h, (n of, 1j tile' jrunount~' e
"11! „'t,l,f 4l I ,'SOra. y'7 Un aq [LJpiif' ,i+it Igtn, 1" ''yy ff hi all i 41 i1[~~ f}'fer,Ich the Irlig/..~g
nyl i~ n to jury lfa Nf/L
y I .c,e Ipt till ewtse, oroparator of taw INMUrd,hl~fwlY "bids Ind i l f r~le f„ rids I ~n All O I[h~;~!en y4 iiq
-I r.,r,lIuIJrfriy gullsiHreofh or Organisation jointly or aewntly Ilebie Ic~~,t K ` t d bf pr all tit it ,.tlGa
~ . N II e
f tie' =
( together with Such ~»ner or operates for Such bodily
Wuryr .n, : eke ~(htal? DpQ~ ~y ypr11) y
Inful4if liability citivouaol'61 l1aDfe e fig
y Jrtj / !Cc h ~ ~ lfiloivMll lSS the Same d/n1IW'
nduffirq arY WMA geld {1 r Ihl H Dar , 3.r 1 y P~ 1,
*eWw,and , l 1
imou i~ I~e '1'kd Eiie rtl!►1'a1"Y fuY bl ifl'lll,wntf p+Vwre at' lpl libq;epd-fues e0: r
0% accwnt of Audi bodily Injury under an/ workmen'o a:~:I bfR the IIrM I'dnilwtrW ht r"aeMtlele'tshy/nM includw tl
c eemp~lr mi" WW,dwbiUtY tuglsfIce Wo Of AAV lfmifaf lrnr I „ .i~j) an Yhlhaeftl Ihlg~h;wY iwdl~er
k) A" 4 swit mods undir this tnaramil to a for any It Lured shall w Y y bii/ wlllcl► Is owned or ope~a~ed by a sell knurer
feC epptpa (n'faduttiiat 4 tha armouM:ol daifrtegee w he gray M R' c.I ,r ra meaning of any motes whlde tinendbl fagomlDNhy
entitled to rocf."e from Any person of orgonlratfori who Is an lag, moles d sni sew or a<,y stor v1s law,
Inured slider the @+tMily Injury hability coverage of the policy.
":a1AYnN wnonwiIIII I m sne an wloptebi atAicM r se jln tl out of St+, a r
: " ~
401 aW srstobile nor a hind a.-tandsile, , , ~ , f"un"
"owned '+utomobifs" rssetrts an, automobile owned by the named N, under the prpvi110" W the raptor vehicle finenetef responsibility tow
k+surad; W the motes vehicle eomputsory niurarxe faw,r any similar lava of any
Stale or province, a non-resident is feouired to maintain insurance with
"Private Patentor automobile"meini a I" Wheel private oboist" respect 19 the porratipn Of use of a motrx vehicle in such state a
or station wagon typo awomotrile; Proving end such insurance r IremMts are platter than the insurance
"trailer" inefudes temt Vaif« b6f d safulp- ?PPry s lid t ty, and kinds of
0 at l prvrbe pr thill tttb ' Intl y
VI ADDITIONS oat not rntlta?e fiebHe c°foPro vmeno~ by wch
'Pq all bl et N' lord, In 'such laW in III
b'y the policy, but Ont to the'extent
1 CONOITION motor and ply With ratpapt 10 the op stion4 oo we 61'a
0 In
A. Excess insurance - Hired and NOnOwned Automebite under is iow TOOK n1u WfI pFbViOed dial the InaurehEe
a ! A Ih~fl f ~k,t►rdd t 11te drat III at alit Is Othir
With respect to a hired automobile or a nonawnad automobile, this valid a cadet ~ foal . e'~t`nde► this. of
aA, oth~t' motor vehicle
ineurateee shall t» excess irtwrence over any other valid and collectible Insurance policy in 10 event Mill sni✓ per~pn br iAtieed'td receive
inwrenct available to the irtaured. duPlicele D YmsnU,for ihp same elerrilrito o} bs6
I.
AUTOM061CE MEDICAL PAYMENTS 111160PANCE ,
,
I , COVERAGE F - AUTOMOQ),,E MEDICAL PAYMENTS IV ADDITIONAL DEFINITIONS
The bunt Will pay all reaoneble medical c ,
PtnN
txjseAfe Incurred within The additional definitions appikoible to automobla,•npdtly.injury
ohs year frtkn the date of the aWdenl:
liability In coca pfsI appry.10 tthhIt Insuranu0 and wfiti used In
OirMjon 1. to or (Or ask WOn Wfio suits r'i bodily injury, caused i ref~47a ' tq r Is iriturinerl Ilhr lrtrlitid indorFAntMtf lphfil • part of the
t' • i' by'accident, while occupying a designated automobile po
which is bell used by a person for whom bodily injury
.
~labllRitb-INbbl fti lf'off0Pdod'under this policy with d►){{ggnoted autqmoors'' mea•M an wtomobite deal ated in the
wpbct'itrt rt bYf;' " u r [n r ! , is vet' i . t l „ ~f)0 uild, 004:t htcrly del { 1, a r v .,r, Q"1
bl~~b~t 3,I-iQ Of for Ki h person who austsim bodiy injury, caused al BPI Butt mobile not owned by thet named InsurlJ while umpors.
by dr,ekdortt; whAj debtlpSgrrqq br; lrhHe it pirdestrien, fy Uxd of 1 t44llltufe for an axned automobiledesignated in
thr6u0 bilhb struck by a hghfv6 ittkfo. c - tfIt Ahoc~ulo Whh/M1 wlbf~t/W6 fib efcr(rlil use nor aervkh"Ili-or
lop"Ir,0, c80isq 0 Jbitakdo,-1, ior fit
t ut'edn and'.:,
t E>sduslon6 o ,q I r ci grin , rot ~ Sall i t~ Prlpte aySU.+t-omobilr if
s u• ,.a o, ~ Y
That i 00er 9u itq e,u •,,r f _e d~a ' r, ~'t~e
~y~lf~a RTti
g t r m hdt i FdAil;'b ► ''d'fi~l bl
' p
nsurenos I no ~*pi W. r.. .-'~•~rMAIr)A~t+r • I, yv., '
r1►1,_tR y., tNpry t ~WtY . t4fF der l f,7QI ){fhfl a~ of
othervri Mgaged In dutiif' in ~onrSlSn tY1tfi ~t ~ite ig}' Q' I M Irtyjh Z Iiit~{tN(
ri t t u. bddAalgJif biMfits therefor see In wiicis win rc wen nr
part tither pa able M n,, t la r "I r "I ,r or , trails other then
repylrs~ to b, provide~undsr any workman's compensation law: t' Ind a farm riPeJJ, tracts W ,oi~ter~Avtrlppryftl.9s11dirm ~pl III so
fbl.{a Jr Jt I'I ('t ♦ Ii•:'1[>, 1LF,y;+lr, .f pr(, i ajI I r i it tU
bodily Inlur ,dW to war* ~,~LL azd ftyl. snit . rl FG t ljo
>(~11)h.A W rapt (r, r tP y• + a t Publkroads,
b1 a tghlole
r:,btcWfitto' or kM►r!Qf r!"lQIKtl4nrt1t,3P /RY t 4,r~ton . °pbntPedonrlLdtea~ti,Nettteadw'orc valves a.:,l
espy Of,ihe.Ofl~ptl t., ry, t q :.A Ir.,,d'. r 14 } y+{tMe 0 4~ ..~~1 L f tn• i ~~.~e~ i,,t
kai radar DiNe on 1, tyt r 1P * xyTd t 1;! : c c.
yy rail, or poppy iNW sQY,I gloY, pI o named "mWkM'eafsMWr rnNlre 0"0601 f°r.twalM«y+estldsN
~~p4rpq t QI I /yx4 l 4t
r surgical,
R:fIlbt+fMn PA, . Py she a+aY M'd tiennl egtvketi in4fYdin9 medletrr d4yM~at eM r1eiRNlr
Ify
Y
b IOWn bljFthh Xt by!ralM~ ovtp! tfie pemw +arMit # P. p° ira "illgrFAr'iflo - lithef, ply~erfil„ yl Pr~IY pA,,f+ ha ~vgrsry ^'a M: CI r,
t 1. N Iayr nvA r,,r rlr,
n3 r, iORiRenNtiQl11/YYIu uK.ir•t a•, •.;a nrr r, 4, ld7 t I D1IIII eA A:u 14 V POUCY,TiAR1T0I~Vf TERjtITOAYrI ca„!. cµ a,i lr, . o,,; rtr•. r,,
(d) Wilder DlvWon 2, to bodily Injury sustained While occupying a TM fnutrrance APPI* Only to aosidems which occur during the policy
h4hany vablals owned. by My io"foo, pit wrMtod {.tjl(lil+t,[}Qylar Period withln'aho anyltaY datcrtbed iq p~rapraph;l,tl;.a ill. gt N+s
ON or pew ImVred by any Pe van pr,Prpar let n o f„ q the delirttrlon of polky tairitory. , , I I., r
Masedinw '
I'( In{ r.u i,
r era ,i 0 7n,, 'F,~~• ,I,
, ,;i, rvn VI AppIIIONA,J,C,ONDITfONS I A
• ..1-. IP , v,,lur i r s ,,.aliir , " II I ~-r,~. , r , rre.r
w,t 4rr•y.. A. Mft~icol hwortt{p; If and PaKmMt of Claim
l~A r 1 r..
11 PARSONS INSURED DIVISION As tpon~a~prgt;' If the Inf+urties ed p~r osonl or someone on hit behalf shall
give, t. t 8' om 4(ti'66 pi dr 1kll~ IiWU 661h it re~tiired, shall,
Emh hQQf the foNminq k,tn Insureq under this ins~uancp, to, ibe extent after eat feotnasl from'iho'eonSpaitV,'s 66044bthorlistfbn to enable
Nl IPri rsaipw the wertPon
i,nu Y. pQ .pbain med' I rtwllttta'nQ cftpill, !,f ,f1jSPrQ JAr
„ ~~i'ley` ie'goAdodgAe+pc11is1hilyredfh'tM khbdule; ,r+ t it iA Iur Pferjion ( II submit la Physical e.amirw oh br Phystons
r„A ra ir,. n „ felltft~t y ~{N~~rr~~~vvy{~A}}n and as °Illn at the compalry, may
fbl q'h04 telige~IS pf the Mrste hQu )ttjd N.xjds dP'tiynitRd Pilrjq~i'yAis rea'Ibn' 'YttyYeQT+irl. 'the'toMipdNY'#49'OW th}"hijuedd Oulorl-N lofty
f > paMeMd tlN,relifivra 1 pen611 Or ,wg413011 ipn fandarinq the lorviut and such P+yrnent shall
led it pucad9sigrI per ton shatI die, any perto.l who Wes an insured at rrluce -the , amoutll PaVablio,het/wWN. (of,:!fli ((tJyryr.,d,{~J)renl
v.d+e tkM of wch llnth lltali sontin4e,lo W op,irsewetb'„ A y01111, r h 11 not constitute anedmiIlion of Caw ily gf any person or,
writ r
r a,
Q% Limit AS
LI jllTY
la~l,. A. If ~..n,e. I y, 11. *11LaN IMUrencs P:
1, s, e
lM 1h18 pptlc 1 1
;,'ff 'inesj ih`e f<umDell?i'D:W4i stwrle'Iainra eAb~a'Inww*II r;al "riIib t'Ywih.t~or' itii ) su>ai,eYrelt ny6oiAhiNt~~la rrrdneMlM N
ai s or '1u t Vol
rbrof bdddy tnjuW or ei In r, oulgnl0gia r!s RpTPirf'fi or automobile mad"I espenseinwra:ce.
4+yt fit) bnibbirl{ t iu4AliiMfi ptifi ►llppltor, the Rmit of IIapNJly 11 I al `jn 648{rC t lid tA` 1he ycrtedtNe 6t "y~pH"abit', to 'wash 691yrpf+ct~ urn err
Qlvitfpn shaft be excats insurance over any other
I+ar Olt li'ihe Alfa i cdm0AV 1 Il/bdily fd/ ad exponW Woried valI 11xr f ~+~lo Ie i' ryMO i1} Ire~tEpl p. me is pr nr pmob,fe
byyyor ,yt bliksli of Nell perapn who sutrainl bodiy injury no the result or y' I app fi I p#rdr + eyed e'1Q l 0 ,..,1i Qowo ahyI Mhor
Fl1rt pK rdMl. jr~y I t ~ ,n . 1 !.,c ti•1• ry
r V.t ll i191,1ia ,rfr l!``rt~n1 I~.llr ~~~22 r d,,, t..a K'~',wt r. ,4{ter Ilu,.,, 1rr•-;.I.
tNAM more than one m1dN N l~yltlMts covsragl afforded by this 0~! Nen AppltabOleypf Subtegatren C°rMrtien r...•.. n
ratty wanes io the loss, the compsoor shdi not La IIauo lot mores than The fiubogat
'padmeont of the Mil l yplkabfo limit of lisbifil'r Phe S It C11 lion on . Condition duel not apply to the Awurnobits II
'h '.~1,''fr'•i,'1 d4ilillkllP,17 IN711!!`li!'f