HomeMy WebLinkAbout000332.tiff Insurer Authorized
Document of Insurance
( Lloyds & Companies )
Policy Number, PW0330021
Insured: Colorado Counties Casualty and Property Pool
Period; From : Vt January 2020
To : Vt January 2027
Sum Insured Primary $25, 000, 000
Gallagher
The Walbrook Building
25 Walbrook
London
EC4N 8AW
Registered Company No.1193013
Gallagher
Insurance Risk Management Consulting
416;
Gallagher
I!rrsurance Risk Management Consulting
This Insurance is effected with certain Underwriters at Lloyd 's , London (not incorporated ) and
certain Companies . In this document these Underwriters and Companies will hereinafter be referred to as
"the Insurers". The Insurers hereby agree in consideration of payment to them of the premium specified
herein by or on behalf of the Insured , to insure against loss , including but not limited to associated
expenses specified herein , if any, to the extent and in the manner provided in this Document of
Insurance.
The Security Details contained in this document state which Insurers are party to this
contract and defines their several (not joint) liability.
It should be noted that if the attached wordings and endorsements refer to 'the Assured ' it
is deemed to mean 'the Insured' . It is noted that if there are references in the attached wordings and
endorsements to ' Underwriters' it is deemed to mean 'the Insurers' . It is further noted that if there are
references to 'this policy' in the attached wordings and endorsements it is deemed to mean 'this
Document of Insurance' .
If any terms, clauses or conditions are unclear you are advised to contact your broker immediately.
Broker
Arthur J . Gallag her
The Walbrook Building
25 Walbrook, London
EC4N 8AW
United Kingdom .
Property Division : +44(0 ) 207204 6000
Claims Division : +44(0 ) 207204 6119
S
DUTY OF FAIR PRESENTATION
We have set out below the applicable duty of disclosure that you have as regards insurers, where your
policy is governed by the laws of England, Wales, Scotland, and Northern Ireland .
You are required to make a fair presentation of the risk to Insurers which discloses every material
circumstance which you know or ought to know relating to the risk to be insured . A circumstance is
material if it would influence the judgment of a prudent insurer in determining whether to provide
insurance for the risk and, if so, on what terms .
What you know : You will be expected to know any information which is known by individuals who are: (a )
part of your senior management (i . e . individuals who play a significant role in the making of decisions about
how your activities are to be managed or organised ); ( b) responsible for arranging your insurance (i. e.
individuals who participate on your behalf in the process of procuring your insurance in any capacity) .
What you ought to know: In addition , you are expected to know any information that should reasonably
have been revealed by a reasonable search of information available to you (whether the search is
conducted by making enquiries or by other means). This could include any information held within your
organisation or by any other person .
Clear and Accessible disclosure: The disclosure you give must be made in a manner which would be
reasonably clear and accessible to a prudent insurer.
Every material representation of a matter of fact which you make must be substantially correct and every
material representation as to a matter of expectation or belief must be made in good faith.
Failure to comply with the duty of fair presentation could mean that the policy is void or that Insurers are
not liable to pay all or part of your claim (s).
If you are in any doubt as to what may constitute a fair presentation, please feel free to contact us and we
will endeavour to assist you .
If your policy is not subject to English law you are expected to disclose risk information in accordance with
the requirements of the applicable law. In such circumstances we expect you will disclose risk information
at least equal to the standard required under English law and where the applicable law requires you to
disclose information over and above the level required under English law you will provide such information
in accordance with that law.
INSURER AUTHORIZED DOCUMENT OF INSURANCE
CONTENTS PAGE
SECTION I -RISK DETAILS 2
SECTION II - INFORMATION 5
SECTION III - SECURITY DETAILS 7
SECTION IV - CONTRACT ADMINISTRATION AND ADVISORY SECTIONS 10
SECTION ' - FISCAL AND REGULATORY SECTION 13
SECTION VI - BROKER REMUNERATION AND DEDUCTIONS SECTION 14
SECTION VII - THE WORDING 15
SECTION VIII - SUPPLEMENTAL CLAUSES 17
Placed by :
Gallagher
1262 Risk Placement Services , Inc .
AST
MARKET REFORM CONTRACT
UMR : B1262PW0330021
SECTION I -RISK DETAILS
UNIQUE MARKET
REFERENCE : B1263PW0330021
TYPE : Risks of Direct Physical Loss or Damage Including Flood, Earthquake
and Equipment Breakdown.
INSURED : Colorado Counties Casualty and Property Pool and its affiliated ,
subsidiary, and associated companies and/or corporations and the insured's
interest in partnerships and joint ventures as now exist or may hereafter be
constituted or acquired and any party in interest which the insured is
responsible to insure .
ADDRESS: C/O CTSI
800 Grant ST, Suite 400
Denver, CO 80203
PERIOD : From : 1st January 2021
To: 1st January 2022
Beginning and ending at 12 : 01 a .m . Local Standard Time at the location of the
property insured .
INTEREST: Real and Personal Property as described in the Policy Wording and as
declared to the Underwriters.
TIME ELEMENT: Business Interruption as described in the Policy Wording
and as declared to the Underwriters .
SUM INSURED : Subject to the ` Order Hereon' stated in SECTION III - SECURITY
DETAILS, the Limits of Underwriters' Liability shall be the following Limit(s) of
Liability.
Limit(s) of Liability: USD 25 , 000, 000 ultimate net loss each occurrence,
U SD 25 , 000 , 000 ultimate net loss each occurrence and in the
aggregate any one policy year in respect of the peril of Flood , and
U SD 25 , 000 , 000 ultimate net loss each occurrence and in the
aggregate any one policy year in respect of the peril of Earthquake.
DEDUCTIBLES : All Other Perils :
U SD 150, 000 per occurrence for loss from All Perils except:
Windstorm! Hail :
2% Per Building/Structure of the sum of all values listed in the most recent
Schedule of Values on file with the Company for each separately identifiable
building or structure that has sustained a loss or damage and for which a
claim is being made under this policy; subject to the minimum deductible of
U SD 1 , 000, 000 per occurrence.
This is a non-admitted carrier.
onsiTo Report a Loss _ _ Gallagher
It is the responsibility of RPS
� Dial toll-free #'I (844)777-833 or visit our
1262 to arrange for the filing and • Website : https :llmy. rpsins.com/claimsfnol
AJG paying of surplus lines tax + Contact Insurer directly (see policy section)
MARKET REFORM CONTRACT
UMR : BI262PW0330021
DEDUCTIBLES
Continued : Flood- SFHA/ 100 Year Flood :
2% of the total insurable value at each covered location (including 12 months
loss of income/extra expense if covered ) involved in the loss as of the date of
loss ; subject to a minimum of USD 1 , 000, 000 per occurrence.
Time Element:
24 Hours Service Interruption
All as more fully stated in the Policy Wording and as declared to the
Underwriters .
NOTICES : NOT APPLICABLE
As attached in SECTION VIII — SUPPLEMENTAL CLAUSES
TERRITORY: United States of America , its territories, possessions and Canada .
CONDITIONS : As per Wording attached SECTION VII .
SUPPLEMENTAL
CLAUSES: as attached SECTION VIII including :-
WEH Asbestos Endorsement ( 1994) - 518ARM00210
Biological or Chemical Materials Exclusion - NMA2962
Radioactive Contamination Exclusion Clause -
Physical Damage - Direct (U . S.A. ) — NMA 1191
War and Terrorism Exclusion Endorsement - N MA2918
U .S . Terrorism Risk Insurance Act Of 2002 As Amended Not Purchased
Clause - LMA5390
Fraudulent Conduct and Misrepresentation Clause - LMA5120
Application of Sublimits Endorsement — LMA5130
Sanction Limitation and Exclusion Clause LMA3100
Inadvertent Errors and Omissions Clause
Extension of Coverage — Miscellaneous Unnamed Location
Off Premises Utilities' Services Clause (Business Interruption )
- LMA5041 (amended)
Ingress/Egress Extension ( Business Interruption) — LMA 5164
Civil or Military Authority Extension (Business Interruption) — LMA5161
Business Interruption Extension— LMA 5039 (amended )
Property Cyber and Data Endorsement — LMA5400
Communicable Disease Endorsement — LMA5393
Debris Removal Endorsement — LMA 2343
CHOICE OF LAW
& JURISDICTION : Law : State of Colorado , United States of America.
Jurisdiction : United States of America per the LMA5020 Service of Suit
Clause .
LMA 5020 Service of Suit Clause naming Lloyd's America , Inc. , Attention :
Legal Department, 280 Park Avenue, East Tower, 25th Floor, New York, NY
10017
G) Gallagher
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MARKET REFORM CONTRACT
UMR : B1262PW0330021
PREMIUM : Material Damage / Time Element
USD 2 , 500, 000 ( 100% ) Annual .
(Hereon USD 750, 000 for 30% order)
PREMIUM PAYMENT
TERMS : Premium Payment Condition (Time On Risk) 4/86
It is a condition of this contract of Insurance that the premium due at inception
must be paid to and received by Insurers on or before midnight on
16th February 2021
If this condition is not complied with , then this contract of Insurance shall
terminate on the above date with the Insured hereby agreeing to pay premium
calculated at not less than pro rata temporis.
TAXES PAYABLE BY
INSURED AND
ADMINISTERED BY
INSURER(S) : Nil
INSURER CONTRACT
DOCUMENTATION : This document details the contract terms entered into by the Insurer(s ), and
constitutes the contract document
This Contract is subject to U . S. State Surplus Lines requirements. It is the
responsibility of the surplus lines broker to affix a surplus lines notice to the
contract document before it is provided to the Insured . In the event that the
surplus lines notice is not affixed the contract document the Insured should
contact the surplus lines broker.
Gallagher
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UMR : B1262PW0330021
0021
SECTION II - INFORMATION
The following Information was provided to Insurer(s ) to support the assessment of the risk at the time of
underwriting :
Information per Presentation which held on Arthur J Gallagher. file and available on request, and which
noted and agreed by Insurer( s ) .
Total Declared Values : USD 2 , 960, 088,209
Approximate breakdown of values as per Schedule contained within Submission which noted and agreed by
Insurer(s).
Loss record (as advised to Arthur J Gallagher. contained within Submission which noted and agreed by
Insurer(s).
Program Limits
USD 50 , 000 , 000 In the aggregate annually as respects Earthquake Loss
USD 5 , 000 , 000 In the aggregate as respects any Flood loss in Zones A, AO, AE , AH, Al -80, A9►9,
AR
USD 50 , 000,000 In the Aggregate as respects all other Flood loss
USD 50 , 000 , 000 In the aggregate annually for all Flood losses combined
USD 25 , 000,000 Newly acquired property any one Occurrence — 90 Days ; coverage ceases if the
newly acquired property is not reported within 90 days from the date of acquisition
USD 2503000 Accounts Receivable
U SD 5 , 000 , 000 Builders risks , renovations , repairs made by the Insured at any location (including
new locations with total contract cost under $5 ,000 ,000 ) within the territorial limits of
the policy, any one occurrence
USD 8 , 071 , 695 Builders risks , renovations , repairs made by the Insured at any location (including
new locations with total contract cost under $8 ,071 ,695) within the territorial limits of
the policy, any one occurrence in respect of the Following location only: Ouray
County Builders Risk Project - 541 4TH,OURAY, CO 81427
USD 1 , 000, 000 Builders Risk Soft Costs/ Additional Expenses per Company Endorsement;
USD 50,000 Unscheduled Locations
USD 500,000 Business Interruption with 90 Day Ordinary Payroll Limitation; and 180 Days
Extended Period of Indemnity
USD 250, 000 Civil Authority — 4 Weeks Maximum
USD 250, 000 Ingress/Egress — 4 Weeks Maximum
USD 1 , 000, 000 Unnamed Location , any one occurrence.
USD 100, 00 Personal Property of Employees at a described location
USD 50 ,000 Personal Property of Others while on the Insured 's property
USD 10,000,000 Ordinance or Law
USD 10,000,000 Extra Expense
USD 1 , 000, 000 Expediting Expense
USD 1 , 000, 000 Property in Transit
USD 10,000,000 Contractors' Equipment subject to maximum USD 1 ,500,000 per item
USD 5, 000, 000 Fine Arts subject to maximum USD 500 ,000 per item
USD 1 , 000 , 000 Fire Fighting Materials
USD 250, 000 Furs , Jewelry, Precious Stones and Metals not used for industrial purposes
U SD 250, 000 Loss Adjustment Expenses/Professional Services
USD 10 ,000,000 Service Interruption subject to 24 hour waiting period and 5 mile distance limitation
U SD 1 , 000, 000 Errors or Omissions
USD 1 , 000, 000 Vehicle Physical Damage - Over the Road
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USD 25 ,000 in the Annual Aggregate Pollution Clean Up and Removal , each County listed as a
Named Insured subject to a USD 1 ,500 ,000 Annual Aggregate for all
USD 100, 000 Limited Mold/Fungi/Wet & Dry Rot - Terms per Company Endorsement
USD 100, 000 Trees and Shrubs
USD 10 ,000 ,000 Valuable Papers
...'. _ . Gallagher
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SECTION III - SECURITY DETAILS
INSURER' S
LIABILITY ( RE)INSURERS LIABILITY CLAUSE
(Re) insurer's liability several not joint
The liability of a (re)insurer under this contract is several and not joint with
other (re)insurers party to this contract. A (re)insurer is liable only for the
proportion of liability it has underwritten . A (re)insurer is not jointly liable for the
proportion of liability underwritten by any other (re)insurer. Nor is a (re)insurer
otherwise responsible for any liability of any other (re)insurer that may
underwrite this contract.
The proportion of liability under this contract underwritten by a (re)insurer (or,
in the case of a Lloyd's syndicate, the total of the proportions underwritten by
all the members of the syndicate taken together) is shown next to its stamp .
This is subject always to the provision concerning "signing" below.
In the case of a Lloyd 's syndicate , each member of the syndicate (rather than
the syndicate itself) is a (re)insurer. Each member has underwritten a
proportion of the total shown for the syndicate (that total itself being the total of
the proportions underwritten by a l l the members of the syndicate taken
together) . The liability of each member of the syndicate is several and not joint
with other members. A member is liable only for that member's proportion . A
member is not jointly liable for any other member's proportion . Nor is any
member otherwise responsible for any liability of any other (re)insurer that
may underwrite this contract. The business address of each member is
Lloyd's , One Lime Street, London EC3M 7HA. The identity of each member of
a Lloyd's syndicate and their respective proportion may be obtained by writing
to Market Services , Lloyd's, at the above address .
Proportion of liability
Unless there is "signing" (see below), the proportion of liability under this
contract underwritten by each (re)insurer (or, in the case of a Lloyd's
syndicate , the total of the proportions underwritten by all the members of the
syndicate taken together) is shown next to its stamp and is referred to as its
"written line".
Where this contract permits , written lines , or certain written lines , may be
adjusted ("signed"). In that case a schedule is to be appended to this contract
to show the definitive proportion of liability under this contract underwritten by
each (re)insurer (or, in the case of a Lloyd's syndicate, the total of the
proportions underwritten by all the members of the syndicate taken together).
G)l.. . - . Gallagher
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MARKET REFORM CONTRACT
UMR : B1262PW0330021
A definitive proportion (or, in the case of a Lloyd 's syndicate, the total of the
proportions underwritten by all the members of a Lloyd 's syndicate taken
together) is referred to as a "signed line" . The signed lines shown in the
schedule will prevail over the written lines unless a proven error in calculation
has occurred .
Although reference is made at various points in this clause to "this contract" in
the singular, where the circumstances so require this should be read as a
reference to contracts in the plural .
LMA3333
21 June 2007
ORDER HEREON : 30 % of 100%
BASIS OF WRITTEN
LINES: Percentage of Whole
SIGNING
PROVISIONS: In the event that the written lines hereon exceed 100% of the order, any lines
written "to stand" will be allocated in full and all other lines will be signed down
in equal proportions so that the aggregate signed lines are equal to 100% of
the order without further agreement of any of the
(re )insurers .
However:
a) in the event that the placement of the order is not completed by the
commencement date of the period of insurance then all lines written by that
date will be signed in full ;
b) the signed lines resulting from the application of the above provisions can
be varied , before or after the commencement date of the period of insurance,
by the documented agreement of the
(re)insured and all (re)insurers whose lines are to be varied . The variation to
the contracts will take effect only when all such (re)insurers have agreed , with
the resulting variation in signed lines commencing from the date set out in that
agreement.
Gallagher
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MARKET REFORM CONTRACT
UMR : B1262PW0330021
In a co-insurance placement, following (re)insurers may, but are not obliged to , follow the premium charged
by the lead (re) insurer.
( Re) insurers may not seek to guarantee for themselves terms as favourable as those which others
subsequently achieve during the placement.
WRITTEN
LINES
In respect of electronic lines the Underwriter(s ) agreement and
participation to this Contract has been accepted upon the Lloyd ' s
Placing Platform Limited ( PPL) program .
Confirmation of Underwriter(s ) acceptance is noted within Market
Submission - Security Details located on the final pages of this
document.
ilrair„)
Gallagher
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SECTION IV - CONTRACT ADMINISTRATION AND ADVISORY SECTIONS
SUBSCRIPTION AGREEMENT SECTION
SLIP LEADER: AFB 623/2623
BASIS OF
AGREEMENT TO
CONTRACT
CHANGES: GUA (version 2 . 0) February 2014 with Non-Marine Schedule October 2001
Final premium/ going in values to be agreed Leading Underwriter only.
Insurer(s ) hereon agree to contribute to survey and valuation fees, as incurred .
Agreement to net equivalent downwards (if required) is to be agreed by Slip Leader
only.
Extensions to Premium Payment Condition date to be agreed by Slip Leader only.
Endorsements will be advised to the following market when necessary under the
terms of this agreement by Arthur J Gallagher using Fax or email .
OTHER AGREEMENT
PARTIES FOR
CONTRACT CHANGES,
FOR PART 2 GUA
CHANGES ONLY: Slip leader only to agree part two changes .
AGREEMENT PARTIES
FOR CONTRACT
CHANGES, FOR THEIR
PROPORTION ONLY,
IF ANY: None
BASIS OF CLAIMS
AGREEMENT : Claims to be managed in accordance with :
i ) The Lloyd 's Claims Scheme (Combined) , or as amended or any successor thereto.
(N. B. The applicable Scheme/part will be determined by the rules and scope of the
Scheme(s)).
ii) IUA claims agreement practices .
iii) The practices of any company(ies) electing to agree claims in respect of their own
participation .
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MARKET REFORM CONTRACT
UMR : B1262PW0330021
CLAIMS AGREEMENT
PARTIES : i } For Lloyd' s syndicates
The leading Lloyd 's syndicate and , where required by the applicable Lloyd's Claims
Scheme, the second Lloyd 's syndicate and/or the Scheme Service Provider.
CLAIMS AGREEMENT
PARTIES : The second Lloyd 's Syndicate is APL 1969
(continued)
ii) Those companies acting in accordance with the IUA claims agreement practices ,
excepting those that may have opted out via iii below.
iii) Those companies that have specifically elected to agree claims in respect of their
own participation .
iv) All other subscribing insurers that are not party to the Lloyd's/lUA claims
agreement practices , each in respect of their own participation .
CLAIMS
ADMINISTRATION : Broker to enter claims advices into the relevant market CLASS system . All Insurer(s)
to use their respective market CLASS systems for claims agreements where available .
E-mail to be used by Broker to Insurer(s) for distribution of claim file information in
support of CLASS entry.
Insurer(s ) to respond to claims matters via CLASS if possible.
RULES AND EXTENT
OF ANY OTHER
DELEGATED CLAIMS
AUTHORITY: None
EXPERT(S) FEES
COLLECTION : Fees to be collected directly between Underwriters and Experts
SETTLEMENT DUE
DATE : 16th February 2021
BUREAUX
ARRANGEMENTS: Insurer(s ) authorise Xchanging Ins-sure Services Limited and/or Xchanging Claims
Services Limited to take down additional premiums, return premium , non-premium
endorsements and claims on photo-copies of Market Reform Contract, signing slip or
full policy as applicable .
LPSO/LPC/XIS are fully authorised to accept premium as advised by client, and
processed by Arthur J Gallagher. including final stock/loss of profits , or other
adjustments as applicable without prior agreement.
Underwriters hereon agree accept premium and settle claims in US Dollars / Euro
Sterling as required , at rate of exchange at time of settlement from the client / cedant /
reinsured .
Underwriters agree that the broker may release de-linked premium for this contract
into settlement at different times .
4) Gallagher
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MARKET REFORM CONTRACT
UMR : B1262PW0330021
Agreed that if Premium Payment Condition is extended Terms of trade date
automatics y extencec to conform .
Whenever a Premium Payment Condition due date falls on a weekend or public
holiday it is agreed that the date is automatically carried forward to the first normal
weekday thereafter.
1‘:%)
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SECTION V - FISCAL AND REGULATORY SECTION
TAX PAYABLE BY
INSURER(S) : None
COUNTRY OF
ORIGIN : United States of America
OVERSEAS BROKER: Risk Placement Services, Inc.
2400 Lakeview Pkwy Suite 675,
Alpharetta, GA 30009
SURPLUS LI ES
BROKER: Joel Cavaness
2850 Golf Road , 5th Floor
Rolling Meadows , IL 60008
License Number: 93325
STATE OF FILING : Colorado
US
CLASSIFICATION : Surplus Lines
ALLOCATION OF
PREMIUM TO CODING : 100 % P2
REGULATORY CLIENT
CLASSIFICATION : Large Risk
REGULATORY RISK
LOCATION : United States of America (Non EEA)
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SECTION VI - BROKER REMUNERATION AND DEDUCTIONS SECTION
FEE PAYABLE
BY CLIENT? : NO
TOTAL BROKERAGE: 13. 5135 % or Net equivalent downwards if required .
OTHER DEDUCTIONS
FROM PREMIUM : NIL
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SECTION VII - THE WORDING
Wording as agreed and on file with Syndicate AFB 2623/632
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SECTION VIII - SUPPLEMENTAL CLAUSES
Notwithstanding anything to the contrary contained herein , it is understood and agreed that
this insurance is subject to the following clauses which are attached hereto:it
I o. 1 : WEH Asbestos Endorsement ( 1994) - 518ARM0O21 O
No.2 ; Service of Suit Clause (U . S. A.) - LMA5O20
No.3 : Biological or Chemical Materials Exclusion - NMA2962
N o .4 : Radioactive Contamination Exclusion Clause - Physical Damage - Direct (U.S.A.) - NMAI1 1
N o . 5 : War and Terrorism Exclusion Endorsement - NMA2918
No.6 : U .S. Terrorism Risk Insurance Act of 2002 as Amended Not Purchased Clause
No.7 : Fraudulent Conduct and Misrepresentation Clause - LMA512O
No.8 : Application of Sublimits Endorsement — LMA51 0
No. 9 Sanction Limitation and Exclusion Clause — LMA3100
N o . 10 : Inadvertent Errors and Omissions Clause
N o . 11 : Extension of Coverage - Miscellaneous Unnamed Location
N o . 12. Off Premises Utilities' Services Clause (Business Interruption)
- LMA5O41 (amended).
N o . 13 : Ingress/Egress Extension (Business Interruption)
N o . 14 : Civil or Military Authority Extension ( Business Interruption) - LMA5161
No . 15 : Business Interruption Extension - LMA5039 (amended)
No . 16 : Property Cyber and Data Endorsement — LMA 5400
No . 17 : Communicable Disease Endorsement - LMA 5393
No . 18 : Debris Removal Endorsement - LMA 2343
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No. 1
WEH ASBESTOS ENDORSEMENT { 1994}
A. This Policy only insures asbestos physically incorporated in an insured building or structure, and then
only that part of the asbestos which has been physically damaged during the policy period by one of
these Listed Perils :
Fire; Explosion ; Lightning ; Windstorm ; Hail ; Direct impact of vehicle, aircraft or vessel ; Riot or civil
commotion ; vandalism or malicious mischief; or accidental discharge of fire protective equipment.
This coverage is subject to all limitations in the Policy to which this Endorsement is attached and , in
addition , to each of the following specific limitations :
1 . The said building or structure must be insured under this Policy for damage by that Listed Peril .
2 . The Listed peril must be the immediate, sole cause of the damage to the asbestos .
3 . The Insured must report to Underwriters the existence and cost of the damage as soon as
practicable after the Listed Peril first damaged the asbestos . However this policy does not insure
any such damage first reported to Underwriters more than 12 (twelve) months after the expiration , or
termination , of the policy.
4 . Insurance under this Policy in respect of asbestos shall not include any sum relating to:
(i) any faults in the design , manufacture or installation of the asbestos .
(ii) Asbestos not physically damaged by the Listed Peril including any governmental or regulatory
authority direction or request of whatsoever nature relating to undamaged asbestos .
B . Except as set forth in the foregoing Section A, this policy does not insure asbestos or any sum relating
thereto .
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED
518ARM00210
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No. 2
SERVICE OF SUIT CLAUSE ( U . S .A. )
This Service of Suit Clause will not be read to conflict with or override the obligations of the parties to
arbitrate their disputes as provided for in any Arbitration provision within this Policy. This Clause is intended
as an aid to compelling arbitration or enforcing such arbitration or arbitral award , not as an alternative to such
Arbitration provision for resolving disputes arising out of this contract of insurance (or reinsurance).
It is agreed that in the event of the failure of the Underwriters hereon to pay any amount claimed to be due
hereunder, the Underwriters hereon , at the request of the Insured (or Reinsured) , will submit to the
jurisdiction of a Court of competent jurisdiction within the United States . Nothing in this Clause constitutes or
should be understood to constitute a waiver of Underwriters' rights to commence an action in any Court of
competent jurisdiction in the United States , to remove an action to a United States District Court, or to seek a
transfer of a case to another Court as permitted by the laws of the United States or of any State in the United
States .
It is further agreed that service of process in such suit may be made upon Lloyd 's America, Inc. , Attention :
Legal Department, 280 Park Avenue , East Tower, 25th Floor, New York, NY 10017, USA and that in any suit
instituted against any one of them upon this contract, Underwriters will abide by the final decision of such
Court or of any Appellate Court in the event of an appeal .
The above-named are authorized and directed to accept service of process on behalf of Underwriters in any
such suit and/or upon the request of the Insured (or Reinsured) to give a written undertaking to the Insured
(or Reinsured ) that they will enter a general appearance upon Underwriters' behalf in the event such a suit
shall be instituted .
Further, pursuant to any statute of any state, territory or district of the United States which makes provision
therefor, Underwriters hereon hereby designate the Superintendent, Commissioner or Director of Insurance
or other officer specified for that purpose in the statute , or his successor or successors in office , as their true
and lawful attorney upon whom may be served any lawful process in any action , suit or proceeding instituted
by or on behalf of the Insured (or Reinsured ) or any beneficiary hereunder arising out of this contract of
insurance (or reinsurance) , and hereby designate the above-named as the person to whom the said officer is
authorized to mail such process or a true copy thereof.
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED
L MA502 0
No.3
BIOLOGICAL OR CHEMICAL MATERIALS EXCLUSION
It is agreed that this Insurance excludes loss , damage , cost or expense of whatsoever nature directly or
indirectly caused by, resulting from or in connection with the actual or threatened malicious use of
pathogenic or poisonous biological or chemical materials regardless of any other cause or event contributing
concurrently or in any other sequence thereto.
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED
N M A2 062
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No. 4
RADIOACTIVE CONTAMINATION EXCLUSION CLAUSE -
PHYSICAL DAMAGE - DIRECT ( U . S .A. )
This Policy does not cover any loss or damage arising directly or indirectly from nuclear reaction nuclear
radiation or radioactive contamination however such nuclear reaction nuclear radiation or radioactive
contamination may have been caused * NEVERTHELESS if Fire is an insured peril and a Fire arises directly
or indirectly from nuclear reaction nuclear radiation or radioactive contamination any loss or damage arising
directly from that Fire shall (subject to the provisions of this Policy) be covered EXCLUDING however all loss
or damage caused by nuclear reaction nuclear radiation or radioactive contamination arising directly or
indirectly from that Fire .
* NOTE. - If Fire is not an insured peril under this Policy the words "NEVERTHELESS" to the end of the
clause do not apply and should be disregarded .
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED
NMA1191
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No. 5
WAR AND TERRORISM EXCLUSION ENDORSEMENT
Notwithstanding any provision to the contrary within this insurance or any endorsement thereto it is agreed
that this insurance excludes loss , damage, cost or expense of whatsoever nature directly or indirectly caused
by, resulting from or in connection with any of the following regardless of any other cause or event
contributing concurrently or in any other sequence to the loss ;
1 . war, invasion , acts of foreign enemies , hostilities or warlike operations (whether war be declared or not),
civil war, rebellion , revolution , insurrection , civil commotion assuming the proportions of or amounting to
an uprising , military or usurped power; or
2 . any act of terrorism .
For the purpose of this endorsement an act of terrorism means an act, including but not limited to the
use of force or violence and/or the threat thereof, of any person or group(s) of persons , whether acting
alone or on behalf of or in connection with any organisation(s) or government(s), committed for political ,
religious , ideological or similar purposes including the intention to influence any government and/or to
put the public, or any section of the public, in fear.
This endorsement also excludes loss, damage , cost or expense of whatsoever nature directly or indirectly
caused by, resulting from or in connection with any action taken in controlling , preventing , suppressing or in
any way relating to 1 and/or 2 above.
If the Underwriters allege that by reason of this exclusion , any loss , damage, cost or expense is not covered
by this insurance the burden of proving the contrary shall be upon the Assured .
In the event any portion of this endorsement is found to be invalid or unenforceable , the remainder shall
remain in full force and effect.
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED
NMA2918
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No. 6
U . S . TERRORISM RISK INSURANCE ACT OF 2002 AS AMENDED
NOT PURCHASED CLAUSE
This Clause is issued in accordance with the terms and conditions of the "U. S. Terrorism Risk Insurance Act
of 2002" as amended as summarized in the disclosure notice.
It is hereby noted that the Underwriters have made available coverage for "insured losses" directly resulting
from an "act of terrorism" as defined in the "U . S . Terrorism Risk Insurance Act of 2002 ", as amended
("TRIA") and the Insured has declined or not confirmed to purchase this coverage.
This Insurance therefore affords no coverage for losses directly resulting from any "act of terrorism" as
defined in TRIA except to the extent, if any , otherwise provided by this policy►.
All other terms, conditions , insured coverage and exclusions of this Insurance including applicable limits and
deductibles remain unchanged and apply in full force and effect to the coverage provided by this Insurance .
L MA5390
No. 7
FRAUDULENT CONDUCT AND MISREPRESENTATION CLAUSE
The entire Contract of Insurance and any loss or claim thereunder will be void if, whether before or after a
loss , an Insured has :
a . intentionally concealed or Intentionally misrepresented any material fact or circumstance;
b . engaged in fraudulent conduct; or
c. made false statements ;
relating to the Contract of Insurance or any loss or claim thereunder.
In the event that any provision of this clause is found by a court of competent jurisdiction to be invalid or
unenforceable, the other provisions of this clause and the remainder of the provision in question shall not be
affected thereby and shall remain in full force and effect.
LNIA5120
19 November 2008
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED
Gallagher
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No. 8
APPLICATION OF SUBLIMITS ENDORSEMENT
1 . Application To Insured Interests. Each sublimit stated in this policy applies as part of, and not in
addition to, the overall policy limit for an occurrence insured hereunder. Each sublimit is the
maximum amount potentially recoverable from all insurance layers combined for all insured loss,
damage , expense , time element or other insured interest arising from or relating to that aspect of the
occurrence , including but not limited to type of property, construction , geographic area, zone,
location , or peril .
2 . Application Within Perils . If insured under this policy, any sublimit for earthquake , earth
movement, flood , windstorm , named storm , or named windstorm is the maximum amount potentially
recoverable from all insurance layers combined for all insured loss , damage , expense, time element
or other insured interest arising from or relating to such an occurrence. If flood occurs in conjunction
with a windstorm , named storm , named windstorm , earthquake or earth movement, the flood sublimit
applies within and erodes the sublimit for that windstorm , named storm , named windstorm ,
earthquake or earth movement.
This endorsement takes precedence over and , if in conflict with any other wording in the contract
bearing on the application of sublimits , replaces that wording .
L MAS 130
5 March 2009
No. 9
SANCTION LIMITATION AND EXCLUSION CLAUSE
No (re)insurer shall be deemed to provide cover and no (re)insurer shall be liable to pay any claim or provide
any benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of
such benefit would expose that (re)insurer to any sanction , prohibition or restriction under United Nations
resolutions or the trade or economic sanctions , laws or regulations of the European Union , United Kingdom
or United States of America.
L MAS 100
15 September 2010
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0021
No. 10
INADVERTENT ERRORS AND OMISSIONS CLAUSE
The property insured under this polio► is based on property as per Schedule of Values on file with
Underwriters , as submitted by the Insured prior to the inception of this policy.
However, if any property of the Insured is omitted or undervalued because of negligence , error or
oversight of the Insured , the Underwriters will accept that property as if such error or unintentional
omission had not been made. Such omission or under valuation will not prejudice the Insured ' s
right of recovery under this policy . The Insured agrees to report to the Underwriters any omission
or under valuation of property as soon as practicable after it is discovered .
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED
518AJG00209
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0021
No. 11
EXTENSION OF COVERAGE - MISCELLANEOUS UNNAMED LOCATION
If a sublimit is shown in the Schedule , this Policy covers Real and Personal Property and related
Time Element loss that occurs at Miscellaneous Unnamed Locations owned by the Insured or for
which the Insured is legally responsible .
Miscellaneous Unnamed Location means a location not included in the Schedule and/or on a
separate schedule on file with Underwriters and located within the Territory.
There is no coverage under this Extension of Coverage for any location which is covered under
any other Extension of Coverage including but not limited to the Inadvertent Errors and Omissions
Clause .
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED
No . 12
OFF PREMISES UTILITIES' SERVICES CLAUSE (BUSINESS INTERRUPTION)
This Extension is subject to the EXCLUSIONS, CONDITIONS AND LIMITATIONS of the Policy to which this
Extension is attached .
In consideration of the premium paid , it is understood and agreed that if this Policy covers Business
Interruption such coverage shall extend to loss resulting from necessary interruption of business caused by
Direct Physical Loss or Damage , as covered by the Policy to which this Extension is attached , to gas ,
electric, water , and telephone facilities supplying the Insured 's premises . Loss arising from transmission
distribution or feeder lines, however, will be limited to such lines located within five statute miles of the
Insured's premises , subject to a 24 hour waiting period .
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.
LMA5041 (amended)
14/ 12 /2005
Gallagher
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No. 13
INGRESS/EGRESS EXTENSION (BUSINESS INTERRUPTION )
In consideration of the premium paid , and subject to the Exclusions , Conditions and Limitations of the Policy
to which this Extension is attached , if this Policy covers Business Interruption , it is extended to cover the loss
sustained by the Insured due to the necessary► interruption of the Insured 's business due to prevention of
ingress to or egress from an insured location , whether or not the premises or property of the Insured is
damaged , provided that such prevention is a direct result of physical loss or damage of the type insured by
this Policy, to property of the type insured by this Policy situated within one statute mile of the insured
location .
This Extension does not insure loss resulting from :
1 ) lack of incoming or outgoing service consisting of electricity, fuel , gas, water, steam , refrigerant,
sewerage and voice , data or video; or
2 ) picketing or other action by strikers except for physical damage not excluded by this Policy.
This Policy does not provide coverage under this Extension for more than 28 consecutive days .
LMA5164
15 December 2010
No. 14
CIVIL OR MILITARY AUTHORITY EXTENSION (BUSINESS INTERRUPTION )
In consideration of the premium paid , and subject to the Exclusions , Conditions and Limitations of the Policy
to which this Extension is attached , if this Policy covers Business Interruption , it is extended to cover the loss
sustained by the Insured due to the necessary interruption of the Insured 's business due to prevention of
access to the insured location by► order of a civil or military authority, provided that such order is a direct
result of physical damage of the type insured by this Policy, to property of the type insured by this Policy
situated within one statute mile of the insured location .
This Policy does not provide coverage under this Extension for more than 28 consecutive days .
LMA5161
15 December 2010
GL) Gallagher
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No. 15
Business Interruption Extension
In consideration of the premium paid , and subject to the EXCLUSIONS , CONDITIONS AND LIMITATIONS
of the Policy to which this Extension is attached , and also to the FOLLOWING ADDITIONAL CONDITIONS,
EXCLUSIONS AND LIMITATIONS, this Policy is extended to cover loss resulting from necessary
Interruption of Business caused by Direct Physical Loss or Damage , as covered by the Policy to which this
Extension is attached, to the Property Insured .
In the event of such Direct Physical Loss or Damage, the Underwriters shall be liable for the actual loss
sustained by the Insured resulting directly from such necessary Interruption of Business , but not exceeding
the reduction in Gross Earnings , as defined hereafter, less charges and expenses which are not necessary
during the Interruption of Business, for a period not to exceed the lesser of:-
a) such length of time as would be required , with the exercise of due diligence and dispatch , to repair,
rebuild or replace such part of the property as has been destroyed or damaged ,
or
b) eighteen ( 18 ) calendar months ,
commencing with the date of such Direct Physical Loss or Damage and not limited by the expiration of this
Policy.
Extended Period of Indemnity: The period described above shall include such length of time , not to exceed
one hundred and eighty ( 180) days , to restore the Insured 's business to the condition that would have
existed had no Direct Physical Loss or Damage occurred commencing with the later of the following dates :
i ) The date on which the liability of the Underwriters for Direct Physical Loss or Damage would
otherwise terminate; and
ii) The date on which the repair, rebuilding or replacement of such part of the property as has been
destroyed or damaged is actually completed .
Due consideration shall be given to the continuation of normal charges and expenses, including payroll
expenses (but limited to ninety (90) days in respect of Ordinary Payroll), to the extent necessary to resume
operations of the Insured with the same operational capability as existed immediately before the Direct
Physical Loss or Damage.
CONDITIONS
1 . Direct Loss or Damage
No claim shall be payable under this Extension unless and until a claim has been paid , or liability
admitted , in respect of Direct Physical Loss or Damage to Property Insured under the Policy to which
this Extension is attached and which gave rise to Interruption of Business .
This Condition shall not apply if no such payment shall have been made, or liability admitted , solely
owing to the operation of a Deductible in said Policy which excludes liability for losses below a
specified amount.
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3 . Resumption of Operations
If the Insured could reduce the loss resulting from the Interruption of Business ,
a) by complete or partial resumption of operation of the property ,
and/or
b) by making use of Merchandise , Stock (Raw , In Process or Finished ), or any other property
at the Insured's locations or elsewhere,
and/or
c) by using or increasing operations elsewhere,
then such possible reduction shall be taken into account in arriving at the amount of loss hereunder.
4 . Expenses to reduce Loss
This Extension also covers such expenses as are necessarily incurred for the purpose of reducing
loss under this Extension (except expenses incurred to extinguish a fire), and , in respect of
manufacturing risks , such expense, in excess of Normal , as would necessarily be incurred in
replacing any Finished Stock used by the Insured to reduce loss under this Extension ; but in no
event to exceed the amount by which loss under this Extension is thereby reduced . Such expenses
shall not be subject to the application of any contribution clause .
EXCLUSIONS
This Extension does not insure against:-
1 . increase in loss resulting from interference at the insured premises , by strikers or other persons , with
rebuilding , repairing or replacing the property or with the resumption or continuation of operation ;
2 . increase in loss caused by the suspension , lapse , or cancellation of any lease, licence, contract, or
order, unless such results directly from the insured Interruption of Business , and then Underwriters
shall be liable for only such loss as affects the Insured 's earnings during , and limited to, the period of
indemnity covered under this Policy;
3 . increase in loss caused by the enforcement of any ordinance or law regulating the use,
reconstruction , repair or demolition of any property insured hereunder;
4 . loss of market or any other consequential loss .
LIMITATIONS
1 . The Underwriters shall not be liable for more than the smaller of either:-
a) any specific Business Interruption Sublimit stated in the Policy,
or
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b) the Policy Limit of Liability stated in the Policy, where such includes Business Interruption , if
such is a combined limit,
in respect of such loss , regardless of the number of locations suffering an interruption of business as
a result of any one occurrence.
2 . With respect to loss resulting from damage to or destruction of media for, or programming records
pertaining to , electronic data processing or electronically controlled equipment, by the perils insured
against, the length of time for which the Underwriters shall be liable hereunder shall not exceed :-
a) thirty (30) consecutive calendar days or the time required with exercise of due diligence and
dispatch to reproduce the data thereon from duplicates or from originals of the previous
generation , whichever is less ; or,
b) the length of time that would be required to rebuild , repair or replace such other property
herein described as has been damaged or destroyed , but not exceeding eighteen ( 18)
calendar months ,
whichever is the greater length of time .
DEFINITIONS
1 . Gross Earnings are for the assessment of premium and for adjustment in the event of loss defined
as ,
The sum of:-
a) total net sales value of production or sales of Merchandise ,
and
b) other earnings derived from the operations of the business,
less the cost of
c) Raw Stock from which production is derived ,
d ) supplies consisting of materials consumed directly in the conversion of such Raw Stock into
Finished Stock, or in supplying the services sold by the Insured ,
e) Merchandise sold including packaging materials therefor,
f) materials and supplies consumed directly in supplying the service(s) sold by the Insured ,
g ) service(s) purchased from outsiders (not employees of the Insured ) for resale which do not
continue under contract,
h ) the difference between the cost of production and the nett selling price of Finished Stock
which has been sold but not delivered .
No other costs shall be deducted in determining Gross Earnings .
G)
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In determining Gross Earnings due consideration shall be given to the experience of the business before the
date of Direct Physical Loss or Damage and the probable experience thereafter had Direct Physical Loss or
Damage not occurred .
2 . Raw Stock
Material in the state in which the Insured receives it for conversion into Finished Stock.
3 . Stock in Process
Raw Stock which has undergone any ageing , seasoning , mechanical or other process of
manufacture at the Insured's premises but which has not become Finished Stock.
4 . Finished Stock
Stock manufactured by the Insured which in the ordinary course of the Insured 's business is ready
for packing , shipment or sale .
5 . Merchandise
Goods kept for sale by the Insured which are not the product of manufacturing operations conducted
by the Insured .
6 . Normal
The condition that would have existed had no Direct Physical Loss or Damage occurred .
7 . Ordinary Payroll
The entire payroll expense for all employees of the Insured except officers , executives , department
managers, and other employees under contract.
LMA5039 (Amended )
14/ 12/2005
Gallagher
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No. 16
PROPERTY CYBER AND DATA ENDORSEMENT
Notwithstanding any provision to the contrary within this Policy or any endorsement thereto this Policy
excludes any:
1 . 1 Cyber Loss, unless subject to the provisions of paragraph 2 ;
1 .2 loss , damage, liability, claim , cost, expense of whatsoever nature directly or indirectly caused
by, contributed to by, resulting from , arising out of or in connection with any loss of use,
reduction in functionality, repair, replacement, restoration or reproduction of any Data , including
any amount pertaining to the value of such Data , unless subject to the provisions of paragraph
3;
regardless of any other cause or event contributing concurrently or in any other sequence thereto.
2 Subject to all the terms , conditions , limitations and exclusions of this Policy or any endorsement
thereto , this Policy covers physical loss or physical damage to property insured under this Policy
caused by any ensuing fire or explosion which directly results from a Cyber Incident, unless that Cyber
Incident is caused by, contributed to by, resulting from , arising out of or in connection with a Cyber Act
including , but not limited to, any action taken in controlling , preventing , suppressing or remediating any
Cyber Act.
3 Subject to all the terms , conditions , limitations and exclusions of this Policy or any endorsement
thereto , should Data Processing Media owned or operated by the Insured suffer physical loss or
physical damage insured by this Policy, then this Policy will cover the cost to repair or replace the Data
Processing Media itself plus the costs of copying the Data from back-up or from originals of a previous
generation . These costs will not include research and engineering nor any costs of recreating ,
gathering or assembling the Data . If such media is not repaired , replaced or restored the basis of
valuation shall be the cost of the blank Data Processing Media. However, this Policy excludes any
amount pertaining to the value of such Data, to the Insured or any other party, even if such Data
cannot be recreated , gathered or assembled .
4 In the event any portion of this endorsement is found to be invalid or unenforceable , the remainder
shall remain in full force and effect.
5 This endorsement supersedes and , if in conflict with any other wording in the Policy or any
endorsement thereto having a bearing on Cyber Loss , Data or Data Processing Media , replaces that
wording .
Definitions
6 Cyber Loss means any loss , damage , liability, claim , cost or expense of whatsoever nature directly or
indirectly caused by , contributed to by, resulting from , arising out of or in connection with any Cyber
Act or Cyber Incident including , but not limited to, any action taken in controlling , preventing ,
suppressing or remediating any Cyber Act or Cyber Incident.
7 Cyber Act means an unauthorised , malicious or criminal act or series of related unauthorised ,
malicious or criminal acts , regardless of time and place , or the threat or hoax thereof involving access
to, processing of, use of or operation of any Computer System .
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8 Cyber Incident means :
8 . 1 any error or omission or series of related errors or omissions involving access to , processing of,
use of or operation of any Computer System ; or
8 .2 any partial or total unavailability or failure or series of related partial or total unavailability or
failures to access , process , use or operate any Computer System .
9 Computer System means :
9 . 1 any computer, hardware, software , communications system , electronic device (including , but not
limited to, smart phone, laptop , tablet, wearable device) , server, cloud or microcontroller
including any similar system or any configuration of the aforementioned and including any
associated input, output, data storage device, networking equipment or back up facility,
owned or operated by the Insured or any other party.
10 Data means information , facts , concepts , code or any other information of any kind that is recorded or
transmitted in a form to be used , accessed , processed , transmitted or stored by a Computer System .
11 Data Processing Media means any property insured by this Policy on which Data can be stored but
not the Data itself.
L MA5499
11 November 2019
GL) Gallagher
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No. 17
COMMUNICABLE DISEASE ENDORSEMENT
(For use on property policies)
1 . This policy, subject to all applicable terms , conditions and exclusions , covers losses attributable to
direct physical loss or physical damage occurring during the period of insurance . Consequently and
notwithstanding any other provision of this policy to the contrary, this policy does not insure any
loss , damage , claim , cost, expense or other sum , directly or indirectly arising out of, attributable to,
or occurring concurrently or in any sequence with a Communicable Disease or the fear or threat
(whether actual or perceived ) of a Communicable Disease.
2 , For the purposes of this endorsement, loss , damage, claim , cost, expense or other sum , includes ,
but is not limited to, any cost to clean-up , detoxify, remove , monitor or test:
2, 1 . for a Communicable Disease, or
2. 2 . any property insured hereunder that is affected by such Communicable Disease.
3 . As used herein , a Communicable Disease means any disease which can be transmitted by means of
any substance or agent from any organism to another organism where :
3 . 1 . the substance or agent includes , but is not limited to, a virus , bacterium , parasite or other
organism or any variation thereof, whether deemed living or not, and
3 . 2 . the method of transmission , whether direct or indirect, includes but is not limited to, airborne
transmission , bodily fluid transmission , transmission from or to any surface or object, solid ,
liquid or gas or between organisms, and
3 , 3 . the disease , substance or agent can cause or threaten damage to human health or human
welfare or can cause or threaten damage to , deterioration of, loss of value of, marketability of
or loss of use of property insured hereunder.
4 . This endorsement applies to all coverage extensions , additional coverages , exceptions to any
exclusion and other coverage grant(s).
All other terms, conditions and exclusions of the policy remain the same.
LMA5393
25 March 2020
GL) Gallagher
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No. 18
DEBRIS REMOVAL ENDORSEMENT
THIS ENDORSEMENT CONTAINS PROVISIONS WHICH MAY LIMIT OR PREVENT RECOVERY UNDER
THIS POLICY FOR LOSS WHERE COSTS OR EXPENSES FOR DEBRIS REMOVAL ARE INCURRED .
Nothing contained in this Endorsement shall override any Seepage and/or Pollution and/or Contamination
Exclusion or any Radioactive Contamination Exclusion or any other Exclusion applicable to this Policy.
Any provision within this Policy (or within any other Endorsement which forms part of this Policy) which
insures debris removal is cancelled and replaced by the following :
1 . In the event of direct physical damage to or destruction of property, for which Underwriters hereon agree
to pay, or which but for the application of a deductible or underlying amount they would agree to pay
(hereinafter referred to as 'Damage or Destruction') , this Policy also insures , within the sum insured ,
subject to the limitations and method of calculation below, and to all the other terms and conditions of the
Policy, costs or expenses ;
(a) which are reasonably and necessarily incurred by the Assured in the removal , from the premises of
the Assured at which the Damage or Destruction occurred , of debris which results from the Damage
or Destruction ; and
(b) of which the Assured becomes aware and advises the amount thereof to Underwriters hereon within
one year of the commencement of such Damage or Destruction .
2 . In calculating the amount, if any, payable under this Policy for loss where costs or expenses for removal
of debris are incurred by the Assured (subject to the limitations in paragraph 1 above):
(a) the maximum amount of such costs or expenses that can be included in the method of calculation
set out in (b) below shall be the greater of US$25, 000 (twenty-five thousand dollars) or 10% (ten
percent) of the amount of the Damage or Destruction from which such costs or expenses result; and
(b) the amount of such costs or expenses as limited in (a) above shall be added to:
(i) the amount of the Damage or Destruction ; and
(ii) all other amounts of loss, which arise as a result of the same occurrence , and for which
Underwriters hereon also agree to pay, or which but for the application of a deductible or
underlying amount they would agree to pay; and
the resulting sum shall be the amount to which any deductible or underlying amount to which this
Policy is subject and the limit (or applicable sub-limit) of this Policy, shall be applied .
NMA2343
24/ 11 / 1988
1‘1.)
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0021
POLICYHOLDER DISCLOSU RE
NOTICE OF TERRORISM INSURANCE COVERAGE
You are hereby notified that under the Terrorism Risk Insurance Act of 2002 , as amended ("TRIA") , that you
now have a right to purchase insurance coverage for losses arising out of acts of terrorism , as defined in
Section 102 ( 1 ) of the Act, as amended : The term "act of terrorism" means any act that is certified by the
Secretary of the Treasury, in consultation with the Secretary of Homeland Security and the Attorney General
of the United States, to be an act of terrorism ; to be a violent act or an act that is dangerous to human life ,
property, or infrastructure ; to have resulted in damage within the United States , or outside the United States
in the case of an air carrier or vessel or the premises of a United States mission ; and to have been
committed by an individual or individuals, as part of an effort to coerce the civilian population of the United
States or to influence the policy or affect the conduct of the United States Government by coercion . Any
coverage you purchase for "acts of terrorism" shall expire at 12 : 00 midnight December 31 , 2027 , the date on
which the TRIA Program is scheduled to terminate, or the expiry date of the policy whichever occurs first,
and shall not cover any losses or events which arise after the earlier of these dates .
YOU SHOULD KNOW THAT COVERAGE PROVIDED BY THIS POLICY FOR LOSSES CAUSED BY
CERTIFIED ACTS OF TERRORISM IS PARTIALLY REIMBURSED BY THE UNITED STATES UNDER A
FORMULA ESTABLISHED BY FEDERAL LAW . HOWEVER, YOUR POLICY MAY CONTAIN OTHER
EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR
EVENTS . UNDER THIS FORMULA, THE UNITED STATES PAYS 80 % OF COVERED TERRORISM
LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURER(S)
PROVIDING THE COVERAGE . YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE
ACT, AS AMENDED , CONTAINS A USD100 BILLION CAP THAT LIMITS U .S . GOVERNMENT
REIMBURSEMENT AS WELL AS INSURERS' LIABILITY FOR LOSSES RESULTING FROM CERTIFIED
ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANY ONE CALENDAR YEAR
EXCEEDS USD100 BILLION . IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED
USD100 BILLION, YOUR COVERAGE MAY BE REDUCED .
THE PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE
ANY CHARGES FOR THE PORTION OF LOSS COVERED BY THE FEDERAL GOVERNMENT UNDER
THE ACT.
I hereby elect to purchase coverage for acts of terrorism for a prospective premium of
USD
I hereby elect to have coverage for acts of terrorism excluded from my policy.
understand that I will have no coverage for losses arising from acts of terrorism .
Policyholder/Applicant's Signature Syndicate on behalf of certain
underwriters at Lloyd ' s
Print Name Policy Number
Date
LMA9184
G) Gallagher
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09 January 2020
Policy Number: ( UMR) B1262PW0330021
SECURITY DETAILS
REFERENCES
UMR (Unique Market Reference) : B1262PIW0330021
Date contract printed to PDF : 17 :34 14 December 2020
SIGNED UNDERWRITERS
Beazley Syndicates AFB
Calum Brewster
Written Line 10.00% Signed Line 10.00%
Agreed on 11 :28 14 December 2020
For and on behalf of: Written Line Signed Line
Lloyd's Underwriter Syndicate No . AFB 2623 10 .00% 10.00%
82% / AFB 623 18% , London, England
Bound as Slip Leader, Lloyd's Leader
Lloyd's Stamp: AFB 2623/0623
Reference: JWV20F21 AN F F
Description: On behalf of SJJ
Risk Code(s): P2
Apollo Syndicate Management Ltd
Richard Hardcastle
Written Line 4 .00% Signed Line 4 .00%
Agreed on 15:05 14 December 2020
For and on behalf of: % of Written Line Written Line Signed Line
Lloyd's Underwriter Syndicate No . 1969 APL, 100 .00% 4.00% 4 .00%
London , England
Bound
Lloyd's Stamp: 1969
LORS Code: L1969
Reference: 21 PT55569301
Description: RH
Risk Code(s): P2
Market Submission - Security Details Page 1 of 4 14/ 12/2020 1
Policy Number: ( UMR) B1262PW0330021
HCC International Insurance Company PLC
David Mansell
Written Line 6 .00% Signed Line 6 .00%
Agreed on 12:27 14 December 2020
For and on behalf of: % of Written Line Written Line Signed Line
Houston Casualty Company (UK Branch), LIRMA 100 .00% 6.00% 6 .00%
H5100
Bound
XIS Code: H5100
LOPS Code: N1538
Reference: P21 E0230A001
Description:
OBE European Company Operations
Jake Bell
Written Line 5 .00% Signed Line 5 .00%
Agreed on 16:21 14 December 2020
For and on behalf of: Written Line Signed Line
Lloyd's Underwriter Syndicate No . 1886 OBE, 5.00% 5 .00%
London, England
Bound
Lloyd's Stamp: 1886
LORS Code: L1886
Reference: 21 PD 328022 R A
Description:
Risk Code(s): P2
Market Submission - Security Details Page 2 of 4 14/ 12/2020 1
Policy Number: ( UMR) B1262PW0330021
Blenheim Underwriting Limited
Oliver Pirie
Written Line 2 .5% Signed Line 2 .5%
Agreed on 12: 15 14 December 2020
For and on behalf of: % of Written Line Written Line Signed Line
D and F Consortium 9918 . All underwriters as per 100 .00% 2.5% 2 .5%
LP SO Registered Consortium No 9918
Bound
Lloyd's Stamp: 9918
Reference: D21 A8060A001
Description: NJA
Risk Code(s): P2
Agora Syndicate Services Ltd
Stephanie Rowe
Written Line 2 .5% Signed Line 2 .5%
Agreed on 15:09 14 December 2020
For and on behalf of: Written Line Signed Line
Lloyd's Underwriter Syndicate No . 3268 AR, 2. 5% 2 .5%
London, England
Bound
Lloyd's Stamp: 3268
LORS Code: L3268
Reference: DF1F21 AA016A
Description:
Risk Code(s): P2
Market Submission - Security Details Page 3 of 4 14/ 12/2020 1
Policy Number: ( UMR) B1262PW0330021
SETTLEMENT INFORMATION
Allocation of Premium to Coding
P2 at 100 .00%
Allocation of Premium to Year of Account
2020
Terms of Settlement
Settlement Due Date : 16 February 2021
Instalment Premium Period of Credit: 0 day(s)
Adjustment Premium Period of Credit: 0 day(s)
Lloyd's Underwriter Syndicate No . AFB 2623 82% ! AFB 623 18%, London, England
Bureau Leader and Lloyd's Leader
Calum Brewster
Market Submission - Security Details Page 4 of 4 14/ 12/2020 1
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